San Antonio Express-News (Sunday)
Cities face shortages of health care workers
Shortages of health care workers are worsening in Houston, Miami, Baton Rouge and other cities battling sustained COVID-19 outbreaks, exhausting staffers and straining hospitals’ ability to cope with spiking cases.
That need is especially dire for front-line nurses, respiratory therapists and others who play hands-on, bedside roles where one nurse is often required for each critically ill patient.
“At the end of the day, the capacity for critical care is a balance between the space, staff and stuff. And if you have a bottleneck in one, you can’t take additional patients,” said Mahshid Abir, a senior physician policy researcher at the RAND Corporation and director of the Acute Care Research Unit at the University of Michigan. “You have to have all three. … You can’t have a ventilator but not a respiratory therapist.”
“What this is going to do is it’s going to cost lives, not just for COVID patients, but for everyone else in the hospital,” she warned.
The increasingly fraught situation reflects packed hospitals across large swaths of the country: More than 8,800 COVID-19 patients are hospitalized in Texas; Florida has more than 9,400; and at least 13 other states also have thousands of hospitalizations, according to data compiled by the Washington Post.
Facilities in several states, including Texas, South Carolina and Indiana, have in recent weeks reported shortages of such workers, according to federal planning documents viewed by the Post, pitting states and hospitals against one another to recruit staff.
In Florida, 39 hospitals have requested help from the state for respiratory therapists, nurses and nursing assistants. In South Carolina, the National Guard is sending 40 medical professionals to five hospitals in response to rising cases.
Many medical facilities anticipate their staffing problems will deteriorate, according to the planning documents: Texas is hardest hit, with South Carolina close behind. Needs range from pharmacists to physicians.
“What we have right now are essentially three New Yorks with these three major states,” White House coronavirus task force coordinator Deborah Birx said Friday during an appearance on NBC’s “Today” show.
But today’s diffuse transmission requires innovative thinking and a different response from months ago in New York, say experts.
“We missed the boat,” said Serena Bumpus, a leader of multiple Texas nursing organizations and regional director of nursing for the Austin Round Rock Region of Baylor Scott and White Health.
Bumpus blames a lack of coordination at national and state officials. “It feels like this free-for-all,” she said, “and each organization is just kind of left up to their own devices to try to figure this out.”
Theresa Q. Tran, an emergency medicine physician and assistant professor of emergency medicine at the University of Houston’s Baylor College of Medicine, began to feel the crunch in June. Only a few weeks before, she had texted a friend to say how disheartening it was to see crowds of people outdoors without masks on Memorial Day weekend.
Her fears were borne out when she found herself making call after call from her ER, unable to admit a critically ill patient because her hospital had run out of ICU space, but unable to find a hospital able to take them.
Under normal circumstances, the transfer of such patients — “where you’re afraid to look away, or to blink, because they may just crash on you,” as Tran describes them — happens quickly to ensure the close monitoring the ICU affords.
Those critical patients begin to stall in the ER, stretching the abilities of the nurses and doctors attending to them. “A lot of people, they come in, and they need attention immediately,” Tran said, noting that emergency physicians are constantly racing against time. “Time is brain, or time is heart.”
By mid-July, an influx of “surge” staff brought relief, Tran said. But that was short-lived as the crisis jumped from one locality to the next, with the emergency procedures to bring in more staff never quite keeping up with the rising infections.
An ER physician in the Rio Grande Valley said all three of the major trauma hospitals in the area have long since run out of the ability to absorb new ICU patients.
“We’ve been full for weeks,” said the physician, who spoke on the condition of anonymity because he feared retaliation for speaking out about the conditions.
The local nurses are exhausted. Some quit. Even the relief nurses who helped out in New York in the spring seem horrified by the scale of the disaster in South Texas, he said.
“If no one comes and helps us out and gives us the ammo we need to fight this thing, we are not going to win,” the doctor said.
Texas, along with 32 other states, has joined a licensure compact, allowing nurses to practice across state borders, but it is becoming increasingly difficult to recruit from other parts of the country.
Texas medical facilities can apply to the Department of State Health Services for staffers to fill a critical shortage, typically for a twoweek period. But two weeks, which would allow time to respond to most disasters, hardly registers in a pandemic, so facilities have to ask for extensions or make new applications.
The situation has become dire in some rural parts of the state, too.
Steven Gularte, CEO of Chambers Health in Anahuac, 45 miles from Houston, said he had to bring in 10 nurses to help staff his 14bed hospital after Houston facilities started appealing for help to care for patients who no longer needed intensive care but were not ready to go home.
“Normally, we are referring to them,” Gularte said. “Now, they are referring to us.”
Coronavirus has turned the regular staffing challenge at Harris Health in Houston into a daily life-ordeath juggle for Pamela Russell, associate administrator of nursing operations, who helps provide supplemental workers for the system’s two public hospitals and 46 outpatient clinics.
Now, 162 staff members — including more than 50 nurses — are quarantined, either because they tested positive or are awaiting results. Many others need flexible schedules to accommodate child care, she said. Some cannot work in coronavirus units because of their own medical conditions. A few contract nurses left abruptly after learning their units would soon be taking COVID-positive patients.
Russell has turned to the state and the international nonprofit Project Hope for resources, even as she acts as a morale booster, encouraging restaurants to send meals and supporting the hospital CEO in his cheerleading rounds.
“It’s hard to say how long we can do this. I just don’t know,” said Russell, who praised the commitment of the nurses. “Like I said, it’s a calling. But I don’t see it being sustainable.”