Hospitals worried about supply of doctors, nurses
Relief workers harder to find as majority of states face virus surge
As COVID-19 cases continue to climb in Connecticut and the state enters a second wave of the pandemic, hospital officials are confident they have enough personal protective equipment and bed capacity to treat patients — but they are concerned about not having enough physicians and nurses.
At the pandemic’s peak in Connecticut this past spring, when the virus was largely concentrated in the Northeast and Northwest, hospitals were able to fall back on relief workers from other states, particularly from traveling health care worker agencies, to fill staffing gaps. But now, as the virus surges in 45 U.S. states, that extra help will not be readily available and hospitals are preparing creative solutions to ensure adequate staffing levels
going into the winter.
“Our choke points are going to be in nurses and docs,” Gov. Ned Lamont said in a recent TV interview. “They’re stretched. They’ve been working flat out, and now if we ramp up, I can’t go to other states and try and find people to help them.”
Traveling nurses, who are deployed to hospitals through various agencies, are often used to fill vacancies in hospital staff, working until a permanent replacement is found or standing in for a nurse out on leave. Those workers proved particularly critical when Connecticut was at its peak COVID-19 caseload in the spring, helping support hospitals deluged with severely ill patients.
It will be different this winter. “We can’t rely on a pool of health care workers that might be able to help us temporarily. Traveling nurses specifically have been harder to come by,” said Paul Kidwell, senior vice president of policy for the Connecticut Hospital Association.
In late March, Yale New Haven Health benefited from about 300 travelers among its total of 7,000 nurses, and was also able to send somestafffromLawrence+ Memorial Hospital, in New London, to GreenwichHospital to help care for patients in Fairfield County, which was hard-hit by the pandemic.
“Whenyou’re getting into those tiring situations, just a couple extra hands or another body can be really useful,” said Yale New Haven Health chief clinical officer Dr. Thomas Balcezak.
Eight months later, there is no guarantee that those hundreds of extra workers will be available. Yale New Haven is primarily relying on its tiered staffing strategy, which includes re-purposing clinicians into non-clinical roles and additional recruitment.
“The pandemic is so virulent in so many parts of the country that nobody is loaning out staff,” Marna Borgstrom, chief executive officer of Yale New Haven Hospital and Yale New Haven Health, said in a press call Tuesday. “They don’t have nurses and PAs and others to send to any of the many, many hot spot areas.”
Hospitals across the state are preparing for the winter by rejiggering their staffing plans, trying to brace for a surge that could see as many as 1,600 to 1,700 people hospitalized with the virus — in a “best case scenario.” (At the peak of the state’s COVID-19 wave in the spring, there were almost 2,000 people hospitalized.)
At UConn Health, where 25 traveling nurses are currently supporting hospital staff, about 15 will be able to extend their work for a number of months, and a few have been recently added, said UConn Health chief nursing officer Caryl Ryan.
“I think that staffing is probably foremost on everyone’s minds right now,” Ryan said.
One key difference from the spring surge is that UConnplans to keep operating rooms, clinics and post-anesthesia care units open, Ryan said, meaning that those health care workers will stay in place, rather than be reassigned to intensive care units to assist with caring for COVID-19 patients.
To help make up the difference, UConn Health is training nurses who typically work in ICU stepdown units to be able to take on patients with higher levels of care, in addition to floating nurses to other units and relying on overtime work and part-time workers to fill in the gaps, Ryan said. The hospital is also actively recruiting for additional nurses within Connecticut and from neighboring states, through networking, virtual fairs and billboards, she added.
At Hartford Healthcare, chief clinical officer Dr. Ajay Kumar said recently he was satisfied that the health care system would have enough ventilators, hospital beds and other equipment to withstand the surge. But like other hospitals, staffing remains the most pressing issue, he said.
This past spring, Hartford Healthcare benefited from having about 100 traveling health care workers. This winter, “wemaynot be that lucky, because every single state in the country is finding the same challenge at the moment,” Kumar said. Instead, Hartford Healthcare is looking inward to meet staffing demands, transferring staff to where need is greatest within its system, he said.
“At some point, the capacity might reach where we may not have enough people to care for the patients at the time here,” he said. “And we’ve started preparing for that: we have contingency plans to relocate our staff, retrain, redeploy, and a few other things we can do. We are fortunate to have 30,000 people in Hartford Healthcare, so we have tremendous capability of making that happen.”
As hospital administrators focus on solving their staffing puzzles and report comfortable levels of PPE, hospital equipment, and bed capacity, enduring another surge of COVID-19 will mean increased, intense strain on all aspects of their health care systems, in ways that are both predictable and unpredictable.
“If we do not act now and if we’re unable to control the spread of the virus today, in three and a half weeks, we are really going to be in the soup, and that’s not just because of staffing,” said Balcezak, of Yale NewHaven. “It’s because of staffing, it’s because of bed capacity, it’s because of people dying, it’s because of our ability to get ahold of drugs and personal protective equipment. It’s not just one part of our health care system that will be challenged — it’s every part.”