Staffing: Shortages of health care workers loom in state’s hot spots
Could California face a shortage of health care workers during the coronavirus pandemic?
That possibility has state and local officials worried, as case counts and hospitalizations in California skyrocket and more health workers are falling sick, or even dying, from the COVID19 disease.
Health care leaders say hospitals don’t just need more beds. They need specialized workers with the right skills to fight the pandemic. Across the state and the Bay Area, staffing shortages haven’t reached crisis levels just yet. But if current trends continue, the conditions for shortfalls loom large.
“We’re not there yet, but we’re very, very concerned,” California Hospital Association CEO and President Carmela Coyle said. “We have a confluence of things — an increased need for health care workers at the bedside (and) exhausted teams that need to be rested. But that
requires additional staff.” Staff are getting sick themselves as the virus spreads in the community, she added.
When patient numbers plummeted during shelterinplace, health systems cut back on staffing. Now, as non-COVID patients return to seek standard care and procedures, and the coronavirus surges in California, hospitals need more staff. Facilities are turning to inundated travel nurse agencies, or retraining existing staff in critical care. The state amassed an army of volunteer medical professionals and is granting waivers to hospitals to increase how many patients a single nurse can care for under law.
Many health care workers feel they’re already stressed and understaffed. Monthslong anxiety and protests reached a boiling point in the Bay Area this week. Hundreds of workers went on strike in Santa Rosa, staff rallied at South Bay hospitals, and Oakland nurses mourned the death of a coworker from COVID19. Across the state, 20,849 health workers have been infected with the virus and 115 have died, according to the state health department.
“The morale has completely flatlined,” said Stacie Wardner, who works in an ICU at Good Samaritan Hospital in San Jose. “The strain and the stress we’re under, it’s unimaginable.”
In the Bay Area, COVID19 hospitalizations hit a record high with 797 patients on Thursday. Having enough trained staff to care for those patients is critical, local officials said.
“That is what I worry about the most,” Contra Costa County Deputy Health Officer Dr. Ori Tzvieli said.
In Alameda County, filling requests for health care workers is a growing challenge, said Jim Morrissey, with the county emergency medical service. As of July 10, the county staffed 607 shifts.
Counties and hospitals are turning to federal, state and outofstate resources to meet needs. Travel nursing agency Aya Healthcare in San Diego had more than 10,000 jobs posted on Thursday, with around 17% in California, Executive Vice President April Hansen said.
Hansen said the company, which can fill spots within a week, hasn’t tapped its capacity yet. But she added that flu season, which usually stretches hospitals, is on the horizon.
“It is a continuous struggle,” she said. “The crisis is not over.”
California is also receiving federal aid. The U.S. Department of Defense recently sent five teams of about 20 medical personnel each, including doctors, respiratory therapists and nurses, to hospitals in Los Angeles and the Central Valley, according to the California Emergency Medical Services Authority.
The state is rallying its own medical professionals through the California Health Corps, which has 35,000 volunteers ready to work, Gov. Gavin Newsom said. Dr. Mark Ghaly, secretary of California Health and Human Services, said during a news conference Friday that the state would strategically deploy Health Corps staff “to make sure patients get the level of care that they need and that staffing doesn’t become the issue around delivering highquality care throughout the state.”
Coyle wanted to see the Health Corps tripled, but
“If things get really bad, we’re going to be in rough shape when we come to needing nurses.”
Peter Brackner, vice president of Santa Rosa Memorial Hospital’s Independent Staff Nurses Association
cautioned that not all volunteers have the specialized skills for COVID19 patients. The greatest demand is for critical care and ICU nurses.
Hospitals staff units based on statemandated nurse-to-patient ratios and the relative severity of patient sickness. During the pandemic, hospitals can now apply for a waiver to adjust staffing ratios. As of Wednesday, the California Department of Public Health approved waivers for about 60 hospitals, none in the Bay Area.
“In the times of extreme surge that we are experiencing, meeting those ratios becomes difficult and in some cases impossible,” Coyle said.
Nurses unions argued that loosened standards fail to keep workers safe. At Alta Bates Summit Medical Center in Oakland, where nurse Janine PaistePonder died last week, some employees said they’re overwhelmed. Paiste-Ponder worked on a unit where she cared for five patients, both COVID and non-COVID. The ratio complies with law, but fellow nurses said it’s chaotic with that many positive and negative patients.
Sutter Health, which runs the hospital, said state hospitalizations have pushed the system to its “highest surge levels,” according to spokeswoman Monique Binkley Smith. The hospital gives staff caring for COVID-19 patients one N95 mask per shift and uses negative pressure rooms when available, which “can provide a safe environment for patients and caregivers,” she said.
Worker concerns about staffing echo around the Bay Area. At Santa Rosa Memorial Hospital, hundreds of National Union of Healthcare Workers members went on a fiveday strike this week over understaffing and other issues. Peter Brackner, vice president of the hospital’s independent Staff Nurses Association, said nurses filed 60 complaints about staffing with the union in June.
“If things get really bad, we’re going to be in rough shape when we come to needing nurses,” he said.
Christian Hill, a spokesman for Providence St. Joseph’s Health, which runs the hospital, said the facility currently has the right mix of care resources to handle patient volumes and if it doesn’t have enough staff, it doesn’t accept new patients.
“Staffing is a challenge throughout health care in the best of times, more so during a pandemic,” he said. One of the main issues is staff on leaves of absence; the hospital fills in with travel nurses when needed.
At Good Samaritan Hospital in San Jose, employees protested there aren’t enough staff to manage rising numbers of coronavirus patients. Workers said they’re too busy and don’t have backup to take breaks.
“People dread coming to work because we know we’re going to be short,” Wardner said. “We’re relying on each other to put a bite of sandwich in our mouths.”
The hospital has a higher rate of complaints with the California Department of Public Health than the state average, but the department didn’t find any violations in the five most recent complaints since shelterinplace. The hospital’s Chief Nursing Officer Mark Brown said the COVID19 unit is staffed four patients to one nurse, the state ratio for specialty units. He said nurses are offered breaks when required by law, although they might not always take them on time.
The hospital is hiring for open positions and getting more travel nurses. Brown said the pandemic leads to staff feeling overburdened and he is encouraging employees to take scheduled time off and is working on providing counseling.
For some such as Wardner, the stress is becoming unbearable: “Quite frankly, after 20 years of being in this hospital, I’m rethinking, after all this is over, if I even want to do this anymore.”