Hospitals find ways to care for patients and staff during the pandemic

At least 600 healthcare providers have died from the coronavirus. Another 128,000 have been infected with COVID-19, according to the Centers for Disease Control and Prevention.

While many American workers stayed home to limit the virus’ community spread, healthcare workers headed to the front lines. For months, they have put their own safety—and that of their families—at risk to care for those in need.

Throughout all of this, healthcare systems have grappled with how to care for COVID-19 patients, while also caring for their employees, who are battered from months of coping with the stress of the pandemic at work and at home. On top of that, systems have had to maintain staffing ratios.

“This is turning out to be more of a marathon than a sprint,” said Dr. Marc Harrison, CEO of Salt Lake City-based Intermountain Healthcare.

Systems have responded by creating new staffing models, bringing in outside help and collaborating on best practices. At the same time, there has been nationwide backlash from front-line workers who say employers aren’t doing enough.

As the pandemic took hold in the U.S., University of Utah Health sent more than 3,000 employees home to work and redeployed others to new jobs to avoid layoffs and furloughs. Amid all the changes, one thing was constant: regular and open communication from senior leadership.

The health system used videos to keep workers updated and connected and to share tips on how to be resilient during the pandemic, said Sarah Sherer, human resource officer for hospitals and clinics at University of Utah Health.

“I think the biggest thing is always making sure there’s that connectivity between staff and leadership,” Sherer said. “This will end eventually, but people will always remember how you treat them.”

Since March, University of Utah Health has worked with a local childcare provider to fund 200 spots for the children of clinical staff. And now they’re preparing support for parents as they get ready for an unconventional school year.

Sherer stressed the importance of having empathy and accepting feedback from employees. “They’re not only dealing with work-life challenges; it’s home life, it’s social,” she said.

To recognize employees’ hard work, leaders randomly pass out items like donated gift cards. And sometimes, just thanking employees is helpful, Sherer said.

The Joint Commission issued guidelines on how healthcare organizations can support their staffs’ mental health, recommending being transparent, having clear lines of communication and providing psychosocial support resources.

“The mental, emotional and physical strain healthcare workers are experiencing during these unprecedented times of COVID-19 cannot be understated,” said Erin Lawler, a human factors engineer for the Joint Commission.

At Intermountain, caregiver safety officers, who are clinicians themselves, work in COVID-19 units to make sure employees are donning and doffing personal protective equipment properly. In one case, the system’s chief nursing executive, Susan Robel, stopped two caregivers rushing to respond to a patient in arrest because they hadn’t put on their masks properly, Harrison said. “In the heat of battle, they were going to risk taking care of themselves,” he added.

The system has asked front-line workers how to manage their needs. As a result, Intermountain added snacks in break rooms, provided different types of masks by request, offered an on-site laundry service so caregivers don’t have to worry about wearing potentially contaminated clothing home, and provided an emotional support help line for caregivers.

Both Intermountain’s and University of Utah Health’s chief medical officers meet once or twice a week with the CMOs of the region’s two other major health systems to coordinate how they manage visitors and elective procedures, Harrison said. They also sometimes arrange patient transfers when one location becomes too crowded.

Health systems are “taking the frenemy approach” when it comes to dealing with the pandemic, describing the collaborations around staffing, research and education as “very valuable,”  Harrison said.

Egos are out of the way, University of Utah Health’s Sherer added. Instead, the teams try to figure out how to make sure they are in “lockstep” and not creating confusion in the community.

While Utah has not been overwhelmed by a surge of patients, the systems are preparing for the worst, building on lessons learned from their counterparts in harder hit areas.

In early August, a team of healthcare workers from Northwell Health in New York visited, allowing Intermountain nurses to be trained on extracorporeal membrane oxygenation, or life support, for COVID-19 patients. Earlier in the pandemic, when New York City was overrun by COVID-19 cases, Intermountain sent two multidisciplinary teams there—one to Northwell and one to New York-Presbyterian.

For Northwell, handling the surge meant turning to several sources for staffing, including a pool of retired nurses, temporary nurses and redeployed workers.

Northwell used its workforce management system to figure out who could work in different locations. Scheduling and individual capabilities were entered into the system for Northwell employees, internal agency nurses and outside agency workers. “It was not only a matter of real estate space; it was a matter of how to staff that hospital with the right people,” said Elina Petrillo, assistant vice president of HR technology at Northwell.

A list of open shifts was sent to a targeted set of employees, who could choose to take on extra shifts or move to another hospital to meet the need. And Northwell offered hazard pay to cover shifts, as well as a bonus for holidays like Easter, Petrillo said.

Workers were assigned to enter data in the workforce system around the clock to make sure staffing and ICU levels were up to date. Some were sent out to do community testing. Others were assigned to applaud nurses leaving a shift after handling COVID-19 patients.

Yet many caregivers say their organizations aren’t doing enough to protect them—and their patients—as they face the threat of COVID-19. Some employees are choosing not to return after being furloughed, said Jason Siegel, senior director of healthcare partnerships at LaSalle Network, a Chicago-based staffing and recruiting firm. Others are retiring, all while the nursing and physician shortages that plagued the country before the pandemic rage on.

Meanwhile, nurses and other caregivers have gone on strike based on their workplace conditions. They say systems aren’t providing enough PPE, securing enough staffing ratios and are forcing overtime.

“There won’t be anybody to take care of the patients if you don’t take care of us,” said Jean Ross, co-president of the National Nurses United union and a nurse for 46 years.

“Even if you can physically make yourself go through the motions, emotionally you start to crumble,” Ross said. “We are used to people dying but not in sheer numbers like this and so many in the prime of their life.”