As COVID-19 cases surge across the country, the competition for healthcare staff is becoming high stakes.
Hospitals and nursing homes are facing similar dilemmas. In Wisconsin, nursing homes are struggling to accept patients from overrun hospitals, according to John Sauer, president and CEO of LeadingAge Wisconsin, which represents aging service providers.
"We will not admit individuals for whom we don't have staff," Sauer said. "Right now, we're pulling out all the stops. We're looking at bringing in workers from out of state to provide help on a temporary basis."
But those workers come at a cost, one that nursing homes, which have already been burdened with the expense of personal protective equipment, COVID-19 testing and infection control measures, will struggle to cover, Sauer said.
"We're going to pay the piper for those higher costs," Sauer said. Without federal assistance, he predicts, "We're going to see many facilities fail in 2021."
Across the U.S., healthcare providers are doing whatever it takes to staff their facilities, even if it means going into the red. They are halting elective surgeries, cross training workers, bringing in staffing agencies and turning to retired healthcare professionals to find enough people to take care of the nation's sick. Yet, at the same time, some clinicians are retiring early, and others are leaving the profession from burnout or safety concerns, putting more strain on an already depleted workforce.
"It is very challenging, as you can imagine, hospital staffing, now that we've been fighting this pandemic for nine months," said Nancy Foster, vice president of quality and patient safety policy for the American Hospital Association. "We, obviously, especially in this surge, need all of the available clinical experts providing care to those in need of hospital care."
Chase Farmer, vice president of staffing firm Medical Solutions, said that if there were 1,000 ICU nurses sitting on the sidelines right now, there would be jobs for them, and he estimates the number of open positions across the country has likely more than doubled since the pandemic began. He related the staffing supply and demand problem to the N95 mask shortage.
"The big difference is we can't just have Medical Solutions operate 24 hours a day to produce more nurses. It's not like opening up a manufacturing plant," Farmer said.
On top of that, the issues that led to a nursing shortage before the pandemic are being compounded, he said. Fewer people are entering the field, and more experienced workers are retiring than was the case just nine months ago.
Recently, Mayo Clinic reported that 1,443 of its employees in the Midwest, 2.6% of the system's staff in the region, were either out of work because of a COVID-19 diagnosis or from exposure. Of those workers, 93% were infected through community spread. Similarly, Cleveland Clinic said had about 1,000 employees out across its system because of COVID-19, most of whom contracted the virus through community spread.
"Due to the rise in cases, we are concerned about staffing levels and taking steps to ensure we have enough caregivers to meet the needs of our patients," said Kelly Hancock, chief caregiving officer at Cleveland Clinic.
Cleveland Clinic has shifted staff to care for COVID-19 patients, and leadership meets daily to review staffing levels, Hancock said. On Wednesday, the system said it would postpone all nonessential inpatient surgeries requiring a hospital or ICU bed at all but one of its hospitals in Ohio from Dec. 7 through Jan. 4.
Mayo Clinic has mobilized staff from other parts of the country to respond to areas in need, sending volunteers from Arizona and Florida to the hard-hit Midwest, and has brought in newly retired healthcare workers who are still licensed to assist, said Dr. Amy Williams, executive dean of the Mayo Clinic Practice.
"We're shifting staff around the entire health system to have them be where they need to be the most to care for COVID patients. This is a key to how we've been able to manage through the Midwest," Williams said. "We do have staff to cover the gaps that are created by COVID. But the more gaps we see, the harder it will be to cover them."
Dr. Hal Paz, CEO of The Ohio State University Wexner Medical Center, said the system has enough beds for COVID-19 patients and can transition the local convention center into an 1,100-bed surge facility within a few days' time.
"The challenge will be staffing. During the first surge, not every region of the country was impacted. Many rural areas were not impacted," Paz said. "Like every one of my colleagues across the country, we're very concerned about what's ahead of us."
As of Thursday, there were 196,227 new cases of COVID-19 in the U.S., bringing the national total to 13,822,249 cases, according to the Centers for Disease Control and Prevention. There were 2,762 new deaths, increasing the country's COVID-19 death toll to 272,525 people. Health officials only expect that spread to worsen throughout the holiday season as more people travel and congregate indoors.
"That's what give me great concern and great pause. Because we don't know what that's going to look like here in Ohio or the rest of the nation, we have to be prepared," Paz said.
AHA's Foster said that a number of hospitals are reaching out to staffing agencies for help.
"Part of the challenge there is there's such a demand for those additional staff, the agency staff, that the agencies are paying a lot of money to nurses willing to come and work. It makes working for an agency more attractive than working in a hospital," she said. "We're trying to strike the right balance there and not price ourselves out of the market."
Staffing agencies are charging two to three times the normal hourly rate for workers, LeadingAge's Sauer said.
Medical Solutions' clinicians are receiving pay packages that reflect the greater numbers of hours they are working and account for the risk staffers are taking on, said Farmer. Traveling workers, too, are relocating and starting at new facilities within two weeks, which is much faster than usual, said Amber Barna, vice president of clinical and quality services for Medical Solutions.
