Health care facilities have hit the wall on medical staffing due to the growing number of COVID-19 hospitalizations. And that likely means higher operations costs.
The virus has created a huge demand for not only nurses, already in short supply nationwide, but other clinical workers as well. Hospitals and clinics also need to fill slots created by absences when regular staffers test positive or have to quarantine.
As the nation confronts its third surge of COVID patients — the biggest yet — hospitals, nursing homes, labs and other health care providers are squeezed for staff, despite assistance from the National Guard.
It’s not an option for some caregivers to simply operate with fewer employees.
“You can be cited and fined for lack of adequate staff,” said Doug Farmer, president and CEO of Colorado Health Care Association. The association’s membership consists of 205 nursing homes and 68 assisted living facilities, which are subject to federal regulations dictating staffing numbers in certain circumstances.
But for employment agencies that scoop up and then market those workers, 2020 is shaping up to be a very lucrative year, considering some medical personnel contracted through agencies receive twice or even three times normal pay.
With the entire country facing COVID-19 surges in hospitals, traveling nurses command up to $8,000 per week in places like Fargo, North Dakota, one of the nation’s coronavirus hot spots, Kaiser Health News reported last month. That, in turn, leaves rural hospitals that can’t afford to pay that much in a quandary — they can’t compete on salary to attract new employees or temporary workers, and they might lose existing staff to agencies promising sky-high paychecks.
That leaves medical facilities to compete for available workers. But are there enough to go around? According to a study published in 2017 — long before the pandemic hit — the nation was expected to see a shortage of 154,018 nurses this year and 510,394 by 2030.
Even without the pandemic, the Colorado Center for Nursing Excellence reports that Colorado’s 61,000 licensed nurses, which include registered nurses, licensed practical nurses and advanced practice nurses, won’t be enough going forward.
For one thing, 21,000 of those nurses are over the age of 55 and 4,500 are over 65. Other studies have noted the demand for nurses will only grow, even under normal circumstances, as the Baby Boomer generation ages.
Farmer, with the nursing home association, said the first wave of COVID cases in March hit long-term care providers with staffing shortages, because existing workers had to stay home due to lack of child care when schools and daycare centers closed.
“All of a sudden schools and businesses closed,” he said, referring to the safer-at-home shutdown in April and May. “For people working in long-term care who had kids who would otherwise be in school, they had to figure a way to get kids taken care of. They had to choose.”
Now, nursing care facilities are competing with many other facilities for licensed personnel. And many access staff through agencies that hire workers and then market them at higher wages than a regular employee would earn.
“It’s considerably more costly to hire temporary staff,” Farmer said.
Cost isn’t the only drawback, he noted. “When they use staffing agencies, you’re bringing in employees on a temporary basis who don’t understand your culture, and you want to build a team when you’re doing health care,” Farmer said. “We’re caring for human beings, so we want to have enough people and the right people to work with vulnerable people.”
Hiring at nursing homes, in particular, he says, had proven difficult long before COVID. Now, with pots of gold waiting in other cities and states for traveling nurses, “Prices are going up and up and up,” Farmer said.
Those higher costs are hitting a segment of the health care industry that can ill afford rising expenses, he says, citing a 2018 Medicare Payment Advisory Committee report that showed nursing facility profit margins sank from 3 percent to 1 percent in a three-year period.
As nursing home admissions decline due to COVID, Farmer says it’s likely some facilities will go out of business. “I think we definitely have challenges ahead of us,” he said.
On Dec. 8, the state reported 1,755 people hospitalized due to COVID-19, with 83 percent of acute care hospital beds occupied and 30 percent of facilities anticipating staffing shortages in the coming week.
Locally, as of Dec. 8, hospitals were caring for 255 confirmed COVID patients, which led the El Paso County Public Health website to label hospital capacity as “poor/strained.”
UCHealth, which runs city-owned Memorial Hospital system, housed nearly 135 COVID patients as of Dec. 7, up from 125 the week before. Although the system has 570 beds, many are dedicated to other uses, such as birthing, urgent surgeries and the Neonatal Intensive Care Unit.
UCHealth has been recruiting nurses and partnering with nursing schools for years to build the ranks, UCHealth Memorial spokesperson Cary Vogrin said.
Unlike some hospitals, UCHealth didn’t furlough staff early in the pandemic and pushed to hire more people for critical COVID-19 and patient-care positions. Vogrin said the UCHealth system, which runs facilities in northern Colorado, the Denver area and Colorado Springs, hired hundreds of registered nurses, respiratory therapists, certified nursing assistants, laboratory staff and others during March, April and May. Systemwide, UCHealth hired more than 4,100 external candidates.
But as the COVID burden grows, pressure on staffing also grows, she says, not just here, but everywhere.
“All over the country the nursing shortage is very real,” Dr. David Steinbruner, chief medical officer for UCHealth Memorial Hospital Central and Memorial Hospital North, said during a recent media briefing. “So there’s only so many nurses you can find.
“Now, in the pandemic,” he added, “you can imagine how difficult it is to find those people. The problem with this is, it’s a long campaign. You’re constantly getting new patients. As we work through this, we work at phasing where we try to expand the unit, nurses and doctors, where we could absorb doubling of numbers (of COVID patients) but that’s hard to do under safe patient ratios.”
The optimum patient-to-nurse ratio for desirable patient outcomes, according to nurses union National Nurses United, calls for one nurse for every two patients requiring intensive/critical care or respiratory care. So how much can that ratio be stretched to increase nursing access to more patients?
Steinbruner didn’t say, but did note, “At a certain point, things start to fall apart. Once you’re past a one-to-eight ratio, it’s hard for a nurse to know what’s going on with those patients. … There’s no way we can absolutely handle this forever.”
Not only is UCHealth in need of more personnel to address rising numbers of patients, more also are needed to backfill absences for the up to four dozen employees out of commission at any given time due to quarantine or positive COVID tests.
As of Dec. 3, UCHealth had 140 registered nurse openings in the southern region of the state.
Other steps UCHealth has taken:
•Assigning administrative RNs to assist with bedside nursing, while staff from other areas are redeployed to help with inpatient services.
•Hiring advanced care partners (ACPs), or nursing students, as nursing techs. “We are offering new grads who are slated to start in February the opportunity to come on board early in an ACP role,” Vogrin said.
•Training non-clinical staff to assist with support tasks to free up clinical staff to focus on patient care.
•Offering incentive compensation and overtime pay for extra shifts.
•Offering sign-on and relocation bonuses to recruit nursing candidates, while also seeking to hire traveling nurses, for whom there is “fierce competition,” she said.
•Advertising nationally for ICU openings.
•Conducting new employee orientation weekly, rather than twice a month, to speed the onboarding process for new hires.
•Requiring the same certifications and licenses but accepting temporary licensure as approved by the Colorado Department of Regulatory Agencies.
Centura Health, which operates Penrose-St. Francis Health Services, looks within for staff, according to spokesperson Andrea Sinclair.
“One of the benefits of being part of the Centura Health system is the access to additional resources and support, especially as our COVID-19 numbers increase within our communities,” Sinclair said via email.
“We are able to work with our Enterprise Incident Command and Staffing Resources Center to ensure our needs are met locally and we can compassionately take care of our patients and one another. This is especially true given our system’s ability to share resources among our hospitals.”
Centura also is recruiting nurses to return from retirement and shifting staff from less busy units to support ICU and other patient wards, she said.
But many hospitals are turning to outside help.
David Deane, senior vice president of Wanderly, a website where health care professionals can compare offers, told Kaiser Health News that traveling nurses working nationwide increased by more than 60 percent, from 31,000 in 2018 to about 50,000 today.
Employment agencies dominating the flow of nurses include Philadelphia-based The Judge Group. Besides supplying specialties such as registered nurses, lab techs and other frontline health care workers, it has lined up personnel to staff 1,500 COVID-19 testing sites across the United States.
“We’ve been ramping up since May and June,” said David Anderson, the firm’s health care managing director for the western U.S. “There’s been a continuous need, and that’s all over the country for us. Our team is working overtime, extra hours, on weekends to make sure we’re meeting our health care needs.”
He said the agency uses artificial intelligence to scrape job boards and licensing agencies for those licensed in the industry.
“Anyone who has an active license is considered a candidate we would consider,” he said.
Further complicating hospitals’ search for staff is the demand for nurses and other health care occupations to set up safe workplace plans for manufacturers and essential industries, contact tracing and testing, Anderson says.
As for the pay differential, which can be significant, Anderson said, “They are on the front lines of this pandemic. They’re risking it all to make sure people are safe and healthy.”