I hate to say it, but we’ve been proven correct even faster than usual. We warned that the failure to treat nurses well would come back to bite the hospitals that went into Scrooge mode. As we posted on August 3:
In other words, if we have another crisis in hospitals, it’s due not just to Delta but also rule by MBAs:
We told you this would happen. The mass exodus of nursing staff came in waves, month after month. Now this sudden, debilitating, exponential growth of sick people needing care in our communities, & they have no one. YOU didn’t listen, YOU thought travel rates would “normalize.”
— Sarah, RN (@shesinscrubs) July 30, 2021
I was told I was “so intelligent for my age & such an asset,”
In the next breath I was told, I wasn’t worth one more dollar: “giving each person in this system a 1 dollar raise would cost, $2 million dollars, would you be happy with $1?”
I was stunned.
— Sarah, RN (@shesinscrubs) July 30, 2021
Today’s press has many stories about hospitals in Texas, Florida, and some other states being strained to the breaking point due to the latest Covid surge. Obviously, the big driver of this dire situation is the rapid rise in cases. Some also mention staffing levels and even say that their capacity constraint is not beds but manpower. That’s reflected in the super-high pay on offer for “traveling” nurses who go to hospitals that are willing to pay up for extra hands on deck.
Of course, most of these articles, particularly in corporate friendly venues like Bloomberg and Business Insider are going to depict burnout and fear of contracting Covid as the foundation of the nurse shortages. And those are certainly significant factors. However, not being willing to ante up to give nurses and other hospital support staff hazard pay (while eventually paying through the nose for traveling nurses) is an insulting statement about how much management values them. Why should they risk life, limb, and their mental health when the top brass makes clear it cares more about preserving and increasing its pay than spending up to take care of patients and employees?
It wasn’t hard to see that with Delta being super infectious and the US not heavily vaccinated enough to ground out contagion of wild type Covid, even before factoring in reduced efficacy of the Covid vaccines against Delta, that the US was set to suffer a nasty big spike and was likely to see overloaded hospitals again. We also warned that it is seen as unacceptable to the powers that be for heart attack, stroke, and car crash victims not to be able to get adequate care in emergency rooms. Associated Press reported that St. Petersburg is at that point:
In St. Petersburg, some patients wait inside ambulances for up to an hour before hospitals can admit them — a process that usually takes about 15 minutes, Pinellas County Administrator Barry Burton said.
While ambulances sit outside emergency rooms, they are essentially off the grid.
“They’re not available to take another call, which forces the fire department on scene at an accident or something to take that transport. That’s caused quite a backlog for the system.”…
At no other time during the pandemic have intensive care units seen a percentage of COVID patients as high as in the last two days. Last year around mid-July, the percentage edged to 45% with about 1,400 patients. Officials ramped up beds at hospitals and at their peak reported about 2,500 ICU patients at a time. At the height of last year’s summer surge, Florida had about 10,170 COVID-19 hospitalizations overall.
Notice the manpower concerns:
Nearly 70% of Florida hospitals are expecting critical staffing shortage in the next seven days, according to the Florida Hospital Association. The COVID-19 influx is also hitting as Florida hospitals are seeing “unusually high numbers of very ill non-COVID patients,” said the association’s president Mary Mayhew.
Associated Press also ran a stand-alone story on nurse shortages. Key sections:
The rapidly escalating surge in COVID-19 infections across the U.S. has caused a shortage of nurses and other front-line staff in virus hot spots…
Florida, Arkansas, Louisiana and Oregon all have more people hospitalized with COVID-19 than at any other point in the pandemic, and nursing staffs are badly strained.
One system is giving retention bonuses to keep from having nurses decamp to highly paid “traveling nurse” gigs:
Miami’s Jackson Memorial Health System, Florida’s largest medical provider, has been losing nurses to staffing agencies, other hospitals and pandemic burnout, Executive Vice President Julie Staub said. The hospital’s CEO says nurses are being lured away to jobs in other states at double and triple the salary.
Staub said system hospitals have started paying retention bonuses to nurses who agree to stay for a set period. To cover shortages, nurses who agree to work extra are getting the typical time-and-a-half for overtime plus $500 per additional 12-hour shift. Even with that, the hospital sometimes still has to turn to agencies to fill openings.
Twitter had already registered the nurse shortage. For instance:
COVID exploded in my ICUs this week. I was looking as far as Cincinnati to find an ecmo circuit for a young patient yesterday — while we have a few circuits available locally, there are no nurses available. Bed capacity is more than an empty bed, it’s a team to staff it, too.
— Jason B. Martin, MD (@jasonbmartin) August 7, 2021
By contrast, Business Insider ran a story on MD exhaustion. Its opening:
Ed Jimenez was walking down the hall of the University of Florida Health Shands Hospital recently when he ran into a nurse on staff.
The unrelenting pandemic has made it hard at times for Jimenez — CEO of the teaching hospital in Gainesville which counts more than 1,000 beds — to sustain morale among his workforce.
“Everybody I talked to was putting up a wonderful exterior: ‘We got this. We’re helping people,'” he recounted in an interview this week with Insider.
Still, he could see the anguish behind their eyes. The nurse reminded him of what has become one of the pandemic’s most sobering scenes.
Notice Business Insider did not talk to any nurses or technicians: “Insider interviewed seven doctors, hospital leaders, and local government officials, to understand how they’re responding to the situation.” But the story did get one source to ‘fess up that ER care was being compromised:
At one South Florida hospital, some COVID patients have had to wait in the triage area for up to a day since no ICU beds were immediately available, said a doctor in the area who requested not to be identified as they were unauthorized to speak to the media.
And later on, it turned to nursing:
Meanwhile, hospitals are confronting a nationwide shortage of nurses.
Kevin Taylor, the emergency room director at Baptist Health’s two Bethesda Hospital locations in Boynton Beach, said that nurses on staff are making up for the lack of reinforcements by volunteering for extra shifts.
But that was it. The piece then turned to ambulances tied up waiting for admissions, oxygen shortages, and postponement of elective surgeries.
A local news station, in Tenessee, gives a more candid picture of the staffing stress. From WKRN:
Dr. [Todd] Rice [the director of Vanderbilt’s Medical Intensive Care Unit] says staff there faces two challenges. “It’s a double hit. You get hit with more cases, but you also get him from fewer people now to take care of those cases.”
It’s a problem people may not consider. “As the number of cases increases in our community, the number of our employees that are positive also increases,” he says.
That forces a team of specialized professionals to stay home. “We’ve had shortages of our nurses, and our nurse practitioners, and our respiratory therapists, because unfortunately, even if they’re vaccinated, and they’ve tested positive, they’re out of work for 10 days.”
But again, to hear from nurses, you need to go to Twitter (and I assume Facebook, to which I am allergic), where you learn that the heartrendering vignettes of nurses overwhelmed by suffering patients airbrushes out a key part of the picture: that the pay issues we flagged earlier are symptomatic of a lack of respect and concern:
of our sacrifices; including death for some of us from Covid-19 or other occupational hazards, we are treated as if we are invisible. No help is offered. No reinforcements are promised. Our coworkers are told to do more with less, each and every day. (3)
— LiveWellFeelWell (@LivWellFeelWell) August 5, 2021
The pace takes our breath. We watch as coworkers who have fallen are discarded like rusted out cars that have exceeded their usefulness. The broken cars line up in crumpled heaps in the junkyard in numbers that continue to multiply. We are told/forced to keep silent. (4)
— LiveWellFeelWell (@LivWellFeelWell) August 5, 2021
Mirable dictu, one media outlet is connecting the nursing shortage to pay levels:
The Birmingham Black Nurses Association and the Alabama State Nurses Association said the current shortage of nurses in our state has more to do with pay than COVID. https://t.co/VOFX2uN9Cr
— WBRC FOX6 News (@WBRCnews) August 10, 2021
A necessary but not sufficient condition to better treatment of nurses: the public at large recognized that they aren’t paid what they are worth:
Large majorities of Democrats and Republicans believe nurses and health-care aides are underpaid, while almost an identical number say doctors are overpaid, one study found. https://t.co/JOmcPUTF5c
— MarketWatch (@MarketWatch) August 11, 2021
Another looming battle is over vaccination of hospital employees is leading to more nurse departures. At the end of May, 1 in 4 patient-interacting hospital workers had not had any Covid injections; at the 50 largest, the ratio was 1 in 3. Press and media accounts indicate that vaccinated nurses resent working with unvaccinated colleagues, particularly since some hospitals assign only vaccinated staffers to Covid patients. However, some Evangelical sects oppose vaccine use, either out of mistaken beliefs that they rely on embryonic stems cells, or that mandating vaccination is the Mark of the Beast. Many youngish women are also concerned about reproductive effects; the mRNA vaccines can produce very heavy and early periods. The drug makers have not addressed this issue; they’ve instead talked about miscarriage risk, but have stayed mum on the weird menstruation and related fertility concerns. The failure to address this issue directly is not assuaging doubts.
The religious refusniks won’t be converted, and it’s an open question as to how many of the ones worried about reproductive risks will quit if forced to get a jab. Either way, a vaccination mandate will further thin the ranks of hospital nurses at the worst possible time.
So I hope readers will keep us posted with what they see in the local press and learn from medically-connected contacts about hospital and particularly nurse staffing and compensation. As you can infer from this post, what is happening on the nursing front lines is not well covered, despite its considerable importance in the struggle to contain Covid.