Hospitals Face Staffing Shortages, Reduced Budgets in Coronavirus Pandemic

 

Nancy Cleeland By Nancy Cleeland April 7, 2020
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​Along with scarcities of masks, beds and ventilators, U.S. hospitals also worry about having enough specialized nurses, doctors and other medical staff as they confront the coronavirus pandemic.

The shortages may get worse as care providers get sick themselves or leave their jobs to deal with homebound children or sick family members.

[Keep up with the spread of the coronavirus. Track cases as they are reported in each U.S. county.]

"Personnel is becoming more and more the issue," New York City Mayor Bill de Blasio told CNN as he outlined the city's attempts to stay ahead of surging cases of COVID-19, the respiratory disease caused by the virus.

Hospitals across the country have been shuffling resources for weeks to get ready for expected surges of COVID-19 patients, by:

  • Building up supplies of personal protective equipment for medical staff such as face masks and shields, to the extent possible,
  • Postponing elective surgeries, therapies and classes to conserve equipment and create more space to care for coronavirus patients, and
  • Training all medical staff, from oncology nurses to surgical anesthesiologists, to assist with intensive care of coronavirus patients.

"We are now a monolith," tweeted Dr. Zachary D. Levy, an emergency medical physician in Manhasset, N.Y. "We started with a medical ICU, surgical ICU, cardiac ICU, neurosurgical ICU, and a cardiothoracic ICU, plus a dozen mixed specialty floors. Every floor and unit is becoming a COVID unit. There is no more specialization—we're all treating one thing."


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As Demand Rises, Profit Centers Close

These proactive moves are costing hospitals dearly because elective surgeries, now suspended, are a primary source of revenue. In fact, many hospital systems, including those in Philadelphia, Chicago and Duluth, have recently announced layoffs to compensate for the revenue drop.

Although she has seen increased demand for nurses with experience in intensive care, emergency medicine and infectious diseases, most hospitals are being conservative in hiring decisions, said Dr. Iman Abuzeid, chief executive officer of Incredible Health, a nursing staffing agency based in San Francisco.  

"The majority of our hospital clients are trying to get through this crisis with their permanent staff." said Abuzeid, who works with more than 200 hospitals. "But they're keeping their options open," she added. "They all have contingency plans."

However, an analysis of job postings by LinkedIn found a 35 percent increase in daily job postings for health care workers between January and March, even as the overall job market was skidding. This follows a long-term trend and may be only partly reflective of the coronavirus, the analysis noted.

Temporary medical staffing agencies told CNBC.com that demand and pay for intensive care and emergency specialists has spiked wherever the virus touches down. For example, facilities in Spokane, Wash., have been offering up to $120 an hour for medical ICU nurses, well above normal pay, according to Nomad Health, a staffing firm with more than 100,000 registered clinicians, headquartered in New York City.

A survey of 323 hospitals by the Inspector General of the U.S. Dept. of Health and Human Services found widespread concern about having enough specialists to treat COVID-19 patients. "Hospitals reported a shortage of specialized providers needed to meet the anticipated patient surge and raised concerns that staff exposure to the virus may exacerbate staffing shortages and overwork," according to the IG report. "Hospital administrators also expressed concern that fear and uncertainty were taking an emotional toll on staff, both professionally and personally."

Keeping Staff Safe

Making the most of existing or newly hired staff depends on keeping front line workers safe from the virus, which hospitals are doing with varying degrees of success, according to reports from the field solicited by STAT, a media company focused on health, medicine, and science. Terry Adirim, a former senior Department of Homeland Security official who helps lead clinical care at Florida Atlantic University College of Medicine, told STAT that the "variability in preparedness" has to do with hospital leadership, along with a lack of clear federal guidance.

Widespread shortages of masks, face shields and protective gowns have forced hospitals to scramble for supplies, often in competition with each other. Fears expressed by member health systems prompted the American Hospital Association to launch the 100 Million Mask Challenge, connecting manufacturers and hospitals to build up protective gear supplies where they are needed.

In New York City, currently the U.S. epicenter of COVID-19, concerns about personal protective equipment have been on the minds on many health care workers, even more so after two hospital nurses died from the virus. Health care workers told the New York Times they fear there will be many more. "I feel like we're all just being sent to slaughter," said Thomas Riley, a nurse at Jacobi Medical Center in the Bronx.

As COVID-19 cases rose exponentially in New York, state and local officials issued increasingly desperate pleas for medical students, retirees, and doctors and nurses from other states to jump in, and the call is being answered. On March 30, de Blasio announced that more than 500 paramedics and emergency medical technicians, 2,000 nurses and 250 ambulances were arriving from across the country to help. Military personnel were staffing field hospitals capable of treating thousands, and the USNS Comfort now docked in New York will provide roughly 1,000 hospital beds and 1,200 personnel to New York.

But foreseeing a spike in coronavirus cases in the coming week, New York Gov. Andrew Cuomo has begged for more assistance. "Help New York. We are the ones who are hit now," Gov Cuomo said at a press conference. "We're the ones who are hit now. That's today, but tomorrow it's going to somewhere else."

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Provide input as the DOL develops further guidance on the FFCRA. Participate online at https://ffcra.ideascale.com through April 10—an extended deadline.

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