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A Staffing Perfect Storm

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Specializes in Clinical Leadership, Staff Development, Education. Has 28 years experience.

How are hospitals managing staffing during COVID?

Dark storm clouds are brewing as COVID-19 threatens to overwhelm an already stretched nursing workforce.  Read on to learn what some hospital executives are doing to meet staffing challenges head on.

A Staffing Perfect Storm

Things have changed since the early days of the pandemic when elective surgeries were at a standstill.  Nurses accepted travel assignments to COVID “hotspots” to compensate for cancelled shifts, furloughs and layoffs. Other nurses eagerly stepped up to work outside of their own state to fight on the frontlines in a harder hit area of the country. 

Now, hospitals across the country are feeling the strain caused by the fall’s virus resurgence.  The number of available hospital beds are shrinking and higher numbers of healthcare workers are getting sick. This time around, the virus is more widespread and there simply isn’t enough travel nurses to fill the gaps of a nationwide staffing crisis.  Now, more than ever, healthcare leaders are being creative with new strategies for supporting healthcare workers on the front lines.

A Public Plea

A staffing “perfect storm” is brewing as COVID-19 patients flood hospitals across the U.S.  The UW Health System in Wisconsin responded to the urgent situation by publishing a 2-page open letter in the Wisconsin State Journal.  The ad asked residents to join healthcare workers in preventing further virus spread within their community. 

Quote

“Wisconsin is in a bad place right now with no sign of things getting better without action. We are, quite simply, out of time. Without immediate change, our hospitals will be too full to treat all of those with the virus and those with other illnesses or injuries. Soon you or someone you love may need us, but we won’t be able to provide the life-saving care you need, whether for COVID-19, cancer, heart disease or other urgent conditions. As health care providers, we are terrified of that becoming reality.”

All of UW Health’s faculty, staff and colleagues from around the state signed the letter, making a powerful statement.

You can read the full UW Health letter here: An Open Letter to the People of Wisconsin

Hospital Execs Get Creative

I recently read an interesting article in Becker’s Hospital Review, Strategies for COVID-19 Staffing Shortages from 8 Hospital Execs, that shared strategies used by 8 hospital executives to staff adequately during the pandemic.  Here is a look at a few strategies used by executives in the article and other healthcare leaders.

  • Increase the use of part-time and per diem staff for additional shifts.
    • I know... you’re thinking “what part-time and per diem staff”?  This strategy may require hiring additional part-time staff and being creative with their work hours.  Perhaps a nurse is willing to work 6 hours during the shift’s busiest time.
  • Deploy nurses who work away from the bedside to join frontline nurses in supportive roles such as vital signs, treatments, medication passes, admissions and discharges.
  • Sharing resources within healthcare systems to prevent a single facility from becoming overwhelmed.
  • Offering incentives to nurses at another affiliated facility interested in signing up for extra shifts at another struggling facility.  In some cases, short-term contracts are offered to per diem nurses to fill a vacant full-time position.
  • Identifying any duties of frontline nurses that could be performed by another person.  For example:
    • Assigning a phlebotomist to the ER or ICU to help with blood collection.
    • Cross-training surgical and cath lab nurses to transfer and discharge patients to conserve beds in ICUs and intermediate care units.
    • Adding a unit secretary position to nightshift
  • Adding a “site manager” to COVID units to act as a runner for the care team.  The site manager can get supplies or perform other tasks that decrease the number of times the nurse (or other healthcare worker) has to leave the COVID patient’s room.  This will down the amount of time spent donning and doffing PPE.
  • Using telehealth when physicians and other providers are quarantined and unable to provide in-person care safely.  
  • Reduce the risk of staff contracting or transmitting the virus. Implementing infection control teams to change the work culture by encouraging staff and faculty to speak up when they see safety issues.  Send the message “everyone has a right to contribute to a safe work environment”.
  • Moving PPE to facilities that need it the most.
  • Enlisting the primary care and family physicians to help by working in an affiliated or local hospital.

Many nurses hold supportive positions in departments throughout the hospital, such as information technology, quality management, and education and case management.  Assigning these nurses times to work at the bedside can ease the workload for other staff.  I’m almost certain you’ll hear a few “I haven’t taken care of patients in years” and “I’m not comfortable with my bedside skills”.  But, it only takes basic nursing skills to change a simple dressing, follow-up on pain levels, call in consults and other time-consuming tasks.

We Want to Know

Are you part of an innovative plan or strategy to address staffing shortages?  If so, we would love to hear your story.  Tell us about the creative solutions and initiatives in your community.

J.Adderton has 27 years experience as a BSN, MSN and specializes in Clinical Leadership, Staff Development, and Ed

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27 Comment(s)

RN-to- BSN, ADN, RN

Specializes in SCRN. Has 7 years experience.

This is all nice, and I say, it is easy to be "creative" for the administration having meetings on Zoom.

Here is what their creativity looks like on the inpatient unit.

The "helper" nurse from the OB says to me, after asking if I needed help and I asked her to help my patient order food, "um, I'm not comfortable with that. Have someone else do it". 

The educator is mandated to work 2 12hrs bedside shifts a week, and it is messing with her childcare arrangement. She tells me she is about to quit.

Staff running around dehydrated because of "no drinks on units". Soon, we'll have to go out to our cars to hydrate, LOL.

Currently, they offer 500$ bonus for a pick up shift fir a nurse. Guess who is picking up? No one. 

The stress on the people is unbelievable. We do try to do our best and work together, but secretly make own contingency plans.

Thank you! 

 

I work on the unit that houses our COVID unit in the back half. I help the nurses with COVID + discharges for those patients who no longer need hospital support. I have limited interaction, but not NO interactions. 
Recently had symptoms of something viral, so I called off. It happened to be Friday. I called employee health to report my symptoms, like I was supposed to.  Had a virtual provider visit that evening and was tested for COVID on Sunday.  My director texted me on Monday saying I was an essential worker so I should come to work despite my symptoms. Seriously? One of my exposures was a low risk event with a coworker who had traveled out of the area then was positive for COVID and working asymptotic. Hey boss low risk exposure is not no risk. 
 

 

Edited by SunDazed

J.Adderton, BSN, MSN

Specializes in Clinical Leadership, Staff Development, Education. Has 28 years experience.

On 12/16/2020 at 10:55 AM, SunDazed said:

Hey boss low risk exposure is not no risk.

I have had similar situations where employee health gathered information about potential exposure from unit manager, but did not talk to actual employees.  Important information about who did what during shift is not relayed.

On 12/16/2020 at 10:05 AM, RN-to- BSN said:

Currently, they offer 500$ bonus for a pick up shift fir a nurse. Guess who is picking up? No one. 

Sometimes more money doesn't equal out the added stress.

T-Bird78

Has 6 years experience.

I work in an office part of a huge healthcare system. All office clinical staff has been on stand-by to be moved to inpatient settings. One of my CMAs was sent to a hospital and worked as a CNA in the ICU for COVID+ pts.  They’ll move CMA/RMAs to long-term care facilities or as a CNA in a hospital, and we LPNs will be on the floor. I’ve never worked in a hospital but did complete the required learning module for how to use our EMR in inpatient vs ambulatory setting. Just awaiting my orders. 

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 10 years experience.

We have opened up a labor pool. As an educator, I was offered the option of staffing on the floor, working the floor as a "helper nurse" (essentially a PCT with the ability to do meds, sign off on blood and other nursing care but not taking a patient assignment) or working in other ancillary needs. I chose (as did almost everyone) to work with ancillary needs and have been assigned 10 hours per week giving Covid vaccine injections to fellow employees. I know my body would not be able to handle 12 hour shifts on the floor at this point in my life. 

I know we are working critically, double digit short the vast majority of the time. I know that many of the major hospitals in North Texas are overwhelmed and that getting a bed is now not guaranteed. I know that I feel afraid when I contemplate what January may look like. 

@J.Adderton Are you testing employees regularly in your workplace? Some of the SNFs in our area are testing staff weekly. Our hospital sent out an email that the state department of public health recommends weekly testing of employees... and so that would commence.

(Screechy break sound!)

Another email the following week stating not enough test kits to even think about doing this. I have former classmates elsewhere that are testing weekly in their facilities. 

Any idea why some places can get test kits in quantity and others can't?

Most of the nurses here do not trust administration. The suspicion is that if admin starts testing, they will start finding COVID + staff.  That would force them to either justify having COVID + staff work, or not.  There is not enough back up nursing staff in this rural area to meet needs if they have staff off work. Despite directors saying over and over they are not putting us in any working condition they themselves would not feel safe working in... ahem... really?

The nurses hunker down and get it done everyday... despite administration. Not because admin is doing anything to inspire them. Our director mostly says... 'you have to do it you are a nurse... it is your job'....

Funny how that leads to a lot of nurses leaving for other units or other hospitals. 

My huge regional system has made similar pleas involving various media.

I understand and don't think it's wrong to do so. I wish the general public would cooperate.

But it isn't the whole truth to blame health care systems' distress solely on public behavior. Or on covid.

They themselves perfectly laid the ground work to be 100% up [...] creek if they were ever moderately stressed, not to mention a pandemic.

 

TAKOO01, BSN

Has 3 years experience.

2 hours ago, JKL33 said:

They themselves perfectly laid the ground work to be 100% up [...] creek if they were ever moderately stressed, not to mention a pandemic.

Yes, this. And the letter seems to be saying "Sure it would be a super idea to hire and train more nurses to alleviate  the strain, but we prefer to just overwork our non bedside nurses in addition to burning out the floor nurses."

What an innovative idea🙄

You know what our management’s idea of creative staffing is? While we work our butts off doing our jobs plus the jobs of the nurses who have called off due to being exposed, their kid being exposed, no childcare because daycares shut down when a staff member or another kid tests positive they looked at our productivity and decided that we don’t really need the nurses we had because clearly we can handle the work without all of them. So they cut 4 yes 4 FTEs! Now there is no end in site for us and it gets better. 3 nurses are pregnant and due in June because what else can you do when you’re in lock down? So we’ll be down 7 nurses and we’ve been told that Summer vacations will be reduced because of it. There is not enough pizza in the world to make up for this ginormous slap in the face. 

Sorry for the rant but trying to manage 7 phones for an entire shift has made me a teeny bit cranky. 

Also...there is no “list” people. There isn’t going to be a list. Stop calling asking to be put on the list. 😩

LibraNurse27, BSN, RN

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 8 years experience.

My manager tried desperately to hire travelers and asks for an extra nurse or a CNA or a clerk or tele tech (preferably all of those) for our floor. Upper admin responds by canceling per diem staff and saying an extra nurse would make us overstaffed, applying to suspend the legal ratios in CA, and trying to triple our ICU nurses with 3 sick covid pts, CRRT and everything. 

We respond by running crazy, all of us in covid rooms while the phones ring and the tele alarms go off, no one to answer calls or look at alarms. No one to bring supplies or run into your room when your pt is crashing. No one to watch your pts while you transfer one to ICU. But they do send us a nice email with tips on how to reduce stress like do yoga and drink tea. thanks guys 

9 minutes ago, LibraNurse27 said:

But they do send us a nice email with tips on how to reduce stress like do yoga and drink tea. thanks guys 

🤮

brandy1017, ASN, RN

Specializes in Critical Care.

On 12/17/2020 at 2:34 PM, JKL33 said:

My huge regional system has made similar pleas involving various media.

I understand and don't think it's wrong to do so. I wish the general public would cooperate.

But it isn't the whole truth to blame health care systems' distress solely on public behavior. Or on covid.

They themselves perfectly laid the ground work to be 100% up [...] creek if they were ever moderately stressed, not to mention a pandemic.

 

I agree at my healthcare system they had already driven record nurses and PCA's off by layoffs and raising pt ratios before Corona hit.  Now have to rely on travelers getting crisis pay and pulling helpers from all over the hospital and clinics to have enough staff to run the hospital.  Of course, they are blaming Corona for all their woes. 

Then they told nurses we were just replaceable widgets that would be floated to other hospitals in the system if census was low which only decreased morale and lead to more nurses leaving.  Don't believe any nurses actually floated to other hospitals as not enough nurses with so many quitting instead!

They don't have enough of the small TB masks so nurses forced to reuse one.  Interesting that they claim they can't get any when a nurse was able to buy her own on Amazon!

Edited by brandy1017

On 12/17/2020 at 3:34 PM, JKL33 said:

They themselves perfectly laid the ground work to be 100% up [...] creek if they were ever moderately stressed, not to mention a pandemic.

True, but the pandemic did exacerbate things.  

In the Spring, we shut down just about everything that wasn't COVID.  We had the PACU and OR staff helping in ICU.  We had ortho and peds and oncology nurses helping on the med-surg floors.  We had office workers as helpers. The network lost a TON of money, so much that they say the hospital can't survive doing it again.  So now we're muddling through with the staff we have, and we're stretched ridiculously thin.

The hospital is trying to hire now, but wants experienced nurses.  And experienced nurses already have jobs.  In hindsight, they should have hired a bunch of new grads back in June when COVID cases were low here, oriented them though the Summer, and they'd have been ready to go by the time the fall wave hit.  But back then, the hospital was reeling from three months of bleeding money with the profitable departments shut down, so they weren't well positioned to do mass hiring.  And now we're too overwhelmed to onboard newbies, so management finally okayed incentives ($100 per 4 extra hours), but most people are too burned out to pick up.

 

herring_RN, ASN, BSN

Specializes in Critical care, tele, Medical-Surgical. Has 49 years experience.

We just got a phone call that a friend's wife called 911. The ambulance waited a long time at the hospital where he died on the operating table. We don't know his diagnosis or whether he would have survived if the hospital had not been able to treat him sooner.

Last Summer they celebrated their 40th anniversary outside in the parking lot of the club he and my husband belong to, but has been closed since March.

There are no ICU beds at many Los Angeles County hospitals. Hospitals claim they can't find staff and it may be true.

All the time that these hospitals and nursing homes have been intentionally working with a bare minimum staff... Who could have ever predicted that it would become a mess like this if a major outbreak ever happened?  Oh, right, everyone who actually has common sense unlike the majority of hospital and nursing home administration in this country.

On 12/17/2020 at 7:49 PM, LibraNurse27 said:

My manager tried desperately to hire travelers and asks for an extra nurse or a CNA or a clerk or tele tech (preferably all of those) for our floor. Upper admin responds by canceling per diem staff and saying an extra nurse would make us overstaffed, applying to suspend the legal ratios in CA, and trying to triple our ICU nurses with 3 sick covid pts, CRRT and everything. 

We respond by running crazy, all of us in covid rooms while the phones ring and the tele alarms go off, no one to answer calls or look at alarms. No one to bring supplies or run into your room when your pt is crashing. No one to watch your pts while you transfer one to ICU. But they do send us a nice email with tips on how to reduce stress like do yoga and drink tea. thanks guys 

How can these sacks of s*** even hold their heads up?

Or maybe you could do yoga while in your PPE, in the COVID patients' rooms.

Of course, you should go public with this news about monitors not being attended to and phones ringing endlessly.  ANONYMOUSLY

Edited by Kooky Korky

On 12/16/2020 at 9:05 AM, RN-to- BSN said:

This is all nice, and I say, it is easy to be "creative" for the administration having meetings on Zoom.

Here is what their creativity looks like on the inpatient unit.

The "helper" nurse from the OB says to me, after asking if I needed help and I asked her to help my patient order food, "um, I'm not comfortable with that. Have someone else do it". 

The educator is mandated to work 2 12hrs bedside shifts a week, and it is messing with her childcare arrangement. She tells me she is about to quit.

Staff running around dehydrated because of "no drinks on units". Soon, we'll have to go out to our cars to hydrate, LOL.

Currently, they offer 500$ bonus for a pick up shift fir a nurse. Guess who is picking up? No one. 

The stress on the people is unbelievable. We do try to do our best and work together, but secretly make own contingency plans.

Thank you! 

 

I would report that OB nurse and I do mean STAT.  

Let the educator quit.  Who needs her with that attitude?