How to Staff Better During COVID-19 and Disasters

A look at utilizing our own staff during shortages through incentive rather than trying to pull people away from other areas that are also in the same crisis. Nurses COVID Article


How to Staff Better During COVID-19 and Disasters

Any disaster brings in an influx of patients at a higher rate and volume than most hospitals are staffed for even on a good day. In fact, one hospital I used to work for only ever hired for 78% capacity because they usually averaged this census. If it's slower, some float, assignments are lighter, or people get called off. If it's busier, the staff has heavier, potentially unsafe assignments, and some people kindly come in for overtime. Occasionally some institutions utilize mandatory emergency staffing, like another hospital I worked at.

Systems Are Not Perfect

Unfortunately, these systems aren't perfect and work even less when disaster strikes. Sometimes, it's not as bad because if it's for a shorter time frame, such as after a shooting or explosion, people tighten the bootstraps or other hospitals come in to help. When the high demand is a little bit of a longer anticipated influx, such as during a natural disaster, people from all over can come help. You can get travel nurses or crisis personnel to come for a few weeks to that one affected area.

But, what happens when the influx and crisis is all over?

The way it is now during this global pandemic?

Who is going to come save us and help us save our patients?

Once a Nurse ...

One thing states and other countries have been doing is calling on retired medical staff to come back into practice. Now, because we know the sayings, "Once a nurse, always a nurse,” and "A nurse isn't a job, it's who you are,” bravely many people stepped forward. Yet it still does not seem enough. And let's not forget staffing continues to fall everywhere as staff becomes ill or exposed themselves.

Relaxing the Rules

So hospitals are also calling on anyone with a license. We have even lifted rules so that people can practice medicine in a state different from the one in which their license is held.

But, how many people who are staffed in one area are really able to move across state lines to help another, when their own state is also in crisis?

"Crisis Pay"

My friends, colleagues, and I all keep receiving texts, calls, emails, and LinkedIn messages to come work for a few weeks or with essentially entire job offers on the table because of the high demand. Most recently, my friend received an email stating that nurses are urgently needed to help provide care during COVID-19 staffing shortages.

The key I want to zone in on is the second part of that email: The compensation. Crisis pay. Up to $4,700 a week. This is more than most nurses make in an entire month, although I suppose it varies a little more depending on your state and cost of living. This offer is for 8-week assignments, 12-hour shifts with 3 or 4 shifts per week at $103/hr.

Now, the Questions

Why are we not making these offers to our own staff?

On a unit level, a hospital level, or state level?

This is what I asked my friend when she told me about this email. Because otherwise, the only people they are really appealing to are travelers and those who happen to be out of work at this time. I mean, it's not like she or I can leave our current jobs and move over to the next state for the next 8 weeks while our own hospital needs more staff and likely wouldn't accept us back afterward.

Nursing Staff Deserve It

I am not even saying that we need to suddenly increase base pay to "crisis pay" for everyone already working. I am sure there are those who would argue this and likely with some valid points. However, in the interest of being reasonable, I am arguing that staff deserves crisis pay or at least double pay for anything worked above their regularly scheduled hours.

Why? Because there are many people who do not even want to work their regular hours at this time. This is mainly because they are scared to work in these conditions without proper PPE supply or because they are terrified of bringing the virus home to their families. They are also doing a lot more work than on a regular day and under more stressful conditions. However, they would be more willing to do this with fair compensation.

Other Compensation

Do you know why some healthcare professionals are asking for hazard pay or student loan forgiveness? It's not because they feel above their work. It's because they want some sort of compensation for doing at least double the work that should be required of any one person. It's because they want to feel some sort of support for putting themselves at risk. It's because they want to feel VALUED.

There Are Staff Shortages Everywhere Right Now

We can't keep hoping that somehow people will come out of the woodwork to save our own hospitals because everyone is busy weathering their own storms. However, our own staff would likely be willing to help during these shortages with some incentive because in healthcare we always pull together as a team. I think this would also help hospitals from forcing staff to float to units or specialties they do not feel competent or safe working in.

Back to that Email ...

Hence, to circle back around to that email my friend got, my response to her was the realization that if our hospitals or even others within our own state did that and on more of "committed per diem basis" if you will, I would pick up a shift at least one day a week. She said the same. I think if we did a poll, a high percentage of healthcare professionals would also agree. Hospitals need to realize this and capitalize on it to create more of a win-win situation (as much as you can consider things a win under disaster).

Now is Not a time for Penny-Pinching Our Dedicated Nursing Staff

It's no secret that adequate staffing is linked to better patient outcomes. You can easily search and find that good staffing equates to less falls, less pressure injuries, and even higher survival rates. The list goes on and on. So it is crucial for a time like this.

A Win-Win

Beyond that, in the long run, I do believe that if someone sat and crunched all the numbers, paying staff either hazard pay, double time for any time worked over their regular hours, or whatever incentive system thought of—this would still equate to a less overall cost loss for hospitals than not doing so. While it is likely many hospitals will suffer costs from workers falling sick, getting these travelers, or buying more equipment, we all know the high costs associated with negative outcomes and these are going to be higher than ever. And while I do not know for sure, I imagine insurance companies will not be cutting hospitals a break about their rule to not reimburse for hospital-acquired conditions. And, who is best at being able to prevent these conditions? It is the staff at the frontline with direct patient contact.

So, Hospitals and States ...

... start placing more value and respect into your own loyal team. Rather than forcing your staff to work in other areas while offering astonishing packages to outsiders, give those benefits to your staff for picking up extra shifts or floating elsewhere. This Nursing staff delivers for your organization and community on a regular basis.

They deserve the recognition.

They deserve the profit.

They deserve to receive a taste of what they are worth.

This is not a time during which you will be able to pull more staff out of thin air, so it is time to start utilizing your own through those same measures.

Loyalty goes both ways.

Natalia Dabrowska, MSN-CNL, RN. Pediatric Pulmonary Nurse Coordinator at Yale New Haven Children's Hospital. Nurse and Safety Coach at Connecticut Children's Medical Center at UConn Health in the Neonatal Intensive Care Unit.

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Apparently one private equity firm is cutting back pay for doctors and nurses in the ER. This is how sacrifice is repaid in spades.

The charge nurse asked me and my coworker RN to count narcotics with her. We were both busy. I suggested she ask the nursing supervisor who was doing nothing at the time and guess what, the nursing supervisor helped the charge.

Testing relates directly to staffing and allocation of resources. I do not have a masters in public health but havemet many people who do. Where are these people when we need them? Where is someone, anyone - DYNAMIC - coordinating the public response....on ANY level (city,state, national)? Crickets. Unforgivable.

All medical personnel who want to help in this fight (volunteering or paid) should have a nasopharyngeal swab test and an antibody test. You want to see if someone has possibly had Covid in the past and has developed antibodies. Nothing is certain in this time, but it's a fairly educated guess that if they do have the antibodies then they are OK to help or begin helping. It is such a total waste of resources not to do this. Second, testing obviously prevents a HCW from infecting others - esp the nasopharyngeal swab. The antibodies usually do not show up till after around day 5 or later.

Testing now - and set up a Covid Corps. We are wasting resources.

It has been said over and over again. A nurse working during this pandemic is being played (especially if he/she is working with inadequate equipment) if he/she does not get something comparable to this =>

Don't let the public guilt trip you into working for average pay (pre-pandemic) and no bonus, especially when you are risking your life and that of your love ones. Make it worth it.

If you choose to be a martyr, at least remember this: if you die, you die, and you will leave your love ones behind. Who will take care of your love ones in your absence? Society? Maybe, but, for how long?