Metro area hospitals are getting by for now, but if COVID-19 cases continue unchecked, there will not be enough nurses to open new beds in the near future, Kansas City area hospital and nursing officials say.
In fact, some staff shortages are already here, and since the infections are so widespread across the Midwest, there’s little likelihood there will be enough nurses from other parts of the country to step in and bail local hospitals out, as happened in New York City last spring.
“It’s bad and it’s getting worse,” says Heidi Lucas, state director of the Missouri Nurses Association. “In a lot of our towns and communities we’ve got beds available in the hospital but we’re short the staff to properly do the work in those units – and help is not coming.”
As of Nov. 27, the Kansas Hospital Association’s dashboard showed 14 of the metro area’s 33 hospitals, or about 42 percent, reporting they anticipated critical staff shortages in the following week. The association tracks hospital statistics on both sides of the state line.
“All the things we were worried could be possible in March, April and May are actually happening right now, and that should be scary for all of us,” said David Wild, vice president of performance improvement at the University of Kansas Health System during a recent morning briefing.
That’s due to the cascading effects of the new surge in cases, say local health care officials. High community spread means more nurses are liable to contract the disease, forcing them into quarantine.
Childcare also is an issue, says Kelly Sommers, state director of the Kansas State Nurses Association.
When schools return to at-home learning, nurses can’t always get to their shifts. Sommers says COVID-19 cases have resulted in the closure of daycare centers like Building Blocks in Topeka, which served many hospital employees.
All of this is happening at the same time that nurses are needed to deal with growing numbers of patients.
Scrambling for outside help
Normally, hospital administrators might shop for nurses from outside the area when the labor market gets too tight. Florida hospitals for years have managed their seasonal flu cases by drawing on a pool of nurses, placed by agencies, who travel from location to location for limited stays.
But that’s not going to be as easy a fix now.
“The obvious answer is to get some temporary people, traveling nurses,” says Dr. Steve Stites, chief medical officer at the University of Kansas Health System. “But they’re just not as available as they once were because everybody’s scrambling for the same folks.”
Competition for traveling nurses by all accounts is intense right now, with no signs of easing. John Maaske, CEO and founder of Triage, an Omaha-based staffing agency, says his agency has seen a spike in job requests from health care providers.
Back in February, Triage had about 9,000 requests for nursing jobs. Now it’s more like 19,000, Maaske says, with the demand spread pretty evenly throughout the country.
And it’s not just because of the coronavirus. Maaske says there has also been a backlog from the hold on elective procedures earlier in the year.
It’s all complicated by the fact that nursing is a specialized field. Hospitals can’t just hire any registered nurse to fill any position. Intensive care nurses in Covid wards, for instance, have a particular skill set and experience requirements that are completely different from someone in, say, a pediatrics unit.
The trick is finding enough nurses with the right experience, or close enough, so they can pinch hit with minimal extra training.
“At some point you certainly hit a saturation point where there are just not enough nurses to go around,” Maaske says. “I don’t think we’re at that point yet, but I know that’s a concern for obvious reasons.”
Hospitals have been creative in getting people cross-trained and nurses have been willing to help out.
Maaske says that’s borne out by the increase in nurses now willing to travel for the first time. He estimates Triage has seen a 20% uptick in travel nursing from people who have never done it before.
But the demand for temporary nurses has also raised the price of packages they are offered by hospitals desperate to lure them in, Maaske says.
“That’s just classic supply and demand. It’s unfortunate because there’s a cost to that.”
Maaske says he’s seen pay rate increases ranging from 30% to 60% “just given the sheer demand in the marketplace right now.”
That can put some struggling hospitals at a disadvantage. Some are trying to cope by offering other incentives such as flexibility on time off, shifts and other concessions to attract the travelers.
In Kansas, state health department officials have asked for a deeper study of staff shortages, with an eye toward some type of statewide contract that would make Kansas more attractive to traveling nurses, says Cindy Samuelson, senior vice president of the Kansas Hospital Association.
There may be more information available on that in a week or two, according to Kristi Zears, a spokesperson for the Kansas Department of Health and Environment.
Some local hospital officials say they have hired a few temporary nurses in some spots but have been able to hold on so far by other means.
HCA Midwest Health, for example, tends to rely more on nurses from other hospitals within its own network than on those from agencies, although a few agency nurses are hired from time to time, says Suzanne Ford, HCA’s vice president of nursing operations.
The hospital network recently began bringing in nurses from Tulane Medical Center in New Orleans to its Kansas City facilities. Kansas City nurses had previously gone to help at Tulane during a coronavirus surge there.
Elsewhere, hospitals have added more patients per nurse in COVID wards, or have juggled their existing staff to meet the extra demand, say nurse association representatives.
“They’re basically plugging holes,” Lucas, of the Missouri Nurses Association, says.
As an example, nurses with the right training who are now administrators working away from clinical settings have been asked to step in.
“I’m getting calls from nurses who are concerned because they’re later on in their career and they don’t do bedside anymore,” Lucas says. “They’re capable of doing it. However, when your skills are out of practice like that, there is a high learning curve.
“They’re having to learn on the fly and pick up new skills they haven’t used, so they’re nervous about it. And I don’t blame them.”
Nurses are not asked to step into positions they have no training or experience in, but hospitals have become increasingly flexible on how much experience is required in a specialty to hire a traveling nurse, Maaske says. In the past, the norm was 18 to 24 months of experience in a specialty, but now it’s not unheard of for a hospital to take someone with nine months to a year.
“It doesn’t mean that person is still not a very qualified and capable nurse. It just means on paper they don’t have as much of that experience,” he says. “But they are still able to deliver very, very good health care.”
But given the number of new cases, optimism about the immediate future is rare.
“I am worried,” says Sommers, of the Kansas State Nurses Association. “There’s going to be a shortage of staffing no matter what if those numbers continue at the pace we are now seeing and continue to rise.”
“We’re already in crisis mode regarding nurses,” she says. “The numbers can’t continue rising at this rate and in other states, too, because we’ll all be fighting for the same resources, the same staff. And what do you do?”
Stites, the chief medical officer at KU Health System, agrees.
“We have plans. Those plans are imperfect at best. They rely on a pool of labor that may or may not be available,” he says.
“Healthcare is not an unlimited resource and there are not unlimited people to take care of unlimited numbers of sick bay patients.”
Running out of attractive options, Stites and other health care experts have repeatedly implored people in the community to do their part by observing social distancing, wearing masks and engaging in frequent hand washing.
“We can’t just keep doing what we’re doing,” Stites says.