POST 193. September 3, 2021. CORONAVIRUS. Nurses are leaving their hospitals and becoming travel nurses at hospitals across town “because they can make $4,000, $5,000, $6,000, $7,000 a week while not having to relocate anywhere..”

for links to POSTS 1-193 in chronological order highlight and click on

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“According to hospital executives and nursing administrators in several states, the struggle to find enough workers to care for people sick with covid-19 has emerged as a critical problem as other daunting shortages, widespread early in the pandemic, have eased. Once-scarce supplies of protective gear, ventilators and coronavirus tests are now plentiful, hospital officials consistently say.

Finding ways to hire and keep nurses is the main problem, officials say, although some hospitals also are short on respiratory therapists and workers for nutritional services and housekeeping. Some hospitals could enlarge their bed capacity if they had more nurses to tend to the coronavirus patients who would fill them….

Ochsner, with 24 hospitals in Louisiana and into Mississippi, has 300 travel nurses from all over the country.

“Frankly we could use more — probably another 100 to 150 would help us,” said Moffatt, the chief nursing officer.

During the initial surge that hit New Orleans after Mardi Gras last year, Ochsner expanded the role of a hub that coordinates nurses who float among different hospitals in the system. The hub also became a staffing agency to hire contract nurses from elsewhere and was able to recruit about 500 at first.

“In this fourth wave, it’s become a lot harder to recruit nurses,” Moffatt said. She suspects that some travel nurses who worked through earlier pandemic surges are burned out — or have made enough income that they are taking time off.

With the pool of available travel nurses smaller and coronavirus cases flourishing, she said, hospitals in hot spots “are all at this time drinking from the same pool of people.”

Bidding wars occasionally break out. “We will sometimes see an agency nurse accept at Ochsner,” she said, “and . . . two hours later they pull out and [have] accepted a higher rate.”” (A)

“Before the coronavirus pandemic, Ivette Palomeque made $45 an hour on a flexible schedule as a staff intensive-care nurse at Memorial Hermann Health System in Houston.

Today, she earns $120 an hour working in an ICU in McAllen, Texas, the latest in a string of “travel nurse” jobs she has held over the past 16 months. The journey has taken her from Miami to New York City and back to Texas.” (B)

“During the first wave of the pandemic, traveling nurses descended on New York City and other hotspots, then moved on as the virus did. This time around, much of the country is a hotspot. And adding traveling nurses can be costly.

“Travelers are expensive,” Ross said. “We have our nurses begging for them to get extra help. Some states I’m told that are hardest hit right now are finally looking to other states and asking for help, and asking for travelers.”

But even if hospitals have the budget, Ross added, securing travelers only gets harder as demand skyrockets “country-wide, even worldwide.”” (C)

“Travel and resident nurses who spoke to 11Alive Thursday said that if hospitals decide to mandate vaccines, it’ll only drive the number of workers needed in the industry higher.

“I really honestly feel as though it shouldn’t be forced on me now as a nurse,” said travel nurse Shy Warren. “I know a lot of people are so against us nurses not wanting to get the vaccine. But we have also done our research.”..

Ashley Blackmon, president-elect for United Advanced Practice Registered Nurses of Georgia, said the nurse to patient ratio right now proves how bad the shortage is.

“I’ve never seen anything like this. I have friends who work in urgent care and usually at this time of the year, they see 30 patients a day now they’re seeing 130 and one nurse practitioner running an urgent care that’s next to impossible to do,” she said.

“You have bedside nurses and in ERs that, who are doing everything they can do, but there are still 60 people in the waiting room, all coughing in each other’s faces and waiting for 10 hours. In our outreach hospitals in more rural areas of of Georgia that’s never been heard of. So it’s been quite a culture shock.”

Blackmon added that not only are nurses experiencing burnout because of the shortage, but also because they are seeing more deaths now than previously in the pandemic.

Horton said keeping experienced nurses on the job needs to be a priority, along with finding the next generation of nurses. She said developing future nurses is also a challenge because of issues on the academic level.

“We also have the challenge with our nursing faculty,” Horton said. “Many of them are at a point of retirement and because nurses can make more in a clinical setting than they can as a nursing faculty member, it is much more difficult to retain faculty and to recruit faculty in order for us to expand our growth as far as bringing in more nursing students.”” (D)

“But burnout isn’t the only thing compounding California’s nursing shortage: The state’s new vaccine mandate for health care workers is already causing headaches for understaffed hospitals before it is even implemented. Some traveling nurses — who are in high demand nationwide — are turning down California assignments because they don’t want to get vaccinated.

Hospitals say they are reaching a crisis point, straining under the dual forces of more people seeking routine care and surging COVID-19 hospitalizations driven by the Delta variant…

In March 2020, the California Department of Public Health contracted with Aya Health — one of the nation’s largest traveling nurse providers — to pay up to $1 billion over six months to help hospitals meet nursing and other clinical staff shortages…

Last week, Gov. Gavin Newsom signed an executive order reinstating emergency provisions aimed at ensuring adequate staffing. In part, the order allows health care workers from out of state to work in California….

“Out of ratio” means that a nurse is assigned too many patients. California is the only state that caps the number of patients that can be assigned to a single nurse. Under state requirements, for instance, an ICU nurse can have no more than two patients and an emergency room nurse, no more than four.

In December, during the winter surge, emergency waivers for the ratios were granted to hospitals throughout the state, allowing ICU nurses to see three patients, for instance. Critics say the conditions threatened patient safety.

Newsom’s order last week did not reinstate the waivers of the nurse-patient ratios, which expired on Feb. 8. Individual facilities, however, can still apply for them…

Hospital administrators worry that the state’s vaccine mandate for health care workers, which goes into effect Sept. 30, could drive some of their workers out. Already, some report resistance among employees.

“One hospital told us they had 474 unvaccinated employees. They did a big education and incentive push. Only 12 people signed up,” said Richardson, the hospital association’s attorney.

Administrators are particularly concerned about low vaccination rates among support staff like janitors and food service workers. However, some nurses also are wary of the COVID-19 vaccine. Some nurses with large social media followings have participated in protests in Southern California, arguing that the mandates violate their personal freedom….

To contend with local shortages, hospitals are increasingly turning to hiring temporary, traveling nurses from around the country.”  (E)

“Duke hired 1,800 nurses in the past year, and lost 1,200, for a net gain of 600, Fuchs said. But it still has 650 positions that it’s trying to fill, she said.

Nursing shortages are baked into the system in North Carolina, said Taylor, president of the nurses association. Nursing programs at the state’s four-year and community colleges produce 5,000 to 6,000 nursing graduates a year, Taylor said, but the health care industry needs between 7,000 and 8,000 a year.

“So when you look at it, even if we filled every seat that we could in the nursing programs in North Carolina, we’re still short,” he said….

One complicating factor in the staffing at hospitals is the role of travel nurse agencies, which recruit nurses and temporarily hire them out to hospitals where and when they’re needed. As turnover increases, hospitals are leaning more on traveling nurses, said Jeronica Goodwin, WakeMed’s senior vice president of human resources.

“We have increased our nurse agency use like everyone across the Triangle has,” Goodwin said. “I don’t think any hospital across the nation could function right now without travelers.”

But traveling nurse agencies also help increase hospital turnover, because they pay so well. Fuchs says Duke lost 100 nurses in three months last winter to travel agencies.

“Many of our nurses, our younger nurses especially, they choose travel nursing, and it’s because they can make $4,000, $5,000, $6,000, $7,000 a week for being able to care for patients,” she said. “Now what that’s doing for hospitals is putting them in a really tough situation financially.”

As the name implies, nurses who sign on to travel agencies usually go to another part of the country, where the need is greatest. But with everyone in need, nurses find they can work for a travel agency without leaving home.

Taylor says he knows of at least 10 nurses who have left their regular full-time jobs in recent months to become travel nurses.

“I’m talking about still working here in North Carolina, not having to relocate anywhere,” he said. “They’re signing some of these short-term contracts that sometimes can be up to $6,000 or $7,000 a week that they’re being paid, which is sometimes significantly more than what they would be making if they remained in their current full-time position.”

Hospitals are trying all sorts of strategies to bring on more nurses and other health care workers. WakeMed has hired more recruiters and streamlined the hiring process and is holding more job fairs, Goodwin said.

Duke and UNC are offering up to $25,000 to pay off student loans for new hires, as well as relocation expenses and hiring bonuses. Fuchs said Duke is offering a $15,000 signing bonus for experienced nurses for the first time in 25 years.

Hospitals are also working to hang on to the workers they have. They’re offering more flexible hours and assignments and providing more opportunities and bonuses for continuing education and training. Duke stresses its supportive work environment, including adequate staffing levels of nurses and assistants so people don’t feel as stressed.”  (F)

“Even if new cases subside, Wisconsin’s health system administrators know it may be weeks before current infections run their course and the need for nurses lets up.

Beyond that, even, Wisconsin needs more nurses…

Staffing shortages are an old problem made worse by COVID-19

Staffing didn’t just become a problem when coronavirus hit. Wisconsin’s health care workforce is aging, and older employees are retiring faster than they can be replaced, according to a 2020 report from the Wisconsin Hospital Association.

Nurses, perhaps more than other health care positions, are always in short supply. Wisconsin health systems said ICU, critical care and medical-surgical nurse staff were among their most urgently needed.

The main problem is in the pipeline, said Linda Young, dean of the College of Nursing and Health Sciences at the University of Wisconsin-Eau Claire.

Low faculty numbers and not enough sites for clinical rotations mean nursing schools must cap their admittance far lower than the number of qualified students actually applying. In Eau Claire, the school admits 43 students per semester, turning away at least as many more, Young said.

More than 80,000 qualified applicants to U.S. nursing schools were turned away in 2019 for those reasons, according to the American Association of Colleges of Nursing. The country is projected to be short more than 500,000 registered nurses by 2030, found a 2018 forecast from the United States Registered Nurse Workforce Report Card.

Young chairs the legislative committee of the Administrators of Nursing Education of Wisconsin, which in the past budget cycle secured $5 million to help nurses obtain teaching degrees if they commit to teaching for at least three years. Nurses working in academia earn less than those working in clinical settings, she said.

The pandemic has only highlighted the consequences of the nursing shortage, Young said.

“Demand is even greater for more new graduates,” she said. “We’re just not able to get them out.”

More nurses retiring also means there are fewer nurses to help new ones learn the ropes in the hospital, said Connie Bradley, senior vice president and chief nurse executive at Aspirus Health.

Newer nurses are thrown into more complex environments faster than in the past because there aren’t as many experienced nurses to fill those roles, she said.

“Years ago, you wouldn’t bring novices into the (emergency department) or the ICU. Well, now you don’t have other options,” Bradley said. “You have to bring novice nurses in, and yet you have less people who are experienced to train them, so you have new nurses being trained by novice nurses.”

Nurses now juggle patients with other health needs — and they’re burning out

Brusko said feelings of burnout have built up over the past year and a half.

“It would be shortsighted for us to think that our nursing colleagues, and frankly (health care) as a whole, are going to somehow fairly rapidly put this pandemic in their rearview mirror once we get through this,” Brusko said.

It’s especially difficult for them in this phase of the pandemic, where the majority of people who are ill in hospitals could have prevented it by getting vaccinated, he said.

For people at the beginning or end of their careers, the pandemic’s chaos may be the impetus for a career change or retirement, said Dr. Sarah Lulloff, medical director of infection prevention at Hospital Sisters Health System’s St. Vincent Hospital in Green Bay, in a Wednesday press conference.

Those who remain are struggling to balance an increase in COVID-19 patients with their already demanding workload of people with other health needs.”  (G)

PREQUELS

POST 187. August 11, 2021. CORONAVIRUS. “As a result of the increase in COVID-19 cases and hospitalizations, the state of Florida requested 300 ventilators from the federal government.”… “An 11-month-old girl with Covid-19 is stable and no longer intubated one day after she was airlifted to a Texas hospital 150 miles away because of a shortage of pediatric beds in the Houston area.”

http://doctordidyouwashyourhands.com/2021/08/post-187-august-11-2021-coronavirus-as-a-result-of-the-increase-in-covid-19-cases-and-hospitalizations-the-state-of-florida-requested-300-ventilators-from-the-federal-government/

POST 189. August 19,2021. CORONAVIRUS. “There wasn’t a single I.C.U. bed available in Alabama on Wednesday…”…”A triage plan on the Alabama health department’s website suggests that “persons with severe mental retardation” are among those who “may be poor candidates for ventilator support.”

http://doctordidyouwashyourhands.com/2021/08/post-189-august-192021-coronavirus-there-wasnt-a-single-i-c-u-bed-available-in-alabama-on-wednesdaya-triage-plan-on-the-alabama-health-depart/

POST 190, August 21, 2021. CORONAVIRUS. “We’re looking, in essence, at running two systems — a COVID system and a non-COVID system of care,”..“Emergency medical technicians (EMTs) and certified paramedics can now care for patients in Mississippi hospitals and emergency rooms under a new health office order issued by the Mississippi State Department of Health on Wednesday.”

http://doctordidyouwashyourhands.com/2021/08/post-190-august-21-2021-coronavirus-were-looking-in-essence-at-running-two-systems-a-covid-system-and-a-non-covid-system-of-care-emergency-medical/

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