Forty-six states are projected to face hospital staffing shortages in one or more specialties by mid-February as COVID-19 cases continue to surge, according to the Mullan Institute State Hospital Workforce Deficit Estimator.
While hospitalizations and depleting ICU beds has been the main focus in national news, staffing is quickly becoming an even more significant problem. New beds can be set up to minimize the strain, but finding the qualified ICU professionals to staff those beds has proven much tougher –an issue that was becoming widespread even prior to the pandemic.
Developed by researchers at the George Washington University Milken Institute School of Public Health, the estimator indicated in its mid-January update that the vast majority of hospitals nationwide will face a staffing crunch by mid-February. The estimator is used to help states and the federal government gauge the demand for healthcare professionals in order to better prepare for shortfalls in staffing and allocate resources as needed.
According to the data, 34 states will face shortages in ICU doctors by mid-February, meaning in these states COVID-19 patients will have more ICU care needed than hospitals will be able to adequately provide. Hospitalists, who are highly trained doctors that can help provide potentially lifesaving care to not only COVID-19 patients but those with other serious illnesses or injuries, may face shortages in 19 states. Respiratory therapists, essential to serious COVID-19 cases, are expected to fall short in 16 states, with another 20 states facing the risk of having less than 50% capacity for non-COVID cases. As many as 15 states are at risk of shortages in pharmacists as well, with an additional 21 states having less than 50% pharmacist capacity for non-COVID cases.
In Oklahoma, the predicted peak hospital utilization date through mid-February, according to the estimator, was January 27th. The state is one of 13 nationwide that will face shortages or strains in all five specialties tracked: intensivists, critical care nurses, hospitalists, respiratory therapists, and pharmacists. Regionally, shortages or strain on staff are expected in Kansas, Texas, New Mexico, Arkansas, and Louisiana.
As the COVID-19 pandemic ramped up last spring, the need for strategies to ensure healthcare workers were kept healthy and hospitals could remain staffed at appropriate levels to keep up with the influx of hospitalizations was quickly realized. In other countries that have experienced COVID surges prior to the U.S., strategies to maximize the current health workforce emerged. Those strategies included flexibility in licensing and enrollment, maximizing the scope of practice, a transition to “surge capacity” based staffing, increased use of telehealth systems and telemedicine, as well as the re-deployment of healthcare workers to critical areas.
Governors in a number of states issued executive orders to temporarily modify scope-of-practice laws to allow practitioners who currently practice in specialties that would not allow them to treat COVID patients to be available to be utilized if necessary. Examples of expanded scope-of-practice orders include removing requirements for nurse anesthetists, nurse practitioners and physician assistants to practice only under the supervision of a qualified physician in New York (EO 202-11); suspension of collaborative agreement requirements for nurse mid-wives in Pennsylvania, and allowing pharmacists to dispense up to 30-day emergency prescription refills in Florida (EO 20-52).
The estimator does not factor in attrition, which is likely to exacerbate the shortages going forward. Healthcare workers nationwide are facing mental health issues and burnout due to the stress and exhaustion caused by the pandemic. Nurse shortages nationwide have caused skyrocketing competition for replacements, with Wisconsin-based Aspirus Health Care offering $15,000 signing bonuses for nurses with at least a year of experience, according to the Associated Press. Kaiser Health News reported in November that one nurse in Denver, who was taking home just $800 per week as an intensive care nurse at St. Anthony Hospital and lacking access to adequate protective equipment, decided to “go where my skills are needed and I can be guaranteed that I have the protection I need.” Her first assignment, a two-month contract in New Jersey, paid over $5,200 per week and provided adequate personal protective equipment. Some traveling nurses are being hired on a contract basis for as much as $10,000 per week to fill staff shortages.
Early in the pandemic, hospitals struggled and competed for personal protective equipment, COVID tests and ventilators. Now sites across the country are competing for nurses due to the recent surge in cases. Hospital staffing is now a national bidding war, with many hospitals willing to pay exorbitant wages to secure the nurses they need, according to Kaiser Health News. That threatens to shift the supply of nurses toward more affluent areas, leaving rural and urban public hospitals short-staffed as the pandemic worsens, and some hospitals unable to care for critically ill patients.
Normally when staff shortages occur they are often regional, allowing traveling nurses and healthcare workers to be dispatched to the areas most in need — a luxury that has not been afforded during this worldwide pandemic.