With little backup and COVID spread, Florida hospitals could feel staffing squeeze soon
At the height of Florida’s summer COVID surge, Miami hospitals had to enlist out-of-state travel nurses to keep their intensive care units running. Now, nearly a half-year past that crisis point, hospitals are once again nervously eyeing a number of factors that could increase spread and hospitalizations — this time, without any reinforcements to call on.
Worrying hospital leaders: the combination of post-holiday infection surges, seasonal bumps in patients from January to March even in non-COVID years, and the unpredictability of new coronavirus variants that are thought to be more infectious.
Unlike the rise in COVID-19 cases over the summer, when hospitals could easily hire travel nurses to fly into Florida for backup, brutal surges across the country in recent weeks have made it harder to hire more nurses.
“There is greater national demand for travel nurses that makes it more difficult to attract those nurses to Florida, which is different from what we had for availability of travel nurses in July,” Florida Hospital Association CEO Mary Mayhew said in an interview Wednesday. “We were not competing with as many states.”
Mayhew, who told lawmakers the severity of the problem during the Florida Legislature’s committee weeks in Tallahassee last week, said typical workforce challenges and shortages in the healthcare sector have been made “much worse today” because of the pandemic.
While severe shortages have not yet materialized in Florida, the lack of available nurses concerns her.
“I am worried,” said Mayhew, who is the former secretary for Florida’s Agency for Health Care Administration. “This pandemic has had an incredible impact on individuals who have been working on the front lines.”
As of Wednesday — when the national death toll hit a staggering 400,306 — a total of 7,534 people were hospitalized with COVID-19 statewide, with hospitals in North Florida feeling the greatest strain on capacity. Miami-Dade County had 1,077 hospitalizations and Broward had 633. About 15% of ICU beds were available in Miami-Dade Wednesday. About 18% were available in Broward.
The travel nurse conundrum
Martha Baker, a registered nurse and president of SEIU Local 1991, said the threats to staffing at Jackson Health System, Miami-Dade’s public hospital system, include the lack of nurses to hire for backup and also the number of nurses leaving for lucrative contracts in states like California, which may pay $140 an hour, as opposed to Jackson’s starting rate of $27.
“That is like unbelievable,” said Baker, whose union represents more than 5,000 nurses and doctors in the health system. “Why shouldn’t you go? That is really what’s going to be our biggest worry and thorn in our side is that these young nurses are being persuaded.”
Just recently, she said, five nurses in Jackson’s main campus ICU left in one day.
In the summer surge, Baker said, the state sent Jackson a team of 150 healthcare workers “to help bail us out” of a staffing shortage. She admits it’s not likely Jackson would get that sort of help again.
“That was a real blessing,” she said. “But [now] everyone is surging in the country. We are sort of in a place where it’s very worrisome that if we increase in [COVID patient] numbers ... we are dancing on the head of a pin.”
Vicky Perez, a nurse and the director of critical care at Jackson North Medical Center, said while her ICU has managed to have the staffing needed to take care of patients, it is difficult.
“You have to take from here, put some here,” she said.
Perez said the number of patients in the ICU at Jackson North has doubled in the last month, and that the hospital system has worked to hire travel nurses when they can and take advantage of the 20 temporary nurses Jackson hired at the beginning of the pandemic to be on call — paid by the day — when gaps need filling.
“They say the new U.K. COVID strand is more contagious and of course it worries us,” Perez said, who said she’s concerned about having enough “nurses and healthcare workers to take care of our patients.”
In addition to an influx of COVID-19 patients and “snowbirds” that travel annually to winter in Florida, Perez said there is also an increasing number of patients who may have put off seeing a doctor out of fear of getting sick, patients who are now vaccinated and more comfortable seeking treatment or patients who are too sick to put off a visit.
“You have to get creative, think about the amount of patients we are going to get and how we are going to take care of them,” she said.
Healthcare workers getting sick is not the main cause of staffing shortages, as most workers have been vaccinated and are now better equipped with proper personal protective equipment, Perez said.
“The issue is the amount of patients,” she said. “We didn’t have this many patients before.”
Perez said most hospitals in South Florida are turning to agencies to help fill gaps. Baptist Health, for example, contracted with Washington-based nursing agency NuWest to hire 30 nurses on contracts to relieve nursing staff by supplementing the hospital’s vaccination effort.
The NuWest contracts included relocation stipends and salaries up to $5,600 a week, according to NuWest.
“The variant is something we are watching closely as part of the COVID landscape,” Baptist spokeswoman Georgi Pipkin wrote in an email. “[We are] planning for staffing just as we have through the pandemic.”
Across the state, hospitals and counties are also grappling with vaccine rollout, getting shots in the arms of hundreds of thousands of front-line healthcare workers, seniors and people with underlying health conditions.
Perez, the ICU director at Jackson North, said the vaccine rollout at Jackson — one of the most robust in the region — has not pulled talent from places like emergency rooms and ICUs. Nurses administering vaccines are generally employee health nurses, nurses from satellite clinics and nurses from other areas that are not involved in direct patient care.
“We didn’t have to use anybody from the bedside,” Perez said.
New strain a concern
Soumya Sen, the director of research on the University of Minnesota’s Hospitalization Tracking Project, has been leading a team that built a dashboard to study state-by-state hospitalization trends and fatalities. Transmission is a major indicator when it comes to hospitalizations and fatalities.
“Currently, both due to the influx of people traveling across state lines to warmer climates and the spread of the variant in the south of the U.S., we will see the same surges we have seen before,” Sen said.
To prepare, he said hospitals should be looking to tools that allow for staff redeployment and software that can help find temporary staff to fill gaps. He said some hospitals are offering bonuses to hire new nurses and are moving more senior nurses to direct patient care roles. Cancellation of elective surgeries in some states has helped with staffing issues, too, he said.
“There are many reports of front-line healthcare workers getting infected and have to be reassigned,” he said. “With the vaccine rollout, I’m hopeful we can control the spread of the disease and put an end to this issue of hospitals running to full capacity.”
Herald staff writer Ben Conarck contributed to this report.
This story was originally published January 21, 2021 at 6:00 AM.