Health |

Tired, numb and burned out: With hospitals short on workers, those remaining feel pushed to the edge by COVID-19

Consuelo Vargas can’t shake the memory.

Earlier this month, as the nurse’s 12-hour shifts were stretching to 16s, she maneuvered through the emergency department at Stroger Hospital to check on COVID-19 patients. She remembered how one begged her to check up on him more.

“The patient said, ‘Why did you leave me by myself for so long?'” Vargas recalled. But she just didn’t have any more time to give.

“I ran the Chicago Marathon before,” she said, “and this is like the marathon that never ends. Nurses are just running on fumes right now. I want to say that I’m numb. I don’t feel anything. I’m just going through the motions, just to get it done.”

Even as the first vaccine shots begin to roll out to health care workers, doctors and nurses say they are struggling to make it through the pandemic’s darkest surge yet, in an atmosphere some describe as bordering on exhaustion.

Federal data shows that roughly 1 in 5 of the state’s hospitals is reporting a “critical” staff shortage each day, a problem reflected in the desperate competition among hospitals for trained staff at a time when the pandemic is straining resources across the country.

The advertised pay for some workers is approaching $3,000 a week, amid stories of workers quitting or calling in sick, and hospitals adding more beds than they have the staff to cover.

“Compensation now is through the roof … which tells you it’s hard to find people to fill all the jobs we need to fill now,” Joshua Gottlieb, an associate professor at the University of Chicago Harris School of Public Policy, said earlier this month.

Federal officials aren’t providing the names of hospitals reporting staff shortages, but they have released weekly numbers showing that some facilities are at or near capacity in terms of available beds, particularly in working-class areas hit especially hard by the pandemic.

There are some positive signs, with case counts and hospitalizations starting to drop in Illinois, though the latter numbers can be affected by hospitals’ decision making. Hospitals have been more choosy about who gets admitted — some COVID-19 patients who arrive in emergency departments are being sent home with monitoring instructions — and doctors and nurses told the Tribune that some patients with conditions that are usually monitored in intensive care have been moved to other areas.

Workers also said staffing has been strained as hospitals continue to perform elective surgeries. These are often time-sensitive and necessary operations, but they also can be moneymakers for hospitals. Indiana recently tightened the rules on what surgeries hospitals can do amid the surge, but Illinois has not.

“People are tired,” said Pat Meade, a recovery nurse at Amita Health Saint Joseph Medical Center Joliet who is also vice president of the Illinois Nurses Association. “You can’t consistently ask of the same group of people to give more than they can. They’ve got to rest, but the need still exists, so what do you do?”

The staffing shortage

Every day, the federal government collects data from hospitals across the country. One piece of the information is based on this simple question: Do you have a “critical staffing shortage” today?

Back on Labor Day, just 9% of Illinois hospitals answering the question said yes. By the week after Thanksgiving, the figure was 26%, or more than 1 in 4. It’s since slid down a bit to near 20%, or roughly 1 in 5.

!function(){“use strict”;window.addEventListener(“message”,(function(a){if(void 0!==a.data[“datawrapper-height”])for(var e in a.data[“datawrapper-height”]){var t=document.getElementById(“datawrapper-chart-“+e)||document.querySelector(“iframe[src*='”+e+”‘]”);t&&(t.style.height=a.data[“datawrapper-height”][e]+”px”)}}))}();

Dr. Sanjeeb Khatua knows the struggle. The hospital system where he is chief physician executive and COVID-19 incident commander, west suburban Edward-Elmhurst Health, has, like many systems, been asking nurses to work more shifts, with extra pay.

One reason for that? Sick workers. This past week, about 25 of the system’s employees tested positive for COVID-19.

Besides Khatua’s workers being on the front lines of the fight against the virus, they often live nearby, in a region where the percentage of COVID-19 tests coming back positive has recently been among the highest in the state.

“With fatigue and trying to take care of everyone at the same time, it obviously stretches your staffing,” Khatua said.

Even before the pandemic, some health care workers catered to temporary staffing needs by traveling from one place to another for short-term gigs. In the spring, when the pandemic’s first surge was mainly limited to a few, bigger urban areas, it was easier to recruit such workers for temporary jobs to help hospitals cope with COVID-19.

Now, the flare-up is nationwide, to the point that Illinois’ staffing woes seem merely average by comparison. In California, Wisconsin and Virginia, around 30% of hospitals are reporting critical staffing shortages. It’s closer to 40% in Arizona and Missouri.

And in North Dakota — which has been hit so badly that the state allowed some infected health care workers to stay on the job — nearly half of all hospitals said they had a critical shortage the week before Thanksgiving.

!function(){“use strict”;window.addEventListener(“message”,(function(a){if(void 0!==a.data[“datawrapper-height”])for(var e in a.data[“datawrapper-height”]){var t=document.getElementById(“datawrapper-chart-“+e)||document.querySelector(“iframe[src*='”+e+”‘]”);t&&(t.style.height=a.data[“datawrapper-height”][e]+”px”)}}))}();

Many hospitals across the country are desperate for the specially trained nurses who can handle critically ill COVID-19 patients. But there’s only so many to go around and who are willing to travel, which has resulted in competition among hospitals for workers.

Gottlieb, the University of Chicago researcher, found that pay for ICU traveling nurses increased 50% during the spring.

Nationally, hospitals may now be paying about double what they normally do for agency nurses, said John Sebastian, president of travel nursing for Cincinnati-based agency Health Carousel.

That struggle to find enough staff has complicated efforts hospitals made to deal with the pandemic by adding capacity. This year, Illinois hospitals reported they built out roughly 10,000 more beds, up from about 25,000 before the spring surge.

That effort led to some odd statistical moments. Over the summer, Illinois hospitals were reporting they had more beds open than they did a year earlier, at a time when there was no pandemic to drive up demand. At one point, roughly 7,000 more hospital beds were available than the previous year. And yet, hospitals also reported they were busier than the year before, treating roughly 2,500 more patients at that point in time, or a 14% higher patient load, according to a Tribune analysis of state figures.

The number of open beds being reported to the state has since shrunk — in part because of staffing issues. Worried that hospitals might not be able to staff all of the beds they said they had available, state regulators in November tightened the rules on what qualified as an open bed, which erased nearly 2,000 open beds overnight.

Meanwhile, the fall surge was putting more people in the hospital. Now, the number of Illinoisans hospitalized — for any reason — is approaching 25,000 a day, about 6,000 more than last year at this time.

!function(){“use strict”;window.addEventListener(“message”,(function(a){if(void 0!==a.data[“datawrapper-height”])for(var e in a.data[“datawrapper-height”]){var t=document.getElementById(“datawrapper-chart-“+e)||document.querySelector(“iframe[src*='”+e+”‘]”);t&&(t.style.height=a.data[“datawrapper-height”][e]+”px”)}}))}();

Even at some of the hospitals with a higher percentage of open beds — such as Joliet’s Saint Joseph — nurses are quitting under the strain, said ICU nurse Jeanine Johnson.

“The patient load, while it’s been busy, hasn’t been at capacity or anything like that,” Johnson said recently. “But because of unhappiness (among) staff, more and more nurses are leaving, and that’s really causing our short staffing.”

It’s created a vicious cycle that forces the remaining nurses to look after more patients, which leads to more departures. The nurses union has also battled with hospital management this year, striking for two weeks in July.

Johnson said the hospital has hired more nurses and is paying more for nurses to pick up extra shifts, “but that still doesn’t even cover the amount of nurses we’re actually short.”

Michelle Hereford, senior vice president, chief nursing officer and post-acute officer at Amita Health, which runs the Joliet hospital, acknowledged in a statement that “a lot has been asked” of Amita’s workers.

“Nurses and all members of the caregiver team throughout the nation are under unique strain — this is certainly not unique to Joliet or Chicagoland,” Hereford said.

As the pandemic has dragged on, some hospitals even have asked the state for help on staffing — something the state’s health director mentioned to reporters Nov. 13.

“We get that information more anecdotally, by making calls or when people reach out and say, ‘Does IDPH have any staff?'” Dr. Ngozi Ezike said. “And you’re like, ‘Wait a second. We’re not a staffing agency. What’s going on?’ And then you hear some of the stories.”

During that briefing, Ezike said the Illinois Department of Public Health was “starting to think about how we can gather that information” on staffing shortages.

A month later, her agency has yet to require hospitals to report their staffing figures to the state, including ratios of nurses to patients. The department did not respond to questions about why that hadn’t happened and whether it tracks the information that hospitals report to federal regulators.

In an email, agency spokeswoman Melaney Arnold mentioned IDPH’s tightening of the definition of an available bed as one thing the state has done to better monitor hospitals’ capabilities. She also said IDPH and two other state agencies are working on a program for hospitals to ask for more staff to help treat COVID-19 patients.

“This is in direct response to hospitals telling us that staffing is the most challenging part of being able to increase their capacity — they may have the space but need the people,” Arnold wrote.

The Pritzker administration has yet to take steps, like Indiana did earlier this month, to order that elective surgeries be canceled or curtailed. Indiana Gov. Eric Holcomb said he did so because his state was “on fire” and hospital workers were “overwhelmed.”

On that day, 19% of Indiana hospitals reported they had a critical staffing shortage.

The same day, the percentage of Illinois hospitals saying the same was 22%.

‘Just burned out’

The combined effects of staffing shortages and heavier patient loads can be seen in places like Stroger Hospital, a 450-bed teaching hospital in the Illinois Medical District considered the hub of Cook County’s public health care system.

Vargas has been a nurse in the hospital’s emergency room for six years and is also Stroger’s chief nurse representative for the National Nurses United union. She describes the situation as more chaotic and disorganized than the spring, when the hospital suspended elective surgeries, allowing more resources to be directed to the emergency department.

She said she normally works three 12-hour shifts a week, but lately they’ve lasted 16 hours. Sometimes staffing is so tight that ER beds are being shut down, forcing longer patient waits, Vargas said.

In a statement, Cook County Health said that since the beginning of the pandemic, it has worked to handle additional patients through a staffing situation center, by using agency nurses, reducing elective and outpatient care to shift workers to needed areas, and offering staff additional hours.

“Cook County Health continues to closely monitor staffing levels and activate many components of the resurgence plan that address staffing, bed capacity, supplies and more as the pandemic continues,” the statement said.

Recent federal data showed the hospital’s ICU averaged 85% full — beyond the 80% threshold the state considers concerning.

And some hospitals were even worse off, with 10 in the Chicago area reporting their ICUs were at least 90% full.

.graphics-head{
font-family:Arial;
font-size:24px;
font-weight:bold;
margin:0px 0px 10px 0px;
}
.graphics-chatter{
font-family:Arial;
font-size:16px;
margin:0px 0px 10px 0px;
}
.graphics-source{
font-family:Arial;
font-size:12px;
margin:0px 0px 10px 0px;
}

Two suburban doctors told the Tribune that hospital officials said they should not tell reporters how full the facilities were, fearing a loss of customers in what remains a competitive and strained health care economy.

The state collects detailed bed counts from each hospital daily. But the Pritzker administration has refused to release that data, without explanation, and ignored a legal deadline to comply with a public records request. The Tribune is appealing to the state attorney general’s office.

According to the weekly numbers the federal government has made available, one of the busiest area hospitals was Franciscan Health Olympia Fields, which told federal officials that its ICU averaged 99% full in the most recent reporting period. Nearly two-thirds of its ICU patients were there because of the virus.

Dr. Shameeta Thanki works at the hospital as an anesthesiologist, often helping oversee care of ICU patients. She — like other health care workers across the region — said her fear is that they won’t be able to provide the same level of care with staff so strained.

She said the pace seems relentless, with little guidance on treatment from the federal government.

“Every day, you’re flying by the seat of your pants,” she told the Tribune. “We don’t have a lot of time to go figure something out. Things are happening right in front of us — a patient is getting really sick in front of us. We do the best we can.

“We finish the day,” she said, “and our faces hurt. And our ears hurt. And we’re just burned out.”

Chicago Tribune’s Dan Petrella contributed.

jmahr@chicagotribune.com

lschencker@chicagotribune.com