Exploring the healthcare crisis in 2021 can be compared to taking a treacherous voyage toward the center of the Earth. There are layers upon layers of complex challenges that, despite their sturdy exterior, must be dug through and the closer one gets to the core, the hotter it gets until a molten level of anxiety is reached.
Born out of a global pandemic, hospitals and healthcare institutions across the country (and the globe) are in many ways still reeling in the face of ongoing volatility. The Covid-19 virus and its subsequent variants have brought with them an onslaught of not only illness and death, but a mass of confusion, uncertainty, and anger as well. Underneath the weight of all this tragic upheaval and struggling to carry the mountain of rubble that was 2020, are the healthcare professionals and caregivers.
Since the beginning of the pandemic in March of 2020, nurses and other staff from hospitals throughout our area have been inundated with fluctuations in patient numbers, numbers of beds, policy changes, and staff shortages. With winter here, flu and Covid cases are once again on the rise, and hospitals are – once again – bracing themselves for similar surges. As a result, familiar concerns are being raised on state-levels and hot-button issues are again finding themselves at the fore in society.
State lawmakers in New York and Massachusetts are considering, and have made a number of decisions that will once again have an impact on daily life both for hospitals as well as for the public at large. In early December, Massachusetts State Governor Ned Baker said he would be considering looking into the possibility of activating the National Guard to help with hospital staffing, but remains unsure if or how that might work.
Maine and New Hampshire have already activated their members of the National Guard to help alleviate capacity constraints at hospitals in their states. For Baker, the possibility remains but the logistics need to be ironed out, “If there’s a way that we can bring the Guard in and involve them as an ancillary and supportive group to support what’s going on in the healthcare system, we’ll certainly pursue that and try to put it in place,” said Baker.
Numbers and shortages on the rise
Since November, hospitalizations in the State of Massachusetts have risen dramatically. Covid hospitalizations alone went up by 134% in just the last month.
Sweeping changes in various forms of local healthcare aren’t relegated to legislation alone. In Connecticut, executives at Windham Community Hospital, Sharon Hospital, and Johnson Memorial Hospital have- or are planning to halt their hospital’s birthing services, citing a mix of financial challenges, patient safety concerns, and difficulty recruiting OB-GYN healthcare providers.
“At the beginning of the Covid-19 pandemic, we saw unprecedented shortages of equipment and supplies, including medications, protective equipment, and ventilators,” says Mark Marshall, chief medical officer at Sharon Hospital. “We had to be creative to assure we had what was needed to care for both Covid patients and non-Covid patients. As the pandemic wore on, we began to experience staffing shortages which placed even greater pressures on remaining staff. This ‘great resignation’ affected all areas of the hospital, but it was most acutely felt among our nurses.”
Masks and more in New York
In New York, the decision to help stem the tide of hospitalizations has filtered out of the realm of healthcare once again and into the world of small business. New York Governor Kathy Hochul announced that masks will be required in all indoor public places unless the businesses or venues implement a vaccine requirement as of December 13. New York previously instituted a mask mandate way back in April 2020 that lasted over a year, ending in June 2021 for vaccinated individuals. The new mask mandate applies to both patrons and business employees and will be in effect until January 15, after which the State will reevaluate.
At a recent public appearance, Governor Hochul said, “We’re entering a time of uncertainty and we could either plateau here or our cases could get out of control.”
The Governor claims the decision to reinstate a mask mandate was based on a rising number of cases and hospitalizations, which has been especially pronounced in parts of upstate New York. While there’s no question that the mask mandates themselves are certainly a hotly-debated issue, their efficacy remains unclear – especially with what little information lawmakers have provided thus far. While the state has said that violators could face civil and criminal penalties, including a maximum fine of $1,000, local health departments will be in charge of enforcing the requirements.
Nearly 3,500 people are hospitalized with confirmed Covid-19 cases in New York and Hochul said in a statement, “We are heading upward in a direction that I no longer find sustainable.” While the mandate claims to help ease the capacity issues occurring at state hospitals, not every legislator agrees with the notion of policing public responsibility.
“I cannot support the State’s new mandate…”
In a statement released shortly after the announcement of the new mandate, Dutchess County Executive Marc Molinaro said, “I cannot support the State’s new mandate. I do not come at this from a partisan or political perspective, and I live with the pain of losing my father to this virus. Dutchess County has used considerable resources navigating this pandemic to help keep our residents safe and informed. From a practical perspective, the State’s newest mandate is unenforceable and will become confrontational – and they know it.”
He continued, “We have provided calm and consistent leadership during very difficult times. Our health department has and continues to provide broad access to testing, vaccinations, and resources. Our residents have chosen to be vaccinated – now 81% of adults – and thousands make use of our testing resources. Beleaguered small businesses have implemented common-sense measures to protect their employees and patrons. As we educate and inform residents to take the necessary mitigation steps to protect themselves and those they love, we will not escalate tension or conflict or further burden our local small businesses by allocating resources we do not have to this impractical and unenforceable measure.”
Though Dutchess County’s vaccination rate is comfortably high, state-wide data is mixed given the differences in population density from county to county. According to federal data, New York has the seventh highest rate of fully vaccinated residents. Still, reports say that upwards of thirty upstate hospitals have had to limit performing nonessential elective surgeries because of capacity issues.
“As a healthcare worker, I know that hospitals have never been more prepared to tackle any healthcare challenges than they are today,” was the determined sentiment of one area healthcare professional from New York who has endured a wealth of new challenges during the past year. “There have been so many challenges at the hospital where I work that we have faced in each department since the beginning of the pandemic,” she says. “Many of those challenges stem from shortages of every kind including important protective equipment such as masks and gowns, ventilators, and, of course, staffing shortages.”
As with many small businesses in the Tri-state, hospitals have struggled to fill positions and keep up with inventory demand in the face of several surges in patients throughout the last two years.
“There have been innumerable challenges that we have encountered because of the pandemic. One of the most notable obstacles was the ever-changing state mandates when it came to both vaccinations and supplies,” says Dr. Ron Pope, vice president of Medical Services and Care Centers for Columbia Memorial Health (CMH). “The State required that hospitals have three months of proper Personal Protective Equipment (PPE) on-hand. In the beginning, everyone seemed to have trouble keeping up because normally, supplies were low due to infrequent use. Most hospitals burned through their supplies pretty quickly as a result. Other states started stockpiling, which created an even greater shortage.”
To cover staffing shortages, many hospitals deployed staff from testing units to bedside care for Covid patients. Surgeons were in charge of running intensive care units instead of operating rooms since the temporary displacement of elective surgeries. “Everyone worked together to make sure our standards of care were never affected,” said the New York-based professional. “We didn’t have all the supplies we needed so we got creative and figured out ways to safely recycle equipment. Beds in the hospital were in short supply so temporary hospitals went up, some as big as 1,500 beds, and were built in just a matter of weeks. These are just some of the ways the hospitals have adapted to the challenges we’ve faced, and continue to face, on a daily basis.”
A lucrative opportunity
In many ways, the pandemic not only ravaged the healthcare industry practically, it took its toll on the healthcare worker professionally. As a result, travel nursing has proven to be a lucrative opportunity for many, while continuing to strain the professional working in hospital care. “The reasons for the shortage of hospital staff include provider burnout, personal safety concerns, and a rapid rise in competition among hospitals for the few remaining workers. At the same time, companies that hire temporary traveling nurses raised their pay rates dramatically further exacerbating the shortage,” said Marshall. “To adapt, Sharon and other hospitals have had to become much more flexible in their staffing models, even temporarily closing units with low census to better care for the patients on other units.”
According to a report from the Washington Post, 2020 was the year travel nursing took off, with 35% growth over the pre-pandemic year of 2019, and an additional 40% growth expected this year. The conflict has touched nursing in the Northeast as well illuminated by a professional working at a Connecticut area health center, “In my position in the Intensive Care Unit, staffing is limited because many staff members are leaving for higher paying travel RN assignments,” he says. “That has forced the hospital to hire more travel RNs to fill those vacancies.”
The deepening shortage of healthcare professionals has made travel nursing one of the most critically-sought after professions in the industry. Nurses’ unions say there would be no shortage if nurses were adequately paid and afforded better working conditions.
Pay rates vs. workload
“My hospital is one of the lowest paying hospitals in terms of nursing wages,” says the Connecticut-based nurse. “We work in a high risk, high stress environment and are mandated to work overtime because of short staffing, have high patient-staff ratios as a result, and our ancillary staff (CNAs) are constantly floated out of our unit to assist other units, basically increasing the nurses’ workload.”
For the traveling nurse, the most lucrative opportunities seem to be available for those with experience in specialized hospital units such as the various types of ICUs, those willing to move to remote locations for extended periods of time, and those willing to respond immediately to emergency needs.
“During the height of the pandemic, everybody stepped up to pitch in,” says Pope. “Retired workers came back, folks delayed retirement, and we consolidated services in order to get more caregivers involved. Since then, we’ve had even higher surges than 2020, but staff has dwindled. Furloughed workers never came back and now we are being hit with a staffing crisis. In the healthcare industry, we aren’t afforded the ability to increase rates to offset costs. Hospitals pay a fixed amount from insurance companies and that has dramatically put our industry in financial straits. Administrators have to be more creative than ever before when it comes to staffing.”
The demand trend has continued for healthcare workers outside of nursing as well, such as respiratory technicians. “Despite the financial challenges, if administrators could find an equitable way to increase pay rates and make the hospital a more ‘desirable’ place of employment, they would have higher staff retention rates,” reiterates the Connecticut-based nurse.
Holding each other up
Still, the resolve of the hospital-based health-care community remains determined to adapt to the constant need for change. In New York especially, where infection rates hit densely populated areas the hardest, caregivers found the most support among each other. “For me, the most amazing part of the past few years is how the healthcare community came together to help fight this virus,” said the aforementioned New York-based healthcare professional. “Nurses, doctors, respiratory therapists, and many other hospital staff members came from all over the country to help with the staffing shortages in New York. We all held each other up during the hardest and darkest moments which was an amazing thing to be a part of. No one was in this alone and everyone knew it.”
As winter closes in, and uncertainty re-enters the fray, healthcare professionals will continue to balance the mutating virus with an adaptive care approach – while relying on their mutual bond to persevere. “I believe the future of hospital medicine will include a smaller in-patient footprint, especially for small community hospitals,” says Marshall. “We have seen an explosion in telemedicine utilization. This service improves access and efficiency for people who are unable to see their doctor in person. I do not expect a return to pre-pandemic practices, but hopefully, when this crisis abates, we will be able to optimize what we have learned and become a safe, efficient, and sustainable system of healthcare for generations to come.”