Strategies for COVID-19 staffing shortages from 8 hospital execs

A COVID-19 resurgence is putting strain on hospitals to maintain appropriate staff levels when team members get sick. In fact, 22 percent of U.S. hospitals (1,109) reported the week of Nov. 16 that they anticipate a staffing shortage due to the pandemic. 

To dive deeper into how organizations are addressing this, Becker's asked hospital and health system leaders how they are ensuring patients are taken care of while employees are sidelined. Below are their answers:

Jim Skogsbergh. President and CEO of Advocate Aurora Health (Milwaukee and Downers Grove, Ill.): In the event a team member is exposed or becomes symptomatic, we have an employee health infrastructure, including an artificial intelligence-enabled symptom checker and a safe check app for remote screenings. All of this is augmented by our scale as a large health system, which allows us to move staff, equipment, [personal protective equipment] and other resources among our various regions when COVID-19 flares up more in one spot over another. Admittedly, that's harder to do as numbers rise all over the place. But that approach has helped us hold our own as the pandemic grows more challenging. 

Laura Kaiser. President and CEO of SSM Health (St. Louis): Our strategies include utilizing our part-time and per diem staff for additional shifts, reassigning nurses and other staff to bedside caregiving roles, and partnering with national staffing agencies to provide additional resources. We've also been able to share resources and redirect patients to different care sites, as needed, to help ensure no single facility is overwhelmed. In addition, we've expanded our virtual capacity by utilizing a virtual charge nurse to cover several units at a time within each facility. This has reduced the strain on nursing leadership during these challenging times. 

Paula Butts, MSN. Chief Nursing Officer at Piedmont Henry Hospital in Stockbridge, Ga.: We have looked at ways to offload some of the duties for the front-line nurse. For example, we have added full-time phlebotomists in the [intensive care unit] and emergency department to draw labs versus the nurse drawing labs. We have expanded the hours of pharmacy in the emergency department to assist with medication reconciliation. Additionally, we have expanded the skill set of nurses to decompress the critical care department, to include management of patients receiving high-flow oxygen. Surgical services and the cardiac cath lab staff recover and discharge patients to conserve ICU and intermediate care beds.

Burton Paul Drayer, MD. CEO of the Mount Sinai Doctors Faculty Practice and Dean for Clinical Affairs at Mount Sinai Health System (New York City): So far, we have not needed to limit our outpatient visits. But we did severely limit these activities to provide extensive inpatient [staffing] backup during the peak of the New York City hospitalizations in the spring of 2020, and would do it again for future surges.

Carolyn Swinton, RN. Chief Nursing Officer of Prisma Health (Greenville, S.C.): Clinical leadership has partnered with our clinical training team to upskill/cross-train team members who were not actively working due to COVID-19-related declines. Some examples: Nurses in the ambulatory setting with recent acute care experience were reassigned to support medical-surgical nurses. Medical-surgical nurses were upskilled to support patient care in the ICU setting. CRNAs were trained to provide support to nurses in the ICU and supported code and rapid response teams. We even deployed clinical practice specialists and nursing educators to the nursing units to provide support to the clinical staff with vital signs, medication administration, procedures, treatments and admission/transfer/discharge.

Other staffing solutions included creating the site manager role as direct support to nurses taking care of COVID-19 patients. Site managers observe donning and doffing and provide supplies to nurses to decrease the number of times they have to leave a patient room, which allows for better coordination of care and minimized use of PPE. Both clinical and non-clinical team members, including athletic trainers, have held this role.

Dale Beatty, DNP, RN. Chief Nursing Officer and Vice President of Patient Care Services at Stanford (Calif.) Health Care: Structurally, we established a COVID-19 governance called the clinical oversight resource team for all of Stanford Medicine. The governance structure oversees all employee COVID-19 issues. Care delivery topics like staff COVID-19 occupational health and COVID-19 testing, policies and procedure, and care guidelines are just a few examples of what the team addresses. 

When caregivers throughout Stanford Health Care were sidelined due to COVID-19 and testing, they were replaced by our contingency labor pool during the high COVID-19 census period. Currently, our inpatient employees are being supported by our float pool and/or our employees are flexed up to meet the patient care needs. Flexible and dynamic staffing resources have been essential to manage both the highs and lows of our COVID-19 census.

Chad Lefteris. CEO of UC Irvine Health (Orange, Calif.): One of the best ways to ensure patients receive the care they need is to reduce the chances a healthcare worker gets sick in the first place or transmits the virus to others. Our epidemiology and infection prevention team makes an enormous effort to provide timely and comprehensive guidance that staff needs to protect themselves. We also undertook a change in our culture by encouraging staff and faculty to speak up if they see colleagues miss an opportunity to increase safety. We reinforced the message that everyone has the right to contribute to a safer work environment for other staff and patients.

Bruce Meyer, MD. President of Jefferson Health and Senior Executive Vice President of Thomas Jefferson University (Philadelphia): One of the many benefits of Jefferson's early adoption of telehealth is that physicians and other providers who are quarantining or recovering from illness can still care for patients virtually. Additionally, through Jefferson Health's enterprise incident command center, we centrally manage all aspects of our COVID-19 response. During surges, we move staff (or PPE) from one hospital to the next as needed to provide support at all levels, especially critical care teams who can cross-cover on surge floors. We are also able to route ventilators to patients instead of moving patients to ventilators.

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