Nursing shortages were predictable, the pandemic was not

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Nursing shortages didn’t begin with the coronavirus pandemic but the pandemic sure hasn’t helped. With what is being called a fourth wave of the pandemic, nursing shortages are impossible to ignore. In some states like Louisiana, a shortage of nurses was predicted by the year 2020 but no one predicted the pandemic that would exacerbate the situation.

There is a statewide shortage of about 6,000 nurses in Louisiana right now. In Texas, the situation isn’t any better. In Houston, an “internal disaster” was declared Sunday night in the emergency room of Lyndon B. Johnson Hospital. The wait time for patients was 24 hours. Harris Health System officials said Tuesday it was due to a shortage of nurses and a high volume of patients. Under normal circumstances, internal disasters limit the flow of ambulance traffic to a hospital. It’s usually triggered by infrastructure problems from a fire or diagnostic machine failures. On Sunday night, though, LBJ Hospital could only staff 16 of its 24 ICU beds. The number of people in the emergency room rose to 130. Texas is experiencing an acute surge of COVID-19 hospitalizations right now, according to Dr. Esmaeil Porsa, president and CEO of Harris Health System. On Tuesday, for example, the state reported 7,305 hospitalized patients, an increase of 38% over last Tuesday.

In Louisiana, LeAnne Fowler, the Director of LSU Health’s Nurse Practitioner Program said, “The capacity to meet the needs of every patient is just not there.” Demographics play a big role in contributing factors of the nursing shortage.

“It’s very stressful because you basically have to just do what you can,” Fowler said. “When, in any disaster, you have to increase the capacity and expand the capacity of the workforce any way you can. What does that look like? That looks like you doing more than you normally do and trying to make sure that quality is maintained.”

There are a lot of factors contributing to the shortage over the years but a lot of it has to do with demographics. Dr. Karen Lyon with the Louisiana State Board of Nursing says the average age of nurses is getting older. Not to mention the toll a year and a half pandemic takes.

“Everybody stayed on, everybody was committed, everybody loved nurses, people were banging pots, jets were flying over, everybody recognized us, and that was all wonderful, but as it went on and on, nurses got tired,” Lyon said.

Some nurses quit or retired when things slowed down in the Spring and Summer.

Remember the stories we read about nurses going from their homes to other states to help out in places overwhelmed with the pandemic? That isn’t happening anymore because no state has nurses to spare. It’s a nurse’s market now and they are going where the best opportunities are. Traveling nurses are big now, too, and they can make a lot more money. Rooney said that they need to re-work what nursing looks like now. Mental health plays a role, especially during the pandemic.

The Louisiana Board of Nurses has 1,200 applicants that they are trying to get licensed. There is less faculty to train them in hospitals and available clinical space for training is being converted into ICU space. She pointed out that you can’t take a brand new graduate and put them in an ICU caring for seven COVID patients. Hospitals have been partnering with schools to close the gap.

In Houston, two hospitals LBJ and Ben Taub Hospital, need 250 more nurses to be fully staffed. A doctor at LBJ was so frustrated with the situation during the internal disaster declaration that he emailed State Sen. John Whitmire Sunday night about the “untenable” situation. He said the situation was bad in all the area hospitals.

“I am emailing you because I don’t know who else to turn to,” the doctor wrote. “Also, it should be clear that while I work at LBJ, this affects all of the hospitals in Houston. The combined increase in volume from (COVID and) existing normal volume (and) nursing shortage has made this a terrible disaster at every ER and hospital in the city of Houston. We cannot deliver the care that patients in Houston need under these circumstances.”

Harris Health is considering postponing elective surgeries again, as happened at the beginning of the pandemic. It’s been forced to close two clinics. Porsa agreed that the system is facing issues statewide in Texas and in the Texas Medical Center. The nationwide nursing crisis began before the pandemic but it’s grown thanks to nurses retiring, leaving the profession, or quarantining from COVID infections.

“We are in a crisis situation,” he said. “When you look at the rates and the rise of the number of COVID patients, it’s not a curve. It’s a straight line going up. This has never happened throughout the last year and a half in the pandemic. We have never seen this rapid of a rise in our COVID patients.”

The Texas Nurses Association says nurses are burned out and ICU units are full. One medical staffing company notes a 75 percent increase in staffing requests from healthcare providers in the area. It’s only going to get worse as cases continue to grow. COVID hospitalizations are growing as fast as any time during the pandemic in Houston and the numbers are projected to pass previous records by mid-August because of the Delta variant. ICUs are full of unvaccinated people. Roughly half of all eligible Houstonians are fully vaccinated. Texas Medical Center CEO Bill McKeon says we are headed into “dark times.”

This fourth wave of the pandemic is bringing in a rise in pediatric hospitalizations. In past surges, Texas Children’s Hospital took in non-COVID adult patients to help out other hospitals but that’s not possible now.

In Utah, the new surge in COVID-19 cases is causing nurses to quit and take other jobs because of the mental and physical toll. They say they just can’t do it all over again.

“They are very disappointed, and they are very tired and I think the hardest thing for nurses in Utah and across the country is we don’t have to be in this situation,” said Close.

Nixon said nurses most likely never recovered from the first surge of patients almost more than a year ago.

Close said that’s another thing driving them out.

An aging workforce and pandemic burnout are pointed to as the causes of staffing shortages in Washington State. The new wave of the pandemic is pushing hospitals to full capacity. Fortunately, nursing schools are receiving a high number of applicants. Nursing instructors say they just can’t train them fast enough. The increase in patients in Washington is with younger, unvaccinated people.