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The sun was shining as Nancy Blake, PhD, RN, CCRN-K, NHDP-BC, NEA-BC, FAAN, stood outside Harbor UCLA Medical Center in December 2020, a stark contrast to the reality just inside the building, where a surge of patients with COVID-19 overflowed the intensive care unit (ICU) and spread into the emergency department. Los Angeles Country—the most populous county in the United States—had no available ICU beds.
Dr. Blake, the center’s chief operating nurse, was standing outside for an interview with CNN. Members of the nursing team, like many healthcare professionals, had been dealing with COVID-19 for 10 months, and Dr. Blake’s goal was to deliver a message on behalf of her team: They were tired. “It’s a disaster right now for our staff,” Dr. Blake told CNN’s Sara Sidner. “Their patients are dying. There are no family members [allowed in patient rooms], so they’re holding that patient’s hand or they’re on the other side of an iPad where the family is crying. “I am a glass half-full kind of person. My glass is empty right now.”1
Dr. Blake recounted that interview recently during the webcast Best Practices for Managing Staff Shortages, hosted by the Society of Critical Care Medicine (SCCM) and the American Association of Critical-Care Nurses. A multiprofessional panel of experts discussed how staffing challenges arise in overwhelmed healthcare systems and how they have managed staff shortages.
The panel included Dr. Blake, who is now the chief nursing officer at Los Angeles County and USC Medical Center, in addition to:
Kim Bennion, MsHS, RRT, CHC, system respiratory care clinical services administrative director at Intermountain Healthcare in Murray, Utah, USA
Patricia R. Louzon, PharmD, BCPS, BCCCP, FCCM, clinical manager of critical care in the Emergency Department at AdventHealth Orlando in Orlando, Florida, USA
Vinay Maheshwari, MD, MHCDS, FCCP, chair of the Department of Medicine at Christiana Care Health System in Newark, Delaware, USA
The webcast was moderated by Maureen Seckel, MSN, APRN, ACNS-BC, CCNS, CCRN, FCNS, FCCM, medicine/critical care clinical nurse specialist and sepsis coordinator at Christiana Care Health System in Newark, Delaware, USA.
In August and September 2021, the American Nurses Foundation conducted a survey of nearly 10,000 nurses from across the United States about their mental health and wellness. Fifty percent of respondents said that they intended to leave or may leave their position within the next six months.2 Their intent to leave was driven by mental health, staffing, and organizational issues. The survey also found that self-reported burnout had increased by 350% since a similar survey was conducted in June and July 2020. This increase in fatigue and staff shortages is occurring at the same time that many healthcare systems face increased workloads as they try to catch up on previously postponed procedures from earlier in the pandemic.
“It’s much different this time around than earlier in the pandemic,” Dr. Maheshwari said. “The first time around, there was a willingness for everyone to jump into the fray, and there was also a de-escalation of services globally that allowed for redeployed staff from other areas. This time around, however, surgeries still are very active, procedures are very active, and there’s a large number of patients that didn’t seek care for quite a bit of time and are coming into our hospital setting. It makes it really challenging for us at the moment to reallocate staff from other areas. A lot of what we’ve had to do is rely on the same staff who have been burdened and fatigued and stressed.”
Dr. Maheshwari and the other panelists also spoke about staff members leaving to become travel nurses who can work on short-term contracts and make far more than an average full-time nurse. The average salary for a registered nurse in Illinois in 2021 was $80,000.3 Traveling nurses were being offered salaries of up to $8,000 per week during the surge in the summer of 2021 attributed to the Delta variant.
Ms. Bennion said that her healthcare system could not offer the salaries available to traveling nurses. She also pointed out that bringing in traveling nurses presented additional challenges such as training them on operations and practices used in the healthcare system. So she and her colleagues created a hybrid position. Intermountain Healthcare began offering six-month per diem positions targeted to nurses and therapists who lived near the system’s Utah-based hospitals. “We’ve tried to target those who live in our community, who have children, and who really don’t want to uproot those children to work traveling positions,” she said. “That’s brought several out of retirement and back to the workforce.”
Dr. Louzon said that pharmacists have not faced the same type of pressure with traveling positions as nurses have, but she has still seen a number of pharmacists leaving their roles at hospitals for industry positions that are more flexible or do not require a bedside care component. To try to minimize these departures, Dr. Louzon said it is valuable to emphasize professional growth opportunities for those who are considering a new career path. “We try to focus on the long-term aspect and benefits of staying with one institution and also the benefits of being able to teach and conduct research,” Dr. Louzon said. “Those opportunities are a little harder to find in more transient or industry-type positions.”
Dr. Maheshwari agreed that trying to get employees to look at the long term is a good tactic, but he believes that approach is not as effective as it once was. “Some of our staff are of a different generation in which they’re okay with being transient for a period of time in their life,” he said, “which is perhaps different than what we would have experienced 10 or 15 years ago when people were more comfortable planting roots.” For those employees, Dr. Maheshwari said that senior leadership and human resources need to brainstorm different types of benefit packages that could be more enticing to those employees. Instead of lavish retirement packages, for example, Dr. Maheshwari thought that more scheduling flexibility, virtual care opportunities, or the ability to work from home might carry more weight and keep more employees in place and satisfied.
“What this is making us better understand is the talent that we have in the critical care world across all the different disciplines but also how hard it’s been to be a critical care professional through many years, not just during this pandemic,” he said. “It’s unearthed a lot of the cracks and crevices we’ve had in place for quite some time, and I think it’s going to put us in a better place to help address them for our long-term future.”
Watch the full webcast here.
SCCM also has these resources for managing resources and staffing:
This overview on resource availability offers tiered staffing models for augmenting critical care staffing.
The SCCM COVID-19 Rapid Resource Center has several resources on staffing and on resource allocation.
This educational activity was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention (grant number 1 NU50CK000566-01-00). The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services (HHS). Its contents do not necessarily represent the policy of CDC or HHS, and should not be considered an endorsement by the Federal Government.
