FENTON, Mich. -- As the coronavirus surges across the nation and infections and hospitalizations rise, medical administrators are scrambling to find enough nursing help -- especially in rural areas and at small hospitals.
Nurses are being trained to provide care in fields where they have limited experience. Hospitals are scaling back services to ensure enough staff to handle critically ill patients. And health systems are turning to short-term travel nurses to help fill the gaps.
Adding to the strain, experienced nurses are "burned out with this whole [pandemic]," and some are quitting, said Kevin Fitzpatrick, an emergency room nurse at Hurley Medical Center in Flint, Mich., where several left in the past month to work in hospice or home care or at outpatient clinics.
"And replacing them is not easy," Fitzpatrick said.
As a result, he said, the emergency room is operating about five nurses short of its optimal level at any given time, and each one typically cares for four patients as covid-19 hospitalizations surge. Hospital officials did not respond to requests for comment.
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But the departures are not surprising, according to experts, considering not only the mental toll but also the fact that many nurses trained in acute care are over 50 and at increased risk of complications if they contract covid-19, while younger nurses often have children or other family members to worry about.
"Who can actually work and who feels safe working are limited by family obligations to protect their own health," said Karen Donelan, professor of U.S. health policy at Brandeis University's Heller School for Social Policy and Management. "All of those things have been factors."
Donelan said there is little data so far on how the pandemic, which has killed more than 231,000 people in the country, is affecting nursing overall. But some hospitals had a shortage even before the virus took hold, despite a national rise in the number of nurses over the past decade.
With total confirmed coronavirus cases surpassing 9 million in the U.S. and new daily infections rising in 47 states, the need is only increasing.
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Wausau, Wis.-based Aspirus Health Care is offering $15,000 signing bonuses for nurses with at least a year of experience and is hiring contract nurses through private staffing companies to handle a surge in hospitalizations that prompted the system to almost quadruple the number of beds dedicated to covid-19 patients.
Aspirus, which operates five hospitals in Wisconsin and four in small communities in Michigan's Upper Peninsula, also is moving nurses around between departments and facilities as hot spots emerge, said Ruth Risley-Gray, senior vice president and chief nursing officer at Aspirus.
Outside help still is needed, in part because some nurses have gotten sick from or were exposed to the coronavirus during the current wave, which "came with a vengeance" starting in August, Risley-Gray said. At one point in mid-October, 215 staffers were in isolation after showing symptoms or being exposed to someone who tested positive, and some are just starting to return to work.
Aspirus recently was able to hire 18 nurses from outside agencies, and it may need more.
Because the pandemic is surging just about everywhere in the country, hospitals nationwide are competing for the same pool of nurses, offering pay ranging from $1,500 a week to more than $5,000, said April Hansen, executive vice president at San Diego-based Aya Healthcare, which recruits and deploys travel nurses.
She said demand for their services has more than doubled since early in the pandemic, when the greatest need was in hot spots like New York and New Jersey and then moved to southern states. In recent weeks, the virus has been spiking across the country, with new hot spots in places such as the rural upper Midwest and southern-border communities such as El Paso, Texas.
Now placing nurses where they're needed is "like a giant game of whack-a-mole," said Hansen, whose company has about 20,000 openings for contract nurses.
In North Dakota, where infection rates are exploding, hospitals may cut back on elective surgeries and seek government aid to hire more nurses if things get worse, North Dakota Hospital Association President Tim Blasl said.
In Texas, Gov. Greg Abbott recently announced he was sending 75 nurses and respiratory therapists to El Paso to help handle the city's rise in cases. Wisconsin Gov. Tony Evers, meanwhile, issued emergency orders making it easier for nurses from elsewhere to practice in his state and for retired nurses to return.
TEXAS CASES
Texas has surpassed California in recording the highest number of positive coronavirus tests in the U.S. so far, according to data from Johns Hopkins University.
The total number of confirmed cases in Texas as of Monday was 936,816, according to Johns Hopkins. California has had 935,878 cases, followed by Florida with 807,412.
The true number of cases is likely higher because many people haven't been tested, and studies suggest people can be infected and not feel sick.
In cases per 100,000 residents, Texas ranks 19th.
A summer surge of cases overwhelmed hospitals in Houston and along the hard-hit border with Mexico. But when the case numbers dipped, Abbott began relaxing some coronavirus restrictions, allowing restaurants and gyms to let more people inside. He also let county leaders decide whether they wanted to reopen bars at 50% capacity.
But cases and hospitalizations are once again on the rise.
The Johns Hopkins data shows that Texas' seven-day rolling average of test-positivity rate has risen over the past two weeks from 7.12% to 10.72%, while the seven-day rolling average of daily new cases rose from about 4,470 new cases per day to about 6,070.
Texas health officials have reported more than 18,500 deaths from covid-19.
TALK ON FAUCI
Meanwhile, President Donald Trump suggested during a campaign rally Monday that he may fire Dr. Anthony Fauci after the election.
Speaking at a campaign rally in Opa-locka, Fla., Trump expressed frustration that the rise in cases of the virus remains prominent in the news. That sparked his supporters to begin chanting, "Fire Fauci."
"Don't tell anybody, but let me wait until a little bit after the election," Trump replied to thousands of supporters early Monday, adding that he appreciated their "advice."
Technically the president cannot directly fire Fauci, mainly because he is not a political appointee. As a career federal employee and director of the National Institute of Allergy and Infectious Diseases since 1984, Fauci is protected by federal civil service regulations that shield him from being fired or demoted for political reasons.
Fauci could be removed, but it would involve a complicated process layered with civil service protections that requires the government agency to provide evidence that there is just cause for dismissal, including failure to follow orders or misconduct.
Democratic presidential nominee and former Vice President Joe Biden tweeted later Monday in response: "We need a president who actually listens to experts like Dr. Fauci."
RISKS DURING PREGNANCY
Additionally, a report by the Centers for Disease Control and Prevention released Monday found that pregnant women who catch the coronavirus are at greater risk of death and severe illness than women who are not pregnant, even as the risk overall remains small.
The data -- the most comprehensive U.S. accounting to date of how the virus affects pregnant women -- shows that pregnant women are almost three times more likely to be admitted to intensive care units, and more than three times more likely to be put on ventilators. The findings echo previous studies linking pregnancy to increased risk for severe illness.
The overall risk to pregnant women remains small because they tend to be younger and healthy, according to the report. Out of 19,600 pregnant women studied, 33 died -- a 0.2% death rate. For women who are not pregnant, the death rate was 0.1%, the report said.
The CDC study also reinforced findings about the disparate path of the pandemic in the United States, with Black, Hispanic and Asian women at greater peril from the virus.
The report draws on data the CDC collected from hospitals throughout the country. It found that 1.1% of pregnant women were admitted to an intensive care unit after being diagnosed with covid-19, the disease caused by the virus, compared with 0.4% of women who were not pregnant. The rate requiring ventilation was 0.3% for pregnant women and 0.1% for other women.
Information for this article was contributed by Tammy Webber, Zeke Miller, Lauran Neergaard, Bill Barrow and staff members of The Associated Press; and by Paulina Villegas and William Wan of The Washington Post.
