EXECUTIVE SUMMARY
If the first COVID-19 surge was about safety, and the second surge about vaccination, then the third surge is about staffing. Health systems nationwide have seen too many employees leave their jobs and too many workers out sick because of exposure to omicron.
- Some states called in the National Guard to help overwhelmed hospitals.
- Omicron’s spread included mostly mild infections in fully vaccinated people, contributing to worker shortages.
- Although omicron sent a smaller proportion of infected individuals to the hospital, its larger and faster spread still caused hospitals to quickly fill with COVID-19 patients.
After two years of the COVID-19 pandemic, healthcare leaders know how to react and prepare. But with omicron, the earlier lessons learned were not enough to prevent patient surges and staffing shortages.
“Across our organization, it’s worse than we expected. It’s the worst we’ve experienced,” says Mary Beth Pace, RN, BSN, MBA, CCM, vice president of care management of Trinity Health in Livonia, MI.
New data show a steep decline in nursing employment. Compared to October 2018 to December 2019, nursing employment was lower during the period of April 2020 to June 2021, including a 10% decline in nursing assistants and a 20% drop for licensed practical nurses.1
Staffing problems appear to be even worse now. In January, newspapers from Massachusetts to Mississippi reported their hospitals were strapped with too few healthcare workers and too many patients. Many locations requested help from the National Guard.2-4 Hospitals also reported large numbers of staff out sick with COVID-19, or waiting for test results.5 A record 155,900 people were hospitalized with COVID-19 by mid-January, according to the U.S. Department of Health and Human Services.4
“The biggest challenge with omicron is keeping the hospitals staffed. So many healthcare workers have omicron themselves,” says Stephen Colodny, MD, FIDSA, FACP, chief of infection control and prevention at St. Clair Health in Pittsburgh. “We’re trying as hard as we can to keep staffing safe and effective.”
Omicron has been less deadly than the delta variant because it mainly affects the upper pharynx instead of the lungs, Colodny says.
The main problem in managing omicron is its extreme transmissibility. “It’s way more transmissible than the original one, and more than delta,” Colodny adds.
Even people who are vaccinated and have received booster shots are getting sick, although their survival rate is significantly higher than those who are unvaccinated.
“If omicron can infect enough people before a new variant emerges, then there’s a significant possibility we will achieve herd immunity,” Colodny says.
But not without pain, particularly among the nation’s vast healthcare structure. Even if a smaller proportion of people are dying from COVID-19 now, too many are filling beds. Worse, too many healthcare workers — even when fully vaccinated — are contracting the virus and taking sick time. Plus, many nurses and other professionals have left hospital work, or left the field entirely.
Staffing, Patient Surges Are Pain Points
The dual challenges of staffing and the surge of patients make the current COVID-19 wave the worst — despite the availability of highly effective vaccines.
“A few of our hospitals actually report higher volumes of COVID patients than they did during the other two surges that we have experienced,” Pace says. “You can anticipate to the best of your ability, but the fact of the matter is we don’t have enough beds and we don’t have enough staff to care [ideally] for the amount of patients who are hitting our emergency department.”
Michigan reported record-high COVID-19 cases in January, says Colleen Parks, MSN, CCM, ACM-RN, CMAC, director of system care management for Trinity Health.
“Our staff seem to be holding it together, doing a great job for their teams, but they’re drained,” Parks says. (See story in this issue on how case managers endure and cope during the omicron wave.)
With the first phase of the pandemic, and with the delta wave from mid-2021, fewer healthcare workers were getting ill. Facilities still had adequate staff to handle severely sick patients, says Mary McLaughlin Davis, DNP, ACNS-BC, NEA-BC, CCM, senior director of care management nursing for Cleveland (OH) Clinic main campus.
“This strain is washing through everything, everybody,” Davis says. “This round of COVID is more of a staffing issue, along with the surge of patients.”
In 2020, health systems learned a lot about staffing models, what worked, and what did not. But those early lessons have not been as useful as the pandemic evolved and changed, says Meeta Prasad Kerlin, MD, MS, associate professor of medicine, pulmonary, allergy, and critical care division at the University of Pennsylvania Perelman School of Medicine. Kerlin also is with the university’s Palliative and Advanced Illness Research Center. (See story on study about hospitals’ COVID-19 response in this issue.)
“There has been a lot of attrition — people leaving the healthcare workforce in droves and across professions, including nurses, respiratory therapists, physicians, and others,” Kerlin explains. “It’s probably because the last few years have been so taxing.”
Hospitals cope with shortages of beds and staff, including case managers. “Our hospitals are generally pretty full,” Davis says. “We used to be able to triage some patients and move them to another hospital that could care for them just as well, but now every hospital is full.”
Omicron has made the pandemic’s challenges even worse. “This has been terrible and really difficult. Every healthcare worker is exhausted,” says Monica Gandhi, MD, MPH, director of the University of California, San Francisco (UCSF) Center for AIDS Research (CFAR) and professor of medicine and associate chief of the division of HIV, infectious diseases, and global medicine at UCSF. “I don’t think anyone is going to escape exposure to omicron because it’s so transmissible and everywhere. I think this idea that everyone is going to get it is, unfortunately, true.”
Is an End in Sight?
The good news is omicron is so efficient that it is helping build immunity among Americans, including those who are not vaccinated. This might help end the pandemic.
“We’re getting an astronomical number of cases, and we’re building a wall of immunity. A population of those who have been unvaccinated, and even those who have been vaccinated, are also getting a lot of exposure,” Gandhi says. “I think omicron will bring down quells of the pandemic.”
Once the pandemic ends, COVID-19 likely will remain, but in a more limited way, like the annual flu. “What happened in the 1918 pandemic is not that influenza went away. We deal with influenza every year,” Gandhi explains.
The pandemic phase of the 1918 influenza virus ended when populations reached higher levels of immunity. The next phase is endemic, meaning people deal with the virus every year, such as seasonal flu.
“It’s exhausting, and we have so much to go through, but life will get better for healthcare workers in the future,” Gandhi says.
The results of a recent study show nurses need effective communication from their organizations and leadership to support them through crises, such as the COVID-19 pandemic.6
“We spoke with nurses about what was healthy and what helped them with contemporary challenges that were pushing them physically and mentally to the limit,” says Shannon Simonovich, PhD, RN, the study’s lead author and assistant professor of nursing in the College of Science and Health at DePaul University in Chicago.
Survey respondents said they wanted to see their leaders on the floor with them. They also benefited from knowing other nurses were present — that they were not in this crisis alone.
Respondents told researchers they believed their work during the pandemic was a call to duty, says Roxanne S. Spurlark, DNP, APRN, FNP-C, study co-author and assistant professor of nursing in the College of Science and Health at DePaul University. (See story on the study of nurses during COVID-19 crisis in this issue.)
“They felt they were on a battlefield,” Spurlark says. “They’re going to work because it’s a call to duty to serve others, to care for others, but they also felt like while they’re feeding others, they need to be fed, too.”
What healthcare professionals want boils down to these three things, Spurlark says:
- The presence of leadership and co-workers in their department, working on the floor;
- More and timely education about the pandemic and infection prevention;
- Emotional support from leadership and an understanding of their daily challenges.
The strain and distress nurses have experienced during the pandemic is what case managers also have experienced. Everyone’s jobs in hospitals and in the community have been altered because of the pandemic.
“They’re all exhausted, and case managers and social workers are no different,” Pace says. “How they keep morale is based on what they do for their own teams.”
The teams at Trinity Health deserve credit for keeping their heads above water and trying different tactics to maintain team balance, Pace says.
“They try to encourage people to take time off when they can,” she adds. “I applaud each and every case manager because we support them as best we can, but they’re exhausted, and ‘exhausted’ is not a strong enough word.”
REFERENCES
- Firth S. New nurse data confirm falling employment, higher wages. MedPage Today. Jan. 12, 2022.
- Rousseau M. New emergency orders issued to help understaffed Mass. hospitals. Boston.com. Jan. 14, 2022.
- DiNatale S. ‘No one is applying’: Omicron pushes understaffed hospital system into crisis mode. Mississippi Today. Jan. 11, 2022.
- Dublin T. Short-staffed US hospitals lean on National Guard while ceasing nonurgent procedures. HillReporter.com. Jan. 14, 2022.
- Richert C. ‘All hands on deck’: Hospitals report hundreds of staff out with COVID. MPRNews. Jan. 9, 2022.
- Simonovich SD, Spurlark RS, Badowski D, et al. Examining effective communication in nursing practice during COVID-19: A large-scale qualitative study. Int Nurs Rev 2021;68:512-523.
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