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As COVID-19 surges, there is a critical shortage of nurses

“It’s difficult to get people to commute a half hour to 45 minutes, especially during the winter months. Fortunately, we’ve been able to groom our own CNAs, but that doesn’t work with nurses.” Bill Pond, Noble Horizons

Across the Northwest Corner, administrators at hospitals, nursing homes, schools and health-care providers said that COVID-19 has created unprecedented challenges for nurses and for the agencies who depend on them. 

Burnout, reassignments to coronavirus units, fear for their health and that of family members, and the need to stay home and care for elderly relatives or school-age children are among the reasons many nurses are exiting the field.

“A constant drumbeat,” is how Kevin O’Connell, CEO of Geer Village in North Canaan, described the situation. “There was already a shortage of skilled health-care workers, CNAs [certified nursing assistants] and nurses before the pandemic,” he added.

“It’s not the type of work that is appealing to everybody,” said O’Connell. “I’m worried about staff just not wanting to do this work anymore. Our employees are struggling as are everyone else’s.”

Travel is a challenge

AnnMarie Garrison, vice president of Clinical Operations for Visiting Nurse & Hospice of Litchfield County, reported that her agency is currently “down some clinical staff.” The newly created entity was formed through a merger of Salisbury Visiting Nurse Association, VNA Northwest in Bantam and Foothills Visiting Nurse & Healthcare in Winsted.

As often happens after a merger, said Garrison, “some people decided to move on,” so now she is faced with hiring additional nurses to supplement the agency’s staff of about 23 registered nurses (RNs) and four licensed practical nurses (LPNs).

Adding to the hiring challenge is the rural nature of the region, where competition is fierce among those vying for a limited pool of qualified nurses. Health-care providers have had to get creative with their hiring and retention strategies, and management of resources.

Bill Pond, administrator of Noble Horizons in Salisbury, said while nursing levels are stable, “we have had a few people leave to pursue other opportunities.”

He said the longer the pandemic rages on, the greater the toll on staff. “If the trend continues we are going to be faced with the challenge of trying to get people up to Noble. 

“It’s difficult to get people to commute a half hour to 45 minutes, especially during the winter months. Fortunately, we’ve been able to groom our own CNAs, but that doesn’t work with nurses.”

A dangerous job

This past spring, the American Nurses Association conducted a survey of 32,000 nurses and found that 87% feared going to work and 36% cared for an infectious patient without having adequate PPE. The survey also revealed that only 11% of respondents believed they were well-prepared to care for COVID-19 patients.

According to data provided by the U.S. Centers for Disease Control and Prevention (CDC), 36% of health care workers hospitalized with the coronavirus were nurses and nursing assistants.

Garrison, who has worked as a registered nurse for 37 years, 31 of which were spent in home health, said the pandemic has been exhausting for staff since the March lock down. 

“It was very tough on our nurses and all clinical staff. The patients were so sad, lonely and feeling isolated. It took a huge toll on staff. Their hearts were breaking.”

In addition to being stressed about keeping patients, themselves and their families safe, she said, visiting nurses are required to don PPE, including full gowning and N95 respirator masks. While they are glad to have the protective gear, it’s also cumbersome to wear.

Another concern, said the VNA spokeswoman, is the increased community spread. “During this recent uptick I have seen more patients’ family members come down with the virus. Also, we are getting more patients coming out of the hospital COVID-positive, expecting that care will be done at home.”

COVID fatigue among staff, said Geer’s CEO, “is very, very real. We went eight months without a COVID-19 case, and then it came into assisted living so quickly.” Once the contagion reaches the nursing home and nurses need to quarantine, “you could decimate a whole group of your staff and have very little ability to replace them quickly,” he said. As a precaution, Geer has put in place a “full succession plan” for staffing.

Although the North Canaan senior community received an “all clear” report from the state following a viral outbreak there early in the fall, “everyone is worried about the future,” including the upcoming holiday travel season and rising cases, said O’Connell. He said he is also worried that a strain on the health-care system in coming months could result in a shortage of personal protective equipment (PPE) again.

The benefits
of ‘system-ness’

Hospital administrators in the Northwest Corner reported in early December they have been able to keep up with demand by reallocating staff, resources and equipment to where they are needed most.

Both Sharon Hospital (affiliated with Nuvance Health) and Charlotte Hungerford Hospital in Torrington (affiliated with Hartford HealthCare) are part of larger health-care systems, which allows them access to a wider pool of resources. 

“We call it the benefit of ‘system-ness,’” said Daniel J. McIntyre, president of Charlotte Hungerford Hospital and senior vice president of Hartford HealthCare Northwest Region.

Hartford HealthCare has a central recruitment office that focuses on hiring and also works with staffing agencies to fill temporary positions. “Within each region we have the latitude to deploy and re-deploy our most skilled RNs,” he said, as well as the ability to move medical staff to assist in the ICU. Or, non-clinical staff may be assigned to work at a testing facility. “We make the highest and best use of manpower,” said McIntyre.

At Sharon Hospital, spokeswoman Marina Ballantine reported that “current staffing levels are aligned with changing volumes. We are well-prepared through contingency planning and benefit from a collective approach to staffing, resource and bed management — a strength of our seven-hospital system.”

Incentives and
initiatives offered

Health-care agencies say hiring is only half the battle. Retaining staff is crucial. Geer Village has hired a full-time recruiter, is working with staffing agencies and visiting nurse associations to supplement staff with private-duty aides, and is offering nurses COVID-19 bonuses of $100 per shift, according to O’Connell. 

“We brought in four new medical staff last month. The key is to make sure to keep them long-term,” said the Geer administrator. That means keeping them healthy, both physically and mentally, through weekly virtual meetings, pandemic updates, holiday festivities like the recent North Canaan Parade of Lights, peer support and access to mental health counseling.

Sharon Health Care Center is currently recruiting full-time and part-time RNs, LPNs and CNAs, and is offering a $500 sign-on bonus, among other incentives, according to Tim Brown, Athena Health Care spokesman.

He, too, cited obstacles in finding qualified candidates: the area’s rural geography, sparse population and higher cost of living. Retaining nurses has been a challenge, said Brown. Many have chosen to leave direct-care positions to take lower-risk jobs, or to stay at home with family. 

Adding to the staffing difficulty, he said, is the limited pool of certified nursing assistants, as many colleges and private companies ceased offering classes during the pandemic.

Brown recalled the early days of the pandemic when Sharon Health Care was designated a COVID-19 recovery center, and the great toll it took on nurses.  “It was definitely a traumatic time.”

School nurses
have added roles

School nurses have had their work cut out for them during the 2020-2021 academic year. Fortunately, in the Region One School District, staffing of nurses has not been a problem, said Interim Superintendent Lisa Carter. Each of the district’s six elementary schools has a designated nurse, and two nurses are assigned to the high school.

Turnover of nurses has been low, Carter said, and the nurses tend to live in the communities where they work. 

“If we were to lose two or three of them at any given time,” however, that could be problematic. “I would expect that we would feel the pain just like the other agencies that employ nurses in the area.”

In the age of COVID-19, said the Region One head, the role of school nurses “seems to have morphed a little bit.” In addition to their regular duties, they are also conducting initial coronavirus health screenings, calling parents if a child exhibits symptoms, assisting with contact tracing and communicating test results with administrators.

Waiting, and hoping 

The remainder of December through the first week of January, “will be our struggle” in terms of staffing, said McIntyre. “We are definitely paying attention to the number of COVID-positive patients out of our total number of patients.”

During the first wave of the virus, he said, “we were up to 25 patients out of 80 admissions per day.” McIntyre said as of Thursday, Dec. 3, Charlotte Hungerford Hospital was treating 24 coronavirus patients. “So we are close to the peak.”

On the bright side, the hospital president said, COVID-19 vaccines are expected to be distributed to health-care staff throughout the Hartford HealthCare system starting in mid-December. “That will make our colleagues a little more secure.”

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