Health care workers pull together as severe staffing shortages persist

Just two days after narrowly avoiding declaring an internal disaster that would have signaled unsafe conditions for patients, unrelenting staffing issues continued to promise a difficult evening at Scripps Mercy Hospital Chula Vista Thursday.

At 7 p.m., it was clear that the evening shift would be short three nurses and five technicians due to positive coronavirus tests and six of the hospital’s 25 emergency beds were already occupied by patients who couldn’t be transferred to already full hospital units.

Though a second overflow tent would not be ready to free up beds until Friday, Lornna Hopping, manager of patient care for the emergency department, said that the patient census holding steady at 44 for several hours made the situation doable with a little help from some friends.

“How it goes tonight will come down to personal relationships and what the community brings to our door,” Hopping said.

Emergency room personnel check in a patient who was transported by ambulance to Scripps Mercy Hospital Chula Vista.

Emergency room personnel check in a patient who was transported by ambulance to Scripps Mercy Hospital Chula Vista.

(Nelvin C. Cepeda / The San Diego Union-Tribune)

It was clear in the late afternoon that Scripps’ internal pool of on-call workers would not be able to even out the staffing situation and, lately, even the enticement of double pay has not been enough to fill vacant shifts.

Hopping said grinding through the gridlock often comes down to nurses in charge begging, pleading and cutting whatever deals they can with their colleagues, people they trust, who they know will have their backs if there is nowhere else to turn.

“At this time of the day, these are conversations that we’ve already had,” Hopping said. “Somebody’s already said, ‘hey, if I can’t get any staff in and we’re really short, are you available for a short shift? Can I call you?’” Hopping said. “Even if they say no, we know who usually doesn’t mind.”

Scripps Chula Vista’s ability to pull together and back each other up was tested Tuesday when 22 of 24 emergency beds were full with patients who needed to be transferred into already-full hospital beds. For a few hours, it looked like it would be necessary to declare an internal disaster, a term used when a hospital is forced to stop taking all ambulance deliveries and institute stricter limits on who will be served among those who bring themselves to the ER.

Emergency room personnel check in a patient who was transported by ambulance to Scripps Mercy Hospital Chula Vista.

Emergency room personnel check in a patient who was transported by ambulance to Scripps Mercy Hospital Chula Vista.

(Nelvin C. Cepeda / The San Diego Union-Tribune)

Positive tests coming back among oxygen delivery drivers, dialysis workers, skilled nursing facility specialists and others have made it extremely difficult for hospitals to discharge patients from their wards, causing backups in emergency departments. A monster case of gridlock surfaced Monday and Tuesday, potentially creating an unsafe condition for patients whose conditions were deteriorating as they waited to be seen.

Usually, as was the case last winter, other hospitals are able to accept transfers to help an overwhelmed facility keep itself out of trouble. But early this week, that safety net was so strained that when when Scripps Chula Vista asked for help, there was just nothing to give.

“All of my sister hospitals were facing the same thing that I was facing; they weren’t able to absorb the patients,” Hopping said.

Notifying higher-ups of the situation set off a scramble to make room. Administrators who usually do not directly care for patients came in to work shifts and areas were tapped that normally do not hold general-admission patients, including the hospital’s endoscopy suite where gastrointestinal imaging procedures are conducted and an area usually reserved for patients recovering from surgeries.

Emergency room personnel have had to use every available space to place patients, including the hallways.

Emergency room personnel at Scripps Mercy Hospital Chula Vista have had to use every available space to place patients, including the hallways.

(Nelvin C. Cepeda / The San Diego Union-Tribune)

“We were able to place 20 patients in non-traditional areas, and that helped get us through,” Hopping said.

Through it all, the patients have not always been very understanding. Many have been frustrated with long waits and have taken it out on workers already running on fumes.

Dr. Juan Tovar, physician chief operations executive at Scripps Chula Vista, said that the early days of the pandemic, when grateful residents dropped by with cookies and thank you notes, are long gone.

“Patients are less forgiving and patient now, and we have a lot of verbal abuse and some physical abuse,” Tovar said. “If they could just have some empathy, that would really help.”

Hospitals are doing what they can to expand capacity as demand for non-COVID care continues to arrive alongside larger numbers of patients experiencing COVID-19 symptoms. At Scripps Chula Vista, workers labored through the day to set up a second surge tent in the parking lot outside the emergency department that could potentially provide room for patients waiting to be admitted to the main hospital. But simply setting up tents does not do much without enough workers to deliver treatment and watch for worsening conditions.

Matthew Luna worked outside in the parking lot where walk-in ER patients are screened.

Matthew Luna, an emergency room tech at Scripps Mercy Hospital Chula Vista, worked outside in the parking lot where walk-in ER patients are screened.

(Nelvin C. Cepeda / The San Diego Union-Tribune)

On Dec. 30, the California Department of Health published updated quarantine guidance for health care personnel that allows those who are fully vaccinated and boosted to quarantine for only five days as long as they test negative first. And health care workers who have tested positive can return to work in less than five days in locations with “critical staffing shortages” provided they only care for patients with confirmed coronavirus infections.

So far, Scripps and others have been reluctant to go that far, preferring workers quarantine for seven days before returning to work.

Chris Van Gorder, Scripps’ chief executive officer, said in an email Thursday afternoon that getting to the point where workers with mild but still-active infections are being brought back to work is a bridge he would rather not cross.

“This is a fluid situation, and I don’t have a crystal ball,” Van Gorder said. “I would prefer not to for safety reasons, but I can’t say never either.”

San Diego County reported 5,726 new coronavirus cases Thursday. While that number is significantly lower than the 8,204 positives reported Wednesday, it remains significantly greater than last winter’s largest single-day total.




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