Covid-19 Hospitalizations Are Down, But Nurse Shortages Stretch Hospitals


By Kris Maher

Louise Dobbins thought her job would feel less like being an air-traffic controller by now. But finding beds for patients in an overcrowded healthcare system is as hard as ever, she says.

One recent morning, Ms. Dobbins was trying to find beds for 12 patients to transfer into Allegheny General Hospital, one of the biggest hospitals in Pittsburgh that takes many of the region’s sickest patients. But the hospital was already running at 110% capacity.

“I think people are under the misconception that because Covid has peaked and it’s on the downturn that staffing issues will go away,” said Ms. Dobbins, director of capacity management for Allegheny Health Network, a healthcare system in western Pennsylvania. “I don’t think that’s going to happen.”

At 10 a.m., Ms. Dobbins held her daily morning call with the health system’s 14 hospitals to gauge each one’s capacity challenges. Sitting in a room with a big screen that shows the number of beds filled and capacity percentages, Ms. Dobbins got an update from each hospital. At Allegheny General, there were already seven patients in the emergency department waiting for beds, including three who needed to go to the intensive-care unit.

More than a month after the Covid-19 Omicron surge peaked and began to decline, and as states are lifting Covid-related restrictions, the staffing crisis at many hospitals across the country is still running high. A shortage of nurses and other staff means fewer beds are available for patients.

Hospitalization counts have plunged as the Omicron wave recedes. By Monday, the seven-day average for hospitalized people with confirmed and suspected Covid-19 cases in the U.S. was 49,900, down 69% from an all-time high that topped 159,000 five weeks earlier, according to data from the Department of Health and Human Services.

Hospitals from Los Angeles to New York have reported staffing shortages. In 15 states, a third or more of hospitals said they had a critical staffing shortage last month, according to the American Hospital Association. Nurses are among the positions in greatest demand and two-thirds of hospitals across the country have a nurse vacancy rate of 7.5% or more, the association said.

Allegheny General, for example, has only enough personnel to cover about 370 beds, far fewer than the 522 beds the hospital is licensed for, according to Ms. Dobbins.

The pressures have eased since early January, when the health system in Pennsylvania had about 300 Covid-positive patients and more than 50 requests by 7 a.m. each day to transfer patients from mostly smaller hospitals, while dozens waited for beds in emergency departments. Today, the health system has about 130 Covid-positive patients and about 20 total transfer requests on a typical morning.

But staffing and capacity issues are still more strained than earlier in the pandemic. Allegheny Health Network currently has about 1,200 openings for nurses, for example, more than three times as many as a year ago.

Managing the system requires a combination of daily triage and efforts—some of them costly and some still untested—to bring in more nurses and retain existing staff.

Claire Zangerle, chief nurse executive for the health system, said that in the past year she has lost about 350 nurses who decided to work as travel nurses, who travel to other locations and work short-term contracts for higher pay. She has been forced to hire about 400 travel nurses herself as a result, and she has orders out to hire 75 more.

Ms. Zangerle says she pays agencies between $150 and $225 an hour per travel nurse, compared with a staff nurse who might earn $35 to $60 an hour, pushing up labor costs. In 2021, the health system spent $57 million on premium pay for traveling nurses and incentives for current staff nurses, up from about $18 million in 2020, Ms. Zangerle said.

Allegheny Health Network had an operating loss of $136 million in 2020, and a loss of $9 million through the first six months of 2021, as patient volumes improved. But labor costs remain high, prompting Ms. Zangerle and others to lobby state lawmakers for help. In January, Pennsylvania Gov. Tom Wolf signed a bill directing $225 million in pandemic-relief funds to be used to help hospitals and health systems struggling to pay for staff.

Ms. Zangerle said she believes the prices being charged by brokers for travel nurses are excessive. “We’re feeding the beast,” she said. “We need to fill our shifts.”

Meanwhile, at Allegheny General, the health system is paying about $100,000 a month to nurses in penalties for being over a nurse-to-patient ratio required by a contract at the unionized hospital. The ICU, however, always stays within a ratio of one nurse per one or two patients, say administrators and nurses.

Last week, Ms. Zangerle announced a new program aimed at retaining the 110 students who will graduate in May with a nursing diploma from the health system’s nursing schools. The 16-month program costs students $30,000, and the health system is now offering to cover tuition loans to nurses who agree to work for three years at the bedside, the toughest job to fill.

Under another new program, nurses can earn $5 an hour more, up from $1.25 an hour at most, for working steady nights or weekends. Allegheny General is also offering nurses an incentive for working more than 36 hours a week, which currently amounts to $16 per hour for the extra hours. Nurses also earn time and a half on their base pay over 40 hours a week.

Matt Komorowski, 22, said he has been picking up extra shifts in the ICU. For some weeks, he said he has been able to boost his regular pay of $28 an hour to well over $50 an hour for those extra hours.

He said the incentive pay is nice, but as someone who has been on the job for about eight months, he said it is a challenge whenever a more experienced nurse leaves the unit to take a travel job—sometimes to a rival hospital in Pittsburgh.

“It can definitely be very stressful if a lot of people on the floor that day are newer,” he said. “You have to learn on the go.”

While the number of Covid patients at hospitals such as Allegheny General have fallen overall in recent weeks, some still need ICU services. On a recent day when three patients in the hospital’s emergency department were waiting for an ICU bed, a 53-year-old patient with Covid died in the ICU.

Nurse Morgan Veglia, 23, said that within 30 minutes of taking her patient to the morgue, she had a new patient who had suffered an overdose. Down in the emergency department, she said, there was one less person waiting for a bed.


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