As local hospitals become more impacted by coronavirus patients, a new concern has come to light. The question is no longer will there be enough beds to care for all the sick as COVID-19 cases escalate, but will there be enough hospital staff to tend to those beds?
For a 12-hour period this past weekend, ambulance traffic had to be diverted away from Dignity Health’s Mercy Hospital Downtown and Mercy Hospital Southwest. The two facilities reached a point where they couldn’t take any more patients due to staffing, said Kern County Public Health Services Director Matt Constantine.
Constantine said the county is going to start this week tracking hospital staffing as another way to monitor capacity in Kern’s 10 acute care hospitals.
“What we’re talking about is another threat to our health care system that we need to address,” Constantine said.
“Hospitals are good at managing some localized peak demand, where there’s a surge or during flu season or there’s a horrific traffic accident where many people are involved,” Constantine said. But coronavirus presents a problem with sustained, regionwide growth. Constantine said it’s critical to know if what the two Bakersfield hospitals experienced this past weekend was an errant incident or a possible warning of what’s to come.
“We might need to have different triggers that would implement different actions earlier if staffing truly is a limiting factor in Kern County,” Constantine said, referring to the surge plans drawn up by hospitals to increase their bed capacity by up to 40 percent.
Dignity Health didn’t respond to several requests Wednesday for comment but Hall Ambulance spokesman Mark Corum confirmed that ambulance traffic was diverted over the weekend.
As of Tuesday night, neither hospital had beds available, said Mary Lynn Briggs, a staff nurse in the ICU at both Mercy hospitals and the chief nurse representative for the California Nurses Association at both hospitals.
Briggs said patients were being held in the emergency room while rooms were sought for them at other Bakersfield hospitals.
During the day Monday, the hospitals dipped below state-mandated nursing ratios in some units, Briggs said. Some nurses in the medical/surgical unit had six patients instead of the mandated five and some telemetry nurses had five patients instead of the mandated four. In the ICU, the ratio of one nurse to two patients was maintained but Briggs said some patients were so critically ill they needed their own dedicated nurse. She said the hospitals have a combined 28 ICU beds and 17 are for COVID-19 patients; 16 were filled Tuesday, the last day Briggs worked.
“I’ve been a nurse since 1992, I have never seen staffing as short as it is right now,” she said, adding that last week she worked five shifts with no breaks or meals.
She estimates about 15 to 20 staffers between the two hospitals have contracted the virus from patients.
“They’re trying to get travelers to come in and they have gotten some, just not enough,” she said. Briggs said the hospital could offer better financial incentives to employees to work extra shifts and for traveling nurses but so far hasn’t. Despite that many workers are working additional shifts, she said.
“Trying to increase staffing right now can be tricky,” said Jan Emerson-Shea, vice president for external affairs for the California Hospitals Association. Earlier in the pandemic, travel nurses and other healthcare workers were easier to come by. Now, as the virus has spread and places like Texas and Arizona see their own hot spots developing, those healthcare workers are in higher demand.
“Everybody thinks capacity is, ‘do I have enough beds or ventilators,” Emerson-Shea said. “You can find nooks and crannies in hospitals to put more beds. The issue often is staffing. Staffing is key.”
Emerson-Shea said hospitals sometimes run into staffing issues during a bad flu season. Some hospital workers may get sick and then there can be an influx of elderly patients, requiring hospitals to look elsewhere for extra staffing help.
“But the difference with a regular flu season is not every state is having it at the same time,” Emerson-Shea said. “Because of the nature of this pandemic, it’s affected every state in the country.”
Sharlet Briggs, CEO for Adventist Health Bakersfield, with no relation to Mary Lynn Briggs, said she hasn’t encountered problems yet getting additional healthcare workers when her hospital has needed it.
“As we increase our volume of ICU patients we are going to need more ICU nurses,” Sharlet Briggs said.
She said some employees at Adventist Health Bakersfield had contracted the virus but she’s unaware how many.
Kern Medical CEO Russell Judd said as of Monday there had been no known transmissions of the virus from patients to staffers.
Tim McGlew, CEO of the Kern Valley Healthcare District, said while there are no COVID-19 patients currently in his hospital the situation in Bakersfield is impacting his facility, stalling transfers from their emergency department to better-equipped hospitals in Bakersfield. That happens from time to time, he said.
The Kern River Valley has remained largely unscathed by the virus but recently there have been several cases in the community.
He noted that Isabella Lake has been packed with visitors on recent weekends, which is a concern “because they’re coming from Los Angeles and other places that have been having high experiences of COVID. Now we’ve got eight or nine cases in the community. We’ll see what happens over the next couple weeks.”
Mary Lynn Briggs, the ICU nurse at Mercy hospitals, said that among staff there’s a sense that the surge of patients that has been talked about for so long is underway.
“That’s one of the scariest things about all this,” she said. “There is no end in sight.”
John Cox contributed to this report.