COVID-19 Nurse Staffing Demand Increased 245% During Fall Surge

Hospitals experienced increased COVID-19 nursing staffing demand, as well as ICU bed occupancy, during the fall surge of new coronavirus patients, according to new data published in the Epic Health Research Network.

COVID-19 nurse staffing demand increased by 245 percent, or about 50,000 nurses, from September 2020 to December 2020, the new journal of studies leveraging data from hospitals using Epic Systems products revealed.

The data from 183 unique healthcare organizations representing 809 hospitals using Epic’s Pulse Central portal showed that 77,500 nurses directly cared for COVID-19 patients each day during the period, up from just 22,500 nurses in mid-September.

COVID-19 nurse staffing demand was on the higher side for hospitals operating in metropolitan and rural areas, with rates nearly double that of suburban hospitals - 249 percent, 282 percent, and 131 percent, respectively.

Demand increased as more than 100,000 patients were hospitalized with COVID-19 by early December 2020, the analysis explained. The milestone hospitalization rate put significant stress on the healthcare system, which also experienced a substantial increase in ICU bed demand.

About 90 percent more hospitals reached ICU capacity (80 to 100 percent occupancy) during the fall of 2020. Rural hospitals with smaller ICUs reached capacity more quickly, the analysis showed.

More rural hospital ICUs were at capacity from September 2020 to December 2020 compared to previous periods during the ongoing pandemic, including from July to early October when most rural ICUs were at 0 to 20 percent capacity.

Rural ICU staffing also increased the most compared to metro and suburban hospital demand, rising from 46 percent since mid-September, the analysis found.

ICU staffing increased by just 24 percent in ICUs of hospitals operating in metro and suburban areas.

Hospitals, however, are finding themselves coming up short, particularly when it comes to qualified healthcare professionals to care for a growing number of hospitalized COVID-19 patients.

About a fifth of hospitals were experiencing a staffing shortage in mid-November, according to recent HHS data. And that percentage was up from 19 percent earlier that month.

Key COVID-19 metrics, including new cases, hospitalizations, and deaths, have generally gone up since that time, prompting researchers at the COVID Tracking Project to declare December 2020 the deadliest month since the beginning of the pandemic in the US.

Providers across the country are bracing for a surge of new cases after the holidays and scrambling to bolster staffing as hospitals near ICU capacity.

Some providers are calling on healthcare organizations and lawmakers to prioritize adequate nursing staff during this time.

Nurse understaffing has been a challenge for healthcare organizations since before COVID-19 hit. Hospitals and health systems oftentimes staff a skeleton crew of nurses in an effort to cut costs quickly since labor tends to be an organization’s largest expense.

But this has resulted in nurse burnout and poorer clinical outcomes, research has shown.

“We do not yet know how variation in hospital nurse staffing has impacted patient deaths during this unprecedented crisis. We do know from our data that the needed nursing care surge required to treat patients with COVID-19 is being created from a deficit status quo in which the nurse workforce was already emotionally depleted prior to the surge in patients with COVID-19,” says lead author of the research Karen Lasater from the Center for Health Outcomes and Policy Research at the University of Pennsylvania.

Healthcare organizations are having to be flexible with staffing to meet demand and alleviate shortages of key providers. At NYC Health + Hospitals, for example, flexibility was key to implementing new processes and tools to ensure an adequate workforce during the initial surge of COVID-19 in New York.

“To care for an immense wave of critically ill COVID-19 patients, NYC Health + Hospitals had to develop new systems and tools to redeploy, recruit, onboard, and train thousands of staff and volunteers in record time,” Chris Keeley, assistant vice president at the Office of Ambulatory Care, wrote in a June 2020 Health Affairs report.

Among the new systems was a single-source onboarding portal to streamline the addition of new staff. The health system also created three new staff positions to facilitate communication about staffing across different parts of the organization and implemented training technology to inform staff of protocols as quickly as possible.

“Clear and ongoing communication among members of the cross-departmental teams—along with the creativity and flexibility of IT staff—were essential to the smooth and effective operation of the new systems,” Keely stated.

During the start of the pandemic, Nebraska Medicine also leveraged technology to better manage float pools for staff. The system tracked productivity data using the technology to direct staff to areas most in need of providers, including sending outpatient surgical nurses who could not facilitate elective procedures to other parts of the health system.

“Our thought was we have not had to furlough anybody yet and we really don't want to,” Kristi Atkinson, budget and cost accounting manager at Nebraska Medicine, said in an interview with RevCycleIntelligence. “We were looking at what could we do differently, who could we shift around to preserve as much as we can, knowing that this is our new normal. This is not a short-term challenge.”