Staff shortages, COVID patients pushing hospitals to breaking point
In much of the country, the number of COVID cases is falling. The Omicron variant may result in less severe illness, but inside many of the country's hospitals, the work is more demanding than ever.
That's largely because - according to the U.S. Bureau of Labor Statistics - nearly 400,000 health care workers have left since the start of the pandemic. Last month, hospitals in 18 states reported critical staff shortages… including Kentucky.
So two weeks ago, we went to Louisville, a place where the vaccination and infection rate has pretty much mirrored the national average.
We saw ER's that were shorthanded and nurses and doctors who were exhausted. After two years of soldiering through COVID, they told us the pandemic had pushed them and their hospital close to a breaking point.
When we arrived in Louisville, ambulances were rushing to hospitals only to wait almost an hour to drop off patients because emergency rooms were full. The hectic pace of treating cardiac cases and accident victims was pushed to new levels by another wave of COVID patients needing treatment.
Sharyn Alfonsi: How quickly does it go from busy to insane?
Alyssa Parra: A matter of minutes. We can have, you know, no patients signing into triage and then look out there and there is ten.
Alyssa Parra is a supervising nurse in the emergency room at the University of Louisville Hospital, one of the largest in the region.
Parra was one of five employees 60 Minutes followed to see how staff shortages were impacting hospitals. We agreed not to identify patients and to stay out of the way. It wasn't easy because patients were parked anywhere there was space. 85% of those hospitalized for COVID in Kentucky are not fully vaccinated.
Alyssa Parra: We are holding admitted patients in the emergency department for days upon days so…
Sharyn Alfonsi: So they are just sitting in the ER because there's not a bed?
Alyssa Parra: Yes.
Alyssa Parra: I feel like everybody is in survival mode. And not only just us in the emergency department. I think the whole hospital is.
Sharyn Alfonsi: What does that look like when you're trying to survive? What does that mean?
Alyssa Parra: How can we take care of patients effectively every single day with the staff that we have?
Parra told us her ER had fewer nurses than at any point during the pandemic. Usually, she'll have about a dozen nurses on a shift. But on the day we were with her, she had just nine other nurses to treat 71 patients in the ER, with 16 more in the waiting room.
Sharyn Alfonsi: Have you had nurses quit that work for you?
Alyssa Parra: Yes.
Sharyn Alfonsi: Tell me about that.
Alyssa Parra: You know, some of them have got to a point, you know, where they have stepped away. And, you know, they've, you know, moved on and said, you know, "I-- I need a break from this. I, you know, mentally I just need a break." We just keep putting one foot in front of the other and, you know, trying to take it day by day and I just try to bring positive energy every day.
Sharyn Alfonsi: How hard is that right now?
Alyssa Parra: Difficult, and it's-- it's getting more difficult each day.
The contagiousness of the Omicron variant has stretched the staff further. Last month, 450 employees called in sick on the same day.
Dr. Jason Smith is trying to fill the holes. He's the hospital's chief medical officer and a trauma surgeon.
Dr. Jason Smith: We had an entire wave of nurses and physicians who'd worked for 25, 30, 35 years, they said, "I-- th-- I'm done. I'm not gonna-- I'm not gonna do this anymore." And they left.
Sharyn Alfonsi: Somebody quits. It's not like replacing a fry cook.
Dr. Jason Smith: And therein lies the issue, you know? If you think about-- a nurse, on average it takes four to five years to train a nurse. It can take eight to 12 years to train a physician or a surgeon. So if you turned on the tap today and said, "I'm gonna double the amount so that we have enough," we still won't have enough for four or five years.
Sharyn Alfonsi: It seems like you're describing a system at its breaking point.
Dr. Jason Smith: I think we are. And I think that's the biggest worry I have. Are we gonna have a system that we can't support after this pandemic is over?
Dr. Jason Smith: What we expect when we come to the hospital is there's gonna be a physician, and there's gonna be a nurse, and they're gonna take care of me. But in the future, that may not look that way. We're gonna have to rethink how we care for individuals in the hospital moving forward.
Up on the 7th floor, we met Amanda Swinney in the ICU. As a respiratory therapist, her job is to help people breathe.
But over the last two years, she says she's barely had a chance to breathe herself. On this day, she was darting among 40 patients. Almost double her normal workload.
Sharyn Alfonsi: When you have a COVID patient who comes in, not vaccinated, are you thinking now like, "It didn't have to be this way."
Amanda Swinney: I do get a sense of, "Wow. Had you chosen a different route, then we wouldn't be where we are now." It's just frustrating. It's frustrating when there's something out there that can keep you from dying, it can lower your odds of being hospitalized, and having severe disease. I just don't understand why more people don't.
Swinney told us that sometimes she feels numb.
Amanda Swinney: There's, like, this thing called compassion fatigue where, you know, I feel like I gave so much those first, like, nine months, and got so close to so many patients that we lost, that now I almost can't do that. It's just too much loss, I guess.
Sharyn Alfonsi: some of the nurses have described it like a war zone. But in a war zone, right, they-- they change out the frontline every so often.
Amanda Swinney: Right. Right. We can't-- we can't get away from it. We can't work from home. We can't do virtual. You know, we have to show up. And it's just,- it just keeps coming, it just keeps coming.
Sharyn Alfonsi: Is this the new reality?
Amanda Swinney: I don't know. I'm not sure. I don't know that I could, in another year, keep up this pace.
Hospitals in Louisville have been working together so they don't have to turn away patients, but staff shortages in other parts of the country have forced health systems to cancel elective surgeries, temporarily close parts of maternity wards or leave hospital beds empty.
Nurses are often the backbone of those hospitals. In a survey last fall, the Kentucky Nurses Association reported one in four nurses said they were likely to quit their job in the next three months. Delanor Manson is the CEO of the association.
Delanor Manson: When you think about nursing as being 53% of the health care workforce, those are large numbers. You have to know that there was a nursing shortage prior to the pandemic. The pandemic has ripped off the bandage.
Delanor Manson: They're overworked. They have to do things that it doesn't take a nurse to do.
Sharyn Alfonsi: Like what?
Delanor Manson: Baths. Walking patients. Turning patients. But someone else could do that; it doesn't take a degree or a license to do those things.
That work is important for patient care and is usually handled by aides, now they're in short supply too. So in some hospitals, nurses have had to mop floors or empty trash.
Julia Anderson: As soon as you transfer a patient or discharge a patient, it's not five minutes later you're getting another patient. That's a drink and a potty break.
Julia Anderson is an ICU nurse. She was just 19 when she began her career in 2020. Anderson had graduated high school early, enrolled in a fast-track training program and was quickly assigned to treat the sickest COVID patients.
Sharyn Alfonsi: I imagine there's nothing they can teach you in nursing school to prepare you for this moment.
Julia Anderson: No. Not at all. I mean, they didn't teach you that you would have to zip up your first body bag. I-- I still remember the first patient's name. The first room. What happened and everything. And that was hard.
The frequency of COVID deaths here has declined, but the stress hasn't. Anderson says nurses are increasingly being confronted by angry patients. Some of them, enraged by the long waits for care.
Julia Anderson: Last week, I had a patient put her hands on me after cussing me out for probably ten minutes. Put her hands on me and pushed me as hard as she could. I've been called every name under the book.
Sharyn Alfonsi: You have?
Julia Anderson: Oh my goodness, yes. In one ear, out the other ear. You know--
Sharyn Alfonsi: Really? That doesn't bother you?
Julia Anderson: It used to.
Sharyn Alfonsi: Yeah.
Julia Anderson: It used to bother me really bad. I mean, I've-- I've cried before at some of the names I've been called by family members, by patients. But now, I guess I'm immune to it.
Sharyn Alfonsi: Does anybody who's not in that room, in that hospital understand truly?
Julia Anderson: I tell my mom all the time, "I wish you were a fly on the wall for one shift. But until you can get somebody who goes through it with you and has a patient pass in one room. And then the next patient's on their call light saying, "You forgot to bring me my water. You told me you would 45 minutes ago." And you put on a face and you say, "Yes, ma'am, I'm so sorry. I'll bring you that water," knowing that you are about to cry. You are about to let it out. But you can't.
We got a sense of that when we met Krystal Totten. She works with patients who need ECMO – a machine that oxygenates blood outside the body and is used when lungs are too weak to do the job. Last September, a fellow nurse and friend, Becky Fulks, became one of her patients when Fulks became sick with COVID.
Krystal Totten: I remember just, like, you know, just breaking down because seeing somebody at their worst point, you know, not knowing if they're gonna live or die is, you know, is very-- is very hard.
Fulks is a heart and lung nurse. She was vaccinated and working through the pandemic.
Sharyn Alfonsi: She was in bad shape when you saw her?
Krystal Totten: Oh, she-- yeah. So for a patient to need to go on ECMO, it's a last ditch effort. It's a maximum form of life support.
Last month, Becky Fulks began to improve. She was taken off the ECMO machine, but still has a tracheostomy tube. It's unclear if the 49-year-old mother of two will ever get back to nursing.
Sharyn Alfonsi: What does Becky's story tell us about all the nurses?
Krystal Totten: It's weird to say, she's one of the lucky ones-- who have fought through this. You're putting yourself and your family at risk, you know, every day to take care of people. Even people who-- I've had people look me in the face and tell me it's not real and that they're putting chips in your body.
Sharyn Alfonsi: That has to be hard as a nurse.
Krystal Totten: It's-- it's really hard.
Sharyn Alfonsi: Especially when your friend's down the hall.
Krystal Totten: It's-- it's very difficult. It feels like a slap in the face.
Dr. Jason Smith: This is our story, but you could take this story to New York, Chicago, LA, Phoenix, you know, Atlanta. You will hear this story at pretty much every hospital, every healthcare system across the country right now.
We invited Dr. Jason Smith's colleagues from the two other large medical systems in Louisville to join our conversation. Dr. Steven Hester is chief medical officer with Norton Healthcare. And Dr. Chuck Anderson is with Baptist Health.
Sharyn Alfonsi: Raise your hand if you're hiring at least 50 nurses right now, open positions. (LAUGH) At least 50.
(VOICES) Yeah.
Dr. Chuck Anderson: If-- if they walk in tomorrow, we'll take 'em.
Sharyn Alfonsi: You'll take 'em. A hundred?
Dr. Chuck Anderson: Yes.
Dr. Jason Smith: Yeah.
Sharyn Alfonsi: 150? 150 nurses you're looking for?
Dr. Chuck Anderson: Pre-pandemic-- I think we all had a buffer. I think our buffer is a fine line right now, and that's what's making it difficult.
The supply of nursing school graduates is also falling short, leaving hospitals without enough reinforcements.
Although applications to nursing schools are up, record numbers of prospective nurses are being denied admission because there aren't enough instructors. Last year, 1,700 qualified applicants in Kentucky were turned away from nursing schools because of the lack of teachers.
Dr. Jason Smith: This pandemic will end. All pandemics end. But it's the carry-forward from what we're having to do, and the amount of human capital that we're burning through right now, that are gonna impact the health care system for the next two, five, 10 years.
And a wave of 70 million aging baby boomers is about to flood American health care. Doctors, technicians and an estimated 270,000 new registered nurses will be needed to help care for them, according to the Bureau of Labor Statistics.
Sharyn Alfonsi: Why do you think we haven't been talking about what's next?
Dr. Jason Smith: Well it's a difficult conversation to have. It's not right in front of your face. This is what's the chronic problem? How am I gonna manage the chronic problem? And in healthcare managing chrob-- chronic problems are often much more difficult than, you know, the-- the acute problem. What we're seeing now in a pandemic may become an everyday occurrence, and that's not something that we can sustain for decades.
Produced by Guy Campanile. Associate producer, Clare Hymes. Broadcast associate, Elizabeth Germino. Edited by Warren Lustig.