Hospitals are running out of staff

Staffing at rural hospitals can be difficult even in the best of times. Over 60% of the areas defined by the federal government as lacking sufficient medical personnel are rural. COVID-19 often adds to the burden.

“For rural hospitals, if one of your nurses needs to be quarantined due to COVID, and then another nurse or a physician needs to be quarantined, you suddenly find yourself in a situation where you don’t have minimum staffing levels anymore,” said Michael Topchik, national leader for the Chartis Center for Rural Health.

That is what happened to the Northern Rockies Medical Center located in Cut Bank, Montana.

“In March, we lost five of our floor staff, and our floor staff is only about 12 to 14 people,” said Cherie Taylor, the CEO.

Cut Bank is a town of about 3,000 located 30 miles south of the Canadian border, and Northern Rockies is a “critical access” hospital, a federal designation for hospitals that have no more than 25 beds and are located more than 35 miles from any other hospitals. Medicare reimburses critical access hospitals for 99% of the cost of treating Medicare patients. Critical access hospitals are known for having small staffs.

Northern Rockies’s staff were infected with the coronavirus because they lacked personal protective equipment to protect their eyes when treating a patient who was not wearing a mask.

“We were literally taking people out of their offices in the hospital and putting them in scrubs to help,” said Taylor. She assigned office staff to take care of registration and paperwork normally handled by floor staff.

“My chief nursing officer was working a crazy amount of hours per day just to get everything covered and help support the floor and patients. She was also doing hospital laundry on evenings and weekends,” Taylor added.

Rich Rasmussen, president and CEO of the Montana Hospital Association, said that it is much harder for rural hospitals to fill staff positions during a crisis than hospitals in more urban areas.

“It is hard to get [substitute staff] even in an emergency like this to pick up and move from, say, Florida to come to … Cut Back to provider emergency coverage for staffing needs,” he said. “The ability to effectively manage the pandemic in Montana is much more acute than for urban hospitals, which often have a deeper bench of personnel and where the supply of personnel isn’t as restricted as it is when you have to drive four to five hours from an airport.”

Sometimes, COVID-19 can close down the entire department of a critical access hospital. That’s what happened in the hospital that is part of the McKenzie County Healthcare System in Watford City, North Dakota, according to Chief Administrative Officer Mike Curtis. McKenzie County has a population of over 6,300 and borders Montana on the west.

Curtis wouldn’t say specifically which department it was, but he did say the hospital had to reschedule certain patient procedures. “It had a pretty notable impact,” he said.

He noted the stress that COVID-19-related staffing shortages can have on hospital personnel.

“Many of them work a good deal of overtime, and they end up in areas that they are less comfortable with because they’ve been moved to another department,” Curtis said. “There is also the uncertainty that comes with not knowing who might get COVID next. Overall, our staff have done a bang-up job.”

A final challenge rural hospitals face handling the pandemic is that they often have no intensive care beds to treat sicker COVID-19 patients. That is the case for both Northern Rockies Medical Center and McKenzie County Healthcare System. That means transferring acute COVID-19 patients to large hospitals.

“We’ve transferred more patients than we’ve kept,” said Taylor. “We don’t have the advanced life support needed to transfer by ambulance on the ground. So, we had to do it by air, and that has been a huge chore.”

She added that many of the larger hospitals in North Dakota are seeing large increases in coronavirus patients and so are now asking her to keep COVID-19 patients at Northern Rockies if possible. In the last week, the number of COVID-19 patients in North Dakota hospitals rose from 105 to 166, and those in the ICU increased from 16 to 27.

It is much the same in Montana, where the number of COVID-19 hospitalizations jumped from 166 to 216 in a week.

Curtis said the facilities often transfer patients to Trinity Health in Minot, or Sandford Health or BHI in Bismarck.

“Lately, all three of those facilities are getting pretty full,” he said.