Nurses at Anchorage’s three big hospitals are working long hours under burnout-inducing pressure as the state’s coronavirus pandemic surges into new territory.
As their colleagues fall ill or quarantine, some nurses here say they are spending more time on patient care with less help, struggling to get tested, and at times overwhelmed by the rigors and emotional strife of treating patients cut off from family due to coronavirus precautions.
They describe levels of burnout and stress far beyond the usual for a job that’s always required resilience but now has the added intensity of treating seriously ill COVID-19 patients.
All three of the large hospitals in Anchorage say they’re working to make sure patient care doesn’t suffer. But the state’s hospital association is reporting major staffing issues and challenges transferring patients from rural Alaska, where new cases are rising at disproportionate levels to the rest of the state.
Unless Alaskans start limiting gatherings and wearing masks, health authorities say, there’s no indication the daily high case counts, rising hospitalizations and deaths are going to slow.
Teanna Hehnlin, a nurse for almost 15 years, has worked with COVID-19 patients at Providence Alaska Medical Center since the pandemic began here in March.
Hehnlin, a 37-year-old from Chugiak, said patients with the virus require more nurses for the same number of patients because of the time it takes to treat them. And the virus is compromising nurse and other staff numbers as people get sick or get exposed to infected patients or people in the community. She sees nurses working a lot of extra shifts, team leaders getting pulled into floor charge shifts or even treating patients.
But Hehnlin says in her experience, the hospital is “being diligent” to make sure nurses have everything they need.
What takes a toll on her psyche, she said, is going from caring for dying COVID-19 patients to a community where some people downplay the risks of a virus known to cause lengthy ICU stays, stroke or irreversible lung damage, and suffering for family and friends mourning those who don’t survive.
“People scoffing at the masking mandates and not wanting to do their equal parts and saying it’s a hoax, that doesn’t feel good,” she said. “We’re in here holding the hands of patients as they take their last breaths.”
Overworked and understaffed
Even Alaska’s top health officials acknowledge there aren’t enough nurses in the state to staff existing hospital beds, never mind any overflow centers authorities might open if patients max out health care capacity. Limited staffing in Alaska’s “brittle” health care system prompted Anchorage officials to enact a hunker-down order for the month of December.
Nurses say the problem is reaching critical levels.
One Anchorage registered nurse said the staffing crisis hit home when her young child got sick and spiked a fever. She prayed her pediatrician wouldn’t recommend a trip to the ER — at the hospital where she works. She trusts the providers with her life, she said, but they’re overworked and understaffed.
“It’s bad. It’s really bad,” the nurse said. “It’s a lot worse than the hospitals want the public to know.”
She was one of 11 nurses interviewed for this story. Most did not want to be identified because they feared they’d face workplace retribution or lose their jobs.
Longtime RN Donna Phillips, labor representative for the state nurse union, is familiar with most of the nurses interviewed and supports their contention that Anchorage’s hospitals are being bombarded with patients of all kinds right now and they aren’t keeping up.
Administrators should be doing more to increase nurse numbers, given the CARES Act funds they’ve received, Phillips said. They’re also still choosing to perform lucrative elective procedures that tie up resources.
But the public also needs to take responsibility to reverse the ongoing COVID-19 case trends threatening to overwhelm the state health care system by wearing masks and social distancing in public, she said, recalling a nurse on a staff meeting call this week who picked up food at an Anchorage restaurant. It was packed. No one was wearing a mask.
“Obviously the workload is increasing,” Phillips said. “And the frustrations nurses are feeling about what people aren’t doing to protect themselves — it’s tough.”
Like many of their counterparts around the country, nurses here say they’re working amid labor shortages because hospitals are struggling to recruit and keep nurses.
That’s especially true in Alaska, where the isolation further complicates the challenge of employee retention. Travel nurses, often used to supplement regular staff, are hard to lure here especially with winter coming and high COVID-19 demand in the Lower 48, closer to their families. They can make $8,000 in a week on a contract elsewhere, hospital officials say.
The virus itself is having an obvious impact, increasing patient loads while eroding staff numbers.
Alaska’s coronavirus cases are surging, topping 500 most days. By the weekend, the state ranked 15th nationally for the seven-day average of new cases per capita. Hospitals are filling up in response to the new pressure. Nearly a fifth of the adults hospitalized around the state were COVID-positive as of Saturday.
Providence Alaska Medical Center, the state’s largest hospital, recently acquired a refrigerated trailer to use as a temporary morgue if necessary in light of rising case numbers.
The virus cuts into staff numbers as well. An informal poll of health care facility administrators earlier this month revealed more than 530 medical employees were unable to work due either to a positive COVID-19 test, exposure to a positive person or travel-related quarantine.
Nearly 232,500 health care workers across the country have tested positive for the virus and at least 836 have died with it, according to the Centers for Disease Control and Prevention.
Testing nurses for COVID-19 makes sure they aren’t getting sick and also lowers the risk they might infect patients. But, like many of their counterparts in other states, nurses at Providence and Regional are not regularly tested.
And it can take up to seven days to get test results, a long time to stay out of work with symptoms that could be stress, allergies, dehydration -- or COVID-19. An exposure can put a nurse out of work for 10 to 14 days.
The bigger problem is the challenge of maintaining staffing levels while navigating protocols for nurses potentially exposed to the virus outside of work, given the soaring case counts in Anchorage, where the state’s largest hospitals are.
“If there’s anything that these nurses want, it’s for the community to wear their masks. Please,” one nurse said. “Because we do not have the capacity.”
‘Strapped for staffing’
A number of the nurses interviewed for this story said they felt their employers ignored concerns about staffing and safety issues. One described a 12-hour shift that was so busy she didn’t have time to fill a water bottle, much less take a lunch break.
“I would definitely feel better if we weren’t so strapped for staffing,” said another nurse who works in critical care and has young children. “We’re frequently getting text messages saying ‘Hey, we’re really desperate for nurses to come in and help.’ I’m a team player ... but at the same time I am stretched super super thin trying to keep myself, my family afloat at home.”
Some say the job, which is always stressful, is no longer worth the pay.
“I am as well as others in ICU are burnt out and actively looking for other employment,” another nurse said in an email, expressing frustration over managers ignoring her training recommendations and having unrealistic patient care goals. “(J)ust not seeing an improvement is overwhelming and disrupts my work/life balance.”
Alaska has health care limits that become more critical when needs surge, state health officials acknowledge.
“The hospitals have been trying very hard to stay ahead of this in many, many different ways,” Dr. Anne Zink, the state’s chief medical officer, said during a briefing earlier this month. State health officials hold weekly meetings with hospital CEOs and the state hospital association, Zink said.
Home-monitoring systems and oxymeters can limit the numbers of people coming to the hospital with COVID-19 by allowing patients to stay home unless their condition worsens, she said.
Only one of the city’s three hospitals — Alaska Native Medical Center — is broadly cutting back on elective procedures to ration staff numbers.
Level of care
Hospitals in Anchorage, where the state’s sickest patients often end up, acknowledge they are at times struggling to staff intensive-care beds now, never mind additional beds that might be needed if surging hospitalizations prompt the need to open alternate care centers at Anchorage’s Alaska Airlines Center or the Carlson Center in Fairbanks.
But for now, they say, they are keeping up with patient loads.
Representatives for the three main hospitals in Anchorage say patient care hasn’t suffered.
“Our staffing ratios are determined by the patient’s needs,” said Shirley Young, a spokeswoman for Alaska Native Medical Center, a nonprofit 173-bed health center that provides medical care for the Alaska Tribal Health System.
“We have maintained the same high level of care,” Young said.
At Providence Alaska Medical Center, staffing ratios are similar to what they were a year ago, “though we have provided additional resources on some units when needed related to additional COVID workload,” said Mikal Canfield, a spokesman for the 400-bed hospital that’s part of a nonprofit Catholic network.
“Patients with COVID and patients who could potentially have COVID are provided care in the same units,” Canfield said in an email. “Within these units, we follow strict infection prevention best practices to keep patients and caregivers safe.”
Alaska Regional Hospital, a 250-bed facility operated by national chain HCA Healthcare, is “looking at creative ways to extend the nursing skill set” and considering alternate care models while still ensuring patient safety, spokeswoman Kjerstin Lastufka said in an email.
The hospital has “slightly modified” the skill mix by adding nurse assistants to the existing RN pool, Lastufka said.
“It is always dependent upon patient acuity and care needs,” she said.
‘A crunch coming’
Several of the nurses interviewed for this story, however, said they have seen staffing ratios change.
“I can see a crunch coming toward us,” one Anchorage medical-surgical nurse wrote in an email.
The ratio on their floor shifted from four patients for every nurse to six patients for every nurse plus one nursing assistant, who can’t administer medications and do other tasks that RNs can, the nurse said. Many patients are bed-bound and supposed to be turned regularly to prevent bedsores but it’s hard to find time or an extra pair of hands to assist.
“So, we can’t turn them every 2 hours and do everything we need to do and do it safely,” the nurse wrote.
Another nurse who works with COVID-19 patients described a ratio of one nurse per three patients, partly because it takes so much time to put on and take off PPE each time. But the last time they worked on that floor, the nurse was responsible for two COVID-19 patients and two non-COVID patients.
“This was concerning to me for several reasons," the nurse said in an email. "One patient has been battling cancer and would be at a very high risk for mortality from covid. I also did not feel that patients were even aware that covid patients also existed on that floor let alone that I was working with them simultaneously.”
Generally, nurses say, more RNs who can sign off on certain high-risk medications and are dedicated to the ICU are needed in Anchorage hospitals, not just assistants, especially given the new pressure of dealing with COVID-19 patients.
“Hospitals tell you (their) staffing hasn’t changed but the acuity of what we’re doing is higher because of all the PPE required for every single patient,” Phillips said. “It’s fine to say we’re good, we didn’t do anything differently but you’ve got to do something differently. You’ve got to do something better.”
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