NEW ORLEANS – Louisiana hospitals are in a state of concern fueled by critical staff shortages and an astronomical number of new COVID-19 infections. The state, in which only 40% of residents are fully vaccinated, is averaging nearly 6,000 cases a day, straining urban and rural hospitals alike. From Baton Rouge to Bogalusa and Natchitoches to New Orleans, every hospital needs front-line staff.
What’s different this time around is there are rooms and beds, but not enough trained people to deliver bedside care. While many facilities are running low on beds, it’s not a lack of space that is the problem. Instead, it is a people problem that is leaving patients stranded.
“It’s a real dire situation,” said Dr. Joe Kanter, Louisiana’s chief public health officer. “There’s just not enough qualified staff in the state right now to care for all these patients.”
The Bayou State shattered its record for the number of COVID hospitalizations for 16 days straight in early August. Last week that fever finally broke when the numbers dipped slightly. Still, more people are hospitalized now than at any other point during the pandemic. Hospitals can barely handle this fourth surge.
“Our health care professionals need a break. They are completely exhausted, and that’s physical exhaustion, mental exhaustion, emotional exhaustion. And things are getting tougher, not easier,” said Louisiana Governor John Bel Edwards at a coronavirus briefing Friday.
Recently, during Kanter’s emergency room shift, a heart attack patient was bounced from six different hospitals before finding an emergency room in New Orleans that could take him in.
Last week, Ochsner Health, the state’s largest hospital system, canceled 1,160 surgeries and procedures due to staffing shortages.
“Staffing is absolutely an issue,” Ochsner CEO Warner Thomas told the PBS NewsHour. Even after opening seven new COVID units in the last two months, the medical facility has had to turn down transfer requests from 150 patients from 90 different facilities last week.
“We’ve had some living donor transplants that we’ve put off until we have more bed availability and resources to care for them,” Warner said. “When you have to put these things off, care is affected for lots of individuals. Right now, we’re very busy taking care of the COVID patients.”
Redeployment of resources
As cases are surging, pulling staff from other states is next to impossible, especially along the Gulf Coast, where every state is experiencing a surge in hospitalizations. Unfortunately, this most recent surge is even worse than the darkest days of the winter. Ochsner, for example, redeployed 800 team members from across its system.
At Ochsner’s main campus in New Orleans, 150 physicians work several 12-hour shifts as nurses’ aides. Some empty trash cans or draw blood. Others flip patients or deliver medicine. All are volunteering for different jobs than what they usually do.
“We’ve shut down a lot of our procedure areas and moved those staff members into bedside care areas to help out on the floor or in the intensive care unit,” said Dr. Robert Hart, Ochsner’s chief medical officer and executive vice president. “We’ve even gotten some of our surgeons to come in and be another set of hands for our nurses.”
Dr. Brian Moore is a surgical oncologist and medical director of the Ochsner Cancer Institute. There have been days when the surgeon is operating in the morning and changing bedpans at night. He’s been working a rotation between surgeon and nurses’ aide for two weeks.
“There are a lot of folks who are getting worn down by the constant barrage of COVID, and so whatever we can do to show support, whatever we can do to help is meaningful,” Moore said.
For Dr. David Houghton, a neurologist, standing side by side with nurses after a tortuous 18 months is a point of pride. It was also an opportunity to tear down some of the hierarchy found in medicine and be part of the team.
“When we arrived on the floor, my white coat came off. I was in scrubs like they were. I wasn’t Dr. Houghton anymore. I was David,” said Houghton, who also is the Ochsner vice-chair of neurology movement and memory disorders.
“I’m also sure [the nurses] found quite a bit of humor in it. To see the physicians that ordinarily would be in quite a different role coming into the floor to be doing those things like helping a patient on and off a bedpan and helping with mealtime.”
The redeployed staff has been a welcomed source of help. However, nurses have been stretched thin for much of the pandemic, and the latest wave is nearly unbearable.
The Louisiana Department of Health reports there were only 275 COVID patients in Louisiana hospitals three months ago. Today, there are nearly 3,000 hospitalized. Ninety-one percent are unvaccinated according to the state, a fact that is having a significant impact on nurses.
Because Louisiana continues to be a virus hot spot, it has become increasingly difficult for the state’s health-care workers to keep up with the flood of patients. As a result, hospitals are losing nurses and other workers to burnout or to lucrative, better-paying out-of-state temporary gigs while others are getting sick themselves, putting significant stress on the entire healthcare system.
A pre-pandemic report by NSI National Health Care Retention and RN Staffing in January 2020 showed demand for nurses and allied professionals outpacing supply and warned “a major crisis is evident and deteriorating.” In Louisiana, it’s been a problem for the last 20 years. Nurses are aging out of the system faster than they can be replaced. It was made worse by the pandemic.
“People are just really trying to maintain hope and looking ahead to a day where we are no longer in this position, but it is really hard,” Ecoee Rooney, president of the Louisiana State Nursing Association, told the NewsHour. “People are being asked to work longer hours and more shifts.”
Nurses on the ground in Louisiana say the pandemic is consuming all of the energy of the remaining healthcare workers. Even before the delta variant surge, more than 6,000 nursing positions were open statewide.
A 2020 nurse supply report by the Louisiana State Board of Nursing predicted the nursing shortage would jump from 1,800 unfilled RN jobs in 2019 to 7,200 in 2025. Rooney says there are waiting lists at nursing schools, but there is not enough faculty to train them.
It is why nurses say they are glad to see hospital facilities do what they can to fill the staffing hole.
“When doctors go back to their regular work, they’re not going to forget these experiences of working side by side with nurses at the bedside and understanding the work they do. It will lead to a lot more compassion,” Rooney said.
Making ends meet
In response to the staffing shortages caused by the pandemic, the Louisiana Department of Health is spending $14 million to beef up hospital capacity statewide, hiring health professionals. Fifty-eight hospitals have reached out to the state, saying they are in dire need of staff and can’t provide adequate care.
State and federal teams have also been deployed throughout Louisiana, and they are having an immediate impact.
The Lafayette area, which had just one ICU bed available last week according the the state’s health department, was on the verge of failure until the U.S Navy sent in four physicians, 14 nurses, and two respiratory therapists. It allowed Ochsner Hospital to open 16-18 new beds.
At Children’s Hospital New Orleans, a second federal team arrived this week to assist medical staff confronted with a significant surge in pediatric patients. One in three new COVID cases across the state is among children.
“Our team members have really enjoyed working with this group. They’re not coming here to sightsee. They’re not coming to tell people how to do anything. Instead, they’re saying, ‘where do you need me’?” Dr. Leron Finger, chief quality officer at Children’s Hospital New Orleans, told the NewsHour.
The 14-member federal disaster medical assistance team, or DMAT, consists of doctors, nurses, and other medical professionals who have pediatric ICU experience, and are specifically tasked with helping overwhelmed staff.
“A lot of our team members are leaving their families, their homes, [and] their grandchildren in order to be where we are needed at a moment’s notice. It can be very challenging, but a lot of our families are aware of the commitment to the greater good,” said Paul Decerbo, commander of Rhode Island-1 DMAT. “The bell rings, they all stand up, and they go. There is no hesitation.”
The ripple effect
In rural Louisiana, some patients’ care is delayed so much that things are already at the breaking point. For example, there are no staff or beds available at Our Lady of the Angels Hospital in Bogalusa, Louisiana, 70 miles north of New Orleans.
“It’s very striking as you walk down the hall, especially through the emergency room,” said Dr. Garland Anderson, head of medicine at Our Lady of the Angels Hospital. “We have hallways that are filled with stretchers housing people. In spaces that we would normally use to triage and assess patients, we’re housing them there. It’s full.”
The 35-bed hospital has been at capacity for months, unlike larger hospitals that have only recently been overwhelmed. There is only an available “staffed” bed if someone is released early or dies. Tough decisions must be made.
“Personally, it’s stressful to care for this high number of patients. It’s taxing to myself, my family, my coworkers,” said Garland. “What is heartbreaking in all of this is that this wave is more intense, but it’s also preventable. But, unfortunately, people are not getting the vaccination that could have prevented this.”
Doctors can’t even get sick patients transferred to other hospitals because of staffing shortages. Some wait in the emergency room for two to three days before they can be transported. Even then, it could be a three-hour ride before they find a bed.
What’s worse is that Our Lady of the Angels has just finished a renovation and now has space for 12 new beds. However, the reality is they will likely only open three beds because there’s no staff available.
“We know all these people. If we could just wave a magic wand and get as many beds as we are physically able to, we still need the doctors to staff them. We still need the nurses. There are so many things when you scale up that you need more of,” Anderson said, his voice cracking under stress.