Iowa hospitals face staff shortages amid latest COVID-19 surge

As new coronavirus cases surge in Iowa and hospitals contend with COVID-19 admissions at levels not seen since the vaccines became widely available, local health care officials are preparing for the worst.

They aren’t worried about having enough beds, and there’s plenty of personal protective gear to go around.

Their most precarious resource? The health care staff.

Since Mercy Medical Center in Cedar Rapids reopened its COVID-19 floor two weeks ago, Trent Thompson has seen the latest surge firsthand. As a medical intensive-care unit shift supervisor, Thompson often has added extra hours onto his 12-hour shifts to help care for critically ill patients.

And he’s not alone. He said some of his co-workers work 12-hour shifts six or seven days a week. He knows of nurses who developed kidney stones because they don’t have time to take off their personal protective gear to have a drink of water.

“That makes a lot of us question what we're doing, why we're doing it and if this still is something that we want to do,” Thompson said.

Local health leaders say they are concerned about the pressure on their staff through this latest deadly phase of the pandemic. As cases continue to spike, it’s becoming more likely that the hospital’s ability to maintain enough staff capacity to care for all patients during this period is at risk.

Hospitals already strained

The number of hospitalizations rose to 524 as of Thursday, from 498 the week before, according to the Iowa Department of Public Health data. That’s the highest hospitalization rate since Jan. 14, when 532 patients were admitted for COVID-19.

Patients in the ICU and on ventilators statewide also was at their peak since December. As of Thursday, Iowa had 143 ICU patients and 66 patients on ventilators.

Already, some Iowa hospitals are feeling the strain.

Genesis Health System reported earlier this week that their hospitals in Davenport and Silvis, Ill., had no ICU beds available.

Hospitals in Des Moines, including Iowa Methodist Medical Center and UnityPoint Health-Iowa Lutheran Hospital, also have reported they have hovered around or above their ICU bed capacity for “multiple weeks.”

Increased patient counts is not just driven by COVID-19. Dr. Tony Myers, Mercy Medical’s chief medical officer, said the Cedar Rapids hospitals — as well as hospitals across Eastern Iowa — are seeing an increased census of other critical patients with pneumonia, heart attacks, injuries from accidents and other conditions.

The current pressure on hospitals also ties back to a challenge the health care industry has been dealing with for some time, noted Dr. Dustin Arnold, chief medical officer at UnityPoint Health-St. Luke’s Hospital. Facilities continually seek out candidates to fill open nursing and other staff positions, but very few applicants apply for the work.

“As an industry, we’ve had very little turnover,” Arnold said. “There’s open spots and no one to hire.”

Hospitalizations statewide, locally increased from last week

Maintaining enough staff to care for an increased number of critically ill patients has been a constant worry throughout the past 18 months. While Iowa’s hospitals are not as full as they were this past fall, the latest spike has officials worried.

On Wednesday, UIHC reported 41 COVID-19 admissions, including 36 adult patients and five pediatric patients.

In Cedar Rapids, Mercy Medical had 31 COVID-19 patients and St. Luke’s was caring for 26 COVID-19 patients as of Thursday.

Linn County reported 699 new cases as of Thursday, according to state coronavirus data. The seven-day average reached 100 cases — the highest since Dec. 8, when the seven-day average was 108.

Eleven percent of tests in Linn County were positive, an increase from the 8.8 percent a week before.

Johnson County reported 340 new cases Thursday. The seven-day average for cases was 49, the highest since Jan. 18.

More than 8 percent of Johnson County’s COVID-19 tests came back positive this past week, an increase from the nearly 6 percent rate the week before.

The need for intensive-care beds across the state will continue to grow, peaking at nearly 400 beds in October, according to projections from the Institute for Health Metrics and Evaluation, based at the University of Washington.

“All of us are fearful of that again,” Thompson said. “We don’t want to open up another COVID floor, we don’t want to house 60 patients like we did in October and November.”

Limited opportunities to expand critical care staff

Only one Iowa hospital was reporting a shortage of PPE as of the week ending Aug. 25, according to the latest report from the White House COVID-19 task force. Hospitals also have enough beds — the issue is finding the staff to care for the patients in those beds.

Opening a new unit to care for COVID-19 patients creates a ripple effect throughout the rest of the hospital, Thompson said.

“We have to pull ICU nurses away from the ICU to the COVID-19 floor because you have to deal with ventilators, high flow oxygen and that type of stuff,“ Thompson said.

”I also have to pull medical surge nurses off the floor, too, because then they take care of the non-intensive care patients that are on lower oxygen requirements. But then that also depletes all the other units from nurses, too.“

Myers said it is possible to cross-train some staff from across the hospital to take on other roles, but those opportunities often are limited.

“What is very clear is that you can’t just take a regular nurse and make them an ICU nurse,” Myers said. “When we’re talking about highly skilled nursing staff, you can’t cross-train into that.”

Hospitals can rely on traveling nurses to help fill those gaps. However, many hospitals across the country are relying on that scarce resources as the nation experiences the latest surge.

Cedar Rapids hospitals have been limiting the number of nonemergent procedures for months now. Further limiting that type of care may be more likely if the surge continues to progress — but local health care leaders say they hope to avoid that possibility.

“Colon cancer is still there even if colonoscopies are not happening,” Arnold said.

The best way to avoid overwhelming hospitals is for more Iowans to get vaccinated, hospital officials said. In addition, everyone should wear masks, social distance and practice other public safety measures.

When the COVID-19 vaccines first were distributed earlier this year, health care workers in Eastern Iowa described it as the light at the end of the tunnel of the pandemic. While it’s becoming increasingly clear the pandemic is far from over, the vaccines have provided some respite from the virus for health care facilities.

“I shudder to think what position we’d be in if more than 60 percent of the population was not vaccinated,” Myers said. “It’s clearly effective in keeping people out of the hospital.”

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