Staffing at University of Iowa hospitals is biggest concern in current COVID wave

IOWA CITY — The current wave of COVID-19 hospitalizations is wearing on the University of Iowa Hospitals and Clinics — although it’s not a lack of beds, or equipment, or personal protective gear that's stressing the system.

It’s a lack of workers and burnout among those it has, as a growing number flee the field and the anxieties that come with it — having had and seen enough, UIHC CEO Suresh Gunasekaran said Wednesday.

“We are nationally having a health care worker staffing crisis,” Gunasekaran told reporters. “In general, with this much hospitalization happening across the nation, all hospitals are having trouble retaining their staff and recruiting staff.

“We've had numerous health care workers across the nation exit the health care workforce, either through early retirement or just wanting to temporarily take a break,” he said. “And that's coming to roost inside of Iowa and inside UIHC.”

UIHC and other hospitals are experiencing capacity challenges with the current COVID wave — which this week has pushed hospitalizations from the virus to 638, an Iowa record for 2021, and left the state with 182 available ICU beds, an all-time low.

But capacity concerns for UIHC aren’t as severe as they were during the initial wave in 2020, Gunasekaran said.

“For us, the red line at UIHC is the ability to preserve our workforce, not the availability of beds,” he said.

“We are not having to turn away patients because of lack of beds at any greater rate than we do year-round. … But what I see as a red line is if we're unable to preserve our clinical workforce that has been working so valiantly for 18 months with this high volume, with this high level of moral and mental distress over the severity of the patients that they're seeing.”

Workers are retiring early. They’re following different, less-stressful career paths. Some have been driven away by long hours. By traumatic experiences. Some of the staffing stresses have to do with worker COVID infections and the need to take time off.

“As the pandemic goes on, we continue to have more staff that are out because they're infected,” Gunasekaran said, noting contact tracing shows few are getting infected on the job.

“But we are finding that our employees — when they're off campus, when they're living their lives — end up getting exposed, quite often to people that they live in the same house with.”

To date, UIHC data shows 1,981 UIHC employees have self-reported a positive COVID test — with nine testing positive Tuesday, for example. Every positive employee must isolate at home, Gunasekaran said — regardless of symptoms or vaccination status.

“And so that is causing a workforce challenge for us, both when the employees themselves have to be at home because they've been exposed,” he said. “But also when they have a loved one that they have to care for that is COVID positive.

“Both of these phenomena are causing staffing challenges for us.”

UIHC, which has about 15,000 employees, actively is trying to hire hundreds — and not just for patient care. The campus needs food service workers, housekeepers, maintenance staff, nursing assistants and student aides.

“Every single member of our health care workforce is really needed,” he said. “And folks across all of these disciplines have options to work in other lines of work that aren't as stressful as health care and being on the front lines of a pandemic.”

UIHC, Gunasekaran said, has and is relying more heavily on agency — or traveling — nurses, which are more costly than staff nurses.

“We have had to hire more traveling nurses, as has everyone in the state,” he said. “But I would say that we have not been able to secure as many traveling nurses as we would like or, for that matter, hire as many new staff as we would like.”

UIHC’s hiring has remained mostly typical this year, according to Gunasekaran.

“What's been our challenge this year is that we have had more folks exit the workforce than normal,” he said. “This is what we call the pandemic effect. The exhaustion, the opportunity to do something different, or just needing to take a break. And each one of those things become really difficult when you're as full as we are.”

UIHC as of Wednesday was reporting 37 adult COVID inpatients and 8 pediatric patients under age 18. The adult numbers are well below last year’s surge, but the pediatric inpatient numbers are up.

Although the breakdown of vaccinated and unvaccinated inpatients is always shifting, Gunasekaran on Wednesday said all UIHC’s current COVID inpatients were unvaccinated. That includes the children.

“The majority are unvaccinated,” he said. “The majority are also of an age where they wouldn't have eligibility to get a vaccine.”

Officials with UnityPoint Health-St. Luke’s Hospital in Cedar Rapids on Wednesday told The Gazette they have 30 COVID inpatients, and numbers have hovered between 25 and 30 for a month.

“These numbers are in addition to the higher-than-expected census at the hospital, which is up about 10 to 15 percent,” spokeswoman Sarah Corizzo said, adding, UnityPoint clinics are “experiencing high volumes of sick patients and requests for COVID-19 testing.”

As for staffing, she said, St. Luke’s has experienced some challenges “with nursing positions and other team members.” But, according to Corizzo, “we’ve made it a priority — throughout the pandemic — to maintain staffing levels necessary to deliver reliable, quality patient care in each of our care settings.”

UnityPoint Health is among the state’s providers requiring its team members to get vaccinated. MercyOne in August announced a similar mandate at its facilities.

And Mercy Iowa City on Wednesday said all of its colleagues, medical staff, contractors, students, volunteers, and anyone else doing business in its buildings will have to be vaccinated by Dec. 20.

UIHC has not imposed a vaccine mandate for its employees, although Gunasekaran said it has a high rate — over 90 percent — who have done so voluntarily.

“This is an option that we can keep on the table,” he said. “But right now we don't think that moving forward with a vaccine mandate is our best option.

“We continue to see our vaccination rate inch up as we help our employees overcome their vaccine hesitancy and better understand the value of doing it.”

Vanessa Miller covers higher education for The Gazette.

Comments: (319) 339-3158; vanessa.miller@thegazette.com