Hospitals face staffing ‘domino effect’ from the coronavirus outbreak, adviser says

• As increasing numbers of coronavirus cases boost staffing demands on hospitals , family pressures could curtail available staff.
• Solutions include getting flex staff to commit to your facility and seeking loans.
• Hospitals advocates are pushing Congress to help fund measures to ease staffing demands.

Increasing clinical care demand from the coronavirus outbreak will test hospital staffing, and unique “personal needs” of hospital workers could exacerbate personnel shortages, an adviser says.

The expected surge in coronavirus patients seeking care at hospitals will create a range of staffing issues, said Chris Plance, an adviser with PA Consulting. His prediction followed widely reported projections that 4.8 million hospitalizations will be associated with the novel coronavirus, according to a February webinar by the American Hospital Association.

Staffing shortages may be driven not only by a surge in patients but by hospital workers who need to self-quarantine after becoming ill from the virus or miss work to care for ill family members or children home from closed schools.

“This is a domino effect made worse by the fact that a lot of people have families,” Plance said.

Hospital staffing shortages may include:

• Nurses as hospitals compete for staffing agency support
• Certified nursing assistants, exacerbated by low pay
• Environmental services and transportation staff

Shortages may be aggravated by the traditional hospital practice of staffing at about 60% of patient census and then adding staff as needed through float pools. The challenge is especially serious for smaller hospitals, which may share a float pool with other facilities.

“So, if everybody is staffing up at the same time, those pools don’t cover everybody,” Plance said.

Smaller hospitals also tend to have less cash reserves, making it harder to afford costly agency clinicians.

Looking for staffing solutions

Hospitals are figuring out how they will respond to staff shortages, as none have yet become overburdened, Plance said.

Hospitals can respond with a variety of measures that include:

• Pulling physicians in from primary care practice settings or from specialties focused on elective procedures
• Incentivizing float pool nurses to prioritize a certain hospital
• Pursuing financing to support personnel needs

The financial challenges from meeting staffing demands could be exacerbated by delays in payment as health plans decide how they are going to pay for coronavirus care, Plance said.

“Your receivables could get quite aged,” Plance said. “I would have the expectation that that would occur.”

This week, the American Hospital Association and other provider advocates wrote a letter to congressional leaders seeking financial aid for staffing and a range of other needs, including:

• Updating and training staff on implementation of pandemic preparedness plans to respond to COVID-19, the disease caused by the novel coronavirus
• Obtaining scarce supplies, including personal protective equipment
• Ramping up infection control and triage training for healthcare professionals in all settings
• Training for and implementing expanded telemedicine and telehealth capabilities
• Covering the increased costs associated with higher staffing levels

Recognizing demands on the workforce

Hospital executives should examine their staffing capacity in light of the closure of many schools, which may not allow staff to come in to work.

“This outbreak could get much worse because when your family is at home, where is that nurse going to be? That nurse may not have a choice,” Plance said.

Community hospitals may need to find ways to provide daycare or other family support to ensure staff are available, he said.