JOHNSON CITY, Tenn. (WJHL) – Ballad Health announced COVID-19 hospitalization projections Wednesday morning that far exceed what they predicted just last week. Chief Nursing Executive Lisa Smithgall says the expected surge could be disastrous for a nursing staff already stretched thin.

Smithgall said hospitals have already had to utilize individuals that have training, but don’t typically provide direct treatment to patients, including nursing unit leaders and clinical educators. But Ballad may soon be forced to use non-clinical workers in assistive scenarios as officials predict between 400 and 500 in-patients in the coming weeks.

“We’re going to have an expanded role of nurses taking greater patients per nurse and we’re going to have to try to supplement that with assistive personnel who may or may not be normally in the clinical environment,” Smithgall said.

Bringing in those non-clinical workers depends on the patient to nurse ratio. That ratio also depends on the acuity, or sickness level of the patient.

“Some of our COVID patients are much sicker than our other patients, which would require that you have a little bit less patient to nurse ratio,” Smithgall said.

The ratio is also impacted by staffing issues and internal spread of COVID-19.

Some of Ballad’s nurses are not vaccinated. If they feel COVID symptoms, they must leave work, thus creating a shift to fill. This often forces nurses into unfamiliar shifts.

“We do a lot of juggling sometimes and we move people from their scheduled shifts on days or nights to an opposite shift a different day of the week to cover an immediate need,” Smithgall said.

The day-to-day tasks of nurses will only get more hectic as hospitalizations increase. Nurses in Ballad’s rural hospitals are likely to work with both COVID-infected and non-COVID patients, while many in Ballad’s larger hospitals work exclusively with COVID patients. Nurses wear more PPE when working with COVID patients, meaning they often have to change in and out of gear.

Smithgall is trying to address the hospital’s needs while also dealing with a staff shortage that has impacted hospitals across the Southeast.

This Spring, Ballad’s turnover rate reached as high as 24 percent, leaving its hospitals severely understaffed. Much of that was spurred by the winter surge of COVID-19.

Many nurses were stressed by the high-demand job or found higher paying work outside of the clinical setting, according to Smithgall.

She worried a new surge could further decimate her staffing numbers.

Ballad is trying to reach new nurses through incentives and scholarships. They are also looking for recently retired nurses to assist in lower-stress roles like admissions and discharges to assist front-line nurses.