Hospital system staffing stretched to limit — worse expected as cases continue rise

Local Coronavirus Coverage

KINGSPORT, Tenn. (WJHL) – COVID-19 is already stretching Ballad Health’s staffing capacity thin, and an expected surge in hospitalizations is likely to create a critical situation before the end of the year.

Combined with the emotional toll treating COVID patients and dealing with some people’s continued refusal to take the virus seriously, Ballad officials said at a Wednesday news conference that many clinical staff are exhausted physically and emotionally.

Lisa Smithgall, Ballad’s chief nurse executive, said she was more concerned about the coming ability to adequately staff for COVID demand than she has been yet.

“We are very scared about that,” Smithgall said. She said the system has created additional positions, tried to get additional resources and provided financial incentives for existing staff.

“But there’s a point when there will be so many patients we are worried about that and we would potentially have to implement crisis staffing, which is something around the nation that gets to when you run out of resources for the patients that you have.”

One nurse’s story — and plea

Officials showed a video of veteran intensive care nurse Emily Nichole Egan, who works on a COVID unit at Holston Valley Medical Center, explaining the exhaustion and frustration she and colleagues are experiencing.

“I guess people are tired of being alone, or in their homes and want to get out and be social again, and we understand the importance of mental health, but the fight is getting out of hand,” a masked Egan said.

Egan said they are “losing more than we’re keeping” in the ICU and that she has “put an ungodly amount in body bags that I wasn’t prepared to do. That I wasn’t prepared to give up on a patient but there was nothing else we could do and we lost them.”

Egan spoke of swapping out two deceased COVID patients for two more “just as sick” and said she takes the work home and that she cries — a lot.

She said she understands people’s weariness with COVID and that it’s hard to wear a mask and that people may feel they can’t breathe.

“But seeing these people die that can’t breathe, it starts to take a toll on you.”

Modeling shows dark days ahead

Ballad officials said their modeling shows the likelihood of 550 COVID patients in Ballad hospitals by the end of the year — nearly double the record 287 the system reached Tuesday.

Smithgall and her colleagues spoke at length about the strain COVID is putting on Ballad’s front line clinical workers — and to a person, they said people’s behavior with respect to following public health guidelines will greatly impact how close the system comes to the breaking point.

“Our goal is to stop that … to ask our community to step up, but if we get to that point we aren’t going to have a choice,” Smithgall said.

Already, the system is using National Guard nurses to help support its operations, CEO Alan Levine said. Those troops are conducting testing “so we can redeploy those clinical staff to the hospitals where we believe we’re going to need them.”

But with COVID straining hospital systems nationwide, Ballad will be taking other steps to try and keep enough people treating patients. Those steps could include closing some clinics over the next few weeks to redeploy medical assistants and others into hospital settings.

Levine also said Tennessee Gov. Bill Lee’s latest executive order allows some lower-licensed staff or even unlicensed staff to support teams in certain hospital settings. Levine said Ballad had requested that allowance.

Levine said Tennessee Health Commissioner Dr. Lisa Piercey told him yesterday she “is granting her authority to be flexible with scope of practice.

“We can request of the state the authority to utilize lower-licensed staff to do certain support functions that previously only nursing could do,” Levine said. “Intermuscular shots, keeping of vitals, things like that if we can provide staff to support the nurses then the nurses can take on additional patients if needed.”

All of those changes could be lessened and an elective surgery hiatus shortened if more people begin to take COVID seriously and engage in cautious behaviors, Levine said.

“Not practicing proven steps to avoid the spread of the virus doesn’t make you cool,” Levine said. “It makes you dangerous.”

Levine said Ballad officials would keep encouraging people to follow recommended practices to avoid contracting or spreading COVID.

“We can’t make ’em do it, but we can certainly share the consequences, and when you see the consequences on the staff, on the team members who did sacrifice their Thanksgiving, are sacrificing time with their own families to take care of your family, I think it’s worth that alone to show them support.”

Ballad’s chief infection prevention officer, Jamie Swift, offered a similar assessment. She offered her thanks to the people who are following guidelines but said too many people continue to gather in large groups, not wear masks or otherwise ignore science-based guidelines.

“That really does require us to plan for the worst-case scenario,” Swift said.

“It’s heartbreaking to see what this is doing to our community, it’s heartbreaking to see what it’s doing to my fellow nurses and our fellow team members,” she added.

“One of the hardest things to handle is, I know in the weeks coming there’s going to be more preventable hospitalizations and more preventable deaths.”

Despite the grim assessment, Swift said the more people who change their behaviors to “follow the guidelines to a t” the less severe the numbers will be in terms of hospitalizations and deaths.

“You know what it takes — at this point it’s only up to you individually to make those changes and to help protect our community,” Swift said.

Egan, the ICU nurse, spoke of the high number of patients she’s treated who contracted COVID at a ballgame or a family dinner or birthday party.

“I’ve not seen my grandparents in a long time,” she said. “I sacrifice my time — I give it here and I don’t get to be with them at home or around a Thanksgiving table.”

Egan pleaded with people to do what they can.

“If you could just stop one case by wearing a mask or staying home when you didn’t have to go out, it’d help us so much,” she said. “Just one case. If everybody did that for one person, I think we could stop this.”

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