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Calif. County Hospitals Struggling With Nurse Shortage

“The hospitals are full. People are coming in suffering from neglected conditions because they’ve deferred care for almost a year and a half, or because they’re seeking elective procedures that they’ve delayed.”

(TNS) - Marin County hospitals are coping with a shortage of staffed beds, but not because of a COVID-19 outbreak.

Dr. Matt Willis, the county's public health officer, attributes the problem to a shortage of nurses and a wave of non-COVID patients.

"The hospitals are full," he said. "People are coming in suffering from neglected conditions because they've deferred care for almost a year and a half, or because they're seeking elective procedures that they've delayed."

The situation has changed dramatically since the end of 2020, when a previous surge of COVID-19 cases was threatening to overwhelm California hospitals.

On Dec. 3, Gov. Gavin Newson announced he would begin issuing shelter-at-home orders in regions of the state where intensive care bed capacity fell below 15%.

Marin County stopped issuing daily reports on ICU bed availability at its three hospitals on Dec. 20 after 0% availability was reported at hospitals from Dec. 15 to 18.

At that time, the county stopped basing its calculation of ICU bed availability on the assumption that Marin's three hospitals had adequate staffing to provide a total of 29 intensive care unit beds, about 75% of the ICU beds the hospitals are licensed by the state to operate.

It was acknowledged then that hospital bed availability fluctuated because it depended on staffing levels. Just because a hospital is licensed for a certain number of beds doesn't mean it can always accept that number of patients.

California is the only state in the nation that legally requires a specific ratio of nurses to patients in every hospital unit. For example, the state requires one nurse for every two patients in intensive care and one nurse for every four patients in emergency rooms.

The law also mandates that additional registered nurses be added to the minimum ratios based on a patient classification system that measures severity of illness and the need for specialized technology.

But nurses working at Marin hospitals say they're understaffed nonetheless.

"Kaiser's model is basically to staff us to ratio instead of acuity," said Colleen Gibbons, a registered nurse at its San Rafael hospital. "They use their average daily census for the budget even though we're supposed to be staffing to acuity. At the end of the day if they don't violate ratio, that is their excuse: Well, we maintained ratio."

In addition, Gibbons said, "There has been an increase in our census due to patients delaying care because of COVID; they're sicker and they're trying now to catch up on the surgeries they postponed last year."

Gibbons said Kaiser hospitals in other parts of California where the number of COVID-19 cases are higher, such as Modesto and Roseville, are transferring their non-COVID-19 cases to Kaiser's center in San Rafael.

"We have nurses that have worked some 20 days in a row. Our nurses are burnt out," Gibbons said. "We're seeing nurses looking for clinic positions within Kaiser to get out of the hospital. We can't sustain our current staffing shortage."

Lynn Warner, a nurse in the progressive and metabolic care unit at MarinHealth Medical Center, said, "We have a shortage of nurses and ancillary staff at MarinHealth. We are keeping patients in the emergency room because there are no beds available, and there are no beds available because there is no staff available in the unit."

Warner said nurses are having to do work normally done by ancillary staff due to cutbacks in the number of ancillary personnel.

"If a nurse is looking for a job, they tend to go where the pay is better, and there are better working conditions," Warner said.

"Nurses are tired, tired of being stressed at work due to the high patient volume," Warner said, "and tired of caring for patients who possibly wouldn't have needed to be admitted if they had followed the guidelines for COVID-19."

Jan Emerson-Shea, a spokeswoman for the California Hospital Association, said, "Hospitals across California — and throughout the country — are definitely experiencing staffing shortages, especially with nurses."

"These people are exhausted — and many are burned out," Emerson-Shea said. "Some are retiring early, some are leaving hospital jobs for less stressful opportunities in other health care settings, and some are leaving their profession altogether."

Dr. Naveen Kumark, physician in chief at the San Rafael Medical Center, said, "Our San Rafael Medical Center is working in partnership with Kaiser Permanente hospitals throughout Northern California to address the surge in COVID-19."

"In addition," Kumark said, "we have seen an increase in hospitalizations in order to care for people who may have postponed care earlier during the height of the pandemic."

Kumark wrote that while surgeries are not being postponed at San Rafael Medical Center, "There may be a wait time for certain elective or nonurgent procedures, as we work diligently to address elective surgeries that were postponed from earlier in the pandemic."

Data reported by Marin hospitals to the state's Office of Statewide Health Planning and Development give an indication of how much care has been deferred during the pandemic.

The patient days at the Kaiser center were more than 6% lower in 2020 than in 2019 and the number of visits to the hospital's emergency department were nearly 20% lower in 2020 than 2019.

At MarinHealth Medical Center, the patient days in 2020 were nearly 20% lower than in 2019. Visits to the hospital's emergency department were more than 21% lower in 2020 than in 2019. The number of inpatient surgeries at the hospital were more than 14% lower in 2020 than in 2019.

At Novato Community Hospital, patient days in 2020 dropped more than 14% from the prior year. Visits to the emergency department fell 23% in 2020 compared with 2019. The number of inpatients surgeries declined more than 15% during the same period.

Managers at MarinHealth Medical Center declined to be interviewed about staff shortages. The shortages might not be a recent development.

During the Aug. 10 meeting of the Marin Healthcare District board, MarinHealth CEO David Klein reported that patient volumes were exceeding pre-COVID levels and most Bay Area hospitals, including MarinHealth Medical Center, were experiencing staffing shortages.

In an email, Dr. Karin Shavelson, chief medical officer at MarinHealth, said, "We can say one of the biggest challenges facing healthcare systems today are staff shortages."


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