PASCAGOULA, Miss. — Bobbie Anne Sison was heading to the hospital just before dawn when she got a panicked call from one of her best nurses saying she couldn’t come to work because her car had overheated on Route 63. Ms. Sison is a Pascagoula Hospital nurse manger and quickly made a U turn and raced to get her.
“We have staff members dropping like flies from Covid so there was no way I was going to leave her on the side of the road,” Ms. Sison said a few hours later as she walked the corridors of her 350-bed hospital, which has been steadily filling with Covid patients after a monthslong lull.
On Sunday, 106 coronavirus-infected patients were being treated by Singing River Health System. It is a county-owned network of 3 small hospitals along Mississippi’s Gulf Coast. This was an increase of the number of patients who were there at the beginning of this month, which was only a dozen. Ms. Sison was trying to forget about the future, as 40 percent of all Covid-19 testing in Pascagoula were positive and around 100 hospital employees were sick.
“I just don’t know if we can do this again,” she said.
Even as new cases peak and begin to decline in the Northeast and Upper Midwest, the nation’s hospitals are still confronting a crushing influx of patients. In Mississippi, the latest wave of infections has pushed nearly all of the state’s acute-care hospitals to capacity.
At Pascagoula Hospital, the city’s only acute-care health facility, a wave of departures has left 80 unfilled openings for registered nurses, forcing administrators to mothball a third of its beds. Every bed had been taken by last week’s end, prompting alarming systemwide backup. Coronavirus patients in I.C.U. had no other options. Those who were able to move to another unit were forced to stay put. There were also several seriously ill patients in the E.R. Patients who were too ill to be transferred to the I.C.U. for more intensive care could not be moved.
Lee Bond, Singing River’s chief executive, said the current surge was simply exacerbating a calamitous labor shortage that state hospital leaders and public health officials say will persist long after Omicron fades.
“The real crisis we’re facing right now is a foundational shortage of nurses,” he said.
The nation’s frontline medical workers were running on fumes even before the arrival of Omicron. They have been exhausted and numb from successive waves of illness and death that have hit them over the past two decades. Nearly one fifth have left the medical profession in the last two years. And they are angry — at the patients who refuse to get vaccinated, at the hospital executives who won’t spend the money needed to maintain safe nurse-to-patient ratios, and at the political leaders who call them “health care heroes” while opposing mask and vaccine mandates that might blunt the tsunami of new infections.
The labor shortage has been particularly devastating for small, non-profit safety net hospitals like Singing River that provide care to millions of Americans. They were already financially fragile before the pandemic and have not been able to pay the high salaries offered by large health systems and travel nurse agencies. This has further accelerated the personnel drain that threatens the ability to provide quality healthcare. Travel nurses can earn more that $200 an hour than the $30 earned by Mississippi staff nurses.
“A lot of community hospitals are wondering how they’re going to keep the lights on,” Tim Moore, president of the Mississippi Hospital Association, said.
The unwillingness of Mississippi and other states in the south to accept Medicaid expansion has further exacerbated the financial strain. According to the state economist for Mississippi, this would result in an additional $600million in federal aid each year and 11,000 new jobs each, most of which would be in health care.
Gov. Tate Reeves and other Republican leaders who dominate the state’s government have also resisted calls to devote a significant portion of federal coronavirus relief aid for bonuses that could help stanch health care worker departures.
Kelly Cumbest (45), a registered nursing nurse who manages patient care at the E.R., stated that he had received one application in recent months for 24 positions in his department. “It’s not just Omicron that worries us,” he said. “What scares us is that we don’t have people to take care of heart attacks, strokes and car accidents, and that’s something the politicians and general public really don’t understand.”
Visitors may not be immediately aware of the staffing shortage at Pascagoula Hospital. Doctors and nurses trade pleasantries and reviews of the day’s cafeteria fare as they dart in and out of patient rooms. But the flashing violet lights above a half-dozen doorways tell a different story: They signal a patient’s unanswered call — for water, for assistance getting to the toilet, or increasingly, a request for helping hands to clean up after they could no longer wait.
Sometimes the need for immediate attention is more urgent. Deborah Briggs (64), a newly admitted Covid patient, had lost her oxygen mask in a fit and was struggling to breath. “I’m burning up,” she gasped as three nurses returned the mask to her face and then lifted her into a position that would allow her lungs to more fully expand.
Teresa Phillips (one of the nurses) sighed and tried explaining the difficulty of managing complex medical issues for so many patients with 25% less staff. “I want to make sure my patients are bathed, given their meds on time and have their vital signs continually assessed, but you can’t do that when you’re stretched this thin,” said Ms. Phillips, who had just returned to work after battling Covid for the second time.
Nearly every nurse at Pascagoula Hospital got emotional when asked about their health two years into the pandemic. Caroline Olivera, 24, a self-described “baby nurse” who landed her first nursing job when the pandemic began, cried as she described the physical exhaustion from endless overtime shifts and the emotional toll of so much death. “You know the expression ‘only the fittest survive’? Well, that’s me,” she said.
Residents of Pascagoula are often reminded of this resolve. This 22,000-strong industrial port city is still recovering from the destruction caused Hurricane Katrina. A strong loyalty to the community helped many nurses stay put for a while, despite low wages and worrying rates of vaccination. Only 46 percent are fully immunized in the county.
This devotion began to fade during the calamitous Delta flood of last summer, when administrators were forced to hire travel nurses for the first time.
Many Delta wave skeptics realized they couldn’t resist the monetary lure, and started to leave in droves. Some have taken jobs in Mobile (Ala.) to be closer to their families.
“You can’t blame them,” said Jessica Samples, a registered nurse and 14-year veteran of Pascagoula Hospital who is one of the few old-timers left, though she admits she has been tempted to join them.
The hospital has been forced to hire more nurses from abroad as a result. This has led to a negative effect on its finances, making it even more vulnerable. Hospital leaders state that nearly 80 percent are on short-term contracts on some wards.
Singing River has now incurred $30 million in additional expenses due to the pandemic. Mr. Bond, the chief executive of the company, stated that they have incurred $30 million more expenses due to the pandemic. He and other hospital officials pressed Mississippi state leaders for a quarter of $1.8B in federal pandemic relief funds to pay $20,000 retention bonuses to nurses who stay in the state for a minimum of two years. Lawmakers responded with a far less generous proposal, which would fund bonuses of around 1,000.
The Coronavirus Pandemic: Key Information
With 2,000 unfilled openings for registered nurses and some of the worse health outcomes in the country, hospital executives worry about Mississippi’s longer-term prognosis. Mr. Lowe of the state hospital association said he fears that residents will blame health care workers and turn against the profession for the substandard care they receive.
Brandon Russell, a certified nursing aid, was able this week to keep his cool as he cared for nearly a dozen Covid clients. He had to put on a surgical gown, gloves, and two masks before he could enter each room. Even though the task was simple, it was not difficult. All protective gear must be removed after he leaves the room. This process was repeated many times per day. The job is $10 an hour.
Russell, who has recently recovered from Covid, stated that the past few months had forced him to give up his desire to become a registered nursing assistant. “I love my patients but I’ll be honest with you, I’m ready to quit,” he said. “It doesn’t help that whenever I bring up nursing school, every single nurse here tells me not to do it.”
These sentiments are hurtful for Ms. Sison (36), the nurse manager. She can appear impossibly bright as she rallies her team. She lost track of the number of times she had been called upon to console colleagues who were either suffering from a rapid succession of fatalities or were in irreparable pain. She stated that one nurse suffered a nervous breakdown at work and quit.
“You become a nurse to fix people but there have been weeks during the pandemic when it felt like we lost more people than we saved,” Ms. Sison said, standing in the hallway with a fellow nurse. They started to recall some of the Covid deaths: the 18 year-old boy who was gasping for air, the father of four children at 27 years old, and the elderly man who died minutes before his family arrived.
“Yes, this is what we signed up for, but people forget that we’re still human and we have emotions,” Ms. Sison said. “You try to check it at the door when you go home, but you can’t.” For Ms. Sison, the losses have been personal. In March 2020, she was 33 weeks pregnant. After weeks of battling a mysterious illness, her baby, a boy was stillborn. The news was delivered by doctors the same day that the hospital received its first coronavirus victim. An autopsy concluded that Covid had probably caused his death.
Ms. Sison returned to work three weeks later. “They were there for me,” she said of her co-workers, “and I wasn’t going to leave them at such a terrible moment.”
Just then, an overhead speaker began to play the familiar strains of Brahms’s lullaby. The music stopped all the medical personnel in the hallway. The song marked the birth of a child at Pascagoula Hospital, “a rare moment of goodness,” one woman said.
It reminded them of the days when the hospital played “Don’t Stop Believin’” every time a Covid patient was discharged. The song was a source for joy and hope in a time of darkness that was unrelenting.
But that was years ago, when Pascagoula Hospital’s majority believed that science and self sacrifice would prevail.
“We thought we’d beat this virus,” Ms. Sison said, her voice trailing off. “We don’t play that song any more.”
Source: NY Times