Amid the flurry of respiratory infections, children’s hospitals in the United States are so busy that some have had to set up tents to handle the overflow of patients.
Viruses are partly to blame for overcrowded hospitals and emergency rooms, but for some the problem is staffing: many hospitals have empty beds but not the people to treat someone in them.
“We are very alarmed,” said Dr. Rishi Lulla, director of pediatric hematology/oncology at Hasbro Children’s Hospital in Providence, Rhode Island. “We’re doing the best we can to try to use the resources we have, to expand where we have the ability to serve and serve the most vulnerable children.”
Nationally, about 80% of pediatric hospital beds are occupied. But in certain areas it is much worse: in Rhode Island, for example, beds are 99% full.
Seasonal respiratory viruses fill children’s hospitals every year, but the number of beds filled now is above average.
In the past two years, only about two-thirds of pediatric beds have been used normally, which includes the height of the Covid-19 pandemic, according to a CNN analysis of data from the US Department of Health and Human Services.
Driving much of the current need for beds in children’s hospitals is a surge in RSV cases, which are 60% higher than the 2021 peak. The early start of flu season and an increase in other respiratory viruses are increasing the need for care, in addition to the usual demands, for children with broken bones or asthma attacks.
The National Children’s Hospital in Washington DC warned last week that “this rise in disease is compounded by the national health workforce shortage.” A child with a life-threatening emergency won’t have to wait, the statement says, but “families who come to us with non-urgent problems will have a long wait to be seen.”
“Wait times in county emergency departments and children’s hospitals are getting longer than they’ve ever been,” said Dr. Meghan Bernier, medical director of the pediatric intensive care unit at Johns Hopkins School of Medicine.
Complicating the problem is that the labor shortage problem is not new and will not be solved quickly. US hospitals have been dealing with this for years.
The country needs more doctors and technicians, with a growing shortage in both fields, experts say, but the lack of nurses may be the biggest gap to fill.
2022 analysis found the total number of nurses in the usa It decreased by more than 100,000 from 2020 to 2021, the largest drop seen in four decades. Many of those who left were under the age of 35, and most worked in hospitals.
This is a particular problem for children’s hospitals.
“The pediatric ICU specialty … is highly specialized and difficult to recruit in hospitals today,” Katie Boston-Leary, director of nursing programs at the American Nurses Association, told CNN in an email.
When new employees come in, it costs more to train them. Everyone who works with children needs an additional layer of training beyond that what they would get in standard nursing school. This also reduces the pool of people eligible to work in these hospitals.
There is also a serious problem with billing. Nurse turnover has increased by 50% across the country since 2019, according to Children’s Hospital Association CEO Mark Wietecha.
“Some of our nurses became (traveling nurses); some retired early; some they were stolen by our colleagues at the adult hospital,” he said. “We’ve lost people, and the costs have gone up a lot.”
This high demand means hospitals have to pay more retaining and recruiting nurses. And working with children is a lot of work, taking up more staff time.
Temporary tents to create additional capacity may help in the short term, but the country will likely face the same surge capacity issues with RSV next year and the year after, Wietecha says. He believes that the government’s effort will be needed to solve the problem.
“We know a train is coming down the tracks. The government has responded to some extent, but why don’t we have a road map for the rise of children?”.
Entire children’s hospitals are just one example of a larger problem, Boston-Leary said.
“We have a nursing workforce crisis, and we need a whole-of-government response to address this public health crisis,” she said.
Lulla said his Rhode Island hospital is “aggressively hiring” to increase staff where it can, but is competing with other understaffed hospitals, home health organizations, nursing homes and doctors’ offices.
“We’re doing the best we can to try to use the resources we have,” he said.
The Covid-19 pandemic exacerbated labor shortages in the healthcare industry, with people forced out by burnouts, trauma and fatigue, according to the HHS study. But even before 2020, stress and burnout were “already significant problems”.
During the pandemic, many workers who were not directly dealing with Covid-19 were laid off or their hours were cut, as many people did not attend medical appointments or undergo elective surgeries, especially during lockdowns. Some of these workers never returned.
Staff shortages don’t just mean long waits for a hospital bed. It could threaten patient safety, said Dr. Marcus Schabacker, president and CEO of the Emergency Care Research Institute, an independent nonprofit focused on health care safety and technology.
Staffing shortages top list of institute’s patient safety concerns by 2022.
“The higher the workload, the higher the stress level, the more likely you are to make a mistake,” Schabacker said.
Hospitals have tried to put systems in place to catch potential errors, “but even these redundant systems stretch,” he said.
With pediatric patients, a small mistake can quickly turn into a disaster.
“The margin of error for Peds is smaller, right? So their systems are much more fragile,” Schabacker said. “When we talk about drugs, their systems, body systems, organ systems, have a much smaller margin for error.”
Many of the experienced nurses working now probably won’t be around in the near future. Nearly 20% of RNs are 65 or older, the largest age group in the profession, according to the National Nursing Workforce Survey.
A 2019 U.S. survey predicted a nationwide shortage of registered nurses by 2030.
Colleges of nursing are not increasing capacity to meet increased demand as the US population ages and are unlikely to grow to replace retiring nurses. In 2019, more than 80,000 qualified applicants were rejected, according to the American Association of Colleges of Nursing.
One reason is the lack of teachers. Faculty members are aging, research shows, and while it requires an advanced degree, teaching often pays less than working as a nurse.
“In some ways, it’s a self-perpetuating shortage where if you don’t have enough nurses to work on the wards, you don’t have the capacity to train the next round of nurses,” said expert Katherine Baicker. on the economic analysis of health policy and dean of the University of Chicago’s Harris School of Public Policy. “And in a world where you’re not expanding supply, you find yourself in a kind of begging competition for these scarce professionals.”
Baicker believes technological advances can help. The rise of telemedicine has addressed some of the demand issues, but “doesn’t solve the problem: that we fundamentally need more supply of nurses and doctors and the entire health care workforce.”