A defining characteristic of pandemic-era health care in Oregon has returned in a big way.
Quietly, the Oregon Health Authority last month hired 370 temporary “traveler” nurses and nursing assistants to work in beleaguered hospitals around the state.
But the help being provided is a fraction of what hospitals say they need as they battle a surge of patients with COVID-19 and other respiratory illnesses. In early December, hospitals asked the state to send them a total of 1,543 staffers, according to records obtained by The Lund Report.
The renewed presence of state-funded traveler nurses is somewhat helpful overall, but brings complications of its own, said one nurse at Providence Portland Medical Center, Richard Botterill, who serves as chair of the Oregon Nurses Association bargaining team for the hospital.
The arrival of the “OHA nurses,” as he calls them, “hasn’t really alleviated the situation too much,” Botterill said, speaking in his union capacity. He said the new arrivals, coupled with Providence’s hire of other contract nurses, can contribute to a feeling that staff nurses are just “widgets in a machine.” Not only that, but the contract nurses are guaranteed eight hours of overtime each week, taking shifts that staff nurses can no longer fill if they want to.
“It’s like the whole health care system right now is in need of major surgery,” he added. “Every single day, we’re short staffed.”
The health authority began contracting with staffing agencies in 2020 to bolster health facilities’ operations for influxes of patients during the COVID-19 pandemic. While pandemic measures have expired, the requests point to hospitals’ ongoing staffing and capacity challenges nearly three years after the pandemic was first declared.
The number of staff hired by the state dwarfs the amount hospitals asked for in November when then-Gov. Kate Brown issued an executive order aimed at propping up pediatric units amid surging respiratory syncytial virus, an illness known as RSV that primarily affects children.
In December, the governor expanded her order to include adult hospitals as they saw increasing numbers of patients with RSV, severe flu and COVID-19.
Even with the current surge having reached its peak, hospitals continue to report strains on capacity caused by factors beyond the spread of respiratory illnesses.
“Oregon hospitals are continuing to struggle with staffing on many levels,” a spokesperson for the Oregon Association for Health Systems and Hospitals said in a statement to The Lund Report earlier this month. “We have important work ahead of us this legislative session to find policy solutions that address the workforce crisis, stabilize hospitals’ operations and preserve patients’ access to care.”
Oregon Nurses Association had earlier criticized Brown’s emergency orders, saying on Dec. 7 that the public funds would give hospitals a free hand to bypass state staffing requirements. The union has blamed inadequate staffing by hospitals for driving high nurse turnover.
“A classic ounce of prevention would have been worth a pound of cure if we were focused on investing in growing the workforce and less focused on staffing exactly to the lowest number we possibly could,” said Kevin Mealy, spokesperson for the Oregon Nurses Association.
Mealy said hospitals have underinvested in staffing and that each surge eroded the nursing workforce by burning out nurses. Others have been enticed to take lucrative traveling jobs with staffing agencies, he said.
The Oregon Association of Hospitals and Health Systems did not respond to a request for comment specifically on the state’s temporary hires. But on Friday, the association released numbers showing the latest bad financial news for Oregon hospitals, with nearly two-thirds losing money in the third quarter of 2022. The group blamed the bad financial outlook on rising labor costs and being unable to discharge patients to post-acute facilities.
Becky Hultberg, the association’s CEO, told a legislative panel last month that hospitals were facing a historic moment, likening them to an ecosystem losing its “structure and function.”
“Unfortunately, this could mean fewer services and fewer hospitals if nothing changes,” she said. “So we’re at a really critical juncture where we can no longer take the infrastructure that we have for granted.”
Health authority spokesperson Jonathan Modie told The Lund Report in an email that 2,230 additional staff were sent to Oregon health care facilities in March last year during the surge of the highly contagious omicron variant of COVID-19.
In addition to staff provided from requests made by hospitals in December, roughly 100 state-provided pediatric specialists remain at three Portland area hospitals, according to numbers provided by Modie. Another 118 have been provided to behavioral health facilities and another 52 for long-term care settings.
“Overall, today’s state-provided staffing is a long way from the omicron surge, but we are providing more than many of us would have expected, although we are certainly not where we want to be,” he said.
Hospitals ask, but don’t receive everything
Brown issued an executive order in November to give hospitals more resources and flexibility to treat the sharp rise in pediatric patients sickened with RSV.
Following Brown’s order, Oregon Health & Science University requested 59 registered nurses and 16 respiratory therapists, public records show. Legacy Health asked for 27 registered nurses and 10 respiratory therapists.
As patients with severe cases of the flu, COVID-19 and RSV continued to fill hospitals, Brown expanded her order in December to aid health systems with adult patients in addition to children.
Records show that three hospitals asked the health authority for nearly a third of the total staff requested following Brown’s December order. But these hospitals, like others, caught a small portion of their ask.
Salem Health Hospital, one of the state’s largest acute care hospitals with 494 beds, asked for 330 staff, the largest request.
Lisa Wood, spokesperson for Salem Health, told The Lund Report in an email that the health authority provided the hospital with 25 of the requested staff for 12 weeks who were assigned to various units. She said the hospital census was averaging more than 400 adult acute and critical care patients when it made the request to cover contract staff.
“The extra staff were requested to help cover the additional staffing needs related to a variety of factors: the continuing impact of COVID, the rise in influenza and RSV cases, the longer lengths of stay our patients are experiencing, as well as the 40-80 patients per day who are ready to be discharged from the hospital but long-term care and skilled nursing facilities are unable to care for them,” Wood said .
The second-largest request came from Good Samaritan Regional Medical Center, a smaller 188-bed facility located in Corvallis, which asked the health authority for 120 staff.
The hospital received 16 registered nurses for 12 weeks, according to Tim Eixenberger, the hospital’s vice president of patient care services. Eixenberger said in an emailed response to questions from The Lund Report that the request was based on the influx of patients and the high number of registered nurses and certified nursing assistants calling in sick. The additional staff was primarily used to staff the night shift, he said.
Additionally, the hospital made the request because of difficulties discharging patients to skilled nursing facilities and other transitional care, he said. That’s on top of other patients requiring surgeries after delays, he said.
“Thankfully we are seeing reductions in the virus infections,” said Eixenberger. “We are hoping that the delays often seen in large gatherings at Christmas and New Years will not create a higher increase in (emergency department) and inpatient demand.”
Oregon Health & Science University hospital, the largest in the state with 576 beds, requested the third highest amount of staff at 102.
Nicole Rideout, spokesperson for OHSU, said in an email that the health authority provided the hospital with 25 registered nurses and certified nursing assistants, who arrived the first week of January.
She said the temporary staff provided by the health authority in November and December are contracted for four weeks. OHSU extended the contracts of most nurses who arrived in mid-December to help the hospital’s high occupancy and workforce shortage, she said.
When Brown issued her updated executive order in December, she also announced the Oregon Health Authority was seeking additional nurse staffing contracts worth up to $25 million to help address emergency workforce shortages.
The health authority used state contracts with AMN Health and Maxim Health to provide the temporary staff, according to records.
Under a cost sharing arrangement, the health authority will pay 75% for additional staffing up to eight weeks and half of the cost afterward, with hospitals picking up the rest. The health authority expects to pay $27 million for the additional staffing and hospitals to pay $12 million as a cost share.
Records obtained by The Lund Report show that the health authority has already paid out large sums to the three companies it has contracted with for staffing.
As of Dec. 16, the state had paid Colorado-based Jogan Health $343.4 million to provide nurses and other staff, as well as to provide COVID-19 vaccinations for homebound individuals, agricultural workers and other hard-to-reach populations.
New York-based ATC Healthcare Services was paid $38.7 million for providing health care workers, and San Diego-based AMN Healthcare Inc. was paid $37.2 million.
Before the recent surge in respiratory illness, overall hospital vacancy hovered around 8%, with intensive care units vacancies at 6% and 12%, according to health authority numbers from early December. But vacancies dropped for both to 5% or less as the viruses spread.
The surge caused by RSV, flu and COVID-19 peaked in early December and is expected to drop off, according to an analysis released by OHSU on Friday.
However, hospitals remain crowded and 311 patients remain stuck in the emergency departments waiting for a bed in the hospital, according to the OHSU analysis. That number hovered above 100 a year ago,
“Salem Hospital is consistently near or above 100% capacity,” said Wood, spokesperson for Salem Health. She said the number of COVID-positive patients at the hospital still averages at 25 or more patients a day, which she said equates to a full nursing unit. Another 20 or more patients with RSV or influenza also continue to be hospitalized at Salem Health, she said.
The four hospital systems in the Portland metro area remain under crisis standards of care, emergency measures that give them more flexibility around staffing and to triage the care of patients.
Rideout said OHSU’s adult and pediatric emergency departments are full, along with its intensive care units, and patients are being cared for in hallway beds and semi-private rooms.
“This additional staff is providing invaluable help for our clinicians and allowing us to not only provide necessary care to Oregonians but add surge capacity,” she said.