Nurse shortage concern among doctors as hospitalizations surge

As the number of hospitalizations across the Rio Grande Valley continue to rise, one of the most pressing concerns about how to handle the surge is the possible shortage of nursing staff. At Doctors Hospital at Renaissance in Edinburg, which had to momentarily go on diversion status a few nights ago, Chief Medical Officer Dr. Robert Martinez said they’ve seen a five-fold increase in COVID-19 patients, if not more, that require hospitalization or intensive care unit services.

“Those are labor intensive cases,” Martinez said. “Instead of having a nursing ratio of one to four, those ICU patients require a nursing ration of one to two or one to one so the number of nurses also starts to dwindle for those critical cases and staffing is a big issue for everyone here in the Valley when it comes to nursing.”

At last check, Martinez said DHR had around 70 patients and with about 23 to 25 patients in the intensive care unit. Of those, 19 required intubation.

“Previously, that unit, the most we’ve ever had — the last wave if you will — was five in there at one time with maybe two ICU patients,” Martinez said.

He added that the hospital is getting ready to open up new units to be able to house the patients but that is if they can find the staffing.

“Even though we have real estate, we’re making more room for patients, we don’t have nurses to take care of them,” he said. “Nursing, there’s always been a shortage it seems like, but certainly at this point, all the hospitals are having big issues, including ourselves, with nurses.”

He noted that the work nurses have to perform is slow and methodical to ensure they don’t cross contaminate with COVID-19 patients while trying to do regular business.

“There’s a high stress rate and burnout rate,” Martinez said. “It’s not normal work.”

Dr. Ivan Melendez, the Hidalgo County health authority said he agreed that nurses would be the biggest need.

“That is probably the most important resource that we’re going to lack,” he said.

“It’s a human resource and so it has very limited supply,” Melendez added. “You can’t unplug it and let is rest for the night and then start it again. There’s a lot of emotional exhaustion.”

He noted the mental toll on nurses that this situation would take, given that nurses have to be in the room with patients to administer medications, start IVs, and check vitals.

“The doctors, we have the option to stay in a particular room or outside and use Zoom or use a tele-medication method,” Melendez said.

“There isn’t a line of supply of nurses that can come in and staff,” he said. “So you request it but it’s finite; you can’t build nurses like you can build ventilators or order PPEs so this is the complication or the idiosyncrasy of having a resource that’s a human being.”

After nurses, Melendez said reagents for the diagnostic tests and physical space for patients were the most needed resources.

When DHR went on diversion a few days ago, Martinez said it was only temporary and he said they try to do them in intervals of two hours at maximum.

“Luckily we haven’t had very many of those and we try to prepare and have contingencies at all levels,” he said.

Mostly, the need for diversions is because they’re short on staffing or too many patients are waiting to be discharged because family’s haven’t been able to pick them up, Martinez explained.

“So it’s movement of patients through the system,” he said. “It’s only temporary.”

The worry with COVID-19 patients, however, is they cannot be dealt with within a few hours.

“Some of these patients are critically ill, intubated and require treatment for weeks at a time so it’s not people you can just move through the system,” he said. “They require long term aggressive treatment.”

Martinez said the hospital is currently advancing through their contingency plan but are also in talks with state and local officials about the possibility of housing patients offsite.

“Maybe patients that are less critical and are in need of convalescing,” he said. “They need treatment, can’t go home but they don’t necessarily need to be in the hospital.”

Asked whether the public should be alarmed about the current situation, Martinez said they should.

“They have the ability to control a lot of it and at some point, there will be a tipping point where we will have to say no because we can’t physically take care of anymore,” he said. “And that can happen very, very quickly.”

He added that people needed to heed warnings about social distancing and staying out of harms way because it would be very easy for the system to get overloaded.

“The healthcare community cannot solve this problem, this is a people problem,” he said, reiterating the need for social distance and wearing masks.

“Just because you can’t feel that you’re getting sick, doesn’t mean that you’re not going to get sick or you’re going to give that illness to somebody else,” Martinez said. “This is a community problem and the community is the only one that can stop this or slow this down.”