Hospitals cut services due to staffing issues

Carbon County Memorial Hospital has lost five parturients and nurses due to travel during the COVID-19 pandemic. For a department of only 12 people, the impact was enormous.

The hospital turned to employees and paid nurses three to four times as much to fill vacancies so that the maternity ward could operate.

“This is not something that could have been budgeted in advance. It really hooked us. We have seen a strong impact on our finances,” said Stephanie Hinkle, director of marketing and communications for a hospital in Rawlins, Wyoming.

After four months of intensive work with visiting nurses, Hinkle says the village hospital’s board of trustees has made a difficult decision. “From January to April, we saw such a sharp change in the monetary position. For the good of the entire organization and for us to continue as an organization, something had to happen,” Hinkle said.

The board announced that in June Memorial Hospital would suspend childbirth and obstetric care.

“It was an incredibly difficult and emotional decision,” Chairman Rod Wackerlin said in a press release in April. “Unfortunately, as a result of the pandemic, MHCC has lost a number of nurses, forcing a reliance on traveling nurses and creating a financial imbalance in operations.”

Hospitals such as Memorial Hospital have been forced to temporarily or permanently cut services or merge departments due to lack of staff. While seconders may fill in for short periods of time, hospital managers do not see them as financially viable over time.

Ellis Medicine in Schenectady, New York, has announced that it will suspend admissions to its juvenile inpatient psychiatric unit in May due to staff shortages. “This is disappointing. The difficult situation we are in – as a healthcare provider and together as a community – is related to the healthcare workforce crisis in the country. This crisis was not caused by COVID, but the ripple effects of the pandemic are certainly complicating it,” Ellis Medicine President and CEO Paul Milton wrote in an open letter at the time.

This has been the worst year financially for hospitals since the pandemic, according to a study by consulting firm Kaufman Hall. Nationwide, the operating margin was -0.98% in July, the company said, marking the seventh consecutive negative month. The average change in operating margin was -63.9% year-on-year.

The losses are due to falling patient demand, the high cost of temporary workers and the halting of federal funding streams for pandemic relief, said Eric Swanson, senior vice president of data and analytics at Kaufman Hall. “Hospitals are sort of facing this alone at the moment, and ultimately they are in a tough spot,” he said.

According to Kaufman Hall, contract labor as a percentage of total labor costs increased from 2% in 2019 to 10% in 2022, and contract nurse wages rose from $64 to $150 an hour. Since mid-2020, the number of employees in the healthcare sector has been on the rise, but hospital employment remains 36% lower than in January 2020, according to the Bureau of Labor Statistics.

Theresa Fitzpatrick, senior vice president at Kaufman Hall, said many health systems are cutting back on services and looking for creative ways to continue providing care. “They are becoming much more thoughtful and forward thinking about providing the right level of care in the right place,” she said.

For example, according to Fitzpatrick, some healthcare systems that don’t have enough staff in operating rooms are shifting surgeries from hospitals to outpatient surgery centers. Others are shifting workloads and relying more on support staff to reduce the need for contract workers, she said.

Cleveland University Hospitals has vacancies for approximately 900 registered nurses, about 10% of the total nurses, and this is a significantly higher vacancy rate than usual. “We have shortages everywhere in almost every role,” Hinchey said.

In July, the health system announced that it would stop offering inpatient, emergency, radiological and some outpatient services at its Bedford and Richmond Heights locations and refer patients to other facilities. At the time, university hospitals reported the highest number of unfilled jobs and could not provide a full range of services. University hospitals have retained about 90% of the 500 Bedford and Richmond Heights employees affected by the changes, according to the nonprofit.

“We have to have a couple of things that always stay in the spotlight. including quality and safety. With that comes some very difficult and difficult decisions,” said Michelle Hereford, Chief Nurse.

The health system first reduced the number of inpatient beds in two hospitals and halted operations at one facility in October last year due to staffing shortages. “Over time, we saw the shortage get bigger and bigger and it became harder to find even contract labor,” said Dr. Paul Hinchey, president of the University Hospitals Community Delivery Network. Providing services at the two facilities, when the same care was available at hospitals miles away, became impractical, he said.

Health safety organization ECRI named staffing shortages as the top patient safety issue this year in a report released in March. “We know that understaffing affects patients throughout their entire care process,” said Shannon Davila, Associate Director of Security Solutions at ECRI. program. “Of course, there is a risk to the patient if medical organizations are forced to cut services.”

Health systems must weigh the risks and benefits of cuts in services. A lack of staff could pose a threat to patient safety, Davila said, but there could also be a lack of access. “It can’t just be a quick fix. They have to think about the risk to staff, the finances of the organization, and the risk to the patient.”

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