Coronavirus
Double pay wasn’t enough to keep COVID nurses staffed, so SC hospital upped the ante
During the summer months when COVID-19 cases started spiking around the state, the Tidelands Health System saw its nurse staffing needs increase by 50%.
So to meet that demand, Tidelands began offering double pay to encourage nurses to take extra shifts in addition to their three 12-hours shifts a week. When there wasn’t enough participation, the premium incentive increased to triple pay.
The pay hike sent a convincing message to the health care workers, one nurse said.
“It sweetens the deal and makes it easier to consider working extra shifts, and it increased the morale of a lot of the other staff members and made everyone feel better not only about working extra shifts, but also the hazard of caring for the COVID patients if you will,” said Nicole Kassen, a 47-year-old nurse who works at Tidelands Waccamaw Community Hospital, adding that the pay increase made her think she could work more, sacrificing her personal time.
Tidelands wasn’t alone.
As rising COVID-19 cases brought more hospitalizations and higher demand for health care workers, hospitals called back furloughed nurses, reached out to traveling nurses, and used overtime pay to encourage nurses to pick up additional shifts, and nurses in coordinator or management roles moved back to the bedside to help fill the gaps.
The state also has made it easier for nurses right out of school to get jobs by allowing them to to work in hospitals without having taken their licensing exam.
“Hospitals are using every resource they have to increase their workforce and provide additional support to staff,” said Schipp Ames of the S.C. Hospital Association in an email to The State.
But hiring traveling nurses, and paying extra overtime wages comes at a cost, especially as, for part of the year, hospitals cut back on money making non-emergent procedures that from a medical perspective could be delayed.
According to a study in May by the S.C. Hospital Association, South Carolina hospitals could have as much as $948 million in expenses they don’t receive payment for by the end of the year. When including lost revenue, hospitals in the state could miss out on $2.3 billion this year.
Those loss estimates are what hospitals face even after receiving their piece of the $757 million the federal CARES Act has sent as of Aug. 19 to health care providers in the state.
The South Carolina Legislature also set up a $125 million Hospital Relief Fund to help hospitals cover COVID-19 costs.
‘You often have a headache and your neck hurts’
An increase in COVID-19 patients wasn’t the only stress on hospitals. COVID-19 has hit health care workers, too, forcing them out of work and into quarantine.
Around the state, more than 6,300 health care workers have tested positive for COVID-19, forcing them to miss time from the workplace, according to the Department of Health and Environmental Control. DHEC does not have a breakdown of how many of them worked in hospitals.
Having coworkers in quarantine after being exposed to COVID-19 mostly while out in the community has led to added stress for those nurses filling in shifts, the hospital association said.
Nurses who care for COVID-19 patients must put on more personal protective equipment including putting on a gown, two pairs of gloves, a hair covering, a mask on top of an N95 mask and a face shield, an activity that takes a few minutes.
“It’s not comfortable to wear that N-95 mask most of the day for 12 hours,” Kassen said, who was hired for a coordinator position, but shifted to a bedside nurse role early in the pandemic to help with increased staffing. “You often have a headache and your neck hurts.”
Paying for extra shifts
Nurses working extra shifts and fulfilling additional roles requires more money be spent by hospitals.
At the Medical University of South Carolina, nurses work three 12-hour shifts per week. Over a four-week period when case numbers were high, the hospital system considered mandatory overtime, but was able to avoid it. However, nurses in critical care and labor and delivery units had to be on standby in case they were needed to work an extra shift.
To make sure the shifts were filled, MUSC offered a premium of $175 paid per extra shift on top of overtime pay, said Patti Hart, the chief nursing officer for MUSC Health in Charleston.
Hart said MUSC spent $400,000 to $500,000 per month on overtime and bonus pay during in June and July when cases were spiking. That is $150,00 to $200,000 higher than normal.
Paying nurses more isn’t the the only personnel cost associated with staffing up for COVID-19, hospital officials say.
At Prisma Health, for example, the hospital system set up new roles for staff members because of the additional precautions staff members needed to take because of the coronavirus.
Prisma has staffers screen people coming into the hospital, taking temperatures, and asking questions about symptoms. The hospital system also assigned people to keep track of who enters COVID patients’ rooms and make sure staff members properly put on and take off personal protective equipment.
“That’s an additional cost and appropriately so,” said Carolyn Swinton, the chief nursing officer for Prisma. ”The need has been greater and we have utilized overtime to support patient care during this pandemic.”
Filling shifts with other nurses
Early in the pandemic, hospitals saw the number of patients drop because hospital systems delayed elective and non-emergency procedures to ensure there was enough space for COVID-19 patients.
Parts of hospitals that saw a slow down were able to spare staff to help with COVID patients.
“Every shift matters when you’re trying to staff 24/7/365. One of our big concerns is that we’re not out of the woods yet, so to speak, in terms of the COVID census we have,” said Gayle Resetar, the chief operating officer for Tidelands, which has hospitals along the coast.
Tidelands also reassigned nurses to other departments they could work in without too much additional training. One example was with IT staffers who had worked as nurses in an ICU and returned to the nursing ranks, Resetar said.
MUSC, which organized additional units to treat COVID patients, brought in extra help by partnering with colleges and universities and their professors and nursing instructors, and with local school district nurses who volunteered to be paired up with a registered nurse in the system.
MUSC trained 500 nurses from other departments to work in other critical areas. Nursing managers and directors helped as staff nurses in units.
“It really took us whole when we had that many extra units running,” Hart said.
Another option was reaching out to traveling nurses. But when they’re in high demand, it means the cost of attracting them goes up because of the competition for health care workers. Hospitals have had to to compete with each other around the country to bring traveling nurses on board.
“We were successful in getting some travelers, but that was challenging because there are so many places looking for travelers right now,” Hart said.
Some places are paying double the normal rate for travelers.
“That’s hard to keep up to,” Hart said.
New graduates join nursing ranks
Hospitals have an additional source for nurses, though the pipeline is slow moving because of the pandemic.
The South Carolina Department of Labor Licensing & Regulation is granting temporary authorizations to recent nursing graduates to work even if they have yet to take the licensing exam.
Because testing locations in the state had been closed, about 600 people in this state who have recently graduated from nursing programs were unable to take the licensing exam, according to the S.C. Hospital Association.
Testing locations have since reopened, but fewer nurses can take the exams at the same time because of social distancing concerns.
Tidelands, in Murrells Inlet along the coast, has a handful of nurses it’s hiring with LLR temporary authorizations.
Tidelands has one recent graduate who started the week of Aug. 17 and six more in the pipeline, Resetar said. These are nurses the hospital would have hired under normal circumstances as there is a certain amount of staff vacancies that have occur ever year.
“This is part of our normal recruiting pool of people. For it was very critical this decision be made. May graduation is a part of any health system’s process to backfill normal turnover,” Resetar said.
“The LLR effort is really helping us fill our permanent long-term positions.”
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