• Health-care workers across the country are preparing for or already tackling a wave of new Covid-19 cases as a result of the fast-spreading omicron variant.
• The strain's ability to infect vaccinated people threatens to add to workforce troubles, even if symptoms are mild.
• Health-care workers have also reported high levels of burnout, and many have left the field.

Hospitals across the country are bracing for another wave of Covid-19 cases that promises to be just as bad, if not worse, than the early days of the pandemic.

But this time, they are facing it with fewer nurses; and the staff that remains is exhausted after almost two years of fighting Covid. The health-care industry lost 450,000 workers from February 2020 through November, mostly nurses and residential-care employees, the Bureau of Labor Statistics reported earlier this month.

What's more, the highly mutated and contagious omicron variant can more easily infect vaccinated employees than previous strains. That threatens to further exacerbate the staffing shortage by sending workers home to isolate, even if they have mild or no symptoms.

Retaining enough workers is Dr. Shereef Elnahal's "biggest concern right now by far," he said. At the University Hospital in Newark, New Jersey, where Elnahal is president and CEO, the number of employees out of work due to Covid has doubled for the last three consecutive weeks in a row, he said in a phone interview.

"It's a concern that actually exceeds my concern over omicron-specific hospital admissions based on the trends that we're seeing," he said.

Isolation

While the hospital's been able to find people to fill those shifts right now, "if that trend continues we will be in a very difficult position and we will have to move into crisis staffing," he said.

One of the main reasons health systems like his have mandated vaccines for workers was to keep them healthy so they could continue taking care of sick patients. Omicron, however, presents a challenge because it appears to infect fully vaccinated people. Even asymptomatic cases require at least seven days of isolation for health workers under guidelines from the Centers for Disease Control and Prevention.

"But if they end up getting Covid without symptoms and they still have to be out, that ends up, on the other end, posing a health-care risk and a quality risk to our patients," Elnahal said.

At South Dakota-headquartered Sanford Health, hospital officials are watching Covid cases spike in other parts of the country and adjusting their own surge plans.

Preparing

"We're taking this time to step back and prepare," said Erica DeBoer, chief nursing officer at Sanford. "What worked about our surge plan before and how do we fine-tune that so that we're well prepared?"

For Sanford, that includes drawing from a central labor pool it's formed to ensure extra help at particularly busy times. The pool consists of more than 700 people across the system who get additional training and flexibility with their current roles to help fill in the gaps. That includes both clinical and nonclinical staff, who can help with certain nursing work that doesn't require a license to give nurses a break or let them focus on more pressing needs.

Ohio-based Bon Secours Mercy Health accelerated implementation of a new scheduling system during the pandemic so workers could book extra shifts in advance and have more certainty over their schedules, Dani Bowie, vice president of nursing workforce development, said.

Traveling nurses agency Trusted Health is already seeing a surge in demand for workers similar to past waves at roughly four times higher than normal, according to Amanda Maxedon, vice president of marketplace.

Mental health impact

Health workers at the beginning of the pandemic also weren't struggling with almost two years of fatigue.

"The real problem is everybody's tired," said Betty Jo Rocchio, chief nursing officer at Mercy, a system operating in several states including Missouri and Oklahoma. "Everybody is mentally, physically and emotionally worn out from dealing with the impact of Covid."

Rocchio said Mercy offers an employee assistance program with mental wellness built into it and the system also calls on more unlicensed workers to help cover certain tasks to assist patients. She said they have made a "conscious shift" to find additional staff and train them up.

"I think that's a big de-stresser, knowing there's more help coming on the units than there has been in the past," she said.

Trauma and exhaustion

While health-care systems take steps to support their workers' mental health, Maxedon said it's important for the support to feel meaningful to employees. Providing therapy and space for workers to talk through their experiences during the pandemic are the types of things that "go a lot farther" than pizza parties and one-off yoga classes, she said.

"I think the trauma that the nurses are going through is going to be a bit deeper than that, and so having long-term sustainable programs is going to be really important," she added.

While wages for traveling nurses have risen throughout the pandemic and typically double during surges, the extra pay alone isn't incentive enough for some.

"In 2019, it was hopeful that it was going to be short-lived and nurses were really flocking to help and wanting to help. And what we're seeing this time around is I think nurses are more frustrated and they're tired and they're burnt out," Maxedon said. "And so while the pay may be increasing, it's not enough anymore to get nurses to take those roles."

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