Zachary Pritchett feels too exhausted to sleep.
The nurse’s back hurts from putting ventilated patients on their stomachs at his Henderson Hospital. His feet are sore from 12-hour shifts in the intensive care unit. When he goes home he goes straight to bed, but his mind keeps spinning.
Pritchett, 33, ponders how overworked his employees are. Some seek advice, and a nurse barely walked to her car this week after working 10 days in a row.
The intensive care unit on St. Rose Dominican Hospital’s Siena campus is already full, Pritchett said. As he lies in bed, he wonders when it will be too much.
“It’s not sustainable at all,” he said on Thursday. “I would say we are fast approaching our breaking point.”
Frontline hospital workers in Clark County say the ongoing COVID-19 surge is pushing them to the limit, despite the Nevada Hospital Association’s assurances that hospitals in the area have room to accommodate more patients.
While hundreds of beds across the country remain empty, eight of the county’s 17 acute care hospitals said they reached or exceeded the maximum capacity of their occupied hospital beds for at least a day during the first half of December. Thirteen reported the same thing for their staffed adult ICU beds, and eight reported a “critical staff shortage” according to NHA data obtained from the Review Journal.
The surge in patient numbers has prompted a hospital to hire more than 150 part-time workers since November to strengthen its ranks.
The hospital association collects hospital-level data on a daily basis, but only shares aggregated county-level data with the public or most health authorities. The hospital-level data will be provided to Nevada COVID-19 Response Director Caleb Cage, a member of Governor Steve Sisolak’s office. The review journal received copies of the reports November 2 through December 15 under the state’s Public Records Act.
Hospitals report both the number of occupied and licensed beds. The former describes beds for which the hospital has sufficient staff available, while the latter represents the maximum number of beds for which the hospital is approved.
NHA officials this week refused to speak to the review journal about the hospital-level data. Spokeswoman Amy Shogren said the association considered the information confidential, although it was regularly shared with the governor’s office.
During a COVID-19 task force meeting in Nevada Thursday, the association’s executive director, Chris Lake, told government officials that hospitals across the state have “some challenges” in filling and discharging patients who are recovering. However, it wasn’t until Monday that the association claimed that Nevada’s health infrastructure “remains intact and in good shape,” even though hospital stays from COVID-19 have more than quadrupled since September, shattering records.
Sick, tired, overworked
However, Clark County hospital staff say the current patient burden is already overwhelming their facilities.
The labor and maternity unit at one of the largest hospitals in the Las Vegas Valley hosts overflow patients who are non-COVID-19, said nurse Yarleny Roa-Dugan. The staff in the intensive care unit and in the emergency room work in mandatory overtime.
“They’re sick, they’re tired, and they’re overworked,” said Roa-Dugan, who asked that their employer not be named. “We don’t think we can continue at this pace.”
In another major hospital, patients are being held in the emergency room because they have no place elsewhere, said lifeguard Ralaya Allen. She recently worked 14 days in a row to help the hospital keep up with demand.
“Patients don’t stop coming and with COVID they are sicker,” she said. “We’re already bursting at the seams.”
The same practice takes place on St. Rose Dominican Hospital’s Siena campus, Pritchett said. Some patients wait days before being transferred from the emergency room. The standard nurse-to-patient ratio in the hospital can often not be maintained.
Even so, Pritchett’s Hospital reported no critical staff shortage in early December, according to the review journal. The hospital also reported that it was slightly below capacity for intensive care beds on most days, only reaching its maximum capacity once.
The nurse said he strongly disagreed with this assessment.
“The truth is that we’re small on the ground and we hurt the staff,” he said. “The nurses are so spread out that they cannot spend time with their patients.”
A Valley Health System doctor in Las Vegas said the company is trying to attract more nurses to its six acute care hospitals, but a nationwide shortage is making it difficult to find. Southern California hospitals ran out of available intensive care beds Thursday, and health officials there say they are also facing staff shortages.
“I superior everyone hospital is in a Competition to the the equal small group of Nurses “ said the Doctor, who spoken on condition of Anonymity.
Discharging COVID-19 patients for recovery is also becoming more difficult for Clark County hospitals, the NHA data shows. The number of medically cleared patients waiting to be discharged to a qualified care facility or other alternative care facility rose from fewer than 20 in early November to 120 by mid-December.
Nevada health officials have formed a “hospital discharge strike team” to resolve the issue, Department of Health spokeswoman Shannon Litz wrote in an email. This includes weekly meetings with hospitals and qualified care facilities to find shelter for patients to recover.
“Every region within the state has dedicated staff who deal with these issues,” Litz wrote. “This is not a one-size-fits-all approach and we are developing strategies to support institutions.”
Personnel critical during the climb
Clark County has backup plans if local hospitals run out of space for patients.
The Las Vegas Convention Center could be converted into an alternative care facility, adding hundreds of beds for patients with less severe injuries and discomfort. However, such a facility would require doctors, nurses, and technicians to treat patients.
“It takes people to take care of other people,” said Mason Van Houweling, CEO of the University Medical Center. “Without them we couldn’t operate.”
UMC was among the hospitals that did not report any critical staff or bed shortages in early December, but Van Houweling said a “delicate balance” was required to adequately staff the hospital. This includes ensuring that employees are not granted vacation requests, that employees work an extra day per week, and that administrators are enrolled in patient care.
The hospital has hired more than 150 part-time workers in the past six weeks. Many hospitals may currently not be able to afford this strategy.
The increased demand for temporary nurses nationwide has resulted in recruitment agencies effectively doubling their salary requirements, Van Houweling said. Hospitals can expect to pay $ 7,000 a week for an ICU nurse if they can find ones to hire.
“It is being managed at current levels,” he said of the ongoing COVID-19 surge in southern Nevada. “(But if) hospital stays increase … we could get into this personnel crisis.”
In Reno, the Renown Regional Medical Center reported almost daily that capacity was overloaded in early December. However, no critical staff shortages were reported.
As of Friday, the hospital was caring for 21 patients in a medical overflow unit that opened in its parking garage last month. Almost 400 patients have been treated in the department since it opened, the hospital reports.
Hospitals are silent about reports
Las Vegas hospital officials, whose facilities reported staff and occupancy shortages, declined to be interviewed this week.
The Valley Health System owns Henderson Hospital, which has had a critical staff shortage every day from December 1 to December 15. Another company’s facility, Spring Valley Hospital, reported that the intensive care unit was full for 13 days over the same period.
In lieu of an interview, Valley Health System spokeswoman Gretchen Papez wrote in a statement that her company was working to “clear emergency rooms and inpatient beds” and that “other areas of the hospital could be used to care for patients if needed.”
Sunrise Hospital, the largest in southern Nevada, reported a critical staff shortage for at least eight days this month. MountainView Hospital reported bottlenecks for 10 days. Southern Hills Hospital operated its intensive care beds at maximum capacity or above for 14 days.
HCA Healthcare, which owns all three hospitals, also released a written statement instead of letting an official speak about the problems. Company spokesman Antonio Castelan wrote that hospitals had postponed elective surgeries to free up beds and “increase ICU staff and capacity to ensure we are ready to care for our patients and protect the health and wellbeing of our colleagues” .
St. Rose Dominican’s two intensive care units hospitals reported being operated at near or full capacity in early December. The system’s campus in Las Vegas reported that its staff were critically scarce for eight days in a row.
Friday morning, Dignity Health-St. Rose Dominican Hospitals spokesman Gordon Absher said the company’s employees were unavailable for an interview and were preparing a written statement. As of Friday evening, it was not made available.
Pritchett said the nurses on his construction site sensed the lack of communication from the hospital administrators.
“What are you hiding? That’s my question, ”he said. “There are times when we can’t even get a response to our administration emails.”
Contact Michael Scott Davidson at [email protected] or 702-477-3861. Follow @davidsonlvrj on Twitter.