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Not Enough Nurses: Even With Hazard Pay California Hospitals Face Fierce Competition For Fill-Ins

Nurses treat a COVID-19 patient in the ICU at Sharp Grossmont Hospital in La Mesa. (Mario Tama/Getty Images)
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By Gina Pollack, Megan Nguyen and Monica Bushman

There's no question that the California's health care system is struggling under the weight of the post-Thanksgiving COVID-19 surge.

ICU beds have run out for coronavirus patients in L.A. County. Hospitals in Orange County have been ordered to stop diverting ambulances to other medical centers when their emergency rooms get too busy. Frontline and essential workers are calling for a four-week lockdown to reduce the virus' surge. Even Mayor Eric Garcetti's 9-year-old daughter tested positive for COVID-19.

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Of course, the affects on healthcare workers are unprecedented. Nurses are reporting serious levels of burnout and depression -- some are quitting. Some are protesting. And as positive cases of the virus continue to increase, California is looking out-of-state to help fill staffing holes.


California, and the U.S. as a whole, is dealing with serious critical personnel shortages when it comes to nursing, especially now. But Dr. Timothy Brewer, epidemiologist and professor of medicine at UCLA's Fielding School of Public Health, said that's not new.

"We've had nursing shortages for years, particularly in high-end positions like ICU nurses, emergency room nurses," he told AirTalk, KPCC's daily public affairs show. "That's always been a challenge, and it's exacerbated by the fact that we're seeing a national rise in COVID cases."

In the spring, when cases were surging in specific states such as New York, it was easy to send nurses from other states to address the growing number of patients," Brewer said. But now, when so many states are experiencing surges, "there's really no extra capacity in the system to move people around."

On Wednesday, Governor Gavin Newsom said the Golden State is now looking to other countries to fill staffing shortages at hospitals. State officials are also discussing the possibility of bringing back the USNS Mercy hospital ship to the Port of Los Angeles. They've now requested 10 teams of 20 medical personnel from the Department of Defense.

State Health and Human Services Secretary Dr. Mark Ghaly says hospitals are usually able to fill shortages without intervention from the state by using staffing companies for traveling nurses. But those companies are already stretched thin.

"Usually we get close to 100% of our requests [for traveling nurses]," Ghaly said in a news conference Wednesday. "We're lucky to get two-thirds at the moment."

Meg Vernon is the managing director of Stability Healthcare, a staffing company based in San Pedro. She says some hospitals are now offering hazard pay rates as an incentive to attract more nurses to California.

"There are more orders than I've ever seen and I've been doing this for 17 years," Vernon said. "Right now it is truly everywhere, every state. It's hard to find a place that's saying, 'We're adequately staffed. We've got enough people, we're good to go' ... they're at such capacity right now."

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Because of that high demand, hospitals across the country are bumping up pay rates for traveling nurses. Kaiser Health news reported that some nuses willing to work in COVID units are beind offered as much as $10,000 per week.

Here's an exceprt from their reporting:

In Sioux Falls, South Dakota, nurses can make more than $6,200 a week. A recent posting for a job in Fargo, North Dakota, offered more than $8,000 a week. Some can get as much as $10,000. Early in the pandemic, hospitals were competing for ventilators, COVID tests and personal protective equipment. Now, sites across the country are competing for nurses.

But before you see those high pay numbers and enroll in nursing school, consider the emotional toll the job takes:
With a base rate of $95 an hour, he said, some nurses working overtime end up coming away with $10,000 a week, though there are downsides, like the fact that the gig doesn't come with health insurance and it's an unstable, boom-and-bust market.

Amber Hazard, who lives in Texas, started as a traveling ICU nurse before the pandemic and said eye-catching sums like that come with a hidden fee, paid in sanity.

"How your soul is affected by this is nothing you can put a price on," she said.


California is currently the only state with a nurse-to-patient staffing law. The ratio is two patients for each ICU nurse, and three patients for nurses in step-down units, which are for patients who are stable enough to transfer out of the ICU.

But the nurse's union says hospitals are now "exploiting the pandemic" to get around the ratios at a time when ICU nurses are already experiencing high levels of burnout and depression.

"I've had people who've been active military, that have been nurses for quite some time, saying, 'I can't work in the ICU, I need a break,' like this is just too traumatic," Vernon said.

The California Nurses Association is now calling on the state to stop allowing hospitals to temporarily increase the number of patients assigned to nurses in intensive care units. This comes as Southern California's capacity in those units dropped to 0%.

Tinny Abogado is a step-down nurse at Kaiser Permanente Los Angeles Medical Center. Under the emergency waiver process that the state announced last Friday, she can now be asked to take on four patients instead of three:

"This is so so risky. To say, 'Oh it's just one more' is totally wrong and ignorant. COVID patients in our units are very sick. It only takes one unstable patient to take up all of my time."

In a statement, the California Hospital Association says the union's claims are "false, and worse, irresponsible, in the middle of the greatest health crisis in generations."