Editorial

A November 2020 survey from National Nurses United, the largest union of RNs in the US, rang some alarm bells about the preparedness of healthcare facilities bracing for influenza season along with COVID-19 case surges.

Among the more than 15,000 nurses surveyed by the union, 30% named staffing shortages as their number one concern, with 42% saying staffing had worsened recently.

Healthcare system weaknesses were evident in the following responses from hospital RNs:

• only 18% reported any preparation for surge capacity and planning

• only 17% reported universal personal protective equipment (PPE) use in emergency departments

• only 12% reported that their employer had increased PPE stock and supply in preparation for flu season/COVID-19 surge.

According to data from the US Department of Health and Human Services, 22% of all American hospitals were experiencing staffing shortages in November. The Mayo Clinic and Cleveland Clinic reportedly had upwards of 1,000 employees sidelined because of COVID-19 exposures or infections.

COVID-19 cases and hospital admissions skyrocketed in November, and as of early December, more than 100,000 patients nationwide were hospitalized with COVID-19. Top healthcare industry leaders discouraged holiday travel, predicting that those who gathered over Thanksgiving could well be infected by Christmas. And researchers at Washington University in St Louis forecast some 20 million cases of COVID-19 by the end of January 2021.

Here we go again

Under these conditions, it’s not surprising that some healthcare facilities have once again postponed elective surgical procedures—more than 110 hospitals were doing so as of December 9 to make room for additional patients and help conserve PPE.

OR Manager has previously addressed the significant revenue losses sustained during surgical case pauses, along with the upheavals in staffing and workflow brought on by patient surges. But these pauses have also had a big impact on patients who have delayed getting care. Although it’s too soon to know the long-term effects of such delays, some researchers already have projected a 10% reduction in 5-year survival rates for breast cancer patients and a 16% reduction in 5-year survival rates for colon cancer patients.

The Roadmap for Maintaining Essential Surgery during COVID-19 Pandemic, a joint statement from the American College of Surgeons, American Society of Anesthesiologists, AORN, and the American Hospital Association, was issued to help healthcare providers accommodate all of the safety and treatment protocols needed for surgical patient care in the COVID-19 era. An updated version of the roadmap was issued in late November (https://www.facs.org/covid-19/clinical-guidance/nov2020-roadmap).

Much of the focus is on COVID-19 testing, supply chain strategies and PPE procurement, case scheduling and prioritization, risk mitigation, and data management. In the section titled “Additional COVID-19 Related Issues,” the top item is “healthcare worker well-being, including students and trainees, if applicable: work hours, posttraumatic stress, burnout, suicide risk.”

This is an area that deserves to be a high priority. The longer this pandemic drags on, the more critical it will be to address the psychological and emotional impact on caregivers.

Leveraging leadership

Quint Studer, founder of the Studer Group consulting firm, and Diana Hendel, PharmD, characterize the chronic stress and burnout experienced during the pandemic as trauma. “With stress, there is the belief that things can get back to normal, or close to normal,” they say. “With trauma, there is the realization that things may never get back to the way they were. With the unknowns of COVID-19 and the fact that it is lasting longer and the impact is wider than most imagined, what started out as stress on an organization may have transitioned into trauma.”

They believe leaders must play a prominent role in helping their staffs navigate through a crisis that has turned traumatic. They advise leaders to:

• Super-focus on communicating—even if they don’t have all the answers or have to share bad news.

• Round physically and verbally to stay connected with employees.

• Reward and recognize the heroic work that is being done.

• Realize that they have the opportunity and responsibility to destigmatize mental health.

COVID-19-related strain has been considerable, and everyone caring for patients deserves recognition for their passion and commitment during this crisis. Imminent vaccine distribution and the promise of efforts to contain the virus give us reason to hope we will be in a better place a year from now. In the meantime, stay safe and be strong. OR Manager is deeply grateful for all you have done and continue to do every day. ✥

References

Madrigal A C. Hospitals can’t go on like this. The Atlantic. November 17, 2020. https://www.theatlantic.com/science/archive/2020/11/third-surge-hospitals-staffing-shortage/617128/.

Meng L, Thomadsen R, Yao S. Forecasting the spread of COVID-19 under different reopening strategies. Scientific Reports. November 23, 2020. https://www.nature.com/articles/s41598-020-77292-8.

Meredith J W, High K P, Freischlag J A. Preserving elective surgeries in the COVID-19 pandemic and the future. JAMA. 2020;324(17):1725-1726.

Paavola A. 92 hospitals postponing elective procedures amid the COVID-19 resurgence. Becker’s Hospital Review. December 3, 2020. https://www.beckershospitalreview.com/patient-flow/8-hospitals-postponing-elective-procedures-amid-covid-19-resurgence.html.

Studer Q, Hendel D. We’ve moved from stress to trauma. Here’s what that means for leaders. Becker’s Hospital Review. November 25, 2020. https://www.beckershospitalreview.com/hospital-management-administration/we-ve-moved-from-stress-to-trauma-here-s-what-that-means-for-leaders.html.