Hospital officials say need for healthcare workers limits capacity for care

With the fourth wave of Covid-19 infections here, ‘people are just tired,’ says Dartmouth- Hitchcock CEO Joanne Conroy.

Dr. Joanne Conroy has experienced firsthand the impact of staffing shortages on patients at Dartmouth-Hitchcock Medical Center.

One of the health system’s responses to a lack of workers has been to halt blood draws at its Heater Road medical building in Lebanon on weekdays.

Instead, patients are directed to the main DHMC campus for that service during the week. It was there, on the third floor, that the Dartmouth-Hitchcock Health CEO recently found herself needing to have her own blood drawn.

There were so many other patients waiting that, after 30 minutes, she left with plans to return later in the day.

In a phone interview, she described the scene as “kind of a madhouse.”

Conroy said she recognizes that simply coming back later isn’t an option for many patients. However, the D-HH system and other healthcare providers have to adapt to what is a nationwide staffing shortage, Conroy said. And it comes as the Covid-19 pandemic continues to drive up hospitalizations, and people who delayed care amid the early stages of the pandemic are coming in with what have become urgent needs.

As of the first week in September, D-HH was seeking to fill about 730 positions in Lebanon alone, according to its website. Smaller hospitals also are seeking dozens of workers. The shortage is especially acute in nursing but also is apparent in sectors such as food and janitorial services and in various technology positions.

While the Upper Valley had a low unemployment rate before the pandemic and a nationwide nursing shortage has been on the horizon for years, Conroy and others said the worsening of the shortage has been “precipitous” in recent months.

“The workforce has shrunk,” said Dr. Joseph Perras, CEO of Mt. Ascutney Hospital and Health Center in Vermont, a member of the D-HH system.

“I think we’re all trying to figure out why.”

In addition to the change to blood draws, D-HH also has been forced to reschedule some patients’ elective procedures such as knee and hip replacements as many as three times, Conroy said. Elective cases are the “only place we have wiggle room,” she said.

On a daily basis, hospital officials are determining how many of the medical center’s 396 licensed beds can be occupied by patients depending on staff availability. In some cases, they are leaving the second bed in a two-bed room vacant, Conroy said. Wait times have also increased in the emergency department.

“Whenever the house is full, people are waiting in the (emergency department) longer,” Conroy said.

New London Hospital, another member of the D-HH system, is seeing a “huge tidal wave of people coming to the ER,” said Tom Manion, the hospital’s CEO, in a video posted online last week.

“People are coming in because they haven’t taken care of themselves,” he said.

Jeff Tieman, CEO of the Vermont Association of Hospitals and Health Systems, said increased demand for care is also coming from people seeking mental health care through hospital emergency departments. The situation is made more acute by staffing challenges faced by mental health providers, such as the Brattleboro Retreat. And hospitals are having trouble discharging patients to nursing homes, at least in part because some nursing homes have beds they can’t fill due to staffing issues there, he said.

“Right now, this workforce shortage is literally the most serious issue (facing) Vermont hospitals,” he said.

‘We’re going to manage’ the surge

Conroy pointed to fatigue with the ongoing pandemic and a generational difference in work-life balance expectations as contributing factors to the workforce shortage. Now, as the fourth wave of Covid-19 infections is here, “people are just tired,” Conroy said.

Still, she said, the health system is prepared to handle an increase in inpatient Covid-19 cases if the region sees a significant surge.

“We’ve modeled it,” she said. “We’re going to manage it.”

New London Hospital is among those turning to travelers for nursing care, Manion said in the video. Such workers usually come at a premium wage and stay for 12-week stints. In addition to vacancies in permanent nursing posts, New London Hospital is short about 40% of positions in environmental services, Manion said. As a result, he mentioned the hospital is relying on people pulling extra shifts.

He urged community members to thank both nurses and janitors they may see out in the community.

“They are working very, very hard,” he said.

In spite of the workforce challenges, Conroy is unwavering in D-HH’s decision to mandate Covid-19 vaccines for employees, though she is hopeful that vaccine-hesitant employees ultimately opt for the shots. As of the first week in September, 90% of D-HH employees had been vaccinated. The deadline to comply with the health system’s mandate is the end of September.

“It’s a ground game now,” she said. Supervisors are having one-on-one conversations with vaccine-hesitant workers.

In some cases, supervisors are walking employees to the vaccination clinic and sitting with them after they get the jab “to make them feel comfortable” and to say, “We want you to stay; we also need you to be vaccinated,” Conroy said.

In response to the workforce shortage, D-HH is increasing pay and benefits; offering pathways for career development; and asking patients to get vaccinated and show patience and kindness to healthcare workers.

DHMC will be prepared to staff the new $150 million patient pavilion that’s currently under construction, Conroy said.

Because the new space will allow the hospital to close off and renovate some of its current rooms, DHMC is “not really filling and staffing 65 new beds day one,” she said. It will be “more gradual.”

She also said that it’s not usually difficult to staff a newer building, which will be equipped to deliver any level of care and also will offer a “better experience” for patients, families and nurses.

D-HH also is continuing to work on longer-term staffing solutions, such as partnerships with Upper Valley educational institutions to train workers. In the meantime, D-HH and other healthcare organizations are paying high rates and competing with each other to attract traveling nurses and other staff.

D-HH also has been working with other area employers and with Vital Communities on the thorny issue of workforce housing, which she said is likely to include subsidizing housing for some workers.

“We’re kind of all in this together,” she said of D-HH and other area employers.

Pandemic fatigue and varying work-life balance expectations contribute to the workforce shortage.