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U.S. hospitals brace for another challenge — an unprecedented shortage of nurses

Hospitals across the country are trying to fill thousands of "crisis" nursing jobs, particularly intensive care unit and emergency room positions.
Image: Michael Fazio
Prime Staffing CEO Michael Fazio delivers pizzas to nurses at work.NBC News

As hospitals around the country prepare for a surge of tens of thousands of coronavirus patients expected in the coming weeks, they are trying to fill thousands of "crisis" nursing jobs nationwide, particularly intensive care unit and emergency room positions.

Even before the coronavirus outbreak, several states were experiencing nursing shortages, and without a dramatic increase in staffing, hospital administrators and advocates fear the health care system will not be able to handle the demand.

“The American Nurses Association is concerned about the pending shortage of nurses to care for COVID-19 patients," said Ernest Grant, the group's present, in a statement to NBC News. "It is critical that healthcare facilities and the federal government do all they can to protect this essential workforce.”

Last week, Vice President Mike Pence announced that the Department of Health and Human Services will allow medical professionals to practice across state lines to address staffing shortages amid the outbreak.

New York Governor Andrew Cuomo has been sounding the alarm for weeks about a statewide shortage of health care workers, as the state became the U.S. epicenter of the outbreak. Cuomo has called on former nurses and doctors to rejoin the work force, offering accelerated "re-certification on an emergency basis" so they can assist with pandemic response. His administration recently sent letters to medical and nursing schools in the state asking for additional reinforcement.

Nurses on the ground are also pleading for assistance.

Image: Maryland's Medstar St. Mary's
Nurses in the intensive care unit of MedStar St. Mary's Hospital check the fit of protective equipment before entering a patient's room on March 24, 2020 in Leonardtown, Md.Win McNamee / Getty Images

“People will die because, realistically speaking, you cannot attend to ten, 20, or 30 patients to yourself,” said emergency room nurse Katherine Ramos of New York. “How could you possibly give the care, the quality care that is necessary? You can’t.”

“I encourage the nurses that are at home, that you have your license, go, help us out. We're all in this together,” she said. “We need to be together. You know? We need to survive.”

Michael Fazio, the CEO of Prime Staffing, an agency that recruits nurses for major hospitals across the country, said that the demand for nurses is unprecedented. Hospitals and other health care facilities sometimes hire nurses on short term contracts to cover seasonal or other temporary staffing issues through companies like his.

Fazio told NBC News that he placed 100 nurses in the New York City area last week, and is currently trying to fill nearly 2,000 open positions — all posted within the last three weeks. In some cases, he’s flying nurses in from across the country and putting them up in hotels.

“They can't get them in fast enough. Especially, in the ICU and the [emergency department]," he said. "The calls that I'm on starting at 6 in the morning every day — those are the areas the hospitals are really trying to ramp up to make sure they're ready to go.”

Fazio told NBC News that demand for nurses is currently about 20 times that of this time last year, and continues to grow every day.

Crisis staffing

The rising need for "crisis" staffing nurses has prompted rising salaries — experienced nurses can now expect wages twice as high as pre-coronavirus rates, with nurses now making $100 an hour or more in some areas.

"Crisis" or "travel" nurses are typically staffed on short term contracts, and are not eligible for sick pay. Fazio’s company is now offering two weeks paid leave if a nurse becomes ill in the course of caring for coronavirus patients — a serious concern given the highly contagious nature of the illness.

Fazio's firm has begun providing additional services to nurses and their families, at no cost to hospitals or the nurses themselves, in hopes that nurses can focus entirely on their work and limit their potential exposure to the virus.

“We need them - you know, these are the troops. This is the war we're battling, these are the troops. We need [nurses] there to help with patient care,” Fazio told NBC News.

These protections includes nurses now being driven to and from work in private cars whose drivers are certified healthy, sealed lunches being delivered to their hospitals, childcare, and grocery deliveries to their families at home.

Jennifer Farris was placed in a nursing position in an ER by Prime Staffing.
Jennifer Farris was placed in a nursing position in an ER by Prime Staffing.Courtesy Jennifer Farris

Nurses say the measures are helping to keep them and the public safe. They are not just concerned for their own health, but worried about spreading the virus to others.

“I usually would take the subway or the bus to get into work," said Jessica Gonzalez, an ICU nurse in New York City who has been taking the car service offered by Fazio's company. "That eliminates all of those 50 to, I don't know, even 100 people I could possibly come in contact with. And it narrows it down to just one — my driver. That's the only person that I come in contact with.”

Gonzalez, like the rest of nurses interviewed in this article, were recruited by Fazio's firm.

Ramos, the New York-based nurse, is currently working at an emergency room, as well as caring for two ill family members. She said grocery delivery made a major difference in her ability to continue to care for others and help flatten the curve. “They have not just been keeping me safe, but they've been keeping the rest of the populations safe, which is huge," Ramos said. "I don't want to be the one spreading anything to anybody.”

But tough choices may lay ahead. The critical shortage of protective equipment for health care workers could be a major obstacle to recruiting additional nurses. The American Nurses Association has warned that a lack of personal protective equipment will increase the risk of nurses becoming ill themselves, and more equipment is necessary to mitigate potential staff shortages caused by illness and quarantines.

"I'm never gonna put our nurses in a position to be unsafe,” Fazio said. “I’m praying that that day does not come where I have to hold people because I'm not gonna put them in that environment.”

Nurses told NBC News they want to keep working and will persevere. “It's important work. We’re actually saving lives and making a big difference,” ER nurse Jennifer Farris said. “We’re all depending on it.”