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In metro Detroit, hospital systems are bidding against each other to hire critical care nurses as patients stream into emergency rooms with lungs ravaged by the novel coronavirus.
But away from the front lines, health care workers, including nurses, are receiving pink slips as jobs once considered recession-proof are rendered useless due to the cancellation of planned surgeries, outpatient procedures and other elective medical services during the crisis.
As the coronavirus pandemic leaves a trail of devastation in Michigan, it is also defying the laws of health care workforce supply and demand, creating a maddening musical chairs of labor, forcing executives to adjust in real-time, and fueling frustrations among some workers who say they’re tired of being called heroes but treated like pawns.
“Hospitals across the nation are struggling with it,” said Aaron Gillingham, senior vice president and chief human resources officer for Beaumont Health, Michigan’s largest hospital system. “It’s a complete shift in terms of the type of work hospitals were doing [before coronavirus hit], and the type of work they’re doing now.”
Experts warn the ripple effect of this disruption to Michigan’s health care workforce could carry on long after Michigan rounds the corner on the pandemic.
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In metro Detroit, a zero-sum scramble for staff
The Detroit Medical Center critical care nurse was already frustrated with his job. Staffing shortages had plagued the hospital system’s emergency departments for years, he said, and a recent wave of patients direly ill with COVID-19 had only made it worse. He would go an entire 12-hour shift with only one bathroom break and no time to eat.
“We’re not robots,” said the nurse, who spoke anonymously to Bridge for fear that criticizing Michigan hospitals’ handling of the COVID-19 pandemic could bring job repercussions. “We can’t work like that.”
So when Ascension Michigan, another company with southeast Michigan hospitals overwhelmed by the pandemic, offered him higher wages to take a temporary contract caring for its COVID-19 patients, the DMC nurse said he seized the opportunity.
The average wage for a staff critical care nurse in Michigan is $40 an hour, according to the job placement website ZipRecruiter. As hospitals compete to attract workers who can respond to the pandemic, some are offering $85 an hour or more to nurses willing to take a contract.
If he had to work with a shortage of protective equipment, high patient loads, and the daily fear that he’ll become infected at work and bring the virus home to his family, the nurse figured, “I might as well make better money.”
With many hospital workers staying home with COVID-19 symptoms or dying from them, some staging on-the-job protests over staffing shortages and patients continuing to pour into hospitals, officials at Henry Ford Health System, Beaumont Health, Detroit Medical Center, Trinity Health and McLaren — five Michigan systems caring for large numbers of coronavirus patients — all say filling front-line staffing gaps are a dominant concern. Although none quantified the extent of their needs, most said critical-care nurses are the most pressing issue.
Short-staffed hospitals have initiated a variety of efforts to staff up COVID-19 units, but only so many jobs can be filled by reassigning workers to the frontlines, recruiting retirees back onto the payroll or pressing new medical and nursing school graduates into service early. So, hospitals find themselves competing against each other for limited contract staff, and driving prices up in the process.
In some cases, it has become a zero-sum game: Workers move from system to system within the metro area for better pay, resulting in no net increase in care for Michigan patients. Some Michigan workers are even leaving the state, lured by even higher pay in New York’s COVID-19 units.
“We’re playing the game that they’re giving us, you know?” said a nurse who plans to leave DMC for a contract with Henry Ford Health System that pays more than double his current wage.
“You almost feel like a sucker for just taking your regular hourly rate,” he said.
“You almost feel like a sucker for just taking your regular hourly rate.” -- a nurse who plans to leave Detroit Medical Center.
A transformed labor market
Contract nurses, often referred to as travel nurses, are a mainstay in the U.S. health care system, serving as pinch-hitters who fill temporary needs before moving on to a different gig in another workplace.
The usual going rate for a critical care nurse is about $1,500 to $2,000 a week, said Sophia Morris, vice president of account management for the nurse staffing agency Aya Healthcare. But with hospitals in COVID-19 hot spots now in dire need of extra help, desperate hospital managers find themselves forced to sweeten the deal.
The going rate in Michigan has risen to an average of $3,000 or more a week. In New York, it can be $5,000 or more. Some hospitals are also throwing in free or dramatically reduced housing to attract talent.
“We’ve heard of several instances of staffing prices going significantly up over the last few weeks, and it’s absolutely a concern,” said Ruthanne Sudderth, spokeswoman for the Michigan Health & Hospital Association, an industry group.
But in many cases, hospitals outside Michigan’s COVID-19 epicenter may hesitate to let go of workers for fear that the pandemic could soon sweep through their communities, Sudderth said.
“It’s hard to send your staff down the road, because you might need them at a moment’s notice,” she said.
The high price of filling the COVID-19 staffing void is another financial hit for hospitals already losing revenue after canceling scheduled surgeries, outpatient visits and other lucrative procedures in an effort to limit the virus’ spread. Hospital systems contacted for this story would not quantify the extent of their reliance on temporary workers, but all said they are using them to fill at least a portion of their crisis staffing needs.
“When you don’t have revenue coming in the door and your expenses are going up, that’s pretty hard on the balance sheet,” Sudderth said.
John Fox, the CEO of Beaumont Health, told the Washington Post that Beaumont is losing about $100 million a month because of the COVID-19 pandemic. Fox said escalating contract nursing costs are one of many factors contributing to hospitals’ financial duress.
At Henry Ford, Riney said escalating prices for contract staff are a “significant challenge” among many pressures on the hospital system’s budget.
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Thousands of Michigan health care workers whose job doesn't lend itself to front-line work battling COVID-19 find themselves out of work as health care systems struggle to cut budgets thrown out-of-balance by cancelled elective procedures and outpatient visits. (Shutterstock image)
Stories from the front
Bridge Magazine, Detroit Free Press and Michigan Radio are teaming up to report on Michigan hospitals during the coronavirus pandemic. We will be sharing accounts of the challenges doctors, nurses and other hospital personnel face as they work to treat patients and save lives. If you work in a Michigan hospital, we would love to hear from you. You can contact reporters Robin Erb email@example.com at Bridge, Kristen Jordan Shamus firstname.lastname@example.org at the Free Press and Kate Wells email@example.com at Michigan Radio.
Outside the COVID front line, workers out of a job
The financial losses must be made up somewhere. So while the bidding war for front-line workers rages on in southeast Michigan, thousands of Michigan workers whose skills aren’t readily transferable to the front lines or who work for health care systems that haven’t experienced a spike in coronavirus patients are now out of a job.
Sudderth said no comprehensive numbers exist for how many Michigan hospital workers have been laid off or furloughed during the pandemic, but it’s well into the thousands. Trinity Health, a national company that owns Mercy Health in the Grand Rapids area and the St. Joseph Mercy Health System in southeast Michigan, has announced plans to furlough as many as 2,500 Michigan employees. Flint-based McLaren is also pursuing furloughs and layoffs. Oaklawn Hospital in Marshall laid off nearly 200 employees. And the list goes on.
Some rural hospitals, already struggling before the pandemic, warn the financial hit caused by canceled elective procedures and office visits during the COVID-19 pandemic could force them to permanently close.
The idea that health care workers are losing their jobs during a pandemic “just doesn’t make sense,” said Jamie Brown, a nurse at Ascension Borgess Hospital and president of the Michigan Nurses Association, which represents more than 11,000 nurses across the state. Brown argued that instead of laying off workers, hospitals should re-train them to work on the front lines.
“This is a moment when we need all hands on deck,” she said. “We know all these health care professionals will be needed again very soon, whether for a COVID surge that could be coming to their hospitals or when elective surgeries resume.”
But retraining workers in the midst of a pandemic could prove tricky, said Marianne Udow-Phillips, executive director of the Center for Health and Research Transformation at the University of Michigan and a former director of the Michigan Department of Human Services.
“You’ve got everybody deployed to the front lines and you don’t have the capacity to do that kind of training,” Udow-Phillips said. “But it’s a lesson learned for what we could do to prepare for the future.”
Some hospital systems, like Traverse City-based Munson Healthcare, have tried to avoid layoffs by creating “labor pools” that keep workers on the payroll by splitting a limited number of available work hours among many pool members. Ed Ness, Munson’s president and CEO, said the northern Lower Peninsula health care system expects to hemorrhage $7 to $10 million per month during the pandemic. The pools help cut labor costs while ensuring staff are available to resume working full time if and when a surge in COVID-19 cases starts to fill Munson’s hospital beds, Ness said.
“We’re trying to keep them employed and offer them benefits so that, as the world changes, we can adjust their hours upward,” Ness said.
Ness acknowledged that, long term, health care executives must consider ways to ensure that the next pandemic doesn’t produce such a painful mismatch of available labor supply, demand and budget.
Lessons learned for future crises
The uneven match between Michigan’s COVID-19 health care staffing needs and supply is just one of many “cracks in our system” exposed by the pandemic, Udow-Phillips said. It has labor groups and industry experts worried about the pandemic’s long-term effect on Michigan’s health care workforce.
Laid-off workers may find new jobs or move into a different field, leaving new labor shortages when the pandemic subsides and health care systems reopen their surgery wings and outpatient facilities. Front-line workers may burn out due to high workloads and stressful circumstances. Workers who left their permanent position to take a high-paying contract gig may never return. The next generation of college students may steer clear of medical professions after watching workers endure illness and even death, layoffs, equipment shortages, abysmal working conditions and other challenges during the pandemic.
But experts said the COVID-19 staffing crisis also presents an opportunity to fix the system’s flaws.
State and federal policy changes could help prepare Michigan’s health care systems for future pandemics, Udow-Phillips said.
For example, the state medical board could grant nurse practitioners the ability to prescribe medicine without oversight from a doctor, making them better-equipped to serve as frontline workers when a crisis strikes. Permanently reducing state-by-state barriers to medical licensing would make it easier for crisis-stricken areas to call for help from across state lines. Some patient advocacy groups have long sought these changes, Udow-Phillips said, but a pandemic lends new urgency to the conversation.
Hospital administrators, too, are taking notes on ways to avoid repeating the coronavirus staffing woes the next time a pandemic hits.
At Munson, Ness said hospital administrators might create a pool of staff members willing to travel to fill urgent needs within Munson’s eight hospitals and numerous other facilities, which would reduce the system’s reliance on contract nurses from outside the area.
Beaumont officials may consider requiring administrative nurses (staff managers who rarely provide patient care) to pull occasional bedside shifts, keeping their clinical skills fresh in case of a crisis.
“We’re … having meetings every day about the things we’re learning and the things we’d do differently,” Gillingham said.
The DMC worker who left his job to take a contract at Ascension has one more idea for hospital administrators to add to the list:
“I hope the higher-ups can look at it as patient care, not just numbers,” he said.
“We’re not machines. We’ve got feelings. We’ve got families. You want us to represent you well, but you have to invest back into your employees.”
Bridge reporter Robin Erb contributed to this report.