Florida hospitals’ staff shortages strain a depleted, exhausted workforce amid COVID surge

At South Florida hospitals where beds continue to fill with patients who have COVID-19, most of whom are unvaccinated, there is no longer a silver lining in the evidence that omicron is milder than previous versions of the virus.

Though this time around fewer COVID-positive patients need the intensive care unit and many have been admitted for another medical reason, omicron’s evolutionary advantage as the most contagious variant yet is fueling record cases among hospital workers as well as the community — adding strain to a healthcare system already under stress from the nearly two-year-long pandemic.

The sudden and overwhelming number of infections threatens to undermine not just hospitals but many of the institutions that society relies on to function smoothly, said Dr. Carla McWilliams, chief of infectious disease and quality and safety at Cleveland Clinic Florida in Weston.

“We’re seeing so many cases in so many different persons that it’s extremely disruptive to society as a whole,” McWilliams said. “Teachers, police officers, firefighters, the same holds true for hospitals like us. ... It is very difficult for us to manage hospital operations when we have hundreds of employees out with COVID-19.”

For hospitals, which have struggled with a nursing shortage that predates the pandemic, the latest wave of infections among workers has stretched staff thin, forcing administrators to rely on more costly agency nurses and to offer financial incentives for existing employees to fill shifts and keep themselves free of the virus, said Mary Mayhew, president of the Florida Hospital Association.

“The sheer volume of staff who are out because of COVID is just creating a significant challenge to the system,” Mayhew added.

‘Burnout is there’

Mayhew said the preponderance of hospital workers calling in sick with COVID-19 have mild to moderate illness and that many are returning to work after five days as recently recommended by the Centers for Disease Control and Prevention, which halved from 10 days the suggested quarantine and isolation period on Dec. 27 in part to help hospitals and other industries overcome staff shortages.

At Jackson Health System, Miami-Dade’s public hospital network, about 435 employees have tested positive for COVID-19 during the past 10 days. That’s about 3% of Jackson Health’s 13,700 full-time employees.

Alix Zacharski, a medical intensive care unit nurse and manager for Jackson Memorial Hospital in Miami, said the high number of COVID infections among staff after nearly two years of working through the pandemic is making it more difficult for healthcare workers to do their jobs.

“It has been very challenging to keep our spirits up because the burnout is there,” Zacharski said.

Zacharski sets the schedule for nurses in Jackson Memorial’s ICU, which had 33 inpatients with COVID-19 on Wednesday, and she said it has proven “challenging day to day and shift to shift” as more colleagues fall ill.

“We rely pretty much on a lot of our nurses and PCTs [patient care technicians] and any ancillary staff to do extra shifts,” she said.

Martha Baker, a registered nurse and president of the labor union for Jackson Health doctors and nurses, said the increased number of workers with COVID-19 is happening at a time when the public hospital system is still recovering from the loss of hundreds of nurses last year after the 2021 winter surge strained medical centers across the country.

“The rest of the country was on fire and we lost like 800 nurses who went to travel and get like four times the money they get regularly,” she said. “We’ve been working hard to get restaffed.”

Memorial, Cleveland Clinic dealing with staff shortages

At Memorial Healthcare System, the public hospital for South Broward, about 400 healthcare workers, or about 3% of the more than 14,000 employees were out with COVID-19 this week, said Margie Vargas-Hernandez, chief human resources officer.

“This has been pretty dramatic in a short period of time, just a matter of a couple of weeks,” she said.

During the entire pandemic, Vargas-Hernandez said, no more than 55 to 70 employees have been out at any given time due to COVID-19.

“I don’t think there’s any industry that’s not being impacted by what’s taking place today,” she said.

At Cleveland Clinic Florida in Weston, about 250 or 7% of the hospital’s nearly 3,600 employees, are out sick with COVID-19.

McWilliams, the hospital’s infectious disease chief, said the Weston facility was the first in the Cleveland Clinic Florida system to experience COVID-related staff shortages but that its medical centers elsewhere in the state are now starting to feel the impact.

“The spread is to the north,” she said. “Our northern hospitals in Indian River and Martin counties started very low and over the last week we’ve seen a sharp increase. We probably expect that number to continue to increase.”

Vaccine policies helped hospitals

In South Florida, many hospitals adopted policies during the summer delta wave that strongly encouraged and in some cases required workers to be vaccinated against COVID-19 as a condition of employment — policies that administrators credit with contributing to milder disease among workers during the current surge.

Many hospitals are now reporting high vaccination rates among employees.

Michelle Kligman, chief experience officer and senior vice president of human resources for Jackson Health, said about 85% of employees are fully vaccinated, and that the recent wave has encouraged more to do so in the hope of evading the virus.

“That helps,” Kligman said. “What they’re experiencing is a mild illness for about five to six days.“

Jackson Health does not require vaccination as a condition of employment, but those who are not vaccinated are banned from dining areas, must wear N-95 respirator masks at all times while indoors, and pay a bi-weekly penalty of $50 in health insurance premiums.

At Memorial Healthcare in South Broward, Vargas-Hernandez said about 90% of staff is vaccinated. Memorial Healthcare System does not have a vaccine mandate, but those workers who do not take the shots must wear N-95 respirator masks indoors and attend meetings via video conference or phone.

“I believe that it is working,” Vargas-Hernandez said of the policy. “We’re very pleased about that, and we saw an increase in those seeking vaccinations as the latest variant started to become prevalent in the community.”

More than 3,000 workers or 85% of Cleveland Clinic Weston’s staff is fully vaccinated, McWilliams said. And though many have had COVID-19, she said, “They are mild infections in the breakthrough cases, which is very good.”

The region’s largest not-for-profit hospital system, Baptist Health South Florida, does have an employee vaccine mandate.

In November, Baptist Health reported that 94% of its more than 24,000 employees were vaccinated, and about 5% had received an approved exemption for religious or medical reasons. About 120 employees, or less than 1% of Baptist Health’s workforce, did not comply with the mandate and resigned.

A Baptist Health spokesperson said the network of 11 hospitals in Miami-Dade, Monroe and Palm Beach counties has seen an increased number of staff call in sick with COVID-19 but did not respond when asked how many.

“We are fortunate to be able to shift staff and resources across our various entities in order to care for our community,” Georgi Pipkin, director of communications, said in an email. Pipkin said Baptist Health is offering bonuses for staff to pick up extra shifts, and that the CDC’s new guidance shortening the isolation period is helping fully vaccinated staff return to work faster.

“This new guidance has allowed staff to safely return to work, helping with staffing levels as we continue to see a high demand for care across our system,” she said.

Florida versus the feds

Although vaccine policies have helped hospitals weather the current surge, few have enforced a hard mandate for employees — citing the conflict between the federal government’s mandate for healthcare workers to be vaccinated by Jan. 4 and Florida’s legal ban on employer vaccine mandates adopted in November.

Though federal courts have ordered preliminary injunctions blocking the vaccine mandate, the federal Centers for Medicare and Medicaid Services or CMS said in a Dec. 28 memo that the agency will enforce the mandate in 25 states, including Florida.

Under the CMS vaccine mandate, those hospitals that do not achieve 100% vaccination rates for workers risk being terminated from the Medicare and Medicaid programs, the largest payers in the U.S. healthcare system.

CMS administrators said in the Dec. 28 memo that hospitals will have until the end of March to comply with the rule or risk losing access to federal healthcare programs.

But Gov. Ron DeSantis’ administration has refused to comply.

On Tuesday, Florida’s Agency for Health Care Administration, which regulates hospitals in the state and enforces the federal government’s Medicaid and Medicare laws, said it will not survey hospitals for compliance with the mandate.

In a prepared statement, AHCA Secretary Simone Marstiller said the agency “will follow Florida law” and accused the Biden administration of violating the rights of healthcare workers.

“Florida law prohibits vaccine mandates and protects jobs,” Marstiller said.

Under Florida law, the attorney general’s office can impose fines of up to $10,000 per violation for employers with fewer than 100 workers and up to $50,000 per violation for those with 100 or more employees.

The Supreme Court is expected to settle the conflict between federal and state vaccine mandates for healthcare workers on Friday during a special hearing to address the legality of the Biden administration’s policy.

The court’s special hearing will take place as the omicron variant drives the number of new cases to their highest levels on record for the pandemic, which is entering a third year. Florida reported 59,587 new COVID cases and one new death on Tuesday, according to Wednesday’s report to the CDC, based on Herald calculations of CDC data.

What lies ahead?

While the Supreme Court considers arguments for and against the healthcare worker vaccine mandate, South Florida hospitals continue to see rising numbers of patients with COVID-19.

As COVID-positive patients return and more workers call in sick, some hospitals have been forced to temporarily stop certain services.

Holy Cross Hospital in Fort Lauderdale, which has an employee vaccine mandate, temporarily closed its maternity ward this week due to COVID-related staffing shortages.

A Baptist Health spokesperson said some medical procedures are being rescheduled on a case-by-case basis. Cleveland Clinic Florida has had to “scale back on certain procedures because of pockets of shortages to provide care,” McWilliams said.

So far, though, no hospitals in South Florida have had to repeat the more dramatic steps taken during prior waves, such as canceling elective surgeries and transforming conference rooms into COVID patient units.

But that could change. “If hospitalizations continue to go up, it’s possible that we may have to do that,” said McWilliams, the Cleveland Clinic infectious disease chief.

Jackson Health’s Baker said healthcare workers are loathe to let staffing shortages compromise their mission to serve patients.

If there’s a bright side to the most recent surge in cases and staffing shortages, she said, it’s the sense of teamwork and camaraderie that prevails and helps hospitals and their workers pull through each crisis.

“People want to come back,” she said of hospital workers who fall ill. “They don’t want to use their time to be sick, and I think they feel guilty. They haven’t been taking vacation time even. They feel guilty they’re short staffed with their teammates.”

Yet healthcare workers entering a third year of the pandemic can’t help but wonder what the unpredictable virus has in store, said Zacharski, the ICU nurse manager.

“The rapid spread is very surprising, so it kind of has left us all puzzled as to what else is out there that is waiting for us, and that just leaves us with a very sour taste,” she said. “We’re hoping for a better year, to be honest. We’re hoping that we don’t have to deal with another wave.”