Hospitals in R.I. are struggling with burnout and staffing issues — and the problems are bigger than COVID

“People are still working 12 hour shifts in full PPE,” one chief nursing executive said. “It’s day in and day out, and really gets to you.”

Dr. Seth Koenig, chief of pulmonary, critical care and sleep medicine at Kent Hospital stands outside a COVID-19 patient's room in the intensive care unit in Warwick, Rhode Island.David Goldman/Associated Press

PROVIDENCE — Cathy Duquette has been a nurse for more than 35 years, and knows what burnout in the industry looks and feels like.

When COVID-19 patients first flooded Rhode Island’s hospitals early last spring, health care workers were able to uplift one another, confident that they’d be able to get the job done. But then the second wave came last fall. And the third wave has been a “constant battering” of the entire health care workforce.

The immense pressure on hospitals is not solely attributable to COVID-19 patients. There were 137 patients with COVID-19 in Rhode Island hospitals on Monday, the last day for which data is available; that number topped 500 in December. But medical professionals say things are as challenging as they’ve been in the past year and a half.

Routine procedures like hip and knee replacements that have been put off for the last 19 months are being scheduled, as are tests and screenings that were delayed as many avoided the hospital. Now these patients are coming in all at once.

Dr. Cathy Duquette is the chief nursing executive at Lifespan Corp., which owns Rhode Island, The Miriam, Hasbro Children's, Newport, and Bradley Hospitals. Bill Murphy/Lifespan

“People are still working 12 hour shifts in full PPE,” said Duquette, who is now the chief nursing executive at Lifespan Corp., which owns Rhode Island, The Miriam, Hasbro Children’s, Newport, and Bradley Hospitals. And nurses are constantly having to remind people of the rules. “It’s day in and day out and really gets to you after a while. Add that on to utter exhaustion and frustration of staffing shortages.”

Nursing homes are also short-staffed, so procedures that would ordinarily happen there are now being sent to the hospital. In turn, it’s also causing delayed discharges from the hospitals to the nursing homes. The entire system is congested, according to Duquette.

Hospitals around the state use what’s called the NEDOCS score to track overcrowding in emergency departments. A score of 200 indicates the most severe overcrowding. At times in the last few weeks, hospitals in Rhode Island have gone all the way to 200.

According to Lisa Tomasso, spokeswoman for the Hospital Association of Rhode Island, acute care hospitals in Providence and the surrounding areas have averaged NEDOCS scores of at least 141 since the beginning of September. A score above 141 indicates that a facility is “severely overcrowded,” Tomasso said. A high NEDOCS score doesn’t automatically mean a hospital will have to divert patients, but it does underscore the challenges that hospitals face right now.

“My ER nurses are getting slammed,” said Dr. John Stoukides, chief of geriatrics and palliative medicine and vice chairman of medicine at Roger Williams Medical Center in Providence. “If I don’t have beds upstairs, they end up staying down at the ER.”

Privately, medical professionals at hospitals around the state describe overcrowding, long waits, more patients leaving without being seen, and a fear that the situation might only get worse. More patients are “boarding,” or waiting in the emergency department because no bed is available upstairs. In the case of psychiatric patients, that can last for days. In some cases, people might spend more than 10 hours in waiting rooms.

A medical team helps turn over a COVID-19 patient on a respirator onto the stomach to help with breathing inside the intensive care unit at Kent Hospital.David Goldman/Associated Press

In one instance, a nurse at Hasbro Children’s told the Globe that they had to have families wait outside in their car because there wasn’t enough space in the waiting room to fit them. On Thursday, part of the emergency department at Rhode Island Hospital, the state’s largest hospital and only Level I trauma center in southeastern New England, was forced to close due to a nursing shortage.

“The healthcare workforce shortage existed prior to COVID-19,” Tomasso said. “The pandemic and its protracted nature have only exacerbated that problem.”

At Lifespan, there are 1,800 job vacancies. The figure was about 1,000 in July, the system’s leadership said at the time. Other hospital systems in Rhode Island report a similar uptick in vacancies.

“After being a nurse for 37 years, you know that shortages come in cycles. But across the board, we are seeing a 30 to 40 percent [job] vacancy rate. I can’t even remember a time coming close to that,” said Lynn Blais, president of United Nurses & Allied Professionals, which represents more than 7,000 health care workers in Rhode Island. “This weighs on my mind every day. It keeps me up at night.”

Her union members fought for a new contract with Fatima Hospital, which included a safe-staffing grid. It was approved, but it doesn’t go into effect for another year and a half.

The state has also imposed a vaccine mandate for all health care workers in the state come Oct. 1. Those that are not vaccinated could lose their jobs and, possibly, their license. It also means these hospitals could have hundreds of more vacancies for each facility.

One union leader, who supports the vaccine mandate, told the Globe that in a recent meeting with Governor Dan McKee, a union member asked what the contingency plan was to help with staffing across the board. They said a contingency plan wasn’t shared with them and they were asked what the state should do. Shortly after, the state announced hospitals would have some temporary wiggle room on the mandate.

In the meantime, hospitals are spending thousands on traveling nurses and contracted assignments.

John O’Leary, Lifespan’s vice president of talent acquisition sourcing, told the Globe that the system has to spend “nearly triple” of what it normally does to pay for traveling nurses. Before the pandemic, Lifespan hired less than 50 traveling nurses, who are more expensive and whose assignments last about 13 weeks. Now they are up to 120 to 130.

“We want people to invest in Lifespan for the long run versus those short-term assignments,” he said. “But you can basically make a year’s salary in three month’s time as a traveling nurse.”

Lifespan is offering new hires bonuses of up to $20,000 for signing on.

“But I’ve seen sign-on bonuses as high as $50,000 for specific specialties in other parts of the country,” said O’Leary. “So it’s certainly challenging.”

Judy Thorpe, the chief nursing officer at Kent Hospital in Warwick, said the hospital is also offering part-time staff the opportunity to work full-time for an eight to 12 week stretch — with higher pay if they make that commitment.

“Everybody’s developing contingency plans,” Thorpe said, “because we’re not quite sure what’s going to happen.”