“Same song, second verse.”
Larry Shackelford, president and CEO of Washington Regional Medical Center in Fayetteville, balks at the phrase as it relates to the latest round of COVID-19 variants. There are similarities between the events of 2020 and 2021, sure, but something about the current situation feels a world apart from that of last year.
“We’ve been in this pandemic for 18 months. It’s the same pandemic, but it feels different now,” Shackelford said. “It really is almost a new pandemic, I think. It’s happened much more quickly, and the speed of increase was greater, and it happened at a time when everybody was already really tired.”
“Tired” is the theme of any conversation about the current state of health care in Arkansas — nay, the nation — and Shackelford’s facility is no exception. He doesn’t have to look far to see the effect of a year and a half of front-line staff holding back the tide with a teacup; he can read it in their body language, see it in their eyes.
And, after more than three decades in hospital administration, he finds himself more concerned than he has ever been about the ability of the system to hold the line against a virulent adversary.
“What we’re seeing now is, we’re at risk of not being able to do some of the core services that our community depends upon because of the demand and the impact of COVID,” he said. “We’re tired of COVID, we’re tired of talking about COVID, but I have never in my career seen a particular crisis that has put at greater risk the overall general health of our community.”
The problem is not just an Arkansas one, but that is of small comfort to the local medical community, which for months has been operating in a state at or near the top of infection rates compared to anywhere in the nation. Arkansas’ new cases began surging over the summer, touching off a nearly endless string of reports pointing to high infection rates and a spike in the death toll. As of the end of August, the state’s official COVID total was closing in on 24,000 cases.
The pivotal moment came on Aug. 24 when Gov. Asa Hutchinson announced the state had officially run out of ICU beds due to the number of COVID patients, a statistic that was picked up by news outlets around the country. Shackelford said that cataclysmic scenario could easily repeat itself in the future, as managing space needs becomes extremely complicated.
“This is a war on COVID, and when you’re doing wartime management, you have to do things differently,” he said. “We’ve got a group of key leaders that meets every morning, first thing. It’s a daily event where we’re trying to look at what is our bed space, what is our staffing? The particular challenge is, we’re not just seeing sick COVID patients, but it also ties to the fact that there were many that put wellness and elective procedures by the wayside last year, and we’re now seeing some of the results of that. People are coming to the ER, and they’re sicker when they get here.
“For us, and I think for lots of hospitals in Northwest Arkansas, it’s not just an equation of the number of hospital beds that you have and that you can open. It’s the acuity of both the critical care and COVID. The intensity of the staffing means you can’t open all the physical beds that you’ve got. So, as we’re trying to look down the road, if we see [numbers are] going to continue to grow, then you have to start making decisions that are hard. What are other core parts of our business that we can put back on hold to be able to redeploy those staff to take care of what’s here now?”
Jeri Horton and fellow UAMS RN Victoria Wilkinson.
That alone is enough to demoralize front-line workers, but in this third wave, there are additional factors adding to the decaying morale, administrators said. Arkansas continues to rank near the bottom of states in terms of vaccinations. On Aug. 30, the Mayo Clinic ranked the Natural State 15th lowest for people who have received one dose (53 percent) and 7th lowest for people who are fully vaccinated (41 percent). Mississippi ranks last on both measurements.
Thus, said administrators, many caregivers are feeling the additional weight of frustration over dealing with conditions they see as entirely avoidable, if only more people would sit for a vaccine.
Matt Troup
“That’s another aspect of this that is different today,” said Matt Troup, president and CEO of Conway Regional Health System. “We all had a lot of sympathy and empathy a year ago, because really there was nothing we could do. But today, a lot of our clinicians are so frustrated and puzzled, because this is so preventable if people would just accept the vaccine. For some staff, it’s human nature to not help but feel like all of this is preventable.”
Complicating the situation is the high number of health care workers who themselves have not been vaccinated. In June, statistics from the U.S. Department of Health and Human Services (HHS) were released on vaccination rates among front-line workers in 2,500 hospitals nationwide. The numbers showed overall around 25 percent of health care workers with direct contact to patients have not received a single dose of the vaccine as of the end of May. Just in the nation’s 50 largest hospitals, the number was even higher, close to 33 percent.
Larry Shackelford
The situation led several Arkansas hospitals to make the controversial decision over the summer to require vaccination of its employees, among them Arkansas Heart Hospital, CHI St. Vincent, Arkansas Children’s Hospital, Washington Regional, Mercy Health Systems, Medical Associates of Northwest Arkansas, St. Bernards Healthcare System in Jonesboro and Baptist Memorial Health Care.
Conway Regional is also on that list; Troup said the COVID situation is so dire that personal freedoms have to be weighed against the greater good of public health.
“I think the one thing I feel like we can do as an organization is mandate the vaccine, because at least I can say that we did all we could to protect ourselves, our patients and our community,” he said. “The data is so incredibly overwhelming that vaccination helps to reduce the severity of illness. There’s a new study coming out about every 12 minutes it seems like, and no one is refuting the fact that if you get vaccinated, you’re less likely to be hospitalized.And if you are hospitalized, you’re less likely to be put on a vent and die.
“Getting the vaccine could also mean that when your loved one has a heart attack or needs an ICU bed, we’re able to be there for them. That’s the disconnect I think the community at large is not seeing; getting the vaccine means that we’re able to take care of other patients. We need to be willing as a community to suspend our individual right to refuse the vaccination for the benefit of the good of helping our fellow neighbor.”
The announcement touched off protests in some communities among health care workers being forced to choose between keeping their jobs or maintaining their right to choose. Troup said he expects to lose some workers over the mandate, which he finds regrettable.
“There is a small minority who have kind of moved on from the clinical argument that the vaccine is unsafe and it’s dangerous and are really getting down more to a rights issue,” he said. “There are going to be staff, I’m sure, that will leave our employ over this, and I hate it because we need them. We’re at a time when we need every hand that we can possibly get.
“This morning, as I’m sitting here, we have well over 30 critical care patients, and for a 150-bed hospital, that is a really intense service. People need to realize that the vaccine is the answer to freeing up that bed for their next loved one. We need to get beyond the individual rights issue.”
UAMS registered nurse Haylie Day
One hospital that is not mandating vaccinations is UAMS, but only because state law prohibits it, said Dr. Stephen “Steppe” Mette, senior vice chancellor for UAMS Health and chief executive officer for UAMS Medical Center. He said the hospital is seeking a waiver from that regulation to allow it to require vaccinations among all employees. Without it, he said, COVID variants will continue to escalate and with it, staff burnout or attrition to travel nursing positions, which are generally more lucrative than hospital employment, ultimately compromising hospitals’ ability to deliver care.
UAMS registered nurse Chad Conder
“We’ve had enough time as a society, as the public, as a community, to do the right thing,” he said. “We already went into the pandemic with a nursing and respiratory therapist and technician shortage in Arkansas, certainly at UAMS. And the degree of illness and how full our hospitals are and the severity of illness and what we’re asking our health care providers to do, I think will indeed result in more great nurses, great health care professionals leaving the profession because of fatigue, burnout and frustration.
“I’ve never seen, in my 35 years in health care, the number of providers and health care professionals who are demoralized and frustrated to the point of disenchantment with the profession, based so much on the certainty this third wave could have been prevented by the public adhering to public health measures — getting vaccinated, mask wearing, et cetera. All the hard work that went into the first and second waves through the first year of the pandemic feels, not wasted, but why are we still doing this? That demoralization, that disenfranchisement, is extremely worrisome.”
In the meantime, Mette said the hospital continues to do what it can to provide for the physical and mental health and well-being of its front-line staff, something that grows harder with rising infection rates and growing employment vacancies.
“We try to emphasize with our staff that they need to take care of themselves. We, as an organization, try to do things that will emphasize the need for wellness and resilience,” he said. “We are trying to address some compensation issues and bonus pay, which is a double-edged sword — incentivizing individuals to work more because of our staffing shortage just leads to more burnout.
“We have not instituted any kind of requests not to go on vacation, like we did in the first part of the pandemic. We have not put requests for leave on hold during this third wave. We do value that time off, and I think that is helping, but it’s insufficient.”
Stephen Mette
At this, Mette paused, searching for the words to continue. Like all hospital chief executives, his is the challenge of leading a team into daily battle against an enemy hydra, feeding them on small victories and scant hope, working desperately to preserve them to fight another day. It’s a mission that often pits his charges against their own instincts.
“You know the old adage, ‘Physician, heal thyself,’” he said. “Well, not only physicians, but other health care workers are really not the best at making sure they take care of themselves, because they’re so mission-driven. They’re in the profession to take care of others, often at the expense of their own health and their own happiness.
“Our providers, our nurses, our respiratory specialists, our technicians, our physicians have really become experts in taking care of COVID-19 patients, as evidenced by our mortality rates continuing to go down at UAMS. We’ve become experts, but it comes at a toll. It has been an 18-month marathon, and people are worn out.”
