Consider This from NPR - COVID Is Straining Rural Hospitals, Where There's No Plan B

Episode Date: December 7, 2020

Health care facilities in rural areas hard-hit by the coronavirus are running out of ways to provide safe care to patients. Unlike earlier in the pandemic, it's more difficult to find hospitals with capacity to spare. A travel nurse shares an audio diary recorded for NPR in Fargo, N.D., and two health care workers from North Dakota and Utah describe the unique challenges they're facing. WPLN's Blake Farmer and NPR's Carrie Feibel have reported on the staffing challenges hospitals are facing.In participating regions, you'll also hear a local news segment that will help you make sense of what's going on in your community.Email us at [e-mail] more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Just listen to how things have been lately for COVID ICU nurse Anthony Looney. I can't remember the last time I worked a shift and didn't put a body in a body bag. Looney is a travel nurse. He's based in Kentucky, but his most recent assignment has been in North Dakota, where he spent the week of Thanksgiving in a hotel room. And we know that because he kept an audio diary for us. So I'm pretty exhausted. I've worked four 12s in a row and then I have to day off and I'll be going back for three more in a row before I get another day off. Looney has been working at Sanford Medical Center in Fargo. It's the only level one trauma

center in the state, which is largely rural. So patients come from all over. To my understanding, they've had to open up a couple different units that didn't even exist before to fit these patients into their hospital. In North Dakota, like a lot of places, the biggest problem isn't space. It's a lack of staff. A safe COVID ICU unit, Looney says, has a patient-to-nurse ratio of two to one. And that's because we need to be watching these people's intake and output and their electrolytes and their labs and replacing their labs and doing just normal stuff that nurses do. But if you add on a third patient, then things get more unsafe. And if you tack on a fourth patient, it becomes even more unsafe. And if you tack on a fourth patient, it becomes even more unsafe.

And every day, more patients are being admitted to hospitals that cannot make the math work. There are only so many travel nurses like Anthony Looney to go around, and he's been working 60 hours a week, spending what little time he gets off work, alone in his hotel room, ordering takeout on DoorDash. I'm just really beat from working so much. I miss my home. I miss my co-workers that I work really close to down in Kentucky. And my dog's up here with me. She's keeping me sane. And I'm going to log off here and probably take another night. Consider this. In many rural areas with smaller health care systems, there aren't enough

people to take care of the caseload. And every day, the number of hospitalized patients goes up. I'm Adi Cornish. It's Monday, December 7th. Download the WISE app today or visit WISE.com. T's and C's apply. Writer Baratunde Thurston says this democracy experiment requires more than just voting. This is incumbent on all of us. It takes two. It takes two to make a thing go right. It takes two to knock it out of sight. And both parties in a national level discourse, both sides have to still remain committed. How to be a good citizen.

That's on the TED Radio Hour from NPR. It's Consider This from NPR. When the first wave of the pandemic hit the U.S. back in the spring, hospitals did not have the same problems they do now. In fact, in most of the country, hospitals were actually seeing fewer patients than normal. And nurses like Laura Williams were able to help out where they were needed most. So I was working mainly six or seven days a week, but I felt very invigorated. Williams helped launch a field hospital in New York City. It was really a hot zone where we were

always in full PPE and every patient who was admitted was COVID positive. Back then, the pandemic was a patchwork. Some areas were hit really hard and had to fly in health care workers. Some areas weren't and had health care workers to spare. But things are really different now. Cases are at record highs everywhere. Hospitalizations are rising everywhere. Hospital capacity is almost exclusively about staffing. Physical space, physical beds, not the issue.

That's Dr. Lisa Percy with the Tennessee Department of Health. In Tennessee, like a lot of places, ERs are being pushed to the limit. Here's Dr. Jessica Rosen, an emergency physician at St. Thomas Health in Nashville. We have been frequently on diversion, meaning that we don't take transfers from other hospitals. We try to send ambulances to other hospitals because we have no beds available. Jessica Rosen and the other health care workers you just heard spoke to reporter Blake Farmer. He's been covering the pandemic for NPR from Nashville. The process of shuffling patients around until they get to a hospital with capacity, that's easier near cities with big hospital networks.

Health care providers, clinics, primary care docs in rural areas do not always have that luxury. Some are the only option for hundreds of miles. And infections that set in over the Thanksgiving holiday will soon send even more people to the hospital. So things are about to get harder for nurses like Tessa Johnson. I am a registered nurse. I currently serve as an executive director in a long-term

care facility in Dickinson, North Dakota, which is a very rural area. Now, when Tessa says rural, she means? Rural is, North Dakota is rural in general. Where I live, it's on the western side of the state. Population is about 17,000. So that's in North Dakota. About 900 miles southwest, in Utah… Rural for me is 8,000. … is Danelle Pendergrass. I am a women's health nurse practitioner and own and operate Eastern Utah Women's Health in Price, Utah.

In the small towns where they live, healthcare workers like Tessa and Danelle struggle with a lot of the same challenges that exist in more populated areas. But they have far fewer resources to get by with and almost no one to pass the buck to. Tessa, Danelle and I spoke over Zoom last week about their unique challenges. To start, Danelle told me a lot of people who come into her Utah clinic with symptoms of COVID-19 are convinced they don't have it. They're always calling and saying, I know it's just a sinus infection, or I've had this before. And to really convince somebody that they need to get a COVID test has been interesting during this time. People don't want to even entertain the idea that it could be COVID. Meaning how do they reply? Oh, I know it's not COVID. And I'm like, how do you know it's not COVID? Oh, I just know it's

not COVID. There's no way I can have it. Tessa, you were just nodding at that. What are you hearing? Because you're at a long-term care facility. So how would you be hearing that? Same. I've heard that same thing for a couple of different reasons. I have a staff member who called off with a sore throat and she did go to the clinic and she told me, I think it's just strep. I refuse the COVID test. And I said, why would you do that? And she just said, I don't know. I just don't want to take another one. And I also have a nurse practitioner who is my very best friend, and she works in even more rural area, North Dakota, about 60 miles north of here, tiny little oil field community. And she's point blank told me, I will not get tested unless I am mandated by my employer for a couple of reasons.

A, I don't want to quarantine, and B, I don't want to take my PTO. And she's a nurse practitioner who very much understands the disease. But I think I really think that's part of the issue sometimes is people are, they're scared to be off work. When has it felt like a struggle? I know that there was a surge in North Dakota of COVID. Does that mean you are dealing with sick people, trying to refer them to hospitals? Like, what does that mean for the actual care you're trying to provide? You know, if I had to pick out one thing that's the most difficult for me as an administrator in this role during this time has been the emotional turmoil of the staffing process. So we get tested right

now weekly. So that's just a condition of employment at this point in our line of work. But even now, if you just give this week for an example, last week, Wednesday, the day before Thanksgiving, we tested. We didn't get results till Sunday. So we wait. I check my phone 16,000 times a day for results. I panic about what's going to happen and how are we going to quickly change that and what's going to happen when we get the results and if there's a positive, how am I quickly going to get it? And it depends on who the resident is and where they live and if they have a roommate and how are we going to get them isolated.

Then I worry constantly about what if four staff come back positive? How am I going to staff my building? And so I have that constant stress and then you get the results and then you deal with that. And then you have about a day of breathing room, and then you test again. It's that constant emotional cycle. Danelle, you were nodding during Tessa's comments there, which were like making my heart beat, just listening to you describe the stress of it.

Since you're a nurse practitioner and you're at a clinic, are you still face-to-face with patients at this point? And what does that mean in the midst of a COVID surge that your state has been dealing with? Yes, we're still face-to-face with patients. We try and do as much as we can telehealth, but then people still come in. So what that looks like for patients is sometimes going and meeting the patient where they're at, which oftentimes is in their vehicle, or we're very careful on who comes in. So we do the whole screening questionnaire, take the temperatures, we're allowing only one person in so they're not meeting in the halls with somebody else who may or may not be. They're required to wear masks. And I have had actual patients

come in without a mask. We've asked them to please put their mask on and they have gotten so upset, told us we were infringing on their rights, and left our office saying they will never come back because we asked them to protect themselves and us. So it's been very interesting that way. Some people are totally fine with it, with wearing a mask, and other people just will not do it. How are you both feeling about the next couple of months? We've had a lot of public health experts tell us that there is a feeling of dread that there could be kind of a post holiday surge. Is that something you're hearing within your nursing networks, or in the facilities where you're working?

Yeah, I worry about it. We do anticipate, I think I have mixed feelings. Let's start with that. I continually am just appalled by the way people behave in our state. We've, we've heard our whole lives that were North Dakota nice. But again, this morning on Facebook, there's a girl I know that had a post that said, I'm just so heartbroken that our kids have to wear masks during sports. And I just thought, I just can't take it anymore. And someone commented, you should see how heartbreaking it is to see a COVID patient in the hospital. If it doesn't affect people personally, they just don't get it. And whether that's my husband, who is a welder who thinks he's never taken a flu shot in

his life, and it's politicized, he thinks. I think after he saw what I go through, he may understand it a little more. We have our county sheriffs in our state. I'm sorry, in our counties. Can we go back to the husband, though? You're saying he may have a better sense. So even in your own home, you've got a skeptic. I still battle it in my own home. Yes, absolutely. For somebody who he too thought it was politicized. He too thought that it would be gone on November 4th. You know, he still is that person, no matter how much I share, educate. He sees my tears. He sees my stress. He sees what we do. It doesn't personally affect his day-to-day life. And again, I just feel so strongly that until it directly affects people, they just don't understand.

Danelle, in Utah where you are, what are you seeing that either makes you hopeful or concerned about the next few weeks? I'm more concerned as opposed to hopeful. And the reason why I'm more concerned is some things that Tessa actually touched on. Number one, our town, our community prides itself in taking care of one another. Somebody falls down, we'll be the first ones there to lift you up. We bind together. We make sure we're all taken care of. But people will not do the simplest things as wearing a mask, social distancing. And I feel oftentimes rule is left out of the conversations. We're always like the last to get things or the last actually to see the rise

in COVID cases. And so they lock everything down at the beginning and people in the rural areas are like, oh, it doesn't affect us. We don't even have one COVID. But to tell them it's coming and we still need to prepare for that. It's just too late by that time. All the politics have gotten involved and people are not going to go back on and change their mind about how they would like to protect themselves and their community. And it makes me a lot less hopeful that this is going to be under control. So we're really preparing for the next two months in my facility. Well, Danelle Pendergrass, thank you so much for speaking with us. Thank you. I appreciate the opportunity.

And Tessa Johnson, thank you for talking with us. Absolutely. Thank you. It's Consider This from NPR. I'm Audie Cornish.