‘We are in a crisis’: Houston nursing shortage comes to a head as 'onslaught' of patients swarm LBJ hospital

Houston nurse Jacquelyn Bhones manages the stress of her workday with 10-minute “microbreaks,” sipping water in a quiet room until she has to return to her patients.

Bhones, 43, has been treating COVID-19 patients at a Houston hospital throughout the pandemic, sometimes working up to 60 hours a week amid a nursing shortage and numerous surges in virus-related hospitalizations.

“It’s just been difficult,” she said.

Her growing workload is part of a problem that healthcare providers are facing throughout the state and the Houston-area. A nationwide nursing shortage that started before the pandemic — coupled with nurses who retired, left the profession or are quarantining from COVID infections — has further strained hospitals dealing with a fourth surge of patients battling the virus. The shortage came to a head this weekend when Lyndon B. Johnson Hospital in Houston was forced to declare an “internal disaster”, briefly halting ambulance traffic as emergency room wait times swelled to 24 hours.

COVID HELP DESK: What you need to know about the delta variant

While the state sent additional nurses to help during previous surges, this time it is directing city and county governments to make use of federal dollars through the Coronavirus Local Fiscal Recovery Funds. In a June 29 letter to mayors and county judges, the Texas Division of Emergency Management said the funds are available to boost hospital staffing and increase pay for essential workers.

Meanwhile, nurses on the front lines “are burned out,” Texas Nurses Association CEO Cindy Zolnierek wrote in a letter to the public last week.

“We are all tired of this; nurses are tired of this,” she said.

‘A terrible disaster’

The shortage has come into clearer view while Texas deals with an acute surge of COVID-19 hospitalizations. On Wednesday, the state reported 7,685 hospitalizations, up from 7,305 on Tuesday and an increase of 35.7 percent from a week ago. The Texas Medical Center is admitting about 281 patients per day — the majority of which are unvaccinated — compared to 246 last week and 51 last month.

Harris Health System needs about 250 nurses to fully staff LBJ and Ben Taub hospitals. University of Texas Medical Branch in Galveston recently requested about 100 nurses from staffing agencies for its four hospitals. The shortage has contributed to a backlog of 279 patients waiting for a general bed and 35 patients waiting for an ICU bed at hospitals throughout the nine-county region that includes Houston, according to the Southeast Texas Regional Advisory Council.

The extent of the problem is less clear at Texas Medical Center hospitals. An internal memo at Houston Methodist Hospital said it “is struggling with staffing as the numbers of our COVID-19 patients rise,” but spokeswoman Gale Smith said a hiring bump this year has allowed the hospital to operate at full capacity.

Vanessa Astros, a spokeswoman for Baylor St. Luke's Medical Center, said the hospital “is definitely being impacted” but could not immediately provide staffing numbers. Memorial Hermann also could not provide staffing numbers by press time.

The severity of the nursing shortage at LBJ Hospital first came to light after an emergency room doctor emailed State Sen. John Whitmire Sunday night about the “untenable” situation there.

“The combined increase in volume from (COVID and) existing normal volume (and) nursing shortage has made this a terrible disaster at every ER and hospital in the city of Houston,” the doctor wrote.

On HoustonChronicle.com: How COVID cost Houston $294 million in medical tourism dollars last year

Porsa said the hospital could only staff 16 of its 24 ICU beds. At one point, about 130 people were in the ER waiting room from an “onslaught” of patients with a variety of health problems. The hospital was no longer under an internal disaster by Monday but consistently remains at or near full capacity, he said.

“We are in a crisis situation,” he said. “When you look at the rates and the rise of the number of COVID patients, it’s not a curve. It’s a straight line going up. This has never happened throughout the last year and a half in the pandemic. We have never seen this rapid of a rise in our COVID patients.”

‘Multi-faceted problem’

The nursing shortage has been simmering for years, but the pandemic magnified the importance of the profession, said Dr. Kathleen Reeve, associate dean at the University of Houston College of Nursing.

Texas is projected to have a deficit of 59,970 nurses by 2030, according to state health data. An aging population and dwindling nursing school faculty has contributed to the problem, Reeve said. More nurses are retiring and nursing programs have limited capacity to accept students.

Additionally, the stress of the pandemic has pushed some nurses into other professions or to more lucrative jobs at agencies that place them at hospitals on a temporary basis.

“It’s a multi-faceted problem, and it’s not going to be anything that’s easily addressed,” Reeve said.

Staffing agencies in Houston are experiencing an uptick in requests from hospitals. MedRelief Staffing CEO Jence Cantu said she is seeing more healthcare providers offering “crisis rates,” or double the standard rate for the position.

“I do believe we will see more of the crisis rates being implemented, as they had been previously in the pandemic,” she said.

Christina Cornealius, founder and CEO of CBC Medical Staffing in Houston, said her company has seen a roughly 75 percent increase in requests from healthcare providers in the area.

“Due to the pandemic and fatigue, those (nursing) shortages have drastically increased and the weeks to come could pose some extraordinary challenges for healthcare workers and the community,” she said.

Funding

The Houston-area benefited last year from an influx of hundreds of nurses from the state, which spent about $5.4 billion to contract with staffing firms to hire health care providers from April 2020 through June 2021. That money was reimbursed by the federal government. Porsa said the Harris Health System took on about 140 additional nurses from that effort.

On HoustonChronicle.com: How to talk to your loved ones about getting the COVID-19 vaccine

Now, Texas Department of State Health Services is highlighting more than $10 billion in federal money that is “available to pay for urgent COVID-19 response needs, including medical surge staffing,” said health department spokesperson Chris Van Deusen. The city of Houston’s allotment is $607 million, while Harris County’s portion is $915 million, according to state records.

Local governments receive the money in two installments: Half in May, and half to be delivered next year, according to the U.S. Department of the Treasury. Houston city spokesperson Mary Benton said the city used about $198 million from the first allotment to fill the budget gap from the pandemic and stave off city staff cuts.About $10 million went to the Houston Zoo, which was affected by COVID, she said. She said information on the remaining funds was not available by press time.

Rafael Lemaitre, a spokesman for Harris County Judge Lina Hidalgo, said the county has earmarked most of the funds to support “immediate COVID needs” but did not know whether that included more nurses.

Darrell Pile, CEO of the Southeast Texas Regional Advisory Council, said many healthcare providers cannot quickly access the funds to hire more staff.

“The funds are not quickly accessible and the volume of patients are mounting as the shift in support from the state of Texas last Friday to local governments seems to have happened with little notice to local leaders,” he said.

For Bhones, the Houston nurse, more funding could mean fewer shifts and more time to recover from the workday.

“You really don’t have time for yourself,” she said. “From when you first go to work, you’re seeing COVID patients all day long.”