My colleagues and I have talked to dozens of clinical executives in the past month about how they're staffing for Covid-19—from those readying for a surge to organizations already on the other side of their market's apex. Here are four lessons learned from those conversations that I recommend that all clinical executives keep in mind as they customize their organization's Covid-19 staffing strategy.
1. Account for reduced productivity in your Covid-19 staffing needs projections
Clinical executives are already using Covid-19 bed projections in their market to estimate their staffing needs. But they are accounting for more than just a surge in patient volume. They are also adjusting for the loss of productivity associated with Covid-19 care.
There are two reasons Covid-19 negatively impacts productivity:
- Between ventilator management, proning, and donning and doffing of PPE, the care itself is more labor intensive—and requires additional staff to deliver.
- It's inevitable that some clinicians will fall ill and be unable to work. Exactly how many will contract the virus is still unknown, given uneven testing and reporting. But in the last week the CDC reported at least 9,000 health care workers had contracted the virus. State-level projections indicate that health care workers make up anywhere from 3% to 11% of total Covid-19 cases. Organizations should plan to accommodate for the higher end of the range in their staffing plans, particularly as PPE shortages continue to grow more severe.
2. Redeploy clinicians not well suited to inpatient care to other Covid-19 hotspots
Most organizations have already begun the complicated process of redeploying ambulatory staff to the acute care setting. For staff with inpatient experience or competencies related to Covid-19 care, their redeployment is critical to increasing capacity.
But there are clinicians whose specialty and previous experience aren't well suited to inpatient redeployment. Organizations should leverage this capacity to staff other hot spots in the local community:
- Flexing RNs to SNFs and home health services will allow hospitals to discharge more patients and increase their own capacity.
- It's estimated that Covid-19 has caused over 3,000 deaths in U.S. nursing homes, facilities that traditionally struggle with maintaining their staffing pools. Extending RN or MD support to bolster infection control is key to preventing an outbreak.
3. Scale the expertise of clinicians in Covid-19-related specialties
Many organizations redeploying staff to acute care settings are increasingly investing in cross-training on inpatient skills and competencies—through online modules available through professional societies or in-person "boot camps." Unfortunately, these trainings have limited applicability in the current challenge, as it typically takes years for frontline clinicians to become clinically competent in caring for critically ill patients.
Organizations should instead consider investing more heavily in scaling the expertise of the experienced clinicians they have at the bedside to deliver quality care to critical Covid-19 patients. CNOs across the country report converting their ICUs to team-based staffing models led by an ICU RN or NP. For physicians, a virtual option may be the best answer. Several organizations have extended critical care or palliative care physician coverage by implementing a virtual provider consult model via FaceTime. In addition to providing an extra layer of clinical support, this approach also reduces the risk of those specialized clinicians contracting the virus themselves.
4. Embed opportunities in frontline workflow to process grief and moral distress
Frontline clinicians are experiencing an unprecedented level of grief and moral distress. Executives should equip leaders to facilitate conversations among frontline clinicians about their well-being.
One option more feasible for peak surge is to equip frontline managers to convert previously scheduled meetings, like unit huddles, into an opportunity to check in on frontline clinician well-being. If their staff have bandwidth, organizations can leverage chaplains, ethicists, or mental health clinicians with facilitating team conversations to collectively process emotion and reinforce resilience.
What are you doing today to ready your organization for post-Covid-19 staffing challenges?
My conversations with our members in the hardest hit markets suggest that a new wave of staffing challenges will surface in the post-Covid-19 era, including staff burnout, increased union action, and a frontline clinician supply shortage.
Revitalizing our workforce to tackle these challenges will take a strategy beyond what most organizations already have in place—a strategy the Advisory Board is committed to helping you navigate. If your organization is already taking steps to prepare for post-Covid-19 staffing challenges and would like to share, please contact me directly at RewersL@advisory.com.