By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
A CNO recently asked me why no one is talking about the high volumes and serious admission delays we are seeing in hospitals nationwide. I am not sure why more is not being said about this, but the sessions and conversations I am having with leaders confirm her concern. We have a serious staffing and patient volume problem in many (albeit not all) hospitals today.
In the past four weeks, I have done sessions with two health systems whose flagship hospitals each had more than 100 patients in the ED awaiting hospital admission. ED managers are increasingly telling me that their areas’ patient volumes and workload are unsustainable. Med-Surg and ICU nurses are overwhelmed with admissions, discharges, and transfers. Two CNOs have shared with me in the past week that they reached out and contacted colleagues in other cities to assist relatives in getting admitted to hospitals. One shared her guilt in “jumping the line” because she, too, is regularly getting these calls.
A partial explanation is that many health systems are inundated with patients with COVID-19, RSV, and now Noro Viruses. But the problem is not just a temporary one. We are seeing the fallout of an aging US population: younger people, who the Wall Street Journal noted last week, are getting diagnosed with cancers not usually seen this early in life, too few subspecialists to see and treat patients earlier on an outpatient basis and the closure of beds in rural hospitals. Getting an MRI in some settings can now take weeks.
The stark reality is that early intervention healthcare in the US is becoming harder, not easier, to access. When all else fails, people go to emergency departments, often very acutely ill. The work of nursing leaders in acute care settings has become much more challenging as staffing is tight, and there is no option to go on diversion. One leader told me that the whole situation was pretty scary, with no clear policy strategy. She noted that her team moves from crisis to crisis.
Most Americans are unaware until they personally confront a problem and need access. Anger levels are high, as I personally observed recently in an ED, as patients wait without answers about when a bed might be available. Nurses keep apologizing for things that they have little control over. I am not sure where this all ends, but like my CNO colleague – I agree we need to start talking about this.
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