A nurse working in the emergency department at Brookdale University Hospital Medical Center in Brooklyn said there have been a lot of close calls lately. On one occasion, they said they entered a part of the facility that no nurse was assigned to cover because the hospital was short-staffed and found a patient xe2x80x9cpulselessxe2x80x9d in his hospital bed after apparently taking off his BPAP, a device to help him breathe.

xe2x80x9cWe caught him in timexe2x80x9d and initiated CPR, said the nurse, who asked to be anonymous for fear of retribution for speaking out about hospital conditions. xe2x80x9cWe intubated him and everything. But still, the fact is that there should have been staff there.xe2x80x9d

The Brookdale employee said they had recent overnight shifts with four or five nurses covering the whole emergency department xe2x80x94 a fraction of the nurses they said are supposed to be on duty.

xe2x80x9cPatients are going to die,xe2x80x9d they said. xe2x80x9cThat’s my biggest fear.xe2x80x9d

Hospital workers across the five boroughs are now in the throes of a staffing shortage New York City health officials predicted a couple of weeks ago. xe2x80x9cOur number one problem in this cycle has been the loss of staff,xe2x80x9d said Dr. Mitchell Katz, president and CEO of NYC Health + Hospitals, the cityxe2x80x99s 11-hospital public system, at a press conference Thursday. xe2x80x9cTherexe2x80x99s nothing about being a nurse or doctor that makes you immune to omicron.xe2x80x9d

Some hospitals are coping with sky-high rates of absenteeism among staff who have caught the virus themselves xe2x80x94 even after the recommended isolation period was reduced from 10 days to five. Meanwhile, city data show COVID-related hospitalizations have been on the rise. And while hospitals report that COVID patients are not arriving in as critical condition as they were in spring 2020 (some are admitted for other reasons and just happen to test positive for the virus), they also are no longer the only priority. Unlike the first wave, many people are now coming in for non-COVID-related care.

At Brookdale and Interfaith xe2x80x94 both of which are part of One Brooklyn Health System xe2x80x94 a combined 356 employees, or about 7% of the workforce, were out sick on Thursday, according to LaRay Brown, the CEO of One Brooklyn. That was an improvement over the previous days, she said.

But the current staffing shortage isnxe2x80x99t exclusively due to people calling out sick. The Brookdale nurse and four others at city hospitals who spoke to WNYC/Gothamist said they have been losing colleagues for months. In some cases, those colleagues retired, and in others they took advantage of better employment opportunities, including temp and travel nursing jobs that pay much higher rates than full-time positions xe2x80x94 rates that city hospitals are now paying as they bring on temporary workers to fill in the gaps.

xe2x80x9cIt is frightening when you look around and you’re like, xe2x80x98Wow, I don’t know anybody here,xe2x80x99xe2x80x9d said Kelley Cabrera, an emergency room nurse at Jacobi hospital in the Bronx, who said colleagues who left have taken institutional knowledge with them. xe2x80x9cLike, everybody here is either brand new or they’re a traveler that just started.xe2x80x9d

Another employee at Jacobi said many colleagues had left in recent months, contributing to staffing problems. But Stephanie Guzman, a spokesperson for NYC Health + Hospitals, which operates Jacobi, denied that it was an issue. xe2x80x8bxe2x80x8bxe2x80x9cWe havenxe2x80x99t heard of a large number of employees leaving their hospital and/or the system, and certainly not causing more strain during the omicron surge,xe2x80x9d she said.

The higher costs that temp and travel nurse agencies demand can create a particular strain for safety-net hospitals like Brookdale that serve primarily low-income patients, since they typically have more precarious finances than hospitals that serve larger numbers of middle-class and wealthy patients who are privately-insured.

Brown, of One Brooklyn, confirmed that her health system has lost staff amid the pandemic. She said she is willing to pay xe2x80x9cpremium pricesxe2x80x9d to bring on temporary workers, which means she may have to cut corners elsewhere. xe2x80x9cWe have other vendors for equipment, for supplies, that we might not be able to pay or might have to pay many months late,xe2x80x9d Brown said.

In order to address staffing needs amid the omicron surge, Mayor Eric Adams announced this week that he would direct $111 million to NYC Health + Hospitals and the city health department. He also said the city would add $33 million to the COVID-19 Hospital Loan Fund, operated through a partnership with Goldman Sachs, to make a total of $45 million in loans available to safety-net hospitals outside the public system, as is the case for One Brooklyn Health System.

xe2x80x9cThis plan will ensure our frontline healthcare heroes have the resources they need to address staffing shortages, and continue providing top-quality care to every person who walks through their doors,xe2x80x9d Adams said in a statement on the funding.

Brown said she appreciated the mayor acknowledging the cityxe2x80x99s private safety-net hospitals, which xe2x80x9care in the neighborhoods that have been and continue to be disproportionately affected with COVID.xe2x80x9d But she said, given One Brooklynxe2x80x99s financial constraints, she would have to think twice about borrowing money.

Temporary Workers Spark Controversy Among Full-Time Staff

While a flexible workforce has become a go-to strategy for responding to COVID surges, increased reliance on temporary workers has also generated resentment among some full-time staff. An intensive care nurse at Lenox Hill Hospital on the Upper East Side, who also asked not to be named for fear of retribution, said they felt undervalued, in part, because they have not received hazard pay during the pandemic.

xe2x80x9cI’m sure you can imagine how it feels when you’re being asked to forgo self care and time off that you’ve earned to come in and work during stressful conditions,xe2x80x9d the nurse said. xe2x80x9cAnd then on top of that, you have somebody come to your unit on a transient basis to make three times what you’re being paid to do essentially less work because a lot of them are not competent in everything that we’ve been trained to do.xe2x80x9d

For instance, if nurses donxe2x80x99t have experience in the type of unit theyxe2x80x99re assigned to, they may not be familiar with the specific medical devices used there and how to troubleshoot when therexe2x80x99s a problem. Even if they do have relevant experience, full-time hospital staff who spoke to WNYC/Gothamist said therexe2x80x99s a learning curve for these nurses in getting acquainted with the nuances of how their particular hospital operates.

Northwell Health, which runs Lenox Hill, said about 5% of its 77,000-person workforce, or about 4,000 employees, were out last Thursday. As of Monday, the figure had improved, dropping below 3%. Northwell, the largest hospital system in the state, is in a much different position than One Brooklyn. It operates its own temporary staffing agency, FlexStaff, which a spokesperson said it is using to fill in gaps during the current surge.

Sean Petty, a nurse in the pediatric emergency room at Jacobi, said the medical center had suffered a xe2x80x9cbrain drainxe2x80x9d in recent months. He said temporary staff xe2x80x94 when they were available xe2x80x94 were not able to replace the experience and expertise of those who had left, particularly in a specialized area such as pediatric care.

Petty said staffing issues began to emerge even before omicron arrived in the city in November. The pediatric emergency room was largely empty in spring 2020, during the height of the pandemic in New York, but volume increased as the cityxe2x80x99s lockdown lifted and kids went back to school. That was to be expected. xe2x80x9cWhat was not OK,xe2x80x9d Petty said, xe2x80x9cwas that happening at the same time as the hospital becoming increasingly fragile in terms of its staffing.xe2x80x9d

While NYC Health + Hospitals has acknowledged an overall staffing shortage amid the current COVID wave, Guzman, the agencyxe2x80x99s spokesperson, said the health systemxe2x80x99s pediatric emergency departments did not stand out as a problem area. xe2x80x9cAs for the pediatric EDs, we havenxe2x80x99t heard of any major strains on that front,xe2x80x9d Guzman said. xe2x80x9cIn general, we havenxe2x80x99t experienced what other hospital systems nationally have been experiencing with COVID pediatric cases surging.xe2x80x9d

Overall, New York state has seen a dramatic increase in the number of children hospitalized who are positive for COVID-19 in recent weeks. There were 365 patients aged 19 and under hospitalized on January 4th, up from 21 just a month prior. At Jacobi, 39 patients in that age group who were positive for COVID-19 were hospitalized in the week between December 29th and January 5th, according to state data.

Petty said some of the pediatric patients at Jacobi are suffering from other conditions that may be compounded by COVID-19, such as asthma or a respiratory illness known as croup. Regardless, he said, staffing on his unit is now the worst hexe2x80x99s seen in his 14 years at the hospital xe2x80x94 and in his view, itxe2x80x99s having real consequences. Petty said there isnxe2x80x99t always sufficient staff to triage patients when they come in, meaning they are seen in the order they arrive, sometimes waiting two to three hours to be evaluated.

xe2x80x9cIf that person is having respiratory distress, or if that child is ill with a more serious disease, we won’t know it unless the parent brings it to our attention,xe2x80x9d he said.

The Future Of The Health Care Workforce

With vacancies multiplying at some hospitals during the pandemic, the New York State Nurses Association has called on administrators to do more to recruit and retain full-time employees.

xe2x80x9cAt least in the short term, [the rise of temp and travel nursing] has kind of upped the ante in terms of what you need to do to hang on to the nurses you have,xe2x80x9d said Dr. Jean Moore, director of the Center for Health Workforce Studies at SUNY Albany.

Even before the pandemic, nursing shortages were projected for some parts of the country by 2030 because of how many baby boomers were slated to retire this decade. New York had been slated to have a surplus, but itxe2x80x99s unclear how the pandemic will impact that outlook.

xe2x80x9cThe smoke’s gotta clear on the pandemic to really understand if we’re looking at some longer-term trends,xe2x80x9d said Moore.

As of June 2021, the statexe2x80x99s health care workforce as a whole had shrunk by 3% from pre-pandemic levels, according to the governorxe2x80x99s office. That has compounded long standing staffing challenges facing certain sectors such as nursing homes. xe2x80x9cWe simply do not have enough health care workers in our hospitals or in our long-term care facilities or in our ambulances or in the homes of our loved ones,xe2x80x9d Gov. Kathy Hochul said in her State of the State address on Wednesday.

She committed to invest $10 billion over multiple years to bolster the health care workforce. That will include incentives such as higher wages and bonuses for remaining in positions, long-term.

In the meantime, hospital workers said they are struggling with the destabilization the pandemic has caused in the workforce. “It just feels like all of this is crumbling everywhere,xe2x80x9d said Cabrera at Jacobi. xe2x80x9cI just don’t know how this can possibly be sustainable.xe2x80x9d

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This story was updated on Tuesday, January 11th, with a statement from Northwell Health on its staffing situation.