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 “pulseless” in his hospital bed after apparently taking off his BPAP, a device to help him breathe.

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

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

“Patients are going to die,” they said. “That's my biggest fear.”

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. “Our number one problem in this cycle has been the loss of staff,” said Dr. Mitchell Katz, president and CEO of NYC Health + Hospitals, the city’s 11-hospital public system, at a press conference Thursday. “There’s nothing about being a nurse or doctor that makes you immune to omicron.”

Some hospitals are coping with sky-high rates of absenteeism among staff who have caught the virus themselves — 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 — both of which are part of One Brooklyn Health System — 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 isn’t 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 — rates that city hospitals are now paying as they bring on temporary workers to fill in the gaps.

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

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. ​​“We haven’t heard of a large number of employees leaving their hospital and/or the system, and certainly not causing more strain during the omicron surge,” 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 “premium prices” to bring on temporary workers, which means she may have to cut corners elsewhere. “We have other vendors for equipment, for supplies, that we might not be able to pay or might have to pay many months late,” 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.

“This 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,” Adams said in a statement on the funding.

Brown said she appreciated the mayor acknowledging the city’s private safety-net hospitals, which “are in the neighborhoods that have been and continue to be disproportionately affected with COVID.” But she said, given One Brooklyn’s 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.

“I'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,” the nurse said. “And 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.”

For instance, if nurses don’t have experience in the type of unit they’re assigned to, they may not be familiar with the specific medical devices used there and how to troubleshoot when there’s a problem. Even if they do have relevant experience, full-time hospital staff who spoke to WNYC/Gothamist said there’s 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 “brain drain” in recent months. He said temporary staff — when they were available — 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 city’s lockdown lifted and kids went back to school. That was to be expected. “What was not OK,” Petty said, “was that happening at the same time as the hospital becoming increasingly fragile in terms of its staffing.”

While NYC Health + Hospitals has acknowledged an overall staffing shortage amid the current COVID wave, Guzman, the agency’s spokesperson, said the health system’s pediatric emergency departments did not stand out as a problem area. “As for the pediatric EDs, we haven’t heard of any major strains on that front,” Guzman said. “In general, we haven’t experienced what other hospital systems nationally have been experiencing with COVID pediatric cases surging.”

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 he’s seen in his 14 years at the hospital — and in his view, it’s having real consequences. Petty said there isn’t 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.

“If 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,” 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.

“At 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,” 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 it’s unclear how the pandemic will impact that outlook.

“The smoke's gotta clear on the pandemic to really understand if we're looking at some longer-term trends,” said Moore.

As of June 2021, the state’s health care workforce as a whole had shrunk by 3% from pre-pandemic levels, according to the governor’s office. That has compounded long standing staffing challenges facing certain sectors such as nursing homes. “We 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,” 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,” said Cabrera at Jacobi. “I just don't know how this can possibly be sustainable.”

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