The Hospital Capacity Crisis: An Exhausted Workforce Keeps Showing up for Patients Every Day

The national staffing shortage and successive patient surges – Delta and Omicron – have pushed hospitals to the limit. Still, the commitment to patient care has never wavered.   

“Everyone that works here, I can safely say, shows up each day to serve our community and provide services despite the challenges,” said Amanda Kotler, a registered nurse and vice president of nursing at Asante Rogue and Asante Ashland. “So, what I have seen at the staff level and leadership level is just constant reoccurring dedication to try to give every patient their all.”  

Still, Kotler said we should be clear: there has been massive strain on staff that will not be easily overcome. “How do you completely compensate for the trauma that they’ve experienced? That’s what keeps me up at night as a nursing leader.”  

“Just the impact the Delta wave had and the severity of illness and the mortality and just the resources required to get through that and then to have it start happening. Staffing numbers aside, that’s deeply traumatic for our caregivers across the state who gave something all they had.”  

When the public sees the number of hospitalized COVID patients, they may not understand the extra burden on staff. For example, at the peak of the Omicron surge, Asante had around 100 COVID positive patients every day. “There’s not another single diagnosis in the health system that requires that many resources,” said Kotler. “That’s close to 100 patients that have the same disease, we have to isolate for, we have to put precautions in place for, put them in special departments and make sure that everything is safe.”  

The capacity pressures that intensified with the Delta wave never let up in the period before the Omicron wave. “As we decreased from the Delta wave, that’s a reason to celebrate, but then we had this whole other wave of patients that waited and now need care,” said Kotler. “So, the capacity constraints never really alleviated. It’s been this constant stream of trying to serve both patient populations.”  

In response to the staffing shortage (including the difficulty in discharging patients into a more appropriate level of care) and the mission to always put patients first, hospitals have been forced to use contract nurses at unprecedented levels. Kotler says in addition to driving up labor costs, travel nurses present other challenges. “It has a tremendous impact on morale,” said Kotler.   

“Here we are still here, and 40 percent of the workforce are people that are going to leave, and they’re making a tremendous hourly rate,” said Kotler. “What does that look like when I’m standing side by side with these people who don’t have the investment in our patients, in our community?” 

 For Kotler and others, the recent staffing and capacity crisis has driven home the need for real solutions. Everyone with experience in the field knows that creating them won’t come easily, but that we owe it to patients and staff to succeed.   

“We recognize that this isn’t sustainable, and that we value their contributions so much,” she said.  

“Hearing the gratitude over and over, it can be perceived as not enough. But it is truly there. What would we be without these people who have sacrificed for our state and our community?” 

Strides for Social Justice Blends History and Fitness in Eugene

When COVID cancelled the Eugene Marathon, race organizers and longtime partner PeaceHealth were looking for a replacement project to build community health. A turning point came in May of 2020 with the murder of George Floyd.

“We thought immediately that we need to turn our efforts to a social justice initiative,” said Marcy Marshall, PeaceHealth Oregon’s Senior Director of Marketing and Communications. “We were brainstorming and we came up with an idea that would marry social justice into our collective efforts around health and wellness.”

Not long after, Strides for Social Justice was born.

PeaceHealth reached out to prominent Black leaders in the Eugene area to seek input to create and guide the program, which consists of an app to guide participants to various landmarks of local Black history while providing historical context.

The routes are designed to be traveled in the way that suits the user best and were created to be accessible to all ability levels.

“What I do now is, not the walking shoes on, but I ride my bike and so the fun part about it is going up there and riding back down, and then just seeing people of color walking the track and just everybody’s there and it’s free, it’s for the taking,” said DeLeesa Meashintubby, Executive Director of the Volunteers in Medicine Clinic of Lane County and a Strides for Social Justice steering committee member. She said it’s very meaningful to learn more about the achievements of Black residents in Eugene as well as the struggles that they faced.

“I did not know the true history here,” she said. “It just made me feel good to, how do you say it, we represent? And now we’re representing who we truly are in this community.”

One of the more popular routes is a tour of the murals in Westmoreland Park which honor Dr. Edwin Coleman Jr., whose name adorns the community center there. An educator, musician and community activist, Dr. Coleman was a fixture in the Black community for more than half a century.

One group of walkers used the Strides app to guide their walk and read aloud from the markers.

“To know that you’re not alone and to know that someone has come before you and has faced those struggles and maybe paved that way is nice to hear and to see what they left behind for me to benefit from,” said Nanyel Hillsberry, a Data Coordinator for PeaceHealth.

Aside from the knowledge gained, the group exchanged experiences about race relations in Lane County, building empathy along the way.

PeaceHealth recently added two new Strides for Social Justice routes on the University of Oregon campus. One highlights the achievements and experiences of Black UO athletes and coaches and the other focuses on academic achievements and student life.

Marshall said the community embrace of the program has helped make it successful, as has the support of PeaceHealth Oregon leadership. “Social justice is a core value,” she said. “It’s only through awareness that we will be able to dismantle racism in our society.”

Meashintubby agrees. “We can’t get to the future until we know our history and then once we know our history then we can help shape the future.”

A Collaborative New Program Helps Behavioral Health Patients and Eases ED Boarding

“My emotional health just came unraveled. I went to the hospital and said hey, I’m in crisis.”

Daniel Verrier of Eugene had reached a low point when he was admitted to the emergency department at PeaceHealth Sacred Heart Medical Center University District. When his condition stabilized, he might have created a dilemma for the hospital: either keep him “boarding” in the emergency department even though his condition had improved, or discharge him into the community when he still needed behavioral health treatment.

Now there’s an answer called the Guest House, a 10-bedroom respite care center recently opened near the hospital.

“It bridges the gap between those patients that don’t meet the criteria for a psychiatric hospital but also really do need some added support,” said Janet Perez, LCSW, PeaceHealth Manager of Behavioral Health Services. “Boarding is difficult, it’s difficult on the patient. When they’re at the Guest House, it reduces the length of stay in the ED. What that Guest House does is it begins to give that person a sense of safety, they’re being taken care of, while they work on connecting them to resources.”

All the guests stay in a private room, which Verrier said was a major help to his recovery. “I’m hyper vigilant, PTSD real bad, and I didn’t know what to do and so my life would come to an abrupt halt,” he said. “I didn’t really know how to relax until I went there. I was still kind of working on it. To have my own private space where regardless of if I’m having a good day or not, that’s my private space to be was like a really big gift.”

The Guest House services include group therapy and counseling available anytime day or night. Guests enjoy delicious healthy meals prepared by staff. Many are grateful for the peace and the ability to rest.

“One thing I’ve noticed is they’ve gotten more sleep, they’re coming out and talking to people more,” said Jedanndrila Bushnell, Residential Crisis Therapist. “We’ve had one client who said this place really changed his life and he’s never gotten this kind of help before even from other places.”

The Guest House is a collaboration between PeaceHealth and ColumbiaCare, an integrated behavioral health services agency. Plans to open the facility could have been upended by the pandemic, but leaders pushed ahead.

“It’s a great testimony to our collaboration with our county, CCOs, and Columbia Care to be able to get this up and running in a time of pandemic,” said Alicia Beymer, Chief Administrative Officer at PeaceHealth Sacred Heart University District. “It’s exciting to know that we can do that in this sense of adversity.”

Beymer applauds the increase in state funding for behavioral health services included in the budget passed in 2021. “We look at mental health care holistically, caring for mind body and spirit, so with the state funding, it allows us to reach the individual where they’re at and provide compassionate care that’s innovative.”

“There is an opportunity for us to wrap that individual in compassion and love throughout the continuum of care.”

Daniel Verrier has felt that sense of safety and support at the Guest House.

“To have a place that was helping me out without being at a hospital was, is, everything. I’ve got tears of joy just thinking about it.”