Frantic to hire nurses, Florida spends millions on recruits

In the last month as hospitals filled up and cases soared, the Florida Department of Emergency Management signed $379 million in purchase orders for “staff augmentation” services to provide reinforcements to hospital staff facing burnout.
Registered nurse Angela Riinehart examines a potential COVID-19 patient recently inside a triage tent outside Lee Memorial Hospital in Fort Myers, Florida. The tents help prevent the virus from spreading into the emergency room and main hospital.
Registered nurse Angela Riinehart examines a potential COVID-19 patient recently inside a triage tent outside Lee Memorial Hospital in Fort Myers, Florida. The tents help prevent the virus from spreading into the emergency room and main hospital. [ @2020 KINFAY MOROTI/SPECIAL TO TAMPA BAY TIMES | Kinfay Moroti ]
Published July 28, 2020

TALLAHASSEE — Amelia Stansberry had been watching the television news as the COVID cases mounted in New York in April and pondered how she’d like to quit her job and join the traveling nursing corps on the front lines.

“This small voice in the back of my head kept saying, ‘This is what I’m trained to do. What am I doing here when all my brothers and sisters in New York are drowning?’,” said Stansberry, an intensive care unit nurse for five years in Winston-Salem, N.C.

Her hospital had postponed all elective surgeries due to the coronavirus and dramatically reduced her hours but Stansberry, 37, couldn’t imagine asking her husband and 11-year-old daughter to let her leave. Then her husband made a suggestion: “Would you consider going there to help out New York?”

It was exactly the sign Stansberry needed to respond to her “small voice.” She applied for a job with Seattle-based NuWest Group Staffing, moved to New York City where she had never visited, and went to work for 13 weeks treating COVID-19 patients in the brutal epicenter of the global pandemic.

On Monday, Stansberry returned to the front lines, only this time she’s moved to Baptist Health of South Florida in Miami. She is now one of hundreds of medical staff from across the country recruited to relieve Florida hospitals pushed into surge mode and strained by weeks of rising case numbers and crowded ICUs.

$418 million for staff

In the last month as hospitals filled up and cases soared, the Florida Department of Emergency Management signed $379 million in purchase orders for “staff augmentation” services to provide reinforcements to hospital staff facing burnout, according to a Tampa Bay Times/Miami Herald analysis.

The deals, most of them no-bid arrangements, were for everything from nurses to conduct drive-up COVID tests, to respiratory therapists, intensive care unit nurses and certified nursing assistants. By contrast, prior to June 15, only $38 million in purchase orders for staffing had been signed, for a total of $418 million in commitments signed, the analysis showed.

“You have a lot of staff who are burnt out from dealing with this month after month, and we are seeing an increased number of hospitalizations. We have a lot of people that need a break and feel very stretched,‘' said Crystal Stickle, interim president of the Florida Hospital Association, a trade group representing for-profit hospitals.

Complicating the burden as COVID has spread in Florida and hospitals saw a surge in patients, many medical staff have been infected or exposed and have had to stay away from work and in quarantine, she said. “Staffing and [the antiviral drug] Remdesivir are the two things our hospitals tell us that they need.”

Another factor increasing the strain on staff is the special infection controls and other accommodations COVID patients need, said Justin Senior, CEO of the Safety Net Hospital Alliance of Florida which represents non-profit hospitals.

When Jackson Health Systems in Miami reported that 40 percent of its COVID-19 patients had come into the hospital for other conditions and tested positive for the virus, it decided to lower the number of patients it would accept from 1,600 to 1,400 because of the added demands, Senior said.

“COVID changes the workflow.‘' he said. “You need negative air pressure, isolation rooms. You have to control who can go in and out and all of this takes the extra work and precautions, and that reduces your overall staff.”

Burn out and stress

Kristina Hernandez, a laboratory medical technologist who works in the blood bank at Largo Medical Center, is among those who are grateful to see the reinforcements for nursing staff but also wants to see them for her department, the medical technicians who draw the blood.

“On the weekends there are only two (technicians) for the entire hospital,‘' she said. “I see the stress on the nurses faces and the stress on our faces.”

In the last two weeks, she said, nine intensive care nurses submitted resignations and another nurse also quit. “It’s a mixture of not being heard, being stretched as thin as possible and having multiple patients to take care of with no relief in sight,‘' she said. She said she has spoken to some nurses who have decided to leave and take jobs as a traveling nurses.

That is exactly the worry many hospitals have as the state rushes in to contract with staffing firms that may offer more appeal and higher wages than remaining on a hospital’s payroll. “We don’t want them trading one job in their community for another,‘' Stickle said.

Department of Emergency Management Director Jared Moskowitz said “if we find they are doing that we put a halt on the mission and don’t let them continue,‘' he said. They monitor where staff is coming from and “we’ve put an an end to it when it happens.”

Lucrative gigs

Before hospitals can rely on the state, however, many have to work with their own resources, revise schedules, reemploy previously furloughed workers or hire their own search firms, Stickle said. “But really quickly finding staff in a pandemic when everyone is experiencing it at the same time is certainly a challenge.‘'

When hospitals have exhausted their own options, they can ask their local emergency managers to help out. The request then results in a “mission request” at the Division of Emergency management, which has been trying to fill the need by signing a flurry of non-competitive agreements with more than a dozen staffing companies.

To date, the state is attempting to find 2,500 nurses for 65 hospitals, said DEM spokesperson Jason Mahon. “Currently, 1,471 are deployed, with another 754 in the process of being deployed.”

It’s a lucrative gig. Moskowitz said the average contract for a registered nurse can pay $135 an hour; an ICU nurse can make up to $185 an hour.

NuWest gives its employees a stipend of $945 a week for housing, $50 a day for meals and $500 to travel. An ICU nurse makes a total of $6,300 a week, said Sheryl Tullis, the company’s marketing director.

“It’s a really good deal, but it is awful conditions,‘' she said. “They work 12 hour shifts for four days a week.”

Tampa Bay and Miami had greatest needs

Last week, the counties with the greatest need for hospital staffing were Hillsborough and Pinellas. This week, the largest demand is in South Florida.

Tullis said the greatest demand for crisis travel nurses now appears to be for emergency room nurses who can do urgent care and for respiratory therapists.

To accelerate the search, NuWest has a staff of RNs who review each applicant to make sure their immunizations, clinical review and certifications up to date. “Then we get them on a plane,‘' she said.

“The response has been amazing for a couple of reasons,‘' she said, noting that many of their Florida recruits are nurses who like Stansberry had been in New York. “We hear all the time how, ‘This is what I was trained to do’ and for them, it’s like being in the military and on the front lines.”

Since the onset of the crisis, the state has signed $418 million in “staff augmentation” purchase orders with most of them signed between June 15 and July 24, according to the Herald/Times analysis. Most of the agreements, nearly all of them no-bid arrangements, were handed out to four firms: $140 million to Favorite Healthcare Staffing of Overland Park, Kansas; $60 million to Garner Environmental Services of Deer Park, Texas; $35 million to ExecuSearch Holdings in Boca Raton, and $20 million to NuWest Group Staffing of Bellevue, Washington.

Moskowitz said that $418 million is misleading. The state’s contract system updates the date of a purchase order to include the latest order, and the total cost often includes services that were ordered before that date, he said.

He estimates the state has actually only spent $95 million to date for staffing services, and he said the expenses for all staffing to date is capped at $292 million.

Mahon noted that since March, the state has been paying 2,000 traveling nurses and has used them to administer COVID tests at state-run testing sites and “at any time, these nurses can be removed from the testing sites to fulfill hospital requests.”

Hospitals are watching the slight decline in case numbers this week and are hopeful, Senior said, but it’s too early to conclude where the trend is heading.

“If this is a plateau there is optimism we could pull through it,‘' he said. “If it starts going back up there’s a lot of concern.”

COVID’s hidden dangers

Meanwhile, Stansberry is renting an Airbnb in Miami but won’t be visiting the beach. “I don’t feel comfortable doing that,‘' she said. “You guys in Florida need to stay home.”

The most difficult thing about her job, she said, isn’t the “running from one code to another” and operating in constant crisis mode. It’s the hidden dangers of the disease.

“People whose lungs get better and they look like everything is fine again, and then they have have a stroke from COVID because they are throwing blood clots,‘' she said.

The public is so focused on lung damage and breathing difficulties of the virus, she said, “they don’t realize this is also vascular disease and can cause organ damage. We can help you through the breathing, but if you have a stroke, it’s a lot harder.”

At the orientation at Baptist Health on Monday, the visiting nurses were greeted by hospital staff with welcome bags and hand sanitizer.

“Everyone was stopping and talking and thanking us for being there,‘' Stansberry said. “And so knowledgeable! If the staff on the units are even half as friendly, this is going to be a good experience.”