California needs nurses, doctors for coronavirus surge. Here’s what the state is doing to get them
As California braces itself for an onslaught of coronavirus patients, the state needs more than hospital beds and personal protective equipment.
Gov. Gavin Newsom now says he’s looking at loosening rules governing health care workers to free up more doctors and nurses.
The Democratic governor is in talks with hospitals and groups representing medical professionals about how to staff any new medical facilities, including several hospitals the state is leasing.
“Our staffing is going to require more flex, it’s going to require more capacity as it relates to existing ratios, as it relates to current scope of practice,” Newsom said during a news conference Monday. “We’re going to have to do more on rules and regulations.”
His office projects the state will need to add 50,000 beds in its hospital system to treat COVID-19 patients, a sizable increase from the 75,000 beds the system currently has. That will require everything from a 1,000-bed Navy medical ship docked in Los Angeles to tents in hospital parking lots.
To staff those beds, hospitals throughout the state will need more doctors and nurses, particularly those with expertise in respiratory problems, said Joanne Spetz, associate director of research at the University of California San Francisco’s Healthforce Center.
Some will triage patients when they first arrive. Others will monitor those who aren’t yet critically ill. Intensive care doctors and nurses will be needed for patients in the worst shape who are experiencing organ failure, Spetz said.
In the meantime, hospitals will still need to keep up with the existing demands on the medical system, which already operates close to capacity.
“At the same time, they’re trying to also take care of the people who are coming with strokes and heart attacks and opioid overdoses,” Spetz said. “It’s not like people stop having heart attacks.”
Health worker rules
For years, if not decades, health care professionals have battled at the state Capitol over what is known as “scope of practice” - laws governing the types of work various health workers can perform. Newsom said he is in “advanced negotiations” to make changes for this situation.
For example, nurse practitioners have long lobbied to end laws that require them to operate under the oversight of a doctor. They’ve run into opposition from the California Medical Association, which represents doctors who argue nurse practitioners lack the expertise to operate independently of a licensed physician.
Now, the nurse practitioners are arguing the governor should use his emergency powers to waive those rules so they have more flexibility to help treat the incoming surge of patients.
“Our healthcare system needs to bring all resources to bear to get through this public health crisis,” California Association of Nurse Practitioners President Karen Bradley wrote in a Friday letter to Newsom. “We know that this moment requires all hands on deck, and we are ready to serve our state and provide access to care.”
The UCSF Healthforce Center, which studies the health workforce, is among the groups Newsom has asked for guidance on the issue. A memo the center created for the governor’s office recommends the state temporarily waive some nurse practitioner rules.
The UCSF center’s memo also recommends loosening scope of practice laws for certified nursing assistants, licensed vocational nurses, nurse midwives, clinical nurse specialists, paramedics and clinical laboratory workers.
Sen. Richard Pan, D-Sacramento, said he thinks the COVID-19 pandemic is an inappropriate time to move in that direction. The state needs to increase the overall number of health professionals, something waiving scope of practice rules would not do, said Pan, a practicing pediatrician.
“That would be an extremely divisive thing to do,” he said. “We don’t have large numbers of physicians assistants or nurse practitioners sitting around not able to work or respond to this crisis in the state.”
Anthony York, a spokesman for the California Medical Association, declined to comment on the nurse practitioner proposal. He said the organization is instead focusing on helping mobilize more doctors to treat the surge of COVID-19 patients.
The crisis could require a range of emergency measures, from housing patients in dorm rooms to encouraging doctors to use bandanas when masks run out, York said.
“We understand there’s going to be all kinds of emergency measures, things that aren’t usually best practices,” York said.
Calling on retired doctors
The California Medical Association is surveying to find members who may be able to help treat the wave of COVID-19 patients, including people who are retired and others no longer practicing medicine.
California Health and Human Services Secretary Mark Ghaly said the state is receiving many emails from former doctors who want to help.
“It has felt and it continues to feel like an all hands on deck mission,” he said during a recent news briefing. “We know this is going to be a challenge, but we think Californians are going to step up and meet it.”
CMA is urging its members to suspend nonessential medical procedures, such as plastic surgery and LASIK vision improvements. Facilities that routinely do those procedures have some equipment, such as treatment beds, gloves, masks and ventilation equipment, that could be used to accommodate the coming surge in COVID-19 patients and could possibly be outfitted as intensive care units.
Medical facilities for elective surgeries typically aren’t staffed or licensed to be used around the clock, so they would need waivers in order to be used for coronavirus patients.
Newsom has already issued executive orders waiving some licensing requirements for hospitals and staffing requirements for clinics, adult day health care centers, hospices and mobile health units.
Nursing students may be needed
As the state grapples with a shortage of workers, nursing students are raising the alarm that roughly 14,000 of them are at risk of not graduating on time. Those students are close to finishing school but have been shut out of hospitals due to coronavirus and are therefore unable to meet their graduation requirements, which mandate that 75 percent of their clinical training happen in person.
Ryane Panasewicz, a nursing student at West Coast University, started a petition urging the governor and the Board of Registered Nursing to lower the threshold to 50 percent to allow her and her classmates to graduate and join the workforce.
Panasewicz said she’s eager to help treat the surge of coronavirus patients, but worries she won’t be able to.
“I feel a bit helpless,” she told The Sacramento Bee. “I’m almost trained to do something about this, but I can’t.”
The issue is especially urgent because most nurses in California are older than 55, said Scott Casanover, general counsel for West Coast University. That puts them at higher risk from coronavirus, and means some have already been forced to stay home to avoid contracting the disease, Casanover said. Others will have to stop working if they catch the virus from the patients they’re treating.
“It’s a compounding issue,” Casanover said. “It’s like a snowball rolling down a hill.”
Newsom has not said explicitly that he plans to change the nursing student requirements, but on Monday he said fourth-year medical students and nursing students near the end of their training could be called on to treat COVID-19 patients.
Pan said using medical students to treat patients could be an option, as long as they are properly supervised and are compensated fairly.
Meanwhile, Pan said people need to socially distance themselves to slow the spread of the disease to give the health care system a chance to staff up.
“The first line of defense against this pandemic is actually all of us,” Pan said. “The health care professionals are basically the final walls before the breach, but the first line is still all of us doing our part to slow this disease.”
This story was originally published March 24, 2020 at 3:20 PM with the headline "California needs nurses, doctors for coronavirus surge. Here’s what the state is doing to get them."