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Missouri Hospital CEO On Understaffed Rural Hospitals Overstressed By Pandemic


We're going to begin this hour by taking a closer look at the surge of coronavirus cases taking place across the country. Yesterday, the United States recorded more than 99,000 new confirmed cases - the biggest single-day increase of the pandemic so far. There were also more than a thousand deaths in that same 24-hour period. The surge is being fueled by sharp increases in cases in different parts of the country, but especially across the Midwest. And hospitals there and throughout the country are reporting that they are at or near capacity.

Now, throughout this pandemic, we've been checking in with the CEO of the Scotland County Hospital in Memphis, Mo., Dr. Randy Tobler, to hear how things were going in his community, which is in a more rural part of the state. And he is back with us now.

Dr. Tobler, welcome back. Thank you so much for joining us once again.

RANDY TOBLER: My pleasure. Good to be with you.

MARTIN: Well, the last time we spoke, there was kind of a bit of a lull. It seemed like things were better than we had both thought they might be and certainly as well as we'd hoped they would be. But now Missouri is among the states reporting a rise in confirmed cases over the past week, more than 1,800 a day on average. And the last time we talked, your community had been bracing for a spike in cases. So let me start by asking, you know, how are things for you today?

TOBLER: Well, the way I've described it to folks that are scratching their heads and wondering why we're so frenzied now when we weren't before is like the Fourth of July firework that you light the fuse, and you wait, and you wait. And then you walk away because you think it fizzled out, and then, suddenly, it explodes (laughter).

When the surge hit us, starting right after school started about six weeks ago, is when we started to feel that. And we were in the positivity rate of 5% to 10% and hovering along and managing it. But then we started seeing more inpatients, and our previously unfilled isolation area that we had built and segregated away and really had gone relatively unused became fuller than before.

And as of today, for instance, we have three patients on remdesivir, and we would have never imagined that the way things were just idling along previously. So it's really stressing our staff, who not only have to take care of, of course, those patients, which are a higher acuity, but the regular census, which this time of year, you know, in the late summer, early fall and going into winter, always surges anyway with respiratory illnesses and other problems.

MARTIN: So there's sort of the infrastructure issue, and then there's the staffing issue. Do you mind if I ask, like, what's your bed capacity, and how full are you?

TOBLER: Well, our licensed bed capacity is 25. But chronically, we have only been able to staff because of the chronic health care workforce shortage, which has been a problem before COVID - we've only been able to staff 13 and on a surge basis maybe 16 beds. So that's typically, you know, what we staff or with our nursing staff. And now that we're having to add COVID patients, along with our regular medical surgical patients and our obstetric patients, it's really become a staffing issue.

MARTIN: And tell me about that. You're chronically understaffed. Is that correct? And why is that?

TOBLER: Well, if you look at the average age of nurses, for instance, it's higher and higher as time goes on. And there's been a national workforce shortage, but it's been really concentrated in all rural areas. And it's really been one of those silent crises that we've heard about long before the COVID crisis. As there's been more of an outmigration from rural areas of professionals to the metropolitan areas, we've just been unable to attract on a regular basis or retain local people who train in the professions. They end up moving out and going elsewhere.

MARTIN: What do you most worry about heading into the winter?

TOBLER: It's going to be staffing, staffing, staffing. I am truly, viscerally, profoundly worried about how long the resiliency of my staff, and especially the supervisor and manager-level staff, because we don't have many of those - we're a very, very short-staffed organization to begin with, and that's typical of rural hospitals - as people, as women need to stay home.

And most of our caregivers are women. That's the nature of the workforce. As they have to maybe stay home because schools go from in-class learning to remote learning, suddenly, mom has to be home now because dad's out working. Grandma doesn't want to be exposed to the kids necessarily that may be asymptomatic carriers.

That already frontline staff that's already stressed now gets decimated when a classroom or a school system goes, you know, to remote learning, let's say. And then that means the supervisors and the managers have to fill those shifts. Someone has to take them. We can't even hire travelers at this point - what they call traveler nurses, the agency nurses - because they're being taken to other venues - again, because they can work in a metropolitan area with higher pay, frankly.

And so, boy, it's just - it's becoming a real profound stressor on people that are already - they're - we already are on a bare nerve endings, and it's just - I don't know how long that can be sustained if the combined respiratory season/influenza/COVID-19 surge continues indefinitely.

MARTIN: That was Dr. Randy Tobler, CEO of the Scotland County Hospital in Memphis, Mo.

Dr. Tobler, thank you so much for speaking with us. And please know that we're thinking of you.

TOBLER: Well, thanks a lot. And thanks for hearing our story. Appreciate it a lot. Transcript provided by NPR, Copyright NPR.