A Shrinking Band of Southern Nurses, Neck-Deep in Another Covid Wave

When she got a panicked call from one of her best nurses saying she couldn't come to work because her car had overheated on Route 63, Bobbie Anne Sison panicked and headed to the hospital. Ms. Sison, a nurse manager at Pascagoula Hospital, made a U-turn and raced to get her.

Ms. Sison said there was no way she was going to leave her on the side of the road.

At Singing River Health System, a county-owned network of three small hospitals along the Gulf Coast of Mississippi, there were 106 coronavirus patients being treated on Sunday, up from a dozen or so patients at the beginning of the month. Ms. Sison was trying not to think about what the coming days would bring as 40 percent of all Covid-19 tests in Pascagoula came back positive.

She doesn't know if we can do it again.

Hospitals are still facing a huge influx of patients even as new cases peak and begin to decline in the Northeast and Upper Midwest. In Mississippi, the latest wave of infections has pushed nearly all of the state's acute-care hospitals to capacity.

A wave of departures has left 80 unfilled openings for registered nurses at the only acute-care health facility in the city. At the end of last week, every bed was full, prompting a systemwide backup. coronaviruses patients in the I.C.U. had to stay put because there was no other place to go. Several gravely ill patients in the E.R. were stuck because they couldn't be transferred to the I.C.U.

Lee Bond, Singing River's chief executive, said the current surge was simply adding to a calamitous labor shortage that state hospital leaders and public health officials say will persist long after Omicron fades.

He said that the real crisis was a shortage of nurses.

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A board of patient notes was looked at by a registered nurse.

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The only acute-care hospital in Pascagoula is the I.C.U. at Singing River.
The nation's frontline medical workers were running on fumes before Omicron arrived. Successive waves of illness and death have left them exhausted and numb, and nearly one in five have left the profession over the past two years. They are angry at the patients who refuse to get vaccine, at the hospital executives who won't spend the money needed to maintain safe nurse-to-patient ratios, and at the political leaders who oppose vaccine mandates.

The small, nonprofit safety-net hospitals like Singing River have been hard hit by the labor shortage. Even though they are financially fragile, they have not been able to match the salaries of travel nurse agencies and large health systems, which has made it harder for them to provide quality care. Travel nurses make more money than most staff nurses in Mississippi.

Tim Moore, president of the Mississippi Hospital Association, said that a lot of community hospitals are wondering how they are going to keep the lights on.

The refusal of Mississippi and other southern states to embrace Medicaid expansion has made the financial strain worse. An additional $600 million in annual federal aid and 11,000 new jobs would be added to Mississippi, according to the state economist.

Republican leaders who dominate the state government have resisted calls to devote a significant portion of federal coronaviruses relief aid for bonuses that could help stanch health care worker departures.

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Kathey Hall was treated by a nurse.

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Mr. Cumbest said that they don't have enough people to take care of heart attacks, strokes and car accidents.

Kelly Cumbest, a registered nurse who manages patient care in the E.R., said that he had only received one application for 24 openings in his department. He said that it wasn't just Omicron that worried them. The politicians and general public don't understand that we don't have people to take care of heart attacks, strokes and car accidents.

Visitors to Pascagoula Hospital are not immediately aware of the staffing crisis. Doctors and nurses talk to each other as they walk through the patient rooms. The flashing violet lights above a half-dozen doorways tell a different story: They signal a patient's unanswered call for water, for assistance getting to the toilet, or increasingly, a request for helping hands to clean up after they could no longer wait.

The need can be more critical. A newly admitted Covid patient, Deborah Briggs, had thrown off her oxygen mask in a fit of agitated delirium and was struggling to breathe. Three nurses lifted her into a position that would allow her lungs to expand as she gasped, "I'm burning up."

One of the nurses tried to explain the challenge of juggling the medical needs of so many patients with fewer staff. Ms.Phillips, who had just returned to work after battling Covid for the second time, said she wanted to make sure her patients were bathed, given their meds on time and have their vital signs assessed, but she couldn't do that when she was stretched this thin.

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Ms. Olivera teared up as she talked about the beginning of her nursing career.
Almost every nurse at Pascagoula Hospital was emotional when they were asked how they were holding up. The emotional toll of so much death and the physical exhaustion from endless overtime shifts was what caused the self-proclaimed baby nurse to cry. "You know the expression 'only the fittest survive'?" She said that was her.

The residents of Pascagoula, an industrial port town of 22,000 that is still recovering from the damage done by Hurricane Katrina, have a similar resolve. For a while, a constant loyalty to the community helped convince many nurses to stay put despite the low wages and high rates of vaccinations. Only 46 percent of county residents are fully immunized.

During the Delta surge last summer administrators were forced to hire travel nurses for the first time.

After the Delta wave subsided, many holdouts decided they could no longer resist the monetary lure and left in droves. Some people have taken jobs in Mobile, Alabama, so they can stay at home with their families.

Jessica Samples, a registered nurse and 14-year veteran of Pascagoula Hospital who is one of the few old-timers left, said that she has been tempted to join them.

The hospital was forced to hire more travel nurses and threaten its finances because of the departures. Most of the nurses on some wards are on short-term contracts.

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There are nurses in the hospital.
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Small, nonprofit safety-net hospitals like Singing River have been hard hit by the nursing shortage. Travel nurses in other countries can make $200 an hour, compared with the $30 earned by most nurses in Mississippi.

Mr. Bond said that Singing River had racked up $30 million in additional expenses. He and other hospital officials have been pressing Mississippi state leaders to use a quarter of $1.8 billion in federal pandemic relief funds to provide $20,000 retention bonuses to nurses who agree to remain in the state for two years. Lawmakers have countered with a proposal that would give out around $1,000 in bonuses.

Hospital executives worry about Mississippi's long-term health outcomes because of the 2,000 unfilled openings for registered nurses and some of the worse health outcomes in the country. Mr. Lowe said he was worried that residents would blame health care workers for substandard care and turn away people from the profession.

Brandon Russell, 20, a certified nursing assistant, tried to stay chipper as he tended to the needs of nearly a dozen Covid patients last week. He had to wear a surgical gown, gloves, and two masks before entering each room, even if the task was as simple as turning off a light. All the protective gear had to be removed after exiting the room. The process was repeated many times a day. $10 an hour is what the job pays.

Mr. Russell said the past few months had made him abandon his desire to become a nurse. He said that he was ready to quit and that he loved his patients. Every single nurse here tells me not to go to nursing school.

Ms. Sison, the nurse manager, can seem cheerful as she rallies her staff. Over the past few months, she has lost count of the times she had to console her co-workers. She said that one nurse had a nervous breakdown and quit.

Ms. Sison said that she became a nurse to fix people but that it felt like we lost more people than we saved during the Pandemic. The 18-year-old who begged for air as he gasped for air, the 27 year old father who left behind four children, and the elderly man who took his last breath minutes before his family arrived, were some of the Covid deaths that they began to recall.

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There is a shelf in the manager's office.
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A bed was made for a patient in the hospital.

Ms. Sison said that people forget that they are still human and have emotions. You can't check it at the door when you go home. The losses have been personal for Ms. Sison. She was 33 weeks pregnant when the Pandemic hit Pascagoula, and after weeks battling a mysterious illness, the child was stillborn. The hospital's first coronaviruses patient was admitted the same day as the doctors delivered the news. An autopsy found that Covid was to blame for his death.

Ms. Sison was back at work three weeks later. She said that she wasn't going to leave her co-workers at such a bad time.

The speaker began to play the familiar strains of the song. Medical workers stopped in the hallway. One woman said that the song marked the birth of a child at Pascagoula Hospital.

It reminded them of the days when the hospital played a song when a patient was discharged. At a time of darkness, the song was a source of joy.

Back when most of the people at Pascagoula Hospital believed in science and self-sacrifice, that was before.

Ms. Sison said that they thought they would beat the virus. We don't play that song anymore.