Contingency Capacity Strategies to Mitigate Staffing Shortages

When staffing shortages are anticipated, healthcare facilities and employers, in collaboration with human resources and occupational health services, should use contingency capacity strategies to plan and prepare for mitigating this problem. At baseline, healthcare facilities must:

• Understand their staffing needs and the minimum number of staff needed to provide a safe work environment and patient care.
• Be in communication with local healthcare coalitions, federal, state, and local public health partners (e.g., public health emergency preparedness and response staff) to identify additional HCP (e.g., hiring additional HCP, recruiting retired HCP, using students or volunteers), when needed.

Contingency capacity strategies for healthcare facilities include:

Adjusting staff schedules, hiring additional HCP, and rotating HCP to positions that support patient care activities.

• Cancel all non-essential procedures and visits. Shift HCP who work in these areas to support other patient care activities in the facility. Facilities will need to ensure these HCP have received appropriate orientation and training to work in these areas that are new to them.
• Attempt to address social factors that might prevent HCP from reporting to work such as transportation or housing if HCP live with vulnerable individuals.
• Identify additional HCP to work in the facility. Be aware of state-specific emergency waivers or changes to licensure requirements or renewals for select categories of HCP.
• Request that HCP postpone elective time off from work.

Developing regional plans to identify designated healthcare facilities, isolation sites, or alternate care sites with adequate staffing to care for patients with COVID-19.

Developing plans to allow asymptomatic HCP who have had an unprotected exposure to COVID-19 to continue to work.

• These HCP should still report temperature and absence of symptoms each day before starting work. Because recent studies indicate people who are infected with SARS-CoV-2 but do not have symptoms likely also play a role in transmission, these HCP should wear a facemask (for source control) while at work for the 14 days after the exposure event. If HCP develop even mild symptoms consistent with COVID-19, they must cease patient care activities and notify their supervisor or occupational health services prior to leaving work. These individuals should be prioritized for testing.

Prioritizing HCP with suspected COVID-19 for testing, as testing results will impact when they may return to work and which patients they might be permitted to care for.

Developing criteria to determine which HCP with suspected or confirmed COVID-19 (who are well enough to work) could return to work in a healthcare setting before meeting all Return to Work Criteria if shortages continue despite other mitigation strategies.

• Considerations include:
  • The type of HCP shortages that need to be addressed.
  • Where HCP are in the course of their illness (e.g., viral shedding appears to be higher earlier in the course of illness).
  • The types of symptoms they are experiencing (e.g., persistent fever).
  • Their degree of interaction with patients and other HCP in the facility. For example, are they working in telemedicine services, providing direct patient care, or working in a satellite unit reprocessing medical equipment?
  • The type of patients they care for (e.g., immunocompromised patients).
• As part of planning, healthcare facilities (in collaboration with risk management) should create messaging for patients and HCP about actions that will be taken to protect them from exposure to SARS-CoV-2 if HCP with suspected or confirmed COVID-19 are allowed to work.

Crisis Capacity Strategies to Mitigate Staffing Shortages

When staffing shortages are occurring, healthcare facilities and employers (in collaboration with human resources and occupational health services) may need to implement crisis capacity strategies to continue to provide patient care.

When there are no longer enough staff to provide safe patient care:

• Implement regional plans to transfer patients with COVID-19 to designated healthcare facilities, isolation sites or alternate care sites with adequate staffing
• If not already done, allow asymptomatic HCP who have had an unprotected exposure to COVID-19to continue to work.
  • These HCP should still report temperature and absence of symptoms each day before starting work. These HCP should wear a facemask while at work for the 14 days after the exposure event. If HCP develop even mild symptoms consistent with COVID-19, they must cease patient care activities and notify their supervisor or occupational health services prior to leaving work. These individuals should be prioritized for testing.
• If shortages continue despite other mitigation strategies, consider implementing criteria to allow HCP with suspected or confirmed COVID-19 who are well enough to work but have not met all Return to Work Criteriato work. If HCP are allowed to work before meeting all criteria, they should be restricted from contact with severely immunocompromised patients (e.g., transplant, hematology-oncology) and facilities should consider prioritizing their duties in the following order:
  1. If not already done, allow HCP with suspected or confirmed COVID-19 to perform job duties where they do not interact with others (e.g., patients or other HCP), such as in telemedicine services.
  2. Allow HCP with confirmed COVID-19 to provide direct care only for patients with confirmed COVID-19, preferably in a cohort setting.
  3. Allow HCP with confirmed COVID-19 to provide direct care for patients with suspected COVID-19.
  4. As a last resort, allow HCP with confirmed COVID-19 to provide direct care for patients without suspected or confirmed COVID-19.
• If HCP are permitted to return to work before meeting all Return to Work Criteria, they should still adhere to all Return to Work Practices and Work Restrictions recommendations described in that guidance. These include:
  • Wearing a facemask at all times while in the healthcare facility until all symptoms are completely resolved or until 14 days after illness onset, whichever is longer. They should be reminded that in addition to potentially exposing patients, they could also expose their co-workers.
    • Facemasks should be worn even when they are in non-patient care areas such as breakrooms.
    • If they must remove their facemask, for example, in order to eat or drink, they should separate themselves from others.
  • Being restricted from contact with severely immunocompromised patients (e.g., transplant, hematology-oncology) until the full Return to Work Criteria have been met.
  • Adhering to hand hygiene and respiratory hygiene, and cough etiquette (e.g., cover nose and mouth when coughing or sneezing, dispose of tissues in waste receptacles).
  • Self-monitoring for symptoms and seeking re-evaluation from occupational health if respiratory symptoms recur or worsen.

References:

1.https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff-shortages.html