Banner Health, Arizona’s largest health system, is adding nearly 1,000 out-of-state nurses and respiratory therapists to its workforce to help with the COVID-19 pandemic.

The 980 new workers represent about twice the amount of external labor that Banner Health adds in Arizona during a busy flu season, said Naomi Cramer, chief human resources officer for the Phoenix-based company.

The level of care a seriously ill COVID-19 patient needs is much higher than for someone hospitalized with the flu. As a result, more nurses are needed, Banner officials say.

Typically the nurse-to-patient ratio in the ICU ranges from one-to-one to one-to-two. For COVID ICU patients, the ratio is almost always one-to-one, said Phyllis Doulaveris, senior vice president for patient care services and chief nursing officer for Banner Health.

The nurses and respiratory therapists are “traveling” health care workers who take assignments across the country. Normal travel assignments are 13 weeks, but Banner Health began hiring the outside workers for four weeks, with extensions available for eight to 12 weeks, Cramer said.

“We’re very flexible. Some want four weeks, some want eight, some want 12,” she said. “We’re just really thankful for the experienced help.”

Banner is hiring temporary physicians, too

In addition to new out-of-state workers, Banner Health has hired 49 per diem physicians and expects to hire 20 more to help with demand fueled by COVID-19, Cramer said. Those physicians are from across the country, including some from Arizona, she said.

Banner has also “upskilled” about 700 employees to perform job duties that are outside of their normal work duties and has asked the Arizona Department of Health Services to send additional nurses.

The state health department announced Wednesday that it has hired nearly 600 nurses to work in Arizona hospitals cost-free for up to six weeks. Hospitals must apply to that program and show they have exhausted other resources.

State officials say more than 30 hospitals have applied to the program. Some hospitals around the state, including Yuma Regional Medical Center and Tucson Medical Center, are also making use of federal disaster assistance teams to care for patients.

Many other hospitals, including Flagstaff Medical Center, are using out-of-state traveling nurses to help supplement their staffing levels.

Summer is usually a time when patient demand is lower than usual in Arizona hospitals, but right now they are trying not to max out.

As of Wednesday, state data shows 89% of the ICU beds were in use, and 87% of inpatient beds were occupied. That’s with hospitals cutting back on elective surgery, doubling up two patients in rooms normally meant for one and adding beds and staff beyond regular levels.

A total of 3,454 beds were in use statewide by patients with suspected and confirmed COVID-19 on Wednesday.

About 1,500 of those patients are in Banner Health hospitals.

‘Much more complex’ than a busy flu season

Banner Health, which has about 43,000 employees in Arizona, was able to secure extra respiratory therapists, ICU nurses and “progressive care” nurses through a company headquartered in Ohio called ProLink, which provides crisis staffing. Progressive care nurses are for patients who need extra monitoring but aren’t sick enough for the ICU.

While Banner Health has its own internal staffing agency for hiring temporary labor, the COVID-19 crisis created a need for so many highly skilled workers in a short amount of time that an external company was needed, Cramer said.

“This is just a little bit different for the level of acuity with us,” Cramer said. “We got involved with them (ProLink) a little ahead of the curve, before the spike really started to ramp up in Arizona. We’ve worked with them for the past 60 days.”

The winter months, when Arizona’s population typically swells with visitors, coincides with flu season, and it’s not unusual for Banner Health to bring in out-of-state workers to handle that increased demand.

However, what’s happening now with COVID-19 is different — the count of external workers needed now is roughly double what’s required during a busy flu season, Cramer said.

“The reason this number is so high is the amount of care that a COVID patient takes versus a flu patient or a regular ICU patient,” Cramer said. “It’s a much more complex care situation.”

Doulaveris said the nurses Banner is bringing in are seasoned. Many of them have previously worked in COVID-19 hot spots, including Detroit, New York City and New Jersey. 

The traveling nurses have a two-day orientation before they start doing shift work. The orientation includes a series of stations for clinical simulation, Doulaveris said. The second day of orientation involves shadowing a nurse in the unit where they’ll be assigned.

“They are stepping in where they are needed. By and large, the vast majority are caring for COVID patients,” she said. “They are seasoned and experienced with COVID, so we are using most of them in the COVID units.”

Hospitals are more stretched this week

Dr. Marjorie Bessel, chief clinical officer for Banner Health, said this week that Banner hospitals remain stretched — more stretched than they were last week, with more patients in the ICU and more on ventilators.

The hospital system, like many hospitals around the state, has paused elective surgeries due to the pandemic.

Elective refers to surgeries or procedures that can be pushed off for 30 days without causing health problems for the patients. Bessel stressed that pausing elective surgeries is not an ideal scenario because it’s not fully meeting the needs of the community.

If a new breast cancer patient is scheduled to have a mastectomy, for example, it’s stressful and disruptive to have it delayed, she said.

“Just because the hospitals are open and can take in people doesn’t mean we are in good shape,” Bessel said.

It’s a “false sense of assurance” for the public to think everything is OK on the hospital front, she said.

Bringing in 1,000 out-of-state nurses and respiratory therapists plus dozens of extra physicians is not something that has happened easily, but it’s essential to keep meeting patient needs, she said.

“We are the largest health care delivery system in Arizona. Imagine if we weren’t able to do that.”

Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes

Support local journalism.Subscribe to azcentral.com today.

Read or Share this story: https://www.azcentral.com/story/news/local/arizona-health/2020/07/16/banner-health-adds-1-000-temporary-nurses-therapists-doctors-covid-19-care/5438379002/