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A Cornell University student waits for a ride with luggage in tow at the campus in Ithaca, N.Y., Thursday, Dec. 16. Cornell University abruptly shut down all campus activities on Tuesday and moved final exams online after hundreds of students tested positive over three days. …
Longmont United Hospital nurse Brooke Schroeder holds a sign supporting nurses December 2, 2021. Nurses say the hospital is severely understaffed and they’re trying to form a union.
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Longmont United Hospital nurse Brooke Schroeder holds a sign supporting nurses December 2, 2021. Nurses say the hospital is severely understaffed and they’re trying to form a union.
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Harold Burch lives in a home with a spectacular view in Paonia, a rural part of Colorado’s Western Slope. But that’s been little consolation to Burch, 60, as he’s battled a cascade of health problems during the pandemic.
“It’s been a real rodeo,” Burch says. “It’s been a lot of ups and downs and lately it’s been mostly just downers.”
Burch has battled chronic osteoarthritis, rheumatoid arthritis and had two major intestinal surgeries. One specialist he was seeing left her practice last year. Another wouldn’t accept his insurance. Then, Nov. 1, he started experiencing major stomach pain.
“When we talk terrible problems, I can’t leave the house,” he says. He says he hasn’t eaten anything substantial in three weeks.
Burch had to wait that long to be seen by a primary care doctor. He says the doctor told him: “‘If things were different, I would tell you to go to the hospital and be diagnosed, have some tests run and see what’s going on with you.’ But he says, ‘as of today, Delta County hospital is clear full. There are no beds available.'”
The COVID variant delta has overwhelmed the Colorado county of the same name. Hospitals on the Western Slope have been slammed for weeks, and the statewide picture is similarly grim. As of Monday, 1,294 patients were hospitalized with COVID-19, according to the state’s coronavirus website. Half of the state’s hospitals said they anticipated a staffing shortage in mid-December; more than a third of them anticipated ICU bed shortages at the same time.
And behind those numbers, patients — and health care workers — are feeling the impact.
Burch’s doctor told him he might have to wait hours in the ER, perhaps with people who have flu or COVID-19 symptoms. So Burch stayed home.
He’s fully vaccinated. But just 57{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} of people in Delta County have at least one dose of vaccine. And 84{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} of hospitalized COVID-19 patients in Colorado are not vaccinated.
“It’s really frustrating because I did the right thing and like so many other people have, and we’re being just kind of like told, ‘unless you have a really serious problem, like a heart attack, a stroke or something like that, we really don’t have time to mess with you,'” Burch says.
Diann Cullen is a 72-year-old retiree from Broomfield, Colorado, whose doctor told her that her hernia surgery would have to be postponed for weeks feels similarly. She says her reaction was: “Extreme frustration, actually anger … He flat out told me we can’t even do it because of too many COVID patients.”
Burch’s situation is not uncommon this fall, as the state faces its second-worst COVID-19 surge for hospitalizations and deaths. Hospitals are under tremendous strain and that means delays and changes from normal care, as strapped providers do more with less.
“Hospitals across Colorado are in critical condition. We have been at 90{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d}-plus capacity in our ICU and acute care beds for weeks now. And unfortunately, there doesn’t appear to be an end to that situation in the near future,” says Cara Welch, a spokesperson for the Colorado Hospital Association.
Longmont High School teacher and coach Jeff Kloster holds a sign in support of Longmont United Hospital nurses on December 2, 2021, outside the hospital. His wife Kris, a nurse there, was one of the speakers at the protest.
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Longmont High School teacher and coach Jeff Kloster holds a sign in support of Longmont United Hospital nurses on December 2, 2021, outside the hospital. His wife Kris, a nurse there, was one of the speakers at the protest.
Hart Van Denburg/CPR News
What’s pushing hospitals into crisis is dealing with a surge of COVID patients on top of other patients who have delayed care, all with a shortage of staff, says Robin Wittenstein, the CEO of Denver Health, which runs one of the state’s biggest hospital and clinic systems.
“They’re coming into hospitals now sicker than ever before. And they’re coming in larger numbers than we’ve ever seen before,” Wittenstein says. “Our system is on the brink of collapse.”
At the academic medical center UCHealth, ICU Dr. Abbey Lara says the crush of unvaccinated patients means patients face longer waits or they don’t get much-needed diagnostic tests. In the worst-case scenario, “patients who could have survived something had their life cut short because they weren’t able to access care,” she says.
And when there are too many patients being treated by too few staff, Lara says, that ratchets up the difficulty for health care workers.
“I just worry that there’s going to be not only a lot of turnover in the near future,” Lara says. “But I think that access to health care is just going to get even worse in the future.”
The situation is driving more nurses to speak out, like at an event earlier this month held across the street from Longmont United Hospital, in Longmont, Colorado, about 50 miles north of Denver.
Critical care nurse Stephanie Chrisley told a crowd that normally a registered nurse would care for two ventilated, sedated, critical care patients.
“And the last few weeks we have regularly had RNs taking three, and sometimes four patients, at a time,” she says, which prompted boos from the crowd.
That’s unsafe, she says, and now the nurses are looking to unionize. Longmont United says it is focused on the well-being of patients and staff and that its top priority is high-quality care.
Chrisley, a mother of two, says nurses need more hands on deck.
“I have lately been in a state of chronic stress over the crushing guilt that I feel to ensure my patients get the care they need. And yet, somehow still care for myself and my family,” Chrisley says.
Kris Kloster has been a nurse for 32 years, much of that in the ICU. So she’s seen layoffs and staff reductions even before the pandemic hit. Now ICU nurses are dealing with colleagues quitting, restrictions on visitors, worries about catching the virus, anger from some patients who do not believe they have COVID-19.
At the same time, they must cope with suffering and deaths. It’s been “soul sucking,” she says. “That’s the hardest I’ve ever worked.”
Kloster has been speaking out in hopes that Coloradans will understand the physical, emotional and psychological toll on nurses.
“This kind of staffing, this kind of stress is not sustainable,” Kloster says. “And something has to change.”
Longmont United Hospital nurse Kris Kloster speaks to other nurses and supporters December 2, 2021, outside the hospital. They say the hospital is severely understaffed, their workload is unsustainable, and the hospital is trying to block them from forming a union.
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Longmont United Hospital nurse Kris Kloster speaks to other nurses and supporters December 2, 2021, outside the hospital. They say the hospital is severely understaffed, their workload is unsustainable, and the hospital is trying to block them from forming a union.
Hart Van Denburg/CPR News
Nearly a third of the hospital’s registered nurse staff has left since the start of July and many have not been replaced, she says.
The stress nurses and doctors feel is compounded when they feel powerless to take what they regard as an ethically correct action in treating a patient.
There’s a term for that, “moral distress,” says Dr. Barbara Statland, a hospitalist at Denver Health. The tension comes “because you can’t do what you feel is ethically proper. And I’d say that health care workers have been riddled with this.”
Despite the stress and distress, many frontline providers are hanging in there, continuing to care for patients every day. That made the difference for at least one COVID-19 patient who said he was able to get care — just in time.
Rob Blessin from Fort Collins caught the virus this fall and spent 30 days in an ICU ward with pneumonia at North Colorado Medical Center in Greeley. The 58-year-old described the efforts of his doctors and nurses as heroic, some working nine or 10 days in a row, many taking overtime.
“They saved my life. I do feel grateful for everything they did,” says
Blessin says as more coronavirus patients got admitted staff struggled to keep up. “There was just so many people there and very few staff,” he says.
Blessin says he landed in the hospital because he was swayed by internet misinformation and didn’t get vaccinated. It’s a decision he came to regret.
“I guess my recommendation would be to get vaxxed, you know, even if you’re totally against it. Don’t fall into the internet hype,” Blessin says.
After his experience being hospitalized for a month due to the coronavirus, and having talked with his physicians there, he now plans to get vaccinated.
This story was produced in partnership with KHN and Colorado Public Radio.
National Institutes of Health Director Francis Collins served for 12 years under three presidents and presided over an expansion of the agency’s budget and efforts to develop new cures to diseases. Graeme Jennings/Pool/AFP via Getty Images hide caption toggle caption Graeme Jennings/Pool/AFP via Getty Images …
People protest a COVID-19 vaccine mandate for municipal workers on Oct. 28 in New York City. Polling, vaccination and mortality data all suggest that Republicans are the biggest group of unvaccinated Americans and are suffering the worst consequences as a result. David Dee Delgado/Getty Images …
Leslie Clayton, a physician assistant in Minnesota, says a name change for her profession is long overdue. “We don’t assist,” she says. “We provide care as part of a team.”
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Leslie Clayton, a physician assistant in Minnesota, says a name change for her profession is long overdue. “We don’t assist,” she says. “We provide care as part of a team.”
Liam James Doyle for KHN
After 23 years as a physician assistant, Leslie Clayton remains rankled by one facet of her vocation: its title. Specifically, the word “assistant.”
Patients have asked if she’s heading to medical school or in the middle of it. The term confounded even her family, she says: It took years for her parents to understand she does more than take blood pressure and perform similar basic tasks.
“There is an assumption that there has to be some sort of direct, hands-on oversight for us to do our work, and that’s not been accurate for decades,” says Clayton, who practices at a clinic in Golden Valley, Minn. “We don’t assist. We provide care as part of a team.”
Seeking greater understanding for and appreciation of their profession, physician assistants are pushing to rebrand themselves as “physician associates.” Their national group formally replaced “assistant” with “associate” in its name in May, transforming into the American Academy of Physician Associates. The group hopes state legislatures and regulatory bodies will legally enshrine the name change in statutes and rules. The total cost of the campaign, which began in 2018, will reach nearly $22 million, according to a consulting firm hired by the association.
But rechristening the PA name has spiked the blood pressure of physicians, who complain that some patients will wrongly assume a “physician associate” is a junior doctor — much as an attorney who has not yet made partner is an associate. The head of the American Medical Association has warned that the change “will undoubtedly confuse patients and is clearly an attempt to advance their pursuit toward independent practice.” The American Osteopathic Association, another group that represents doctors, accused PAs and other nonphysician clinicians of trying “to obfuscate their credentials through title misappropriation.”
In medicine, seemingly innocuous title changes are inflamed by the unending turf wars between various levels of practitioners who jealously guard their professional prerogatives and the kind of care they are authorized to perform. Just this year, the National Conference of State Legislatures catalogued 280 bills introduced in statehouses to modify scope-of-practice laws that set the practice boundaries of nurses, physician assistants, pharmacists, paramedics, dental hygienists, optometrists and addiction counselors.
Lawmakers allowed North Carolina dental hygienists to administer local anesthetics; permitted Wyoming optometrists — who, unlike ophthalmologists, do not attend medical school — to use lasers and perform surgeries in certain circumstances; and authorized Arkansas certified nurse practitioners to practice independently. Meanwhile, the physicians’ lobby aggressively fights these kinds of proposals in state legislatures, accusing other disciplines of trying to incrementally horn in on things that doctors claim only they are competent to do.
Physician assistants, as they are still legally called, have been steadily granted greater autonomy over the years since 1967, when the Duke University School of Medicine graduated four former Navy medics as the nation’s first class of PAs. Today PAs can perform many of the routine tasks of a primary care doctor, such as examining patients, prescribing most kinds of medications and ordering tests. In most states, all this happens without the need for a physician’s signoff or having a doctor in the same room or even the same building.
Generally, a PA master’s degree takes two academic years to earn and includes about 2,000 hours of clinical work. More than 125,000 PAs were practicing last year in the U.S.; their median annual pay was $115,390. By comparison, family physicians usually attend four years of medical school and then do a three-year medical residency, during which they clock about 10,000 hours. (Specialists spend even more time in residencies.) The median annual pay for a family physician in 2020 was $207,380.
PAs aren’t alone in losing patience with their titles. In August, the American Association of Nurse Anesthetists renamed itself the American Association of Nurse Anesthesiology — its third name since it was founded in 1931. President Dina Velocci said the term “anesthetist” baffles the public and is hard to pronounce, even when she helps people sound out each syllable. (It’s uh-NESS-thuh-tist in the U.S. and indicates a registered nurse, who usually has a bachelor’s degree in nursing, and has then received several more years of education and training in anesthesia.)
The association’s new name is justified since “we’re doing the lion’s share of all the anesthetics in this country,” Velocci says. The legal title for the profession remains certified registered nurse anesthetist (CRNA). “I’m definitely not trying to say I’m a physician,” Velocci says. “I’m clearly using ‘nurse’ in front of it.” Nonetheless, physicians’ groups have condemned the association’s name change.
Likewise, the PAs say there’s no ulterior motive in altering their name. “Changing the title is really just to address that misperception that we only assist,” says Jennifer Orozco, president of the PA association and an administrator at Rush University Medical Center in Chicago. “It won’t change what we do.”
They say “assistant” confuses not just patients but also state lawmakers and those who hire medical professionals. When Clayton recently testified before Minnesota legislators about a scope-of-practice bill, lawmakers “just couldn’t get their heads around” the concept of “an assistant who doesn’t have a direct supervisor,” she says, adding that the message they gave her was, “You guys really need to do something about your title.”
The PA association debated many names. Also-rans included “medical care practitioner” and the widely derided neologism “praxician.” “Physician associate” won out, thanks to several advantages. It allowed PAs to continue to introduce themselves with the same initials, and it had been flirted with as an alternative throughout the profession’s history to distinguish the most highly trained PAs from those with less training. The association even briefly used “associate” in its name for two years in the 1970s, and Yale School of Medicine has offered a physician associate degree since the program opened in 1971.
But a name change alone won’t resolve other disadvantages PAs face. In some states, doctors are required to meet regularly with PAs, periodically visit them in person if they work at a different location and review sample patient charts on a recurring basis. States generally mandate less oversight for nurse practitioners, who perform jobs similar to those of PAs, making them more appealing to some employers. “We’ve heard from our PA colleagues that they’re getting passed over for jobs for nurse practitioners,” says April Stouder, associate director of the Duke Physician Assistant Program.
The physicians’ lobby has opposed greater liberty for nurse practitioners, and many doctors voice similar concerns about patient safety if PAs are allowed to drift too far from physician oversight. Dr. Colene Arnold, a gynecologist in Newington, N.H., started her medical career as a PA, practicing with little supervision. In retrospect, she says, “I didn’t recognize the severity of what I was seeing, and that’s scary.”
Dr. Kevin Klauer, CEO of the American Osteopathic Association, says misdiagnoses by PAs working solo are more likely than when a physician is involved. “If you go to Jiffy Lube and you want an oil change and a tire rotation, that’s what they’re going to do,” he says. “Medicine is not like that.”
Orozco, the PA association president, says such anxieties are overblown. “They will always collaborate with physicians and really want to keep working in that team-based environment,” she says. Doctors should welcome PAs to help fill physician shortages in primary care, behavioral health and telemedicine and free up doctors to focus on complex cases, she adds.
“I can have a jet-engine mechanic change the tires on my car,” she says, “but do I need that every single time?”
Kaiser Health News is a national newsroom and editorially independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.
