Danielle Harrison, practice manager for the Saratoga Springs InstaCare, says on some days it takes a lot of communication and coordination to meet the challenges that arise.
It’s a bad combination. Healthcare systems across the country, including Intermountain, are dealing with unprecedented staffing shortages and COVID-19 is taking critical caregivers out of the lineup. Meanwhile patients, many of them unvaccinated people upset they're sick in the first place, are filling InstaCares and emergency departments looking for relief. Sometimes just getting through a single day requires unusual sacrifices, teamwork, and long hours.
During one such unpredictable day recently, some caregivers in Utah County InstaCares didn’t know where they’d be working from one hour to the next. Some had to work in three clinics in one day and an InstaCare had to be closed because of staffing issues in the county. By the end of the day, with about two dozen patients waiting to be seen at the American Fork InstaCare, physicians and other caregivers from other InstaCares rallied to help caregivers serve their patients in need.
Jen Gilbert, MD, associate medical director for all of Intermountain’s Utah InstaCares in Utah County and southern Utah, says the day started with a caregiver at the Lehi Clinic testing positive for COVID-19. Another in Lehi had been exposed and had to be tested for the virus, and a third had to leave to deal with a death in the family.
“They were all very last-minute no shows that were for legitimate reasons,” Dr. Gilbert says.
Kalynn Johnson, practice manager for the American Fork InstaCare, says that everyone needs help at times, so they work to support each other.
In such situations, things get complicated fast because there aren’t many extra caregivers available. Dr. Gilbert says they have dozens of openings posted in her area that aren’t being filled because of a lack of qualified applicants.
“We just ended up having enough holes in our schedule across our region that we made the decision to close the Lehi InstaCare and consolidate and send the healthy caregivers from there to other locations that also needed help,” says Dr. Gilbert. “There were four InstaCares that were really struggling to find people.”
That afternoon, a nurse working in the American Fork InstaCare got sick with a fever and had to leave mid-shift. Dr. Gilbert says that often a clinic will have one radiology technician, one nurse, one or two medical assistants, and one or two PSRs, in addition to the providers at the clinic. If you take two or three caregivers out of the picture it creates big holes because some caregivers work in more than one clinic and because of the unfilled open positions, there aren’t many who can be drafted when a caregiver is out.
Chad Carman, DO, worked in three different InstaCares during one challenging day.
Most of the caregivers from Lehi were sent to Saratoga Springs. At that location, where a PSR and a radiology technician were out, they had a caregiver who was working ill but had tested negative for COVID-19 and didn’t have a fever, says Dr. Gilbert.
In American Fork one of the providers, Nate Bliss, PA-C, was having trouble with iCentra.
“That slowed him down quite a bit and that clinic was really getting overwhelmed and overloaded during what was our busiest time of the day—in the evenings when the other clinics were closing,” Dr. Gilbert says.
So, they had to draft Chad Carman, DO, and Meggan Hulme, RN, who were at Saratoga Springs but had started their day in Lehi, to come to American Fork to help out. A radiology technician, Deanna Wardle, had gone from Lehi to American Fork to help earlier in the day.
“The poor staff at American Fork were just doing the best they could to keep up, but they were down to two providers, one radiology technician, and a medical assistant,” Dr. Gilbert says.
Deanna Wardle, a radiology technician, went from Lehi to American Fork to help caregivers there with patients.
“For about two hours I was by myself,” says Cole Van Ausdal, medical assistant. “We had a rad tech but she had six x-rays to do and I had to do all the nursing procedures by myself, along with rooming and all that stuff.”
When Dr. Carman got to American Fork he texted Dr. Gilbert and wrote that this is “really bad and we need extra help,” Dr. Gilbert says.
Kalynn Johnson, practice manager for the American Fork InstaCare says it was 7:30 p.m. and there were still 25 people waiting to be seen at American Fork. She says often they can only see four or five patients an hour and they were looking at a very late night. Caregivers who’d already worked 12-hour shifts were facing even more hours of work before they could go home.
This was all happening on Dr. Gilbert’s day off and her husband was out of town. Eventually she got a babysitter and came into American Fork to help them out.
Nate Bliss, PA-C, was on the front lines at the American Fork InstaCare as caregivers there dealt with staffing and patient issues.
“At the end of the day we were all working as a team; it was great,” Dr. Gilbert says.
She said that she and Dr. Carman, Nate and Randy Rogers, MD, were all cleaning rooms.
“We were rooming patients and we were taking patients over to the ED,” she says. “We were doing things the other caregivers would usually do, but I think that really boosted the morale of the caregivers who were stuck shouldering all of that until we got there. It ended up being a good day in that, at least, we got the staff supported and the patient’s taken care of. We made it work at the end of the day.”
Nick Harker, MD, started the day at Lehi and also went to Saratoga Springs to help out. When he finished at Saratoga Springs, he texted he was ready to come to American Fork to help out but by that time they’d caught up, Danielle Harrison, practice manager for Saratoga Springs, says.
Dr. Gilbert says it’s a “tough time” right now for caregivers working in InstaCares. She says the morale is probably the lowest it’s been since the pandemic started, in part, because many of the people they’re trying to help are unvaccinated people who are angry that they got sick. She says her team works together to make the best of things and they have their victories, but it’s work that takes its toll over time.
Danielle says they communicate a lot and rely on each other to deal with staffing challenges.
“It’s been really great working so closely with the managers,” she says. “We’re in constant communication so we can say, ‘Hey, I don’t have this person. Does anyone have an extra or can we shuffle or what can we do?’ So, we’re pretty good at communicating about where we need help.”
“Ultimately we all need help at one point in time,” Kalynn says. “I just try to help others by thinking about how I’d want help if I needed it. Sometimes caregivers are hesitant to work extra hours in another InstaCare but they also know what it’s like to have somebody come in and save them from working an extra three hours at night. And so, they’re willing to do that even though they’re tired and they’ve had a long day.”
Shannon Connor Phillips, MD, MPH, vice president, chief medical officer of Community-Based Care, and president of the Intermountain Medical Group, says the pandemic has asked caregivers to step up in many unexpected ways.
“They’re always putting patients’ needs first and lending a helping hand to their colleagues,” she says. “We are grateful for all the ways our caregivers contribute and for the opportunity to celebrate their great work.”