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Certified Registered Nurse Anesthetist Jonathan White administers medication to a COVID-19 patient before intubating her on  July 21, 2020, at Lafayette General Medical Center in Lafayette, La. A shortage of ICU nurses has led hospitals in south Louisiana, including those in Baton Rouge, to face limits on ICU beds for coronavirus patients. To cope, some hospitals are cutting back on other services.  

The ICU at Baton Rouge General's Bluebonnet Campus has doubled in size over the last few weeks to accommodate a surge in coronavirus patients, but a shortage of critical care nurses has limited that expansion — and left the hospital with zero available ICU beds as of Wednesday morning. 

The hospital has plenty of physical resources — like beds, ventilators and IV pumps — to expand its capacity. But critically ill patients in the ICU require intense around-the-clock care, and without specially trained nurses on hand to offer that care, hospitals are limited in how many patients they can take in. 

To meet the demand, hospitals like Baton Rouge General are gradually closing their operating rooms and limiting elective procedures, freeing up registered nurses to work alongside critical care nurses in the ICU.

"It's a struggle on each shift to find someone to fill a spot, and each time I add a bed in the ICU, I'm stealing a resource from another part of the hospital," said Dr. Stephen Brierre, a pulmonologist who specializes in critical care at Baton Rouge General's Bluebonnet Campus. 

Hospitals across the state are now facing similar challenges as staffing shortages are compounded with a surge in coronavirus cases. Our Lady of the Lake Regional Medical Center in Baton Rouge — one of the state's largest hospitals — was down to just two available ICU beds Wednesday and is in the midst of a two-week pause on non-emergency surgeries that require an inpatient bed. 

The Louisiana Department of Health reported Wednesday that the Baton Rouge region had 195 ICU beds in use and 35 beds available, 14 of which are pediatric ICU beds that can be used for adult patients if necessary. 

Brierre in more normal times works one week on and one week off. He's now working every day, with no breaks and no weekends. His colleagues are weary but dedicated and working an incredible amount of overtime. 

“We are using everything we have to take care of as many patients as we can, and we are stretched, but we will keep doing it and we won’t stop," Brierre said. 

Staffing ICUs was easier at the start of the pandemic, when Louisiana was one of a handful of coronavirus hotspots nationwide. With less demand, Baton Rouge's hospitals could offer competitive wages to fly-in travel nurses, and when the virus briefly subsided in June, many moved on to other hard-hit areas. 

Now, with larger states like Texas, Florida and Arizona facing their own coronavirus surge, there's a "price war" for contract nurses — with some providers offering nurses upwards of $150 an hour. That's a price point Baton Rouge's hospitals can't keep up with, Brierre said.

The rapid spread of the coronavirus throughout the community has also meant hospital staff are more vulnerable to contracting the virus when they're off shift. Baton Rouge General has seven ICU nurses out sick with the virus and ineligible to work for at least 10 days. 

"You can get the coronavirus at the grocery stores just like you can get it working in the ICU," Brierre said. 

When patients are admitted to the ICU, they're effectively on "life support" and are in need of an inordinate amount of care from nursing staff. There's typically one nurse on-hand for every two patients, though that may shift to a one-to-one ratio if a patient is at a high risk of death, Brierre said. 

At the peak of the pandemic in late April and early May, Baton Rouge General's Bluebonnet Campus was able to accommodate 68 patients in its ICU. That meant the hospital had at least 34 critical care nurses on staff tending to the patients. 

With fewer staff available now, the hospital has reached its limit at 40 patients in its ICU, though it's continuing to flex its resources and close other parts of the hospital to make space for additional patients. 

Our Lady of the Lake and Baton Rouge General have both in recent days stopped accepting patient transfers from other hospitals. That's placed some rural providers that don't have ICUs or specialty services in a bind.

Chad Olinde, the chief executive officer of Pointe Coupee General Hospital, said they're now spending longer on the phone reaching out to hospitals in Lafayette, Covington and Alexandria that are willing to accept their patients. 

Doctors warn that if the public ignores social distancing measures and thus hospitalizations increase, medical centers may have to halt all elective procedures, as was the case in the spring. That could mean delaying surgeries and preventative wellness checks.


Email Blake Paterson at bpaterson@theadvocate.com and follow him on Twitter @blakepater