Addressing the 4th Wave in COVID-19 – Supporting the Health Care Workforce During and After the COVID-19 Global Epidemic with Safer Staffing Solutions

Waves of COVID-19
Note: at the time of publication, the source of this graphic was unknown. If you identify the source we will update attribution!

We all are proud of our workforce of dedicated Emergency Department nurses and other medical staff, who have stepped forward courageously to care for patients during this novel coronavirus pandemic! With the accelerated rise of confirmed COVID-19 cases every day, care needs are quickly overwhelming the available supply of equipment and hospital beds. Even as emergency hospital capacity is being rapidly assembled and equipment provided, effective deployment of beds and equipment is impossible without qualified and available ED nursing staff to care for the immediate, rapid influx of patients.

As the renowned medical practice journal, The Lancet, recognizes, it is essential to preserve and protect our vital care staff. “Presently, health-care workers are every country’s most valuable resource. Health-care systems globally could be operating at more than maximum capacity for many months. But health-care workers, unlike ventilators or wards, cannot be urgently manufactured or run at 100% occupancy for long periods. It is vital that governments see workers not simply as pawns to be deployed, but as human individuals. In the global response, the safety of health-care workers must be ensured. Adequate provision of PPE is just the first step; other practical measures must be considered, including cancelling non-essential events to prioritise resources; provision of food, rest, and family support; and psychological support.” (

Medecipher is here to help. We at Medecipher are healthcare providers and administrators who understand first-hand the value of our care staff in ensuring safe and effective patient care.

We were founded to ensure that emergency care staff is allocated most effectively to meet urgent patient needs while considering other realistic constraints, such as nurse availability and finite financial resources.

Nurses, as always, rush to the rescue.  Although there have been past staffing shortages, RNs and affiliated workers are jumping in generously with their time and skills to serve in this crisis. This situation is more like a marathon than a sprint, as additional strain is placed on already-scarce resources who are working long shifts and stretches of consecutive days. And there are still longer-term needs for patient care beyond the immediate window of high patient inflow. Thus, it’s essential to protect the well-being of our valuable nursing staff members who are quick to fill in immediate gaps at the risk of harming their ongoing availability and effectiveness throughout this crisis period and beyond.

We hear from frontline ED nurses and leaders such as Darryn Dunbar, DNP, RN, Medecipher’s Nursing Advisor, that during this pandemic he and many others are working extended 10-14 hour shifts for 10 or more days in a row. “This is day 10 for me. I think it’s probably in my best interests and the hospital’s for me to take the afternoon off.  Today I woke up with a scratchy throat. I’m about to tell my nurses, you can’t work a seventh 12-hour shift in a row,” says Darryn. “My team has really stepped up, working 80, 90, 100 hours a week… Interestingly, our errors have also gone down in a time where we’re seeing higher volume, we’re in a pandemic, and people are worried about being infected.” Such reduction of errors indicates that care providers may be even more attentive and effective in this crisis – up to a point, when exhaustion and fatigue force them to take time off.  

Prolonged stress takes its toll on our frontline healthcare workers who are valiantly battling this virus. Here are recommendations from a JAMA article, “Supporting the Health Care Workforce During the COVID-19 Global Epidemic.”

“Hospital personnel, including caregivers, support staff, administration, and preparedness teams, all will be stressed by the challenges of a prolonged response to COVID-19, and leadership must emphasize the importance of self-care as the center of the response. Transparent and thoughtful communication could contribute to trust and a sense of control. Ensuring that workers feel they get adequate rest, are able to tend to critical personal needs (such as care of an older family member), and are supported both as health care professionals and as individuals will help maintain individual and team performance over the long run. Liberating clinicians and administrative team members from other tasks and commitments allows them to focus on the immediate needs. Provision of food, rest breaks, decompression time, and adequate time off may be as important as provision of protocols and protective equipment as days turn into weeks, then months.” (James G. Adams, MD, and Ron W. Walls, MD, JAMA, 3/12/2020,

While the supply of care staff during this crisis is dramatically increasing with many volunteering for extra duties and nurse staffing agencies recruiting others to fill in gaps across locations, the supply is not infinite and there are practical constraints on how long any individual can continue to work effectively without a break. There are also financial impacts of extended work weeks: high overtime costs might be curtailed or avoided if there were visibility into other possible scheduling options.

Still, as nurses jump in willingly and courageously, “Fear is a big thing with our nurses, doctors, and patients,” says Darryn Dunbar, with the strong possibility of running out of the required equipment to protect themselves against infection. Such fear among the public and providers leads to reactionary moves taking precedence over well-thought out organized plans.  Darryn sees opportunities and learning, as “this COVID experience is informing how we really might do things differently. As for boarding in the ED, our opposite experience is happening right now. People are doing what they should be doing anyway, [discharging patients and] getting people out of the hospital. We are being strategic about how we use resources.”  In the absence of a public health model in the United States, there is much variation in practices in different places, along with lack of education and clarity on what to do, which lead to ineffective use and costly misallocation of resources. For example, there is often more boarding in the ED, while hospitalists recommend getting patients out of the ED: rather than boarding, go home!

9 Strategies for Effective Nurse Staffing in COVID-19

We share here some of Medecipher’s brief recommendations for appropriately allocating resources:

1.     Align with Patient Census (not Arrivals): Your nursing needs may differ during this time based on changes in arrivals and length of stay. Set staffing levels based on patient census, rather than patient arrivals. Apply our Quick Census Calculator: Census = Expected Arrivals x Average Length of Stay

2.     Leverage Staffing Ratios: Set desired staffing ratios to determine the number of staff needed to cover calculated Census.

Use your average arrivals per hour, average LOS, and desired nurse to patient ratio (e.g. 4-to-1) to determine your hourly direct nursing need. 

3.     Set Shift Maximums: Limit the number of consecutive days and hours a nurse can be scheduled, and rotate nurses on shifts to cover census patients while preserving nurse health and capability.

4.     Establish Split-Flow: Apply split-flow for COVID-19 patients to hold and isolate appropriately and contain spread of infection.  

5.     Create Virtual Inpatient Units: Implement observation boarding units as virtual inpatient units within the ED.

6.     Have Staff Practice at the Top of Their License: Reassign lower-skilled tasks from nurses to appropriate other practitioners (EDAs, techs, paramedics, nurses aids) so nurses can handle most capably a higher patient load.

7.     Anticipate Absenteeism: Predict absenteeism and schedule to fill expected gaps.

8.     Leverage Alternative Staffing Sources: Think about broader agency nursing and allied health professional staffing beyond your hospital’s contract staff. For example, Kamana Health is responding to the emergency with immediate contracted staffing (

9.     Think Short- and Long-Term: Right-size your hospital’s own float pool and on-call staff to weather the current crisis, preserve health and availability of your staff, for ongoing patient flow needs now and in the future.

Medecipher Can Help

 Medecipher brings all these pieces and the power of machine learning and predictive analytics to give recommendations specifically for your ED. Medecipher’s capabilities add unique value with insightful approaches based on the analytical science of operations research to optimize the allocation of scarce resources. Operations research has been used successfully in Medecipher’s nurse scheduling solutions in major health systems such as Northwestern Medecine, WellStar Health System and in many other healthcare applications that need to maximize patient outcomes and other objectives such as staff effectiveness and low error rates, subject to practical constraints on capacity, staffing, supplies, and other resources.

Medecipher provides a robust foundation for evaluating and recommending the best allocations of resources to achieve your hospital’s healthcare objectives. Its quick and powerful capabilities support you in deploying your staffing resources for the most effective coverage: right now, during this healthcare crisis, and later for ongoing healthcare delivery and preparation for future peak demands for care.

We can help you right now by helping you determine the staffing resources, capacity, equipment and supplies you need for your ongoing operations, so you are fully prepared to manage now and in your coming fiscal year. And we’re here to help you get through the current crisis. 

  1. Staffing – Customized assessment of your current and ongoing staffing needs to preserve health and availability of your staff, for ongoing patient flow needs now and in the future.
  2. Capacity – Customized assessment of your hospital capacity, relative to throughput targets, that incorporate local, state and national projections. Such as (the IHME capacity calculator or the definitive healthcare one or even the IL hospital one). 
  3. Equipment and supplies – Customized assessment of equipment needs. For example, here’s a forecasting tool developed by Medecipher Co-founder and Chief Scientific Officer, Sanjay Mehrotra, Ph.D., for COVID-19 ventilator allocation, using data from the Institute of Health Metrics and Evaluation (IHME)

We’d love to help you tailor these projections to your individual health system’s readiness, availability of resources, and capabilities, within the systems context of patient throughput. Please contact us!