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ST. LOUIS — As Missouri’s intensive care units swell with record numbers of COVID-19 patients, hospitals across the state are grappling with an increasingly competitive market for temporary health care workers, which has sent costs soaring.

Hospitals have leaned more and more over the past year on staffing agencies to boost ranks during COVID-19 surges, and the nationwide demand for those workers has inflated hourly rates to sometimes double pre-pandemic levels. The Missouri Hospital Association said costs for traveling nurses have risen, in some cases, to $200 per hour.

The Mercy health system at one point was hiring double the regular number of agency workers each month. An official at BJC HealthCare said agency staff were needed especially when permanent employees were out sick or quarantined.

And Scotland County Hospital in northeast Missouri rarely, if ever, used agency staff before the pandemic, said chief nursing officer Elizabeth Guffey. But when the virus hit, she had to add an additional nurse on every shift. Now, of 32 nurses who provide bedside care at the hospital, four are contracted through staffing agencies.

“We’re in the middle of a pandemic,� Guffey said. “The last thing hospitals want to tell their community is, ‘I’m sorry, we have to go on diversion because we don’t have staff to take care of more patients.’�

Last month, the Missouri Hospital Association sent a letter to state Attorney General Eric Schmitt, calling agency rates “exceedingly high.� CEO Herb Kuhn asked Schmitt to condemn the rising costs from staffing agencies “who attempt to extract excessive sums from Missouri hospitals in the midst of this surge.�

“I believe a condemnatory statement from you, as the state’s top consumer advocate ... would have a strong impact at deterring such behavior,� he wrote in the July 27 letter.

Schmitt’s office did not respond to requests for comment.

Hospitals said the current prices are difficult to manage. But they also said they understand there is more demand for the short-term workers than supply, and the agencies have provided critical relief during the pandemic.

One large staffing agency, meanwhile, said it had little choice but to pay more if workers are to travel on short notice to respond to virus hot spots.

“If nurses are going into these hot spots and these COVID units,� said Sophia Morris, vice president of account management for national staffing agency Aya Healthcare, “they’re expecting to be compensated for it.�

Extra help

The pandemic has exacerbated existing nursing shortages.

A 2017 report from the U.S. Department of Health and Human Services projected that several states would have overall shortages by 2030.

And a recent from University of Missouri researchers found that the state’s rural counties generally have higher rates of nursing shortages. The study also found that almost one in three nurses in Missouri are 55 years or older, raising concerns that many could retire in the coming years.

“This acute, COVID issue just kind of put gasoline on the fire,� said Betty Jo Rocchio, senior vice president and chief nursing officer of the Mercy system. “But the fire’s been burning for years.�

Temporary staffing agencies have been a lifeline — if an expensive one — for U.S. hospitals. They provide travel nurses and other health care workers on short-term contracts, often for about 13 weeks. Health care workers sometimes opt to work for those companies in order to gain more flexibility and higher pay.

Aya Healthcare said it had about 300 to 350 pending requests for health care staff in Missouri in late 2019. By August 2020, that number had risen to 550. This month: Upwards of 1,500.

Morris, the Aya vice president, said the company has boosted pay for travel nurses, in some cases, at a loss.

“Really, all of the costs go up with this crisis,� she said.

Scotland County Hospital is a 25-bed facility near the Iowa border, 200 miles northwest of St. Louis. It treats COVID-19 patients with monoclonal antibody therapies, remdesivir, and supplemental oxygen. When patients need a ventilator, they are transferred to larger medical facilities.

The hospital would not have been able to care for its patients as well without the additional help provided by staffing agencies, said Guffey, the chief nursing officer. So though the costs have been higher, they have been a necessary source of aid, she said. The alternative would be to divert more patients to other hospitals.

Guffey said she would prefer to hire more full-time employees. But not all are willing to move to Scotland County.

“We need to do a better job of building up the community and offering more positions, so families want to move to this area,� Guffey said. “That takes time.�

‘Totally and completely exhausted’

Statewide COVID-19 patient numbers, at 2,402 on Friday, are nearing the peak of 2,862 in late December. And the number of patients in intensive care hit 690 on Aug. 9, surpassing the winter peak of 685, according to data from the state Department of Health and Senior Services. The number was 681 on Friday.

On Aug. 11, Missouri Gov. Mike Parson’s office announced that the state will commit $15 million from the federal Coronavirus Aid, Relief, and Economic Security Act to provide staffing for hospitals. The funding is capped at different levels for facilities of different sizes, as measured by numbers of beds, ranging from $50,000 for facilities with 25 or fewer licensed beds, up to $200,000 for facilities with over 400 licensed beds.

“We’ve consistently heard from our health care partners that staffing is one of the biggest challenges we continue to face,� Parson said in a statement announcing the funding.

Meanwhile, health care workers are dealing with added emotional distress during the most recent wave of infections, said Denise Murphy, chief nurse executive for BJC HealthCare.

The latest surge is the first since the vaccines became widely available. Some health care workers said they never expected they would be caring for this number of virus patients again, and many are frustrated by residents’ reluctance to get the shots.

“There’s this simmering anger inside,� Murphy said. “They are exhausted. Totally and completely exhausted.�

Emergency rooms and intensive care units are filling up again, with COVID-19 patients and with patients who deferred needed care because of the pandemic. Some travel nurses, Murphy said, don’t want to come to Missouri, because of its low vaccination rates.

“We have to get enough people vaccinated so that we can stop this incredible stress on the health system,� she said. “The compassion fatigue is real. They’re angry. They’re saying, ‘Please help us. Go get a vaccine. We’re bursting at the seams.’�

Originally published on Aug. 17.