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As the coronavirus pandemic surges across the nation and infections and hospitalizations rise, medical administrators are scrambling to find enough nursing help — especially in rural areas and at small hospitals.Nurses are being trained to provide care in fields where they have limited experience. Hospitals are scaling back services to ensure enough staff to handle critically ill patients. And health systems are turning to short-term travel nurses to help fill the gaps.Adding to the strain, experienced nurses are “burned out with this whole (pandemic)” and some are quitting, said Kevin Fitzpatrick, an emergency room nurse at Hurley Medical Center in Flint, Michigan, where several left just in the past month to work in hospice or home care or at outpatient clinics.“And replacing them is not easy,” Fitzpatrick said.As a result, he said, the ER is operating at about five nurses short of its optimal level at any given time, and each one typically cares for four patients as COVID-19 hospitalizations surge anew. Hospital officials did not respond to requests for comment.But the departures are not surprising, according to experts, considering not only the mental toll but the fact that many nurses trained in acute care are over 50 and at increased risk of complications if they contract COVID-19, while younger nurses often have children or other family to worry about.“Who can actually work and who feels safe working are limited by family obligations to protect their own health,” said Karen Donelan, professor of U.S. health policy at Brandeis University’s Heller School for Social Policy and Management. “All of those things have been factors.”Donelan said there is little data so far on how the pandemic, which has killed more than 231,000 people in the country, is affecting nursing overall. But some hospitals had a shortage even before the virus took hold, despite a national rise in the number of nurses over the past decade.With total confirmed coronavirus cases surpassing 9 million in the U.S. and new daily infections rising in 47 states, the need is only increasing.Wausau, Wisconsin-based Aspirus Health Care is offering ,000 signing bonuses for nurses with at least a year of experience and hiring contract nurses through private staffing companies to handle a surge in hospitalizations that prompted the system to almost quadruple the number of beds dedicated to COVID-19 patients.Aspirus, which operates five hospitals in Wisconsin and four in small communities in Michigan’s Upper Peninsula, also is moving nurses around between departments and facilities as hot spots emerge, said Ruth Risley-Gray, senior vice president and chief nursing officer at Aspirus.Outside help still is needed, in part because some nurses have gotten sick from or were exposed to the cornavirus during the current wave, which “came with a vengeance” starting in August, Risley-Gray said. At one point in mid-October, 215 staffers were in isolation after showing symptoms or being exposed to someone who tested positive, and some are just starting to return to work.Aspirus recently was able to hire 18 nurses from outside agencies, and may need more if the surge continues.Because the pandemic is surging just about everywhere in the country, hospitals nationwide are competing for the same pool of nurses, offering pay ranging from ,500 a week to more than ,000, said April Hansen, executive vice president at San Diego-based Aya Healthcare, which recruits and deploys travel nurses.She said demand for their services has more than doubled since early in the pandemic when the greatest need was in hot spots like New York and New Jersey and then moved to southern states. In recent weeks the virus has been spiking across the country, with the new hot spots in places like the rural upper Midwest and southern-border communities such as El Paso, Texas.Now placing nurses where they’re needed is “like a giant game of whack-a-mole,” said Hansen, whose company has about 20,000 openings for contract nurses.In North Dakota, where infection rates are exploding, hospitals may cut back on elective surgeries and seek government aid to hire more nurses if things get worse, North Dakota Hospital Association president Tim Blasl said.In Texas, Gov. Greg Abbott recently announced he was sending 75 nurses and respiratory therapists to El Paso to help handle the city’s surge. Wisconsin Gov. Tony Evers, meanwhile, issued emergency orders making it easier for nurses from elsewhere to practice in his state and for retired nurses to come back.“This has been a challenge, and we’ve been pleading with the community members to protect themselves and others,” by wearing masks and social distancing, said Aspirus’ Risley-Gray, who said the positivity rate among community members tested by Aspirus rose from under 10% in September to 24% last week.To combat the emotional toll and fatigue that comes with caring for COVID-19 patients, including just donning and removing protective equipment all day, Aspirus has been giving nurses microbreaks and quiet places to get away and collect themselves when they feel overwhelmed.Travel nurses say the need at small hospitals tends to be greater than at larger facilities.Robert Gardner, who’s currently assigned to a hospital in a small town about 20 miles west of Atlanta, said he did search and rescue in the Coast Guard during Hurricane Katrina and the pandemic is “a lot worse.”He worked at a large New Jersey hospital when that state was swamped by the virus in the spring, and now worries that flu season could bring further chaos to hospitals. But he’s determined to stick it out, no matter what.“It’s not even a question,” Gardner said. “Nursing is a calling.” 5727

As President Donald Trump and Vice President Mike Pence prepared to gather for their weekly lunch in August 2017, the President told his staff to add two more plates.Both men had just welcomed new chiefs of staff -- retired Marine Corps Gen. John Kelly and Nick Ayers, a 34-year-old Republican political consultant from Georgia -- and Trump decided to wave the pair into his private dining room off the Oval Office.Until then, a Cabinet member would occasionally join them, but the meals were largely a chance for Trump and Pence to spend time together alone, chatting about politics, policy and whatever popped into Trump's mind -- sometimes prompted by the television in the room tuned to Fox News.But in August 2017, the lunch went from a regular tête-à-tête to a four-man affair, one that became a more formal opportunity for the two offices to coordinate on strategy, policy and scheduling. For Ayers, Pence's new chief of staff, they were useful in another, perhaps more important way: he now had regular face-time with the President. With each passing lunch, Trump grew to know and like Ayers more, two sources close to the President said, allowing Ayers to build a strong personal rapport that could end up paying dividends.As the President considers replacing his chief of staff, Ayers has emerged as a top contender, multiple people familiar with the situation told CNN. Interviews with nearly two dozen current and former White House officials, former Ayers colleagues, sources close to the President and Republican congressional staffers portray an ambitious aide who has worked to insulate his current boss from the chaos of the West Wing, while also angling for a bigger job that would place him squarely in the middle of it.Trump has begun to envy the smoothly operating vice president's office, which Ayers has managed to keep distanced from the daily scrum and scandal of the White House. Ayers has cultivated key allies, including Ivanka Trump and Jared Kushner. He also boasts an impressive track record in Republican politics that could serve the President well in the run-up to his 2020 re-election.But Ayers' meteoric rise has also earned him his fair share of critics, including a few inside the White House. While plans were floated earlier this month for Ayers to become the new chief of staff, multiple sources told CNN, they have stalled amid the President's reluctance to fire Kelly -- who typically does the firing for Trump -- and the backbiting Ayers has faced from some of his West Wing colleagues.Several of Trump's top advisers have voiced concerns to him about Ayers, with some threatening to quit if he is tapped for the job. One of Ayers' top West Wing detractors during the process has been Kellyanne Conway, the combative counselor to the President who vehemently opposed Ayers' hire as Pence's chief of staff last year, two former White House officials and a source familiar with the matter said.Conway disputes those allegations, telling CNN: "I have zero beef with Nick Ayers."Outside the White House, former colleagues of Ayers say his relative youth and outsized ego -- conspicuous even in a world known for naked ambition and self-aggrandizement -- have rubbed fellow political operatives the wrong way. His allies say that people are just jealous or insecure."I think every job he's ever had he's been one of the youngest people to ever have it. And I think that's threatening to some people," said Alex Conant, who worked with Ayers on former Minnesota Gov. Tim Pawlenty's 2012 presidential campaign.Though he's only 36, Ayers has amassed a small fortune that, according to recent financial disclosures, is between million to million. That's been built up through financial investments, fees generated by his own political consulting firm and his former role as a principal in an ad-buying firm called Target Enterprises, which has served as the media buyer on nearly every race Ayers has worked on since he joined in 2011.The arrangement allowed Ayers to earn a consultant's salary while also influencing campaign spending in a way that benefited him financially, a practice that is not illegal but has raised consternation among fellow consultants. A source familiar with the matter insisted all of the candidates Ayers has serviced were aware of the financial arrangement behind his consulting.Still, his finances and involvement with political dark money groups could become political baggage down the road. One of them, Freedom Frontier, for whom he consulted, is the subject of two recent ethics complaints, the most recent of which was filed with the IRS on Tuesday. That complaint, filed by Citizens for Responsibility and Ethics in Washington, contends the group's political spending exceeded legal limits in violation of campaign finance laws.Efforts to reach officials with Freedom Frontier for comment were unsuccessful.  4901

As more and more people are venturing out, some people might be taking a more relaxed stance on wearing masks. This is especially true now that we're months into the pandemic, and the weather is starting to heat up. But is it okay to ask someone to put on a mask who's not wearing one?"I think it’s always reasonable if you see someone not doing something that is helping keeping others safe, then you should feel free to speak up. Particularly if they’re within six feet of your space," said Denver Health Chief Medical Officer Dr. Connie Savor Price.She says it may be a little uncomfortable, and a bit awkward, she says you can always ask. A majority of the states across the country have mask requirements or recommendations. Most of them say you should wear a mask when social distancing is not possible or when you’re inside a business.The CDC also issued a recommendation in April that face coverings should be worn when social distancing is not possible."The hardest thing for me and for others I think is when you’re outside exercising and you’re not within the vicinity of others. And, I think the rules are a little unclear for that. If you’re not within six feet of others then I think it’s okay, but certainly if you’re on a crowded hiking trail, or are in a condition where you’re near others, you should wear a mask and at least put it on when you’re within six feet of others," said Dr. Savor Price.She says the biggest reason to wear a mask isn’t necessarily for your own protection, although you do get moderate protection from them. But, it prevents your respiratory droplets from infecting others if you have the disease. 1649

ATLANTA (AP) — A representative for Tyler Perry says the filmmaker and actor offered to pay the funeral expenses for an 8-year-old girl who was fatally shot in Atlanta. Secoriea Turner was shot while riding in a Jeep Cherokee with her mother and another adult on Saturday night. The shooting occurred near a fast-food restaurant where a Black man, Rayshard Brooks, was killed by a white police officer on June 12. The Wendy's restaurant was later burned, and the area has seen frequent demonstrations against police brutality since. Perry paid for Brooks' funeral last month. No suspect has been arrested in the girl's shooting death. 642

Asked @MarkMeadows if he had information about positive cases in the White House today: pic.twitter.com/WZRZdEsEuT— Raquel Kr?henbühl (@Rkrahenbuhl) September 16, 2020 175

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