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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

At X3 Sports, trainers have a goal of bringing out the warrior within their students by building up their cardiovascular endurance and their self-confidence.After being shut down because of COVID-19 concerns, this mixed martial arts gym in Atlanta is reopening and seeing a major increase in enrollment.“Since a lot of things have been going on in our community, it has increased at least 50% than what it was,” kickboxing coach Rica Grandison said.Grandison says more people are taking these self-defense classes and citing concerns ranging from the pandemic to the protests.She added that these students enrolling represent all races, genders and sexual orientations:“I am part of the LGBTQ community,” Grandison said.“I’ve been called the 'N' word just waiting for a bus. I’ve been called the 'D' word just hanging out with my partner, my significant other at the time,” she said. “So, I have been there.”Now the X3 coaches are sharing their championship credentials with gym members like Shannon Dunlap, who joined this gym to get stronger physically and emotionally.“I am a lot more comfortable in my body; I’m a lot more self-assured,” she said. “I don’t get nervous walking down the street.”The coaches at X3 say the more someone trains, the more muscle memory they will develop. Which means if they ever become a victim of an act of violence, it’s easier to escape that situation without things getting even more physical.“If somebody’s charging you just, just give them a push kick," Grandison said. “Push them away, knock them down, run away.”While Grandison says the best fight is a fight that never happens, she also believes it best for people to have the physical skills to defend themselves. 1714

BAKERSFIELD, California — Fire crews around California are gradually getting the upper hand on wildfires that are ravaging the state.On Monday morning, CalFire updated the progress of multiple fires from around California.The Camp Fire in Butte County is now covering 151,000 and is 66 percent contained. That fire has already claimed the lives of 77 people. About 1,000 people are still unaccounted for. CalFire is reporting that 11,713 homes have been destroyed. That's up more than a 1,000 homes from Sunday's update. PHOTOS: Wildfires devastation in CaliforniaThe Woolsey Fire, burning in Ventura and Los Angeles counties, is now covering 96,949 acres and is 94 percent contained. So far three people have lost their lives in that fire.  789

AURORA, Colo. – Police confirmed Monday afternoon that the man they shot and killed early Monday morning is believed to have shot and killed another man who’d broken into his home minutes earlier.The police shooting happened around in Aurora, Colo. Officers had been called the house on reports that a man had broken into the home.“Officers arrived to a very chaotic and violent scene,” Aurora Police Chief Nick Metz wrote in a news release issued Monday afternoon.Metz said officers who arrived at the scene heard gunshots inside the home and ran into an armed man. An officer shot the man, who died at an area hospital.After clearing the scene, according to Metz, officers found a juvenile injured inside and a man shot dead on the bathroom floor. The child was taken to a hospital for “serious, but non-life-threatening injuries” caused by the intruder, he said.Both men’s identities will be released by the Adams County Coroner’s Office, Metz said. The officer who shot the resident of the home is on standard paid leave.The investigation into the shooting will be conducted by the Aurora Police Major Crimes Unit, the Denver Police Department and the 17th Judicial District Attorney’s Office. Police are also asking anyone who witnessed the shooting to call Detective Randy Hansen at 303-739-6710.“This is a very heartbreaking and tragic situation for everyone involved. We are providing assistance through our victim advocates to help the family of the deceased resident through this very difficult time,” Metz said in a statement. 1555

At least 29 people were killed during a week of severe weather conditions and devastating flooding in Italy, the country's interior minister said Sunday.Twelve people were confirmed dead on the island of Sicily on Sunday, including nine members of two families, the fire brigade announced on Twitter.The families were dining together when their house was submerged by water from a nearby river that suddenly overflowed.The fire brigade said its divers had found the bodies. Among the victims were two children, 1 and 3 years old.Italy's civil protection agency said it was still looking for a doctor who had been on his way to work at a hospital Saturday night and was missing.High winds and heavy rain have devastated parts of the country over the past week, causing the worst flooding in at least a decade in Venice, damages of more than 1 billion euros (.14 billion) in Veneto and landslides that have cut off villages, authorities said.The situation in Sicily is "dramatic," Prime Minister Giuseppe Conte said Sunday.Conte will call a cabinet meeting to announce a state of emergency in affected regions, he said at a press conference in Palermo, Sicily. 1168