If a large COVID-19 surge comes, Oklahoma officials want to be sure there are enough doctors, nurses, aides and other health-care workers to treat the infected.

That involves a lot more than adjusting schedules and paying out a little more overtime.

In a pandemic, questions loom about the total number of medical personnel available, how many are trained to deal with an infectious respiratory disease, how workers can stay healthy and alert, and how to deploy them where the need is greatest. All of this while preserving the state's capacity to treat non-coronavirus patients for other medical conditions.

Dr. Kayse Shrum, Oklahoma's secretary of science and innovation, said state officials are working closely with hospitals to see what levels of staffing would be available. The state has put a moratorium on elective surgeries, in part to free up health-care workers and conserve supplies of personal protective equipment, or PPE.

"When you go into a crisis situation, sometimes you are required to staff at a different level," Shrum said at a press conference Wednesday. "Different standards of care exist when you hit a crisis stage, and so all the hospitals are looking at that currently ... It helps us to understand what we need to do."

At SSM Health Oklahoma, a health system that runs hospitals and clinics, nurses in practice areas that have been sidelined for now like elective surgeries, are getting cross-trained to be able to work alongside their colleagues on the inpatient side, said Elain Richardson, regional chief nursing officer.

"Nurses who work in the PACU (post-anesthesia care unit) are familiar with ventilator care," Richardson said. "So they are going to be assisting some of our critical-care nurses because their work is similar." They wouldn't replace critical-care nurses by taking on a team of patients. "But they can be what we are calling a nurse buddy."

SSM Health is also working with nurse recruitment agencies to fill additional jobs and hopes the state can temporarily change nursing regulations to allow nursing students at the end of their academic studies to practice right away, before taking board exams. About 800 nurses typically graduate each spring from colleges in the Oklahoma City area, Richardson said.

Even before the pandemic, nursing skills were in high demand nationwide. Now hospitals fighting the virus must also deal with competition to recruit nurses to work in COVID-19 hotspots across the country. Richardson said she has heard of New York hospitals offering $10,000 a week, along with room and board, for temporary COVID-19 nursing jobs.

"My concern is always that because nurses are so mobile that New York may be able to entice some staff away to go work there, which obviously would put us in kind of dire straits," she said. But she also is counting on the crisis to taper off in places like New York that will allow nurses to move about the country to help where they are most needed.

"We certainly have our work cut out for us," Richardson said.

The incident commanders for every Oklahoma hospital system have been meeting twice a week to share ideas and the latest models to prepare for a surge, said Kerri Bayer, chief nursing officer for Integris Health. Integris also has its own staff epidemiologist, who helps prepare each of its hospitals to expand capacity in space, workforce and supplies.

"We want to make sure we are at a point where we can surge to a point of constraint," Bayer said, meaning a hospital will max out its capacity when it runs out of space, staffing or supplies. "So whatever constraining factor that is, that's where we know we can no longer surge. From a workforce perspective, we'll be developing shifts or staffing models around that. We'll look at our nurse/patient ratios, and that will be dependent on the acuity of the patient."

From what's happened in other states, Bayer said, the estimates show about 80% of COVID-19 patients won't need to be hospitalized, Bayer said. The rest will need some kind of care in the hospital. About 5% of those hospitalized patients will need ventilators and intensive care.

"We're not just building this out for Integris. We are building out our models to support the state of Oklahoma," Bayer said. "Every health system in the state is looking at bed availability, workforce and how we can partner on supplies."

Hospitals also have policies for when their workers are infected with the coronavirus. The policies vary depending on the severity of the infection, but the general rule of thumb has been staying home from work for up to 14 days, or at least 10 days with 72 hours of fever-free symptoms, Bayer said.

"We're also watching how this virus is demonstrating itself and looking for mutations," Bayer said. "So if we ever feel like that is still not a safe time for them to come back, we'll change that."

Health-care workers are keenly aware of reports of shortages of personal protective equipment nationwide.

Bayer said her hospital system's focus has been on preserving and safely reusing some equipment before a surge occurs, so there are enough pieces of PPE to go around.

"Our caregivers come first, and if they aren't safe and can't take care of their patients, then I've failed in my job," she said.

Meanwhile, the Oklahoma Nurses Association called for a statewide shelter-in-place order for all ages and asked residents to refrain from nonessential travel to minimize exposure. It encouraged nurses to share their experiences with equipment.

Shelly Wells, president-elect of the Oklahoma Nurses Association, said concern is high about the availability of nurses and existing shortages of health-care workers throughout the state.

"The anticipated surge in critically ill patients is resulting in over-stressing a system that was already nearing maximum effectiveness," Wells said.

Oklahoma Watch is a nonprofit organization that produces in-depth and investigative journalism on important public-policy issues facing the state. The organization's website is at http://www.oklahomawatch.org.