Just north of Miami, covid-19 patients are flooding into the six Broward County hospitals run by Memorial Healthcare System, as Florida is being slammed with the highest rate of coronavirus admissions in the country. Memorial has enough beds. Not so with nurses.

The hospital system has scrambled to hire 439 travel nurses from as far away as Alaska, and it is offering some of its own nurses well-paid short-term contracts to compete with the appeal of working for lucrative outside agencies. It is beginning to pause some elective surgeries to shift staff members to patients sick with covid-19, the illness caused by the coronavirus.

Even so, the large public health-care system has about 700 nursing vacancies.

“I wake up every night and ask myself, ‘What else can I be doing?’ ” said Maggie Hansen, senior vice president and chief nurse executive at Memorial, where the census of patients with covid-19 has soared from about 100 four weeks ago to 672 on Thursday.

That predicament is echoed this second pandemic summer in other states, largely across the South, where the virus’s delta variant and relatively low vaccination rates are driving record numbers of coronavirus hospitalizations.

“Every hospital in Arkansas is having major staffing challenges,” said Chris B. Barber, president and chief executive of Jonesboro-based St. Bernards Healthcare. Barber, who is chairman of the Arkansas Hospital Association’s board, said hospital CEOs in the state hold weekly calls about the pandemic. “I can’t get on a call where that’s not the issue — how to staff their hospital,” he said.

According to hospital executives and nursing administrators in several states, the struggle to find enough workers to care for people sick with covid-19 has emerged as a critical problem as other daunting shortages, widespread early in the pandemic, have eased. Once-scarce supplies of protective gear, ventilators and coronavirus tests are now plentiful, hospital officials consistently say.

Finding ways to hire and keep nurses is the main problem, officials say, although some hospitals also are short on respiratory therapists and workers for nutritional services and housekeeping. Some hospitals could enlarge their bed capacity if they had more nurses to tend to the coronavirus patients who would fill them.

The shortages are starting to interfere with other types of care. The disruptions are not as pronounced as during the pandemic’s early months, when hospitals routinely canceled elective procedures and other patients stayed away from needed treatment for fear of contracting the virus. Still, certain hospitals in the hottest of hot spots, such as the medical centers run by Memorial, are slowing other types of care so they can redeploy staff.

“We have begun to dial back on some services,” such as screening colonoscopies and some joint surgeries, said Tracey P. Moffatt, the chief nursing officer and vice president for quality at Ochsner Health System, based in New Orleans. Louisiana has the second-highest rate of coronavirus hospitalizations.

St. Bernards Medical Center, the 440-bed flagship hospital in a system that covers nearly two dozen counties in northeast Arkansas, built a tower with 245,000 square feet for intensive care and surgical services. It opened in December 2019, shortly before the pandemic was declared.

“So, that gave us physical space,” Barber said. Soon after the coronavirus arrived, the hospital drafted a surge plan to add up to 180 beds for covid-19 patients. In the past month, it has used the plan to expand three times — by 95 beds. Barber figures the volume of arriving coronavirus patients would warrant opening perhaps three-dozen more beds, if it had workers to staff them.

The hospital and outlying parts of the St. Bernards system have 350 to 400 job postings on a daily basis out of a workforce of 4,200. That is after hiring almost 30 nurses for the hospital, mostly from the Philippines, through Guardian Healthcare Providers, which recruits workers internationally. The hospital, which never relied on outside nurses before the pandemic, also is using 67 travel nurses.

Hiring through national travel nursing agencies “has been helpful, but it’s extremely competitive,” Barber said. “They are seeing big spikes in demand.”

At Baxter Regional Medical Center, a smaller hospital of 180 beds in the Ozarks of north-central Arkansas, the pandemic was so slow to arrive that the hospital’s two pulmonologists went to help out in New York, an early hot spot, before the first local coronavirus patient arrived in late June last year. On Thanksgiving Day, Baxter hit 34 cases, the peak until late this July, when it reached 45, staying near that level.

Coronavirus patients account for 12 of the 14 people in the intensive care unit. The unit lacks the staff to care for any more, so Baxter was forced to look for another hospital where it could send a neurology patient with an aneurysm and ended up doing the transfer last weekend to a Kentucky hospital, 4½ hours away, because closer ones did not have room, according to Ron Peterson, Baxter’s president and chief executive.

“The issue is staffing, no question about it,” Peterson said.

Baxter is an independent hospital with a thin profit margin in ordinary times and, in a popular retirement area, an uncommonly large number of patients on Medicare, which pays the hospital less than most insurers. To try to keep its own nurses, it has raised their pay by $2 an hour. The dozen travel nurses it has hired, Peterson said, cost three times as much.

It is scheduled to get six more outside nurses soon. “We would . . . hire more if we could even find them,” Peterson said. “At some point, you’ve got to ask, how long can we do this?”

Ochsner, with 24 hospitals in Louisiana and into Mississippi, has 300 travel nurses from all over the country.

“Frankly we could use more — probably another 100 to 150 would help us,” said Moffatt, the chief nursing officer.

During the initial surge that hit New Orleans after Mardi Gras last year, Ochsner expanded the role of a hub that coordinates nurses who float among different hospitals in the system. The hub also became a staffing agency to hire contract nurses from elsewhere and was able to recruit about 500 at first.

“In this fourth wave, it’s become a lot harder to recruit nurses,” Moffatt said. She suspects that some travel nurses who worked through earlier pandemic surges are burned out — or have made enough income that they are taking time off.

With the pool of available travel nurses smaller and coronavirus cases flourishing, she said, hospitals in hot spots “are all at this time drinking from the same pool of people.”

Bidding wars occasionally break out. “We will sometimes see an agency nurse accept at Ochsner,” she said, “and . . . two hours later they pull out and [have] accepted a higher rate.”

The fierce competition means that already-high prices charged by companies that contract out travel nurses have risen.

At a hearing this week before a Texas Senate committee, Esmaeil Porsa, president and chief executive of Harris Health System, a large public health-care network with two hospitals in Houston, said temporary agencies that supply travel nurses typically charged $65 an hour to $145 an hour last year.

A few days ago, Porsa told the legislators, “we were approached by an agency with a rate of $286 an hour for nursing staff.” As of last week, he said, the two hospitals had 133 agency nurses and needed 132 more that the system has been unable to find.

Over the weekend, a nursing shortage prompted one of the Harris safety-net hospitals, Lyndon B. Johnson Hospital in northeast Houston, to close six of its 24 intensive care beds, and it declared an “internal disaster” Sunday night, in which no patients were admitted for most of a day.

“I am faced with a workforce that is tired, overworked and constantly under siege,” Porsa testified. “I have lost staff to fatigue and retirement. I have lost staff to covid infection. And I have lost staff to . . . quite honestly, ridiculously high-paying jobs by temp agencies.”

Texas Gov. Greg Abbott (R) and Arkansas Gov. Asa Hutchinson (R) said in recent days that they were reactivating programs from earlier in the pandemic in which state agencies would help hospitals find staff members, with reimbursements from federal coronavirus relief laws.

At Memorial, the public health-care system in Broward County, the number of coronavirus patients Thursday broke the record set in its hospitals during the pandemic’s surge last summer.

In the year that has elapsed, the system has tried to innovate, seeking ways to train and retain its own staff, and bringing in nurses licensed to work in Florida from Seattle, Vermont and Canada, said Hansen, the chief nurse executive. Some have come from New York. Memorial has already offered a nursing residency program in coordination with a local university. Next week, it is beginning a fellowship program to provide fledgling nurses a year’s specialized training with classes and a mentor.

Training nurses to be specialists, Hansen said, is particularly important because, even before the pandemic, nurses in the baby boomer generation were retiring, and the outflow has quickened because of the rigors of caring for desperately ill people with covid-19.

Memorial furnishes its staff with mental health services — coaching on how to stay resilient, especially as a growing portion of the patients filling hospital beds in this latest surge are younger than before and probably would not be in a hospital if they had been vaccinated against the virus. Memorial’s nurses “are experiencing PTSD already,” Hansen said. “They are seeing things they can’t unsee when they go home.

“It sounds dire, but we are going to get through it,” she said. “It’s just going to be a long haul. We’ve become accustomed to the uncertain aspect of covid.”