The coronavirus pandemic is increasing across the United States as infections and hospitalizations rise. This has resulted in a shortage of nurses, especially in rural areas and at small hospitals.

The problem has led to nurses being trained to provide care in medical areas where they have little experience. Hospitals are reducing some services to keep enough trained medical workers for seriously sick coronavirus patients. And some health systems are employing traveling nurses to assist their doctors.

Nurses with a lot of experience are resigning because they are "burned out," said Kevin Fitzpatrick. He is an emergency room nurse at Hurley Medical Center in Flint, Michigan. Several nurses resigned in just the past month. They took jobs in home care or other places with less demands.

"And replacing them is not easy," Fitzpatrick said.

As a result, he said the emergency room is operating at about five nurses short of its best level. Each nurse cares for about four patients as COVID-19 hospitalizations continue to increase.

Experts say the departures are not surprising. Many nurses trained in emergency care are over 50 and at increased risk of serious medical problems if they get the virus. Younger nurses worry about spreading the virus to their children or other family members.

Worrying about family members often decides "who can actually work and who feels safe working," said Karen Donelan. She is a professor of U.S. health policy at Brandeis University's Heller School for Social Policy and Management.

Donelan said there is little information so far on how the pandemic is affecting nursing overall. But some hospitals had a shortage even before the virus arrived, especially those in rural areas.

With total coronavirus cases above 9 million in the U.S. and new daily infections rising in 47 states, the need for nurses is only increasing. The U.S. has recorded more than 231,000 deaths.

The health care company Aspirus in Wausau, Wisconsin, is offering an extra $15,000 to nurses with at least one year of experience who sign up to work. The company is also using private companies to search for nurses as the number of patients it treats for coronavirus has increased by 300 percent.

Aspirus operates five hospitals in Wisconsin and four in small communities in northern Michigan. It is moving nurses from one hospital to another as new outbreaks take hold, said Ruth Risley-Gray. She is a vice president and the chief nursing officer at Aspirus.

But more nurses are needed. That is because many have gotten sick or tested positive for the coronavirus during the current outbreak. In mid-October, 215 members of Aspirus medical teams were in isolation. They are just beginning to return to work.

Adding to the problem is the fact that hospitals nationwide are all competing for the country's available nurses. April Hansen is executive vice president at San Diego-based Aya Healthcare, a company that provides traveling nurses. Her company is seeking to employ at least 20,000 additional nurses.

In North Dakota, Texas and Wisconsin, government officials have launched efforts to bring more nurses to their states. Infection rates in these states have been exploding.

"We've been pleading with the community members to protect themselves and others," by wearing masks and social distancing, said Aspirus' Risley-Gray.

Traveling nurses say the need seems greater at smaller hospitals than at larger ones.

Robert Gardner is a nurse working in a small hospital outside Atlanta. He says he will stay for as long as he is needed.

"It's not even a question," Gardner said. "Nursing is a calling."

I'm Susan Shand.

The Associated Press reported this story. Susan Shand adapted it for Learning English. George Grow was the editor.

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nurse – n. a person who is trained to care for sick or injured people and who usually works in a hospital or doctor's office

burned out – phrasal verb. feeling very physically and emotionally tired after doing a difficult job for a long time

outbreak – n. the sudden appearance of an illness

positive – adj. in illness, a test that confirms the presence of the illness

isolation – n. the state of being in a place or situation that is separate from others

plead – v. to ask for something in a serious and emotional way

mask – n. a covering used to protect your face or cover your mouth