Pressure is building for M Health Fairview to delay its planned closure of the emergency room at St. Joseph's Hospital, which critics say could limit patient access to health care when it's needed most with the COVID-19 pandemic.

The Minnesota Nurses Association continued criticism of the move at a Friday news conference that lamented the loss of nursing jobs and potential impact on patients, particularly in the east metro.

Fairview this month closed Bethesda Hospital in St. Paul and moved COVID-19 patients to St. Joseph's, where the health system plans to close the emergency room by year's end.

Fairview says the ER closure would have no impact on the region's ability to care for COVID-19 patients. Patients will be routed to St. Joseph's without an emergency room, the health system says, adding that the all-COVID Bethesda facility had no ER.

Yet nurses aren't alone in raising concerns about the plan. Allina Health System and HealthPartners, two of the state's largest health systems, which also operate hospitals near St. Paul's downtown, told the Star Tribune they have asked Fairview to reconsider or delay the ER closure as well.

"Emergency departments serve as the front door to the hospital and support access for those arriving by ambulance," Allina said in a statement. The Minneapolis-based health system operates United Hospital in St. Paul.

"All hospital emergency departments, including United's, are already under enormous strain to meet the care needs of the community," Allina said. "Any reduction in access will further exacerbate an already difficult situation to ensure care for our community's increasing emergency care, mental health and COVID-19 needs."

At Bloomington-based HealthPartners, which operates Regions Hospital in St. Paul, spokesman Vince Rivard wrote by e-mail that "continuing to have St. Joe's as part of our COVID-19 solution, including emergency room care and inpatient care, will be critical over the next several months. Longer term, we will need to work together with M Health Fairview and other health systems to address the needs of the community, including mental health."

Joe Campbell, a spokesman for M Health Fairview, which is also one of the state's largest hospital operators, said that by dialing back at Bethesda and St. Joseph's, the health system is trying to find ways to make care more affordable and accessible. That way, patients don't seek ER care as a last resort when they could get help in clinics and other care settings.

"As the smallest of the three acute care hospitals in Downtown St. Paul, the closing of the St. Joseph's emergency room will have no impact on our region's ability to treat COVID patients," Campbell said in an e-mail. "We continue to care for COVID patients at St. Joseph's as part of our cohorting strategy, and patients will be routed to St. Joseph's through visits to primary care physicians, urgent care, and from our system and other hospitals from across the region."

M Health Fairview is the brand for health care services at Minneapolis-based Fairview Health Services as well as the University of Minnesota.

In October, Fairview announced plans to close Bethesda, which was converted in March to treat COVID-19 patients, and make St. Joseph's Hospital the new flagship for treating pandemic patients. As part of the plan to stem financial losses, Fairview said St. Joseph's would cease being a general hospital, with the emergency room closure by year's end and relocation of certain specialty services within the hospital.

Inpatient mental health care will continue at the downtown St. Paul hospital at least through 2021, Fairview said. The health system also is closing 16 clinics and eliminating 900 jobs as it addresses operating losses due in part to the pandemic.

After the announcement, the Minnesota Nurses Association held a news conference outside the Ramsey County Courthouse in St. Paul to speak out against the closure of Bethesda and cutbacks at St. Joseph's. On Friday, union president Mary Turner said during another St. Paul news conference that state officials should "step up and stop this closing and downsizing of hospitals during a pandemic."

Kasmynn Cessna, an emergency room nurse at St. Joseph's, told reporters that the surge of COVID-19 admissions is putting pressure on her hospital's capacity. Patients are waiting hours in the emergency room for regular hospital beds to open, Cessna said, and in some cases are being transferred across the state to find one.

Last week, seven hospitals in the region were diverting ambulances at the same time, Cessna said, because hospitals were so full.

"Most hospitals are at maximum capacity and full to the brim," she said. "This is not going to end any time soon."

Last week, Fairview said it was looking to hire agency nurses who travel from far away to supplement the ranks of caregivers, who increasingly are being sidelined by the virus — particularly as they are exposed out in the community. Turner, the MNA president, said Friday of the idea: "Good luck on finding enough agency nurses — that's all I'll say."

Campbell, the Fairview spokesman, said traveling nurses started arriving this week and will continue to be placed to build surge capacity.

Many hospitals are very busy, Campbell said, but there aren't a large number of patients spending a long time waiting for beds and being redirected all across the state. Patients are prioritized and treated based on their condition, he said, and sometimes directed to another hospital that can help them.

Campbell said he is regularly on calls about capacity and diversion and had not heard of the circumstance where seven hospitals were diverting patients at the same time. The issue right now with providing care for COVID-19 patients is not about the spaces, he said, but having enough staff to treat them.

"We have plenty of space," Campbell said in an e-mail. "What is going to prevent people from getting care is staffing shortages," so Fairview wants nurses to move into open positions across the health system.

Twitter: @chrissnowbeck