UNC and Rex will are restricting visits by children under 12 years old. Chief Medical Officer Linda Butler said the recent increase in cases prompted the decision.

"We have babies, we have moms who are pregnant who are admitted, they're at high risk, we have patients being treated for cancer who are immunocompromised," she said. "We had to make the decision to protect our patients."

WakeMed officials decided to restrict visits to anyone under 18 years old. Similar bans already are in effect at Cape Fear Valley Medical Center, Carolinas Medical Center and Moses Cone Medical Center.

It will be especially tough on thousands of new families who can't bring big brothers and sisters to see new babies at the hospital.

For Courtney Braswell, who just had her second child, not having her five-year old come and visit would have been difficult.

"I feel it's important for siblings to be able to visit," she said. "They need to be part of the process."

But hospital officials say the risk of the spread of H1N1 and seasonal flu this year is just too great to make exceptions for anyone.

"Most people are pretty understanding when they realize they're putting somebody else's health at risk coming in," said Butler. "They can wait the day or two to see their new sibling when they come home."

Braswell, who will be home with her baby when the ban takes effect, said parents will have to adjust.

"I think if you know it up front and prepare for it and be able to explain it to the older children then that would be a little easier," she said.

Visitation restrictions are common in intensive care areas of the hospital, but hospital officials say visitors don't always pay attention to them. They are hopeful that the threat of H1N1 is enough to discourage folks from taking a chance on putting patients' health - and the health of their children - at risk.

In a statement released to employees, WakeMed indicated layoff notifications will come by Sept. 3.

"About one third of these individuals will, if they choose, have the opportunity to shift to another assignment within the WakeMed system, including the new patient tower," said CEO Bill Atkinson in a written statement. "More than a third of the reductions are in VPs, directors and managers. No staff nurse is being displaced."

Like other major employers in the Triangle, WakeMed saw revenue beginning to fall as early as 2007 and began strategies to avoid layoffs, including cutbacks in overtime and new hires. In 2008, the hospital system continued cost-cutting and elected to suspend its WakeShare program, which awarded employees year-end bonuses based on excess net income.

Don Dalton, spokesperson for the North Carolina Hospital Association, said this is the first staff reduction he has heard of at a major hospital in the state. Smaller hospitals, he said, have borne the brunt of the flagging economy. An NCHA survey last spring showed one in five North Carolina hospitals had already had workforce reductions.

In July, Johnston Health announced the elimination of 31 part- and full-time positions and a reduction in hours for 13 more employees, citing the "weakest economic climate in the past 75 years."

"We've seen some rebound in operating margins and total margins among hospitals, but it has not yet rebounded to the level that it was just a year ago and is still significantly below the level that it was two years ago," said Dalton. "Some of the rebound that we are seeing is due to cost containment measures in hospitals."

Looming cuts in Medicare reimbursement to physicians will add to the financial burden at hospitals, said Dalton. As many as one-third of physicians in the state are employed by hospitals.

"Unless Congress fixes it, physicians will take a 21 percent cut in their reimbursement from Medicare starting next year," he said. "Independent physicians will probably be less eager to add new Medicare patients to their ranks, sending more seniors to hospitals for care. Hospitals do not recover their costs for treating Medicare patients, so that would result in more financial losses at a time when many hospitals' bottom lines are already shaky to nonexistent."

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