Two views from the Covid19 front lines
In Texas:
My view from the front lines:
1) Having trouble Getting PPE again. In the beginning they were locked up. Then when things got better we could request PPE from charge nurse. We still re-used for 2-3 days. Now our masks are locked up again.
2)Having to send patient farther out to get accepting hospitals for transport. We were transferring patient close by but now we’re transferring from farther away. My accepting hospital last night was 112 miles away. This was for a non COVID patient but the closest was only taking Covids. Per our nurses, the nearby hospital just opened up a second Covid wing and that was limiting their ability to take non covid patients.
3)Nurses now being told they are going to have to work ICU, even if their not comfortable doing so. All nurses can be flexed per the hospitals discretion. As a result some nurses working at multiple facilities are no longer picking up shifts at certain places. I get that they need ICU nurses. But ICU nurses are a special breed. They’re incredible smart and are busy the entirety of the shift. If someone has chosen NOT to work ICU, there’s a good reason. Either they’re not good at it or they personally can’t keep up with the intensity. These people have already washed out of ICU nursing. It makes no sense to put them back.
4) Nursing ratios are FUBAR. Normally ICU is 2 patient to 1 nurse ratio. Some places have moved to 3-1 or 4-1. Health care workers are concerned about safety of this and giving poor care. Add to that the above concern about having non ICU nurses in the ICU; now were doubling the work load.
5)Starting to get notification from the state to ask for retired docs to get back into hospitals. Texas Disaster Volunteer Registry is actively asking docs to register. They are also providing info for reactivating licenses.
6) Personally, I’m being asked to make more and more older patient DNR. It can be difficult because I don’t have a preexisting relationship with the family or the community. Patients and family are scared but are generally accepting of the new situation.
Update at 2300 ( as I’m on tonight): all beds closed to COVID Patients in a 150 mile area. All patients admitted for covid (and alert enough) must sign saying they know we have NO Remdisivir and no ICU beds.
Phoenix area:
Phoenix area ER nurse here. Morale is generally low amongst the staff on the floor. The COVID patients are pouring in and we don’t have the resources. Dept of health services will tell you that ICUs are 90% full but that’s a fantasy. ICU patients are sitting in the ER for 24 hours and, in some cases, are being sent in ambulances to different hospitals. Lung bypass units (ECMO) are basically gone, machines to continuously filter the blood (CRRT) are basically gone, we’re out of the “nice” ventilators and are utilizing previously retired and replaced “surge” ventilators and transport ventilators. It’s rough.
We are using the same n95 for a week to two weeks in a row before they are put in a biohazard bin to be “reprocessed” while many hospital workers are out with COVID. The masks are signed out to us and we have to literally sign our name to make sure that we aren’t requesting new masks too frequently. We don’t have enough tests, and when you can manage to get one it takes weeks for the results to come back. A coworker just waited 9 days for her COVID PCR swab to result. 9 days for a front line worker to get test results.
We are failing miserably at every possible level and it’s supremely discouraging. If you come in to my hospital were going to give you excellent care, but people are getting restless. The people who take care of you are going to do their best to smile and give you the best possible care under the circumstances, all in the face of a system that is in crumbling in every direction around them.
We need the public to listen. I would love to put this on hospital admin, they’re a great scapegoat and I have no love for upper admin. But they’re in this too, they don’t want employees writing novels on reddit, they don’t want to recycle respirators, and they definitely want happy healthy patients. But the public doesn’t care, they’ve lost all interest in the face of an inexplicably politicized nightmare situation. We’re overwhelmed, overworked, and it looks like it’s only getting worse.
Some people have asked what they can do and my only answer is to continue to be diligent about masking and social distancing. Maybe consider donating blood as it’s still very much needed and always in short supply. And then, of course, go out and elect politicians who won’t turn a public health crisis into a political show. The governor of AZ held a press conference yesterday and all he did was cap restaurant capacity at 50%. If you think this is a problem, tell him in the polls. Thanks so much everyone!
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Hans Howe 