Part of a series: COVID-19 — Nurses’ Notes from the Front Line

by Richard Barnett, RN

Yesterday, I quit my job as a bedside telemetry RN at a large hospital in Los Angeles’ San Fernando Valley. I’ve been there for seven years, after a 21-year medical career in the U.S. Navy as a hospital corpsman. This included combat experience in Iraq and multiple deployments around the world in multiple healthcare environments.

The hospital left me with a difficult choice. The hospital was not following the procedures they had disseminated to staff in order to limit or prevent avoidable exposure to COVID-19, exposure which would compromise my step-daughter’s fragile health and the health of my other daily contacts who fall into the high-risk categories.

I have experience with high risk, high pressure situations, including those that happen under enemy fire. I understand what it means to make snap decisions in the heat of the moment, but the hospital administration had months to plan and the experiences of healthcare workers and administrators around the world. We already had examples of what is and isn’t working in the face of this new challenge. What’s been happening in my hospital as this virus unfolds is unnecessary and places our patients and staff at inevitable risk without need.

When I got to my shift last night, the department was in a “huddle” to brief the RNs who were coming on shift. The charge nurse told us that they only had universal masks available on the floor and no other sizes. I require a large mask that was not available. I was informed by another nurse of a doctor who had to wear an improper size mask to see a presumed COVID-19 patient. Also during the huddle, we were told that the hospital was running short of isolation stethoscopes, so to just clean them with alcohol. I had to chime in and point out that alcohol wouldn’t sterilize the stethoscopes; that requires bleach.

It was at that point that I went downstairs to quit. The Nursing Supervisor talked me into staying for the remainder of the shift, assuring me that whatever personal protective equipment I would need to care for my patients would be provided. I was then sent from my normal unit to another, due to low staffing issues.

Later in the shift, we learned that a rapid response had been called for a patient from my home unit that had just been admitted from the ER. This patient had not been in isolation of any kind and the rapid response resulted in the patient being moved to ICU, where the patient was intubated and treated as a presumed COVID-19 infection. None of the nurses who responded to the rapid response had been wearing protective equipment because the patient had not been identified as a potential COVID-19 infection prior to arrival on the floor. We also had another patient on the floor with a respiratory diagnosis other than COVID-19 that was not being tested, even though they met all the criteria for COVID screening. The RN caring for that patient also had other patients. To make matters worse, there were no Nursing Assistants on the floor, increasing the patient care loads on the RN’s and decreasing the time they have available for dealing with more complex patient needs. That happens too often, but it’s especially dangerous now.

I also learned that RN’s in the ER had been exposed to another patient that had been sent to the ICU, intubated and identified as a possible COVID-19 infection. Those nurses also had not been wearing protective equipment because the patient had not been identified before being treated in the ER.

We can’t afford to have nurses sick or quarantined. We need more staff to prepare for patients, not fewer. I don’t know if the exposed nurses from my unit and the ER are now quarantined.

Hospital management needs to listen to us. Nurses have been pleading with the Administration for an end to hospital visitors. We are caring for a population with compromised immune systems. They’re sick. During the day shift it was noted by nursing staff that visitors were not even being screened at the front desk. When the hospital resumed screening of visitors, they used security guards who are not trained healthcare professionals.

The bottom line is, even in this healthcare emergency, there are so many things that could improve everyone’s safety. Right now, a nurse could be safer on the job than out in public. All the hospital would need to do is separate out the patients coming in who complain of respiratory symptoms and provide us with proper personal protective gear to care for them. Any logistical or manpower issues that get in the way could be addressed with very little effort.

We need to treat all respiratory patients coming into the hospital as if they have COVID-19 until proven otherwise. It’s really that simple. We can’t keep Nurses in the dark. We can’t afford to lose their assistance in dealing with this crisis. There aren’t enough RNs to begin with.

In addition, all Charge Nurses should be freed up to focus on their duties, not be asked to take patients. There should be enough RNs and Nursing Assistants to ensure that doesn’t happen. The hospital could have nurse managers, hospital administrators, and infectious disease nurses regularly walking the floors each shift, in order to get in front of issues that nurses and frontline caregivers identify before they become big problems.

Nurses routinely place the welfare of their patients in front of their own. They skip meals, they skip bathroom breaks and stay on their feet for 12 hours at a time every shift, but no matter what sacrifices they are willing to make, this crisis is not something they can face without support and protection.