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

by  a Los Angeles Nurse

I’ve been an E.R. Nurse for 12 years at a large Burbank area hospital. I also moonlight at another large hospital near Downtown Los Angeles. The difference between these hospitals’ responses to the coronavirus outbreak is like night and day.

On Monday this week at my regular job, I had three patients. Two of them were very ill and in negative pressure rooms because COVID-19 was suspected. The third was a psychiatric patient who needed constant monitoring. Both of the “rule-out-COVID” patients required me to don/doff protective gear each time I went in and out of their rooms. Later in my shift, I noticed a new patient all the way in a back corner of the E.R. No one told me I had a new patient. I glanced at their chart and realized they showed COVID-19 symptoms. Temperature was 103; heart rate 120. I told the Charge Nurse about the patient. “Oh, I think someone’s back there,” was the reply. I said no one is back there and said that I wouldn’t be able to take that patient. My other three patients were what we call “Level 2 Acuity Emergent” — in other words, they all required a very high level of care. I was given no additional support. It was almost shift change and I was unable to attend to that fourth patient before the end of my shift.

We are so overworked. I’ve seen serious medical errors made because there aren’t enough RNs and support staff on the floor. And that’s before the expected surge in patients.

I can’t help but compare Monday to my last shift at my moonlighting hospital. Let’s just call them Hospital One, my regular job,and Hospital Two, my moonlighting gig.

At Hospital Two, if I have a “rule-out-COVID” patient, then that’s my only patient. Not only that, but there are RNs on duty whose job it is to assist you in donning and doffing protective gear and checking on you with hands-free communication devices to ask “Do you need anything? Are you okay?” That way you don’t have to doff your protective gear just to run out and get a needed item.

At Hospital One, we have no assistance in getting in and out of our personal protective equipment. It’s stressful. You have to double-think every step to make sure you don’t contaminate yourself and others. And we only have one isolation cart for 11 negative pressure rooms. That means you have to track down your protective equipment, either finding the cart or going to the utility room.

At Hospital Two, the negative pressure rooms have glass doors, so you can do frequent visual checks. At Hospital One, you can’t see into the room. The only way to check on your patient is to put on protective equipment and enter the room.

The other crazy thing at Hospital One is the way they’ve set up the E.R. waiting room. Right now, if a patient complains of respiratory symptoms, they’re sent to an area of our large waiting room that’s been screened off by low room dividers — nothing that would protect the other patients in the room from illness. In fact, it’s dangerous for those patients behind the screen. In the ER, our triage Nurses need to be able to scan a room for emergencies. You can’t scan if they’re hidden.

At Hospital One, there’s also no communication from hospital administration right now. Before this outbreak, it seemed like we were getting emails all the time. This healthcare emergency is changing every day. When I come back to work now after a few days off, everything has changed, but there are no emails to staff. Zero. We need just a simple daily update — something that says “these are the issues that came up yesterday; here’s how we’re addressing them.” Or even if you don’t have an answer, just say we’re working on this one, stay tuned. But don’t just stay silent.

some good communication from management could stop some of the serious mishaps I’m seeing. For example, people working outside in the COVID tents come in and walk around the hospital with their contaminated protective gear on. Anyone who’s watched a movie knows that’s unacceptable.

There’s no training and no communication. We went through extensive training for Ebola and that never actually materialized at our hospital. Now when we have something real, suddenly there’s no training.