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

by Carlo Delima, RN

I just got home from working a night shift in our COVID-19 unit, where we care for both positive and “rule-out” patients who require constant care and monitoring. In addition, those of us providing the care must carefully don and doff protective equipment each time we enter then leave an isolation room.

This morning in our shift-change huddle, the Nurses coming onto the day shift got some really bad news.

But let me back up a little bit…

A few weeks ago, each RN in this COVID-19 unit was caring for two patients. Since then, other support staff has been cut. The hospital stopped having Nurse Assistants, Respiratory Therapists, Phlebotomists and other critical caregivers provide direct treatment to our patients. RNs are now doing everything. The other staff just call out instructions from outside the unit entrance doors. Plus we’re now responsible for all the cleaning, since the custodial staff is only sent in to sanitize a room once a patient leaves.

Having two patients is impossibly hard when you’re the only one caring for them. With no other medical staff (even the Doctors are giving us instructions), it’s all on us. Even if I could just have a Nurse Assistant, it would help. They could save me from having to go through the process of doffing my protective gear every time I need an unexpected item. I have to think through everything very carefully to get as much done for my patients as possible each time I go in. We’re often in that room for a long time, especially when the unexpected happens. And trust me, the unexpected happens all the time, even before this pandemic.

A couple weeks ago, I had a “rule out” patient. We’d been chatting for a while as I checked vitals and dispensed medication. Then I noticed the patient’s oxygen saturation dipped. My patient deteriorated very quickly, with respiratory issues. I kept pressing a call light for help, but everyone was too busy with their own COVID patients. I de-gowned to find another Nurse to be a second pair of eyes as we assessed. I found someone and we both gowned back up. We brought a non-rebreather mask to deliver pure oxygen, but still the patient’s oxygen levels wouldn’t improve. I called the rapid response team. It took them time to get to our floor and gown up. They ended up taking the patient to ICU.

This all meant that for that time — an hour or more — that I was with this patient, my other patient had no one to look in on them. No one. And remember, these are super-symptomatic patients. Luckily, that patient was stable during this time, but what if something went wrong? There was no one to even take a peek in and see if they were breathing ok. The patient was completely unattended — no Nurse Assistant, no Respiratory Therapist, no Doctor.

Then last week management changed the nurse-to-patient ratio to three patients for every RN.

So fast forward to this morning…

Our supervisors told us that each RN would now be responsible for the impossible task of caring for four isolation patients at a time. This comes at the same time when management is sending other Nurses home due to “low census.” It’s not low census. We have too many patients. Why is my hospital sending Nurses home right now? It makes no sense…and it’s incredibly dangerous for both our critically ill patients and for those of us scrambling to care for them.

Simply put: it’s impossible to safely care for that many patients. And it’s impossible to rush and do the job of so many people and still be safe about donning and doffing all of our personal protective equipment. It’s just not something you can do quickly. It takes a lot of concentration and there are a lot of steps.

My hospital needs to adequately staff these units. We have the Nurses. But they’re sitting at home.

That’s not where we need Nurses right now.