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

by Laura Malatesta, RN

I’m sick at home with Covid-19.

I’ve worked at West Hills Hospital in L.A.’s San Fernando Valley for 15 years. For 12 of those years, I worked in the ER. It was exciting, and our team of doctors and nurses worked great together. Then, in 2016, a patient kicked me in the head, resulting in a partially detached retina and a loss of vision in my right eye. Trauma isn’t just something that brings people to the ER, it happens inside the hospital, too. In fact, workplace violence is alarmingly high in healthcare settings.

After that injury, I transferred to our telemetry unit, where we care for patients on heart monitors. I thought I would be a bit safer there. Two months ago, my unit was turned into our hospital’s Covid-19 unit.

As news reports describe, most of our patients are very elderly. Many have dementia, and even if they don’t, they experience confusion while they are acutely ill. Many pull out their IV’s or their oxygen, try to climb out of bed, become agitated. On my unit, they are all observed on camera, watched at the nurse’s station by a camera tech. The techs try to warn nurses if a patient needs intervention, but since all of the patients are Covid-19 positive, it takes time to don the PPE. So, even if we’re nearby and available, we rarely can get to the patient before they’ve done some harm to themselves — falling, pulling out IV lines, or pulling off oxygen (which nearly all of the Covid-19 patients need). Also, each nurse is assigned four or even five Covid patients each, so we’re often not nearby.

Our management, in order to limit contact with these highly contagious patients and to save PPE, has instructed us to try to limit each patient to five points of contact per 12-hour shift. This includes all hospital personnel — lab techs, respiratory therapists, physicians, and physical therapists. So, let’s say you’re sick with Covid-19 on my floor and someone needs to take your blood and later a respiratory therapist sees you. If the doctor also enters your room instead of speaking with you via the camera, that leaves only two times for me to go into that room to care for you to stay within the recommended five contacts per 12-hour shift.

Of course, that’s impossible with confused, usually incontinent (and many have diarrhea with Covid-19) patients, most of whom also need to be fed and encouraged to drink. Most have fevers, which dehydrate them, leading to further confusion. When I brought this up with our manager, she indicated we could fudge a little and go into the room a little more often, but it seemed we were often short of the isolation gowns we needed in order to do this. The amount of PPE provided is based on the projected five visits per patient per shift. It also means that our usual practice of bringing a Nurse Assistant with us when dealing with a known confused, possibly combative patient would use up one of those rare contacts, and so many times we would go in alone to clean, turn, feed, and otherwise care for our patients.

So, it’s no wonder that my upset elderly patient was able to reach under both my masks — my N-95 and my surgical mask — and was able to grab my face, probably resulting in the hefty case of Covid-19 that left me in bed for over two weeks. I’ve spoken to several other nurses that also had their PPE compromised by confused, combative patients on our unit.

I heard of a great idea that nurses at a nearby hospital have implemented to protect agitated patients. They are putting puffy mittens on these patients, which keep them from grabbing things, or hurting themselves or others. I told a decision maker about this idea, but so far nothing has come of it.

Nurses are resourceful. We solve problems every day. At the beginning of the Covid-19 outbreak, we had very limited access to the necessary masks, respirators, and gowns we need to keep from contracting and spreading the disease — all the gear that we refer to as PPE. So, some of my colleagues used their social media accounts to ask our community for donations. Others of us brought our own N-95 masks to wear. Hospital administrators at that time told us not to wear the gear — indeed, threatened us with termination if we did. They said it was frightening the patients.

We were shocked at the push-back from management. Several nurses quit over not being able to adequately protect themselves when dealing with Covid patients. This went against everything we knew as nurses about infectious disease control. Then our chief of staff and some doctors in the ER launched a GoFundMe to raise money to purchase PPE that they brought to the hospital staff. Finally, at the end of March, hospital management relented and allowed us to wear our own PPE without comment.

The hospital now provides us with N-95s. But we only get one per shift, so it’s dangerous to take it off in order to eat or drink, as there could be virus on it. To take it off and then put it back on could cause you to infect yourself, no matter how careful you are. Again, this goes against everything we’ve ever been taught or ever practiced. PPE is designed for single use per visit per patient. It is considered contaminated after that one use. It definitely isn’t designed to be worn in hallways or with multiple patients.

We need adequate amounts of PPE. We need to be heard when we have ideas like protective mittens. We need enough staff on hand to properly and safely care for our patients.

Nurses and our patients deserve that.