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

by Karen Ballentyne, RN

Since the pandemic hit my hospital, I can’t shake the feeling that rather than approaching it with good, collaborative crisis planning, management is simply “trying things out” over and over again. I feel like we’re guinea pigs — both Nurses and our patients.

Decisions are made without us, the frontline Nurses. Plans and policies seem to change almost daily, with many of our patient care strategies getting worse instead of better.

I have so many questions…

Why is the hospital aggressively rationing PPE?

Our administrators claim to have “plenty” of protective gowns, yet they ask us to wipe down single-use paper cloth gowns and wear them for multiple patient visits. We’re asked to use each gown five times. I’ve never seen anything like it. Those gowns are contaminated after a single use.

The latest thing is that if you’re close to your next patient room, simply wipe down your gown, get new gloves and go ahead and walk through the hall and into the next room without gowning off and waiting for the dwell time of two to three minutes, then re-donning.

And of course, everyone has heard about the dangerous re-use of N95 respirator masks. The U.S. Center for Disease Control recommends such re-use only in cases where there’s no alternative. But my hospital is having us re-use the masks anyway. We wear them for multiple patient contacts. We put our name on our mask at end of shift and place it in a bag.

Wearing only one N95 mask per shift is especially hard on me because I’m asthmatic. It’s suffocating and makes me very short of breath. If you’ve ever had asthma, you understand the panic I sometimes feel. These are designed to be worn for just one visit into an isolation room. You’re supposed to carefully doff all of this equipment and safely discard all of it after leaving the room.

When the pandemic first started in my hospital, management told us we didn’t even need to wear masks.

Why did they turn my unit into the COVID-19 unit when we don’t have the necessary equipment?

As news reports have informed us, many of those becoming most ill from COVID-19 are people with diabetes. But my floor is unable to provide these patients with insulin drips. We don’t have the proper equipment and it requires more staffing and more training. So instead of the more precise drip treatment, doctors are forced to simply guess how much insulin a patient might need. Or if a patient suffers a heart attack, the COVID-19 unit doesn’t have sufficient staffing levels, training or equipment to put them on a nitro drip. These issues would have been resolved had a different floor been turned into the COVID-19 unit. But that unit has a lower nurse-to-patient ratio.

That would have cost the hospital more money.

Why do they keep increasing the nurse-to-patient ratios, leaving us without enough time to properly care for our patients?

Hospital management recently increased our ratio to four patients per nurse. Many of our patients are coming to us from nursing homes. They require total care. Most are incontinent. Many require frequent blood sugar tests. Most are on multiple medications needed at multiple times in a day. Most need to be spoon fed. There’s a new way of removing catheters that requires more visits to the patient’s room.

This would be a stretch even without the constant donning and doffing of protective gear.

Here’s an example of how dangerous it is for us to be spread so thin. We recently had a patient with dementia wo kept removing his catheter and trying to get up to walk to a bathroom. In doing so, he also ripped off his IV and his monitor sensors. And I can’t tell him to lie back down in a soiled bed. It takes too long for us to don our PPE fast enough to prevent a fall. We don’t have nurse assistants right now, so all the clean-up falls on us. It’s the most dangerous if they pull off their oxygen. Patients are in real distress if that happens. And then we have to get the patient re-hooked up on everything — catheter, monitors, IV.

This particular patient hasn’t fallen yet, but we did have another patient fall not long ago. Poor thing fell right on her face.

Luckily, all our patients are on camera, so that helps a little. But that function is also understaffed. We have just one person watching 30 patient rooms. If a bed alarm goes off and you need to zoom in to see what’s happening, suddenly you can’t see any of the other rooms. And often there are multiple bed alarms going off at once.

The other issue with our insufficient staffing levels shows up if we get an additional patient or two during our shift. Instead of calling in an additional Nurse, unit supervisors give the new patients to our Charge Nurse. That means our Charge is no longer available at all times to assist with “rapid response” situations or other issues.

I know that management could call in an additional Nurse when we need one. I know because the Nurses on my floor created our own private Facebook group and that’s where I see requests to come in — not through a call from management.

Again, the hospital saves money by not calling in needed Nurses when we get additional patients.

Why didn’t our hospital implement an aggressive staff testing program?

I have several colleagues who have fallen ill with COVID-19 and suffered lengthy illness. Many of those Doctors and Nurses worked alongside the rest of us and their patients for days, potentially exposing most of us. If our hospital had tested us, listened when these staff members had symptoms, then this exposure could have remained much more limited.

Why does our hospital still behave as if there are “clean” areas?

Look, we know this disease is airborne. We know that some people are asymptomatic. A lot of people never get fevers. Many of our patients are never tested. A lot of COVID-19 test results are false negatives. In other words, there are no clean units.

A sister hospital owned by the same company that owns my hospital just held a vigil for one of their janitors who died of COVID1–19. One of my fellow Union members at a hospital in Hollywood died of COVID-19. She worked on a supposedly clean floor.

At one point before we were officially the COVID unit, we had a patient who we knew had the disease, but for some reason the hospital wouldn’t test him. His door was wide open, exposing patients and staff. He received aerosol treatments, would get out of bed, would cough on us. We wore our N95s anyway, despite what management said. My colleague finally insisted he get tested and of course he tested positive. He was struggling. She put on her PAPR gear and went into the room. I put on my N95 to join her to do a “rapid response.” We couldn’t watch him die. He lived! He was in his 90s, god love him, and he made it.

But that’s just too much prolonged unnecessary exposure — all that time when he was undiagnosed. And too many of us are getting sick. We’ve already had a couple Nurses quit since all of this started — both of them because they felt they and their families’ lives were being unnecessarily risked.

I agree with them.

I’ve stayed to fight this. I could afford to quit, but I haven’t. But while I continue treating those in my community with COVID-19, I call on my hospital to start taking extra precautions to protect us instead of risking our lives. Start listening to us and treat us like partners instead of treating us like guinea pigs.