Part of a series: COVID-19 — Nurses’ Notes from the Front Line
by Gema B.
My family knew that a vocation requiring patience and compassion suited me. That’s why, at their urging, I became a Nurse 32 years ago. It was the right choice.
Nursing is healing.
But over my long nursing career, I’ve watched hospitals transform into nothing much more than businesses. Big corporations — both for profit and nonprofit — have taken over our hospitals.
In all my years of nursing, I’ve never experienced so much death as I have during the pandemic. I’ve lost count of all the times I’ve broken down and cried in a patient’s room. It’s too much. But what makes it so hard isn’t just the death. It’s feeling like too many of the deaths were preventable. I am heartbroken, frustrated and angry at the enormous loss of life.
My hospital was allowed to disregard California’s nurse-to-patient ratio regulations. They applied for a waiver that allowed them to give us more patients in my ICU than we could possibly safely care for. This flexibility was intended to assist hospitals during a surge in COVID-19 patients. But the only thing those safe staffing waivers did was give my hospital a blank check to continue cutting corners on safety, which started long before the pandemic.
Every day at the beginning of my shift, I pass the hospital chapel and ask God to help me. I can’t stop thinking that if they had prepared for the surge (which we all knew was coming), they could have safely staffed our units and equipped us to save more lives. But instead of doing everything in their power to prepare, they continued to cut corners.
The questions won’t stop running through my head.
What if we had the necessary IV tubing and meds instead of hearing “we’re out of stock” when we need them? What if we had enough PAPRs so that there were fewer delays and more hands to help with an intubation? What if we had the Nurses’ Aides we’ve asked them to bring back after they were cut from the schedule several years ago? What if we had lift teams to help us turn heavy patients?
What if they had done so much more to ensure we had enough Nurses on the floor — to make sure we weren’t forced to ration our care? Why wasn’t more done to bring in permanent experienced Nurses? We’ve lacked new hires for some time. Travelers often accept jobs at other nearby hospitals with better pay and working conditions.
Here’s what it looks like when we’re understaffed:
Back in December when it started getting really bad, we had a COVID-19 patient transferred into the ICU from the Telemetry floor. He was alert but he was basically drowning. Very short of breath. Then there was too long a delay before he was intubated. This was a Sunday and I’d helped a co-worker care for him. He held on. He was my patient the following Wednesday. I had three ICU patients that day, including him. For critically ill ICU patients, we’re only supposed to have one patient. California says no ICU Nurse should care for more than two patients at a time. But because of the “flexibility waivers,” I had three patients. He began to bleed from head to toe. His whole bed was full of blood. I did my best. But I keep thinking that there was more we could have done.
I often have three patients now. Like I said, we often lack supplies and support staff. We still have to drop everything to make rounds. There’s no time to call the doctor and say “hey can we try this?” — before you can even call the doctor, you have other patients to prone, give meds, check IVs, pressors, start new doctor’s orders, check lab results, admit someone new, respond to family members who want to speak with their loved one. Even with just two patients at these acuities, it’s overwhelming.
Just the other day I again had three patients. All three had chest tubes. All three had multiple sedations. All three were critically ill. This is impossible to manage. And it breaks my soul. One of them became agitated. It took me nearly an hour to calm the patient down and let the meds kick in. Then when I could attend my second patient, their oxygen had desaturated to only 82% and they were bleeding from the chest tube. Again, I believe this bleed was caused by a previous shift not being able to check the water seal due to the unmanageable workload. And this whole time, my third patient was also desaturating and breathing hard. When we are understaffed like this, there’s always a delay for pretty much every treatment.
All three of those patients should have been one-to-one ratio. They each should have had their own dedicated Nurse.
As a Nurse, I want to treat every patient like they have a chance to survive.
It feels like the hospital is admitting patients and expecting them to simply die. I go home and feel so bad. I am overwhelmed by regrets that we should have been equipped to do more. I have a friend who knows a Nurse who killed herself in January. It’s too much. I was interviewed by a reporter last year. She called us angels. I replied that we’re angels of death right now. I have a co-worker who’s worked every shift in the COVID unit since the pandemic started. She volunteered. She cries all the time. She wraps up bodies that she’s cared for, sometimes for a week or more. You connect with patients. You connect with their families.
Our hospitals must stop this dangerous practice of ignoring nurse-to-patient ratios and let us do our Nurse’s best for our patients.
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RNs like Gema support California Assembly Bill1422 — the proposed “Patients’ Right to Know” law, which would expose hospitals’ dangerous practice of sidestepping nurse-to-patient ratio regulations.