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

by Sherice Smith, RN

When I was a little girl, my mom struggled with her health. I watched as Nurses cared for her. I could tell they were amazing, even as a tiny girl. I knew that healing came from them. I didn’t have words for it back then, but I saw that it was the Nurse, not the doctor, who spent time, bonded, empathized. They were the dynamic caregivers. I knew at age five that I wanted to be a Nurse. Those were the only toys I wanted to play with.

I’ve been a Labor & Delivery Nurse for more than thirty years. It’s one of the most vulnerable times in a woman’s life. I want to be there for them in that moment — especially those moms that don’t have a partner involved. With me, they know they can tell me their story and I’ll listen. If they want to cry, they can. I’m there for them in this momentous, sometimes scary, eventually joyful time.

It’s powerful.

Sadly, though, I’ve watched our Labor & Delivery unit at my hospital be weakened over the years…and it only got worse during the COVID-19 pandemic. My hospital was granted permission to slash staffing levels even further during the pandemic. To make matters worse, RNs in Labor & Delivery were considered the “float pool” during the surge in COVID infections, meaning they would send us to cover shifts in the ICU or other COVID units. Most of my Labor & Delivery colleagues fell ill with COVID-19, which also meant there were even fewer Nurses available to staff our floors.

These staffing waivers allowed the hospital to cut continue their practice of cutting dangerous corners. We are now out of nurse-to-patient ratio almost every night. In addition to that, because our Labor & Delivery unit is on the same floor as our Post-partum, we are frequently asked to work in both of these units simultaneously, further slashing staff.

One recent shift, I was working on the Post-partum side. I had three moms and three infants. One of my moms, though, had dangerously high blood pressure and had to be on a magnesium IV drip. Based on the level of care and monitoring required, I should not have had more than two moms. So I was already out of ratio. But on top of that, I also had a triage patient over in the Labor and Delivery unit who was on a monitor due to her baby’s lack of movement.

Then suddenly we were hit with two back-to-back emergency rescues in Labor & Delivery. The other two RNs in that unit were also over-extended. But each of them had to take one of the rescue patients. I was pulled to help with an emergency C-section, which meant I had to leave my six patients, including the one whose IV drip I needed to monitor.

The other RN was trying to manage three moms all actively in labor. As I was assisting with prep for the C-section, I noticed on a monitor as I walked by that an in-utero baby’s heart had dropped dangerously. That means the baby is in some sort of distress. Maybe the umbilical cord is choking the baby or something about the mom’s position is causing difficulty. It’s lucky I noticed that in the middle of all this chaos, because about four years ago, the hospital also got rid of all our monitor techs. I ran in to get the baby’s heart rate back up. I repositioned the mom to see if that would work. Luckily, it did.

By the time I got that mom and baby stabilized, I ran back out to help with the C-Section. I still had supplies to give them, but they’d already gone to the O.R.

I went back to the Post-partum unit to check on my patient with the IV drip. Luckily, she was okay, but my patient next to her was now bleeding. This required weighing the pad underneath her now soaked in blood to determine how much blood she’d lost. She’d lost well over 1,000 milliliters, indicating stage two hemorrhaging. I had to call the doctor, get orders, start meds, get her on Pitocin to stop the bleeding. On top of that, I had to do blood draws to run labs because the hospital had also cut the phlebotomists’ schedules. Eventually, I was able to get the hemorrhage under control.

It was crazy that shift until 5 a.m.

Our hospital administrators call these shifts with emergencies “unexpected.” I prefer to call unpredictable. A fire station doesn’t consider fires unexpected. They know that disasters can come at any moment, and they’re prepared for that. We are not prepared. And we’re simply not able to check on our patients as much as we should. Even something as simple as a full bladder can turn into a hemorrhage.

Our patients notice. They wonder why it takes so long to answer their call lights. They wonder why we don’t have the help we need — why it’s just Nurses on our own without support staff.

This is not the Labor & Delivery department that I want for our patients.