Express Yourself: Experience on the front lines during COVID

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A Winters Express opinion column

By Philip Rogers
Special to the Express

In response to the “I don’t care about Omicron, and neither should you” column by Richard Casavecchia in the Feb. 15 edition of the Express.

Richard Casavecchia, you may not care about Omicron, but I’m sure the families of the 60,000 American people that died in January from or with Omicron cared about their loved ones. Should we ignore the virus that led or contributed to their deaths? Should we stop encouraging vaccination?

My own experience as a Sacramento pediatric ICU nurse is that since July we’ve been short staffed nearly every single day and have lost many nurses to burnout. We’re only just now — eight months later — getting to a position of stable staffing on our unit after finally being able to hire several travel nurses along with a handful of new staff nurses. We have been far less affected by COVID than adult units, but have experienced our own surge of severely ill RSV patients in addition to a continuous and significant presence of severely ill pediatric COVID patients.

Travel nurses have been in high demand as many hospitals throughout the country have faced chronic short staffing do to burnout, early retirement, and staff leaving poorly paid positions for highly paid travel jobs (supply and demand at work). Much of the turnover is far beyond what’s normal in the inpatient setting and can be directly or indirectly attributed to the pandemic.

Speaking from my own experience, a one nurse to one patient assignment with an unstable COVID positive patient on a ventilator for 12.5 hours overnight is extremely draining, especially when you’re sweating and dehydrated in your PPE and unable to take a drink of water in your PAPR or N95. It is awful being unable to use the bathroom for six or more hours and knowing that maybe you’ll get one 30 minute break to leave the room, use the facilities, eat and rehydrate because there’s no one to relieve you.

This scenario is what the adult ICUs have faced night in and night out during each COVID surge. Oftentimes the previously one-to-one assignments are being made two patient to one nurse or three patient to one nurse assignments across the country. This means when a patient requires a life saving intervention, it can take minutes to don PPE and get in the room when the response should only take seconds with appropriate staffing and a nurse already in the room. These scenarios can and do lead to patient death in an ICU setting.

The overwhelming amount of death in adult ICUs since COVID began contributes to PTSD, burnout and chronic short staffing. When ICUs are short-staffed, it has downstream effects on lower acuity units. Those units are forced to take sicker patients than they’re trained for and at higher patient-to-nurse ratios, which further contributes to poor patient outcomes.

The downstream effect continues to the Emergency Rooms where patients in some cases are held for days at a time waiting for an appropriate bed. This has contributed to poor outcomes for non-COVID patients in need of a hospital bed. Emergency rooms have likely been more overwhelmed and chronically understaffed than any other hospital unit. Frankly, I feel bad for ER nurses, doctors, techs, EMTs and paramedics as they are the true front line in handling sick COVID patients.

Regarding vaccination, there’s no need to squabble about the effectiveness — the data is abundantly clear that the reduction in hospitalization and severe disease is massive in comparison to being unvaccinated with immune naivety. Any argument against that is willfully ignorant of the data. And at this point in the pandemic, basing arguments on infection rates as opposed to disease is willfully ignorant of what vaccines are designed to do and have always done — prevent severe disease.

I never understood the argument of the pandemic hasn’t been overwhelming because “no one is dying in the streets.” Why would people be dying in the streets from a respiratory infection unless they were homeless, without a phone to call 911, and unable to reach a hospital. It’s a bad faith argument meant to evoke imagery of war and horror in order to lessen the perception of severity of what has actually happened behind hospital doors, i.e. 1 million excess deaths since COVID began.

If you do not work in a hospital Richard, then I don’t trust you to tell me what the situation in the hospital has been. But since you’re willing to opine on what it’s been like in the hospital, I’ll trust that you work in one and simply have nothing to do with inpatient care.

I am hopeful that the Omicron wave marks the end of the pandemic and a shift to a manageable COVID paradigm for hospitals and society at large. I hope nurses across the country are aware that they’ve been grossly underpaid and working in unsafe conditions. It’s time for other states to implement safe staffing ratios like California has and for nurses to organize to demand higher wages and better working conditions.

Hopefully we never face another pandemic like COVID in our lifetimes and hopefully it’s over soon.

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