At this point, things are so disheartening for so many people. The range of nurses’ stories is so wide and varied, from OR nurses being essentially laid off due to no elective surgeries happening, to nurses being offered a lot of money to come to New York City to work.
New York State has taken the unprecedented step of merging all of its 200 hospitals into one system (New York State hospital system consolidation ).
There’s a lot of death. One nurse told a story of how she had 10 patients in one shift and 7 of them died. In some hospitals, there is a different kind of rapid response team called, specifically for CVOID19 patients, and they are being called sometimes just minutes apart on different units throughout the hospital.
Also, nurses are working with their colleagues who end up being patients in their same units; one nurse told of their nursing supervisor being hospitalized in their own ICU, and they conjectured the supervisor most likely would pass away there.
There’s a lot of understaffing and over-working, including on the medical-surgical units. Part of this is because nurses themselves are becoming ill and unable to come to work.
Some nurses are actually more frightened to work in the medical-surgical units because they have a lack of PPE, and all patients are presumed to be COVID19 negative. Of course, when tests come back days later, the nurses discover that they worked with these COVID19 positive patients without proper PPE. There are also many issues around HIPPA and staff not being able to find out the COVID19 status of the patients they worked with previously.
Another nurse relayed this story: he works twelve-hour shifts on a medical-surgical floor, and their usual patient load now runs from 12-15 patients, the only real charting they really do is vital signs and meds. This is possible because NYC has suspended a lot of normal operations when it comes to providing care as per the governor’s laws:
“A massive section of regulations on the “minimum standards” governing hospitals — dealing with everything from patients’ rights to the maintaining of records — has been suspended ‘to the extent necessary to maintain the public health with respect to treatment or containment of individuals with or suspected to have COVID-19’.” (read about all of the laws suspended) .
This nurse cries after every shift, and he stated his tears are so different from before, in part due to his utter exhaustion. His family and friends want him to quit, they are worried about his health, but he stated he can’t quit now, they need him too much.
Nurses are asking about ramifications of quitting their jobs; some claim that they have been threatened that they will be reported to their board of nursing for disciplinary action (this is not the reportable offense of walking out and abandoning patients, rather for resigning their position). While these threats are likely idle, some nurses are still fearful of losing their licenses.
One nurse states that she works in a COVID19 only ICU unit. She says it’s mostly completely staffed by RNs: they have no NPs, PAs, Residents, Techs, or Housekeepers. Nurses and ICU Attending and Intensivists care for the patients. Med Surg nurses act as techs and assist the ICU nurses.
Recruiting: There is still a lot of recruiting going to bring nurses to NYC. One new graduate nurse (recently licensed, with no work experience) posted on social media about being offered to be “trained” to work in the ICU in NYC. All of her travel and lodging would be covered. She would be required to work 21 days, 12-hour shifts, with no days off. The majority of the experienced nurses tried to set her straight about why this was a really bad idea, but we have no idea if she proceeded or not.
It’s not just NYC: We now have a 54-year-old nurse in Michigan who died, Lisa Ewald.
Unfortunately, nurse Ewald may have had some issues with initially being tested by her workplace, Herny Ford Health System in Detroit, Michigan. She was likely exposed on March 24, received her positive test on March 30, and passed away on April 3. She died alone in her home. (Lisa Ewald’s story).
Rest in Peace Nurse Ewald.
Meanwhile, more than 700 Henry Ford employees have tested positive for COVID19; 500 of the positive tests are nurses. (Henry Ford COVID19)
The field of nursing will be forever changed by this.
NurseManifest 
Yes Carey, the situation is going down hill fast.
Some sobering insights. People are trying to spin the idea that the cases are plateauing, and continuing to talk about peak cases in the next 2- 4 weeks. I don’t see that and I will try to explain why. Early on, the global rise in cases was driven by China. That was only natural. The pandemic started there, and spread rapidly through the population. When you plotted the growth in the number of cases in China it followed a clear exponential growth rate characteristic of epidemics.
When China implemented Draconian quarantines they suppressed the spread in china. In the ensuing days, when people plotted the number of cases it looked as though the global rise in cases was plateauing, but that wasn’t the case at all. The high number of cases in China, heavily influenced the graphs of global cases. When you look at plots of global cases now, you see clear exponential growth even with China in the mix because the US now has almost five times as many cases as China.
At the moment, based on the latest data of the last few days, the proportion of new global cases coming out of the US is between 33 – 40%. Now that isn’t as bad as it may seem. There are likely far more cases out there than are being diagnosed and reported and we have hundreds of areas throughout the country with cases. Everyone of them is a potential mini-epidemic about to unfold.
My bellweather for this is the Dominican Republic and Haiti. The Dominican Republic and Haiti have about the same population size. That is about the only similarity. Haiti is the poorest country in the Western Hemisphere so it would be reasonable to conclude that Haiti would have more cases of Covid-19 than the Dominican Republic because of widespread poverty, mal-nutrition, inadequate health care infrastructure, overcrowded slums, inadequate sewage treatment, and poor quality drinking water. So, how many more cases are there in Haiti than the Dominican Republic? Haiti is reporting 25 cases and the Dominican Republic reports 1,956 cases.
So why does Haiti have so few cases? Poor case identification. They just aren’t testing enough people.
Which brings me to the US. Much as was true with China and the global growth in cases, NYS has tried to tighten up, and NYC all the more so. The growth in cases in the US is hopefully not going to be driven as much by NYS going forward, though I am not counting on that. The bedroom communities are experiencing really fast growth in cases. Worse still, I predicted yesterday that there were probably a lot of people in NYC who were now dying at home. It seems like that is happening as there is a large increase in numbers of people dying at home in NYC now, and those are people with other people checking on them.
But the large number of cases in NYC and NYS still influences the shape of the growth curves in the US. Rather than plateauing, I think we are just about to start seeing the growth in cases in places outside the NY metroplex. In my own case, here in FL, what I believe I am seeing is the same effect as Haiti and the Dominican Republic. The growth in cases in FL hasn’t followed the growth in other areas and I believe that it is because they just aren’t doing enough testing in FL. FL is still allowing church services. Grocery store clerks at Walmart are still not being given any protective gear, though at least they don’t have cashiers, they are only using self checkout devices – though since a lot of people aren’t using them, the workers are still, no doubt, fielding help requests face to face.
Florida is also a red state, and didn’t cancel Bike Week, and didn’t cancel Spring Break, and the stay at home order is ambiguous at best. I am a ham radio operator and involved in emergency communications. Ham radio operators have always been a very conservative group, but I was still stunned when trying to explain that it is not safe to run around Florida, go shopping, or attend church services and was accused of being a conspiracy theorist, a damn liberal, a liar, and was even threatened by someone who offered to send a couple of guys over to bomb me.
That is likely what a large portion of Florida is like, so I don’t expect things go well in Florida in the weeks ahead, and they are saying they expect the peak in FL to occur around June 1. I will be happily shocked if that happens, but I am not counting on it, and I think the peak is going to be at least 5-10 times higher in FL than they are forecasting.
So, where does this all leave us? As I said early on, we were seeing a ripple a couple of weeks ago and a lot of people went all out trying to deal with it. A lot of people rose to the occasion, and they are working without adequate protective gear, and I am really not seeing the sense of urgency at the federal level that I believe ought to exist given the magnitude of the problem I believe exists. We need hundreds of millions of PPEs and idiot potus is happily providing millions.
I said earlier that I expected several levels of tsunamis to unfold. New York is experiencing that first tsunami. They will likely have a second or third as well. The city has a population of 8 million people and they are doing about as well as can be expected at self-quarantining – but I don’t think it is sustainable for a long enough period of time to eradicate Covid-19. Not sure if I were a governor in another state, that I would be sending ventilators to NY right now, at least not with any reasonable expectation of getting them back any time soon.
A lot of nurses are going to die, many others are going to suffer permanent lung damage and other adverse effects of exposure. PTSD is going to be astronomical among nurses. Something I am curious about is how many nursing faculty have become ill, but I haven’t seen anything on that.
Yes, they are paying people a lot to work in NY at this point, and I have actually thought about going for two non-pay related reasons: First, I grew up very near Elmhurst. So it is basically my home town. Second, as I tried to explain to my college girlfriend the other day, it is what nursing is really about for me – sitting in a nursing station, writing documentation on all too routine shifts, has never been my vision of nursing.
I fully expect a crisis here, though I have heard of hospitals laying off nurses, or cutting hours back. What I have told those people is to rest up because I believe it is the calm before the storm. When it comes, I will definitely be making my own hazmat suit out of plastic trash bags. I wouldn’t walk into any health facility at the moment without one. My girlfriend’s daughter is a nurse and she has been going on dates, recently attended a funeral for her ex-husband’s family member with a large group of friends and relatives. Fortunately I was able to convince my girlfriend to stop going over to her daughter’s house a month ago just on the basis that she was working in a hospital That was weeks before the funeral and the dating and every time her daughter goes to work she threatens the well being of her patients and colleagues. But that is what we are up against within our own ranks.
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Just a quick update. As a not very well closeted logical positivist, I love correct predictions, even when I don’t like the prediction’s implications and consequences.
In my prior post, I suggested that Florida was going to be a disaster going forward. We have arrived. We still have a pandemic-denying, trump-affiliated republican governor, so things are likely to get a lot worse going forward. Disney World is opening up to the general public this weekend. Why anyone would go to an amusement park in a hot zone baffles the hell out of me. Even worse are the nurses I know who deny that there is any reason to be concerned, who are literally out partying and socializing with friends and family because they don’t believe there is a problem.
I am sad to see that we are once again facing PPE shortages but heartened that we now have nearly unanamous agreement that masks, any masks at all, are better than no masks at all. As I have said in the past, N95 masks are preferable – actually respirators are preferable to N95 tasks, but any physical barrier is better than no physical barrier.
I am devastated by the loss of more than 1,000 first responders/health care workers, but even more disheartened that it is only a down payment, not the final tally of the lives we will have sacrificed in service to humankind before we emerge on the other side.
Elsewhere I referred to a series of tsunamis we would experience. I want to be clear on that point. I am not taking a bow. This isn’t a second tsunami. This is still the first tsunami. With millions of active cases around the globe, and many in impoverished countries with poor nutrition, sanitation, and water, there will be millions more, and the opportunities for deadlier mutations, as well as less deadly mutations, are also growing exponentially. The second tsunami will be a mutation, not a spike in cases or different geographical areas around the country. We never had any control over this at all in the US and the likelihood of getting it under control is steadily declining.
Living in the home of a nationally renowned college football team, I often try to explain what is happening in football terms; Here is my explanation: We are early in the first quarter, we are down 40-0. Our A team is out with career-ending injuries and our B team members are getting their butts whipped. But it is still early in the first quarter. We have 3 1/2 more quarters left to play and we don’t have the option of waving a white flag of surrender the way potus has.
I once again want to emphasize the importance of thinking out of the box, especially when it comes to PPEs. We learned little about how to deal with PPE shortages in the last 4 months. Certainly not at the federal level. With far more, and more dispersed hot spots around the country, the looming PPE shortages are highly likely to be worse than what we saw in March and April. It is easy to send massive supplies to NYC to treat thousands of patients. It is far harder to send massive supplies to scores of different hotspots and many communities are already seeing their health care systems poised on a cliff. We can send Mercy ships to NYC and FL, but we can’t send mercy ships to Arizona.
On a personal note, my mom had emergency surgery about 5 weeks ago. The last place in the world I wanted her was in a Florida hospital. She survived that. Just got a call yesterday that one of the home health nurses who visited us has tested positive for COVID-19. No big shock there. I discharged the agency. That specific nurse’s infection prevention lapses played a large part in my decision. But, that said, home health agencies are the unwanted step-children of our health care system. Home health nurses ought to be wearing hazmat gear, not surgical masks, and gloves because they are entering environments that could be deadlier than an isolation room at a hospital. Instead, they have virtually no protection at all. Home health agencies failed to take advantage of the relative lull over the last couple of months to stockpile PPEs and other equipment. Home health nurses and their patients will be paying the toll for those failings.
We have had sporadic shortages of consumer goods, meats, toilet paper… That is probably going to seem like the good old days unless some real miracles occur. I tried to buy rubbing alcohol over the last two weeks and none of the local stores had any, not just the 91% I wanted. Finally order 99% online.
Even a hyper-vigilant, intensely COVID-19 risk-averse person like me can have a COVID-19 positive person walk into his living environment in a heartbeat. Fortunately, I had fresh air coming in while that nurse was here and thoroughly aired the place out after her last visit. Still, it is a sobering reminder of just how vulnerable we all are.
As Sergeant Phil Esterhaus would say on Hill Street Blues: “Let’s be careful out there”. Let’s be smarter, more careful, more resilient…
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