How front line nurses are doing as pandemic surges

Natasha Deeter, a registered nurse who cares for COVID-19 patients at Upper Valley Medical Center in Miami County, said that she and a coworker admitted the first patient to the COVID unit at the hospital in March.

“I thought, give this a month tops and it is going to be over with and that, of course, has not been what happened,” Deeter said.

Nurses caring for COVID-19 patients in hospitals and nursing homes and more are nine months into the pandemic hitting Ohio and are now on the front lines of the biggest surge of infections yet.

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The impact of the rising spread is playing out in hospitals across Ohio. A flood of sick people are stretching nursing staff thin and staff themselves are getting sick. COVID-19 vaccines are now being distributed to hospital staff who are directly caring for patients with the virus but it will take time for the distribution to happen for all health workers. It is expected to be longer still for the vaccines to help reduce the inflow of patients.

Nurses say the experience has been emotionally taxing; nurses are often also the patient’s support person, because visitors are typically not allowed, Deeter said.

“You’re trying to do everything you can to encourage them and help them through a scary time and they’ll tell you that this is the sickest that they’ve ever felt in their life. When they look at you are are like ‘Am I going to be OK?’ it’s emotionally very draining,” Deeter said.

When she gets home to her family, she said it is hard to engage because she’s leaving work exhausted.

“I feel like a lot of nurses are struggling with that right now. You’re just emotionally exhausted by the time you get home,” she said.

Heather Tubbs Cooley, PhD., RN, and associate professor at Ohio State University, who has researched nurse workload and quality, said the relationship between nurse staffing levels and patient outcomes in hospitals has been documented for decades.

“Nurse workload is a combination of several factors including the number of patients a nurse cares for (staffing ratio), the sickness of the patient (acuity), time pressure and work intensity during a shift. All of these are elevated right now in ICUs nationwide. This is unprecedented – there is no slack in the system,” she said.

For example, ICUs are designed for nurses to have one or two patients, depending on how much care the patient needs. When a nurse has more patients than that, it’s difficult for them to be able to give focused care to each of those patients. COVID-19 patients can also be more unstable and their conditions can worsen quickly.

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“We’re asking them really to work in impossible situations. And that’s very demoralizing for people to leave at the end of the day feeling like they didn’t do all that they wanted to be able to do for patients,” she said.

Then on top of that some nurses are getting sick or quarantining themselves.

Tubbs Cooley said hospitals could support nurses during the surge by finding safe ways to let families visit patients, which can comfort patients and take some of the emotional labor off of nurses.

Hospitals could also spend time cross training nurses to have the skill sets to fill in different places, she said.

“This is not a fast fix and ideally hospitals were doing over the last several months. Nurses are educated as generalists in nursing school; a hospital then further prepares them in a particular specialty. Training ICU nurses takes months, not weeks or days,” Tubbs Cooley said.

She said hospitals could also bring more support staff so that ICU nurses can focus on core work like complex medication administration and continuous surveillance.

The biggest thing the public can do is to take steps to limit spread, she said. High workloads from the COVID-19 surge impacts people needing care because of the coronavirus but it also impacts people who need care because of other reasons, from car wrecks to heart attacks.

“If someone has let’s say a stroke and they need to go to the ICU, they may not be getting the intensity of nursing care that they would otherwise get just because the workload for nurses is so high,” she said. “We need the public to do their part so that every patient can get good care.”

Nurses are being heavily recruited locally and nationally. The Associated Press reported finding salaries as high as $6,200 per week on postings for travel nursing jobs. The AP reported nurses who work in intensive care and on medical-surgical floors are the most in demand. Employers also are willing to pay extra for nurses who can show up on short notice and work 48 or 60 hours per week instead of the standard 36.

The Ohio Hospital Association reported in November that about 20% of hospitals were reporting staffing shortages.

“We certainly are seeing some unique challenges. But by the same token, we are actively recruiting and hiring for nurses, and still have a lot of individuals interested in working for Premier,” said Billie Lucente-Baker, VP for human resources with Premier Health.

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Some nurses also have had to stay home with kids because of remote learning or child care disruptions.

Lucente-Baker said they’ve taken steps to help with workload and retention. They created respite space where nurses can take a break without wearing personal protective equipment; they’ve provided meals for staff while they are working and have programs for emotional and spiritual support such as virtual group sessions.

Officials with both Premier and Kettering Health said they’ve started “Helping Hands” programs to move staff into other support roles they don’t typically work in, from delivering trays to patient transport, to help with work load. Deeter said the program helped with some tasks nurses didn’t have time to do, like resupply their isolation carts or helping with phone answering.

“Our staffing is pretty tight, I’m not going to sugarcoat it, but I do appreciate the fact that Premier had thought outside the box on ways they could help us,” she said.

Long-term care

Staffing strain is also showing in nursing homes and assisted living facilities, which have been hard hit by COVID-19. The pandemic exacerbated pre-existing problems in the long-term care industry of high turnover, low wages and underfunding. Mid-November, about 29% of Ohio nursing homes reported they were short staffed on nurses or aides the four weeks prior.

Chip Wilkins, long-term care ombudsman, who advocates for residents’ rights in these facilities, said about 5 to 10% of the calls his team receives come anonymously from staff with concerns. While his team has to first vet complaints they receive, often it’s that the nurses and aides get protective of their residents and want to alert someone if they are short staffed.

“With COVID where we’ve learned certain residents weren’t being fed and where they’ve had one meal a day because they don’t have the staff to assist a resident who needs help eating every meal,” Wilkins said, recalling one anonymous call from an aide.

The local ombudsman’s office also received a complaint from an aide about a COVID-19 positive worker without symptoms who was still working in a COVID unit. However, Wilkins looked into the issue and learned that current state guidelines allow for this if a facility has gone through all of their staffing contingencies and can’t find anyone and if the staff member is restricted to areas with residents who already have COVID.

When asked about COVID-19 positive asymptomatic workers, Ohio Department of Health said in a statement that they “have aligned with the CDC throughout our pandemic response” with a link to CDC guidelines for health care professionals. The website includes guidelines listed for “crisis capacity strategies” allowing this as a last resort to mitigate staffing shortages.

“It blew me away when I heard it too. I tried to fight it as much as I could and learned that having them there, so long as they are only in the positive unit, is better than not having any aides, if that is the only person willing to work at that time,” Wilkins said.

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