Like most of you, I didn’t see a global pandemic coming and changing around my plans. My goals for 2020 are now at a halt. I started this travel blog and decided to take more trips this year and seeing where this takes me. COVID-19 said “world stop” and we’re still waiting for the part of the song that says “carry on”. Although I can’t carry on with my travel plans right now, I can report to you all my experiences working in New Wuhan (AKA NYC) as a travel nurse. Not only is life as we know it completely different now, but going to work has become down right scary. The rest of what I am going to tell you all is not for the faint of heart. This is all from my personal experiences and what I have seen so far during this crisis. If you want more information about COVID-19, please visit WHO.int or www.cdc.gov.
“When I went back into work, the entire ICU was occupied by patients who tested positive for COVID-19.”
Watching this virus spread so rapidly was shocking to me. I’ve only been a nurse for 4 years, and a PCA 4 years before passing my NCLEX. Thats a total of 8 years working in the medical field. I have been exposed to patients with different strains of flu, MRSA, VRE, C-DIFF, and countless other infectious diseases. One day, I came into work and we had only 1 patient who was positive for COVID-19. I just thought, ” what’s the big deal? How is this any different from the flu?”. I had 2 days off of work and carried on as if everything was normal, but still kept to social distancing guidelines. I continued with planning for my vacation. When I went back into work, the entire ICU was occupied by patients who tested positive for COVID-19. Working in ICU has only exposed me to the worse possible cases of the virus. It seems like once they require a ventilator, there is no chance that they will come off of it. I’ve watched doctors trial the medication used for treatment and prevention of malaria called hydroxychloroquine and chloroquine. They have also tried keeping patients in the prone position (laying on their stomach) to try to prevent them from needing a ventilator or prevent escalation of respiratory failure and hypoxia. Still with a lot of effort, a lot of these patients don’t make it out of the ICU. I have seen patients pass from complications of the flu within months. Complications from COVID-19 has given these people weeks or even only days to live. For the past month, I have watched this virus grow rapidly and kill rapidly. People with weak immune systems or pre-existing illness have little chance against this virus. This doesn’t mean that the young and healthy are completely invincible against this though! I’ve seen as young as 30 years old in the ICU from this. Everyone is at risk of catching it and many will survive it. But for the sake of those with little chance at fighting against it, we all need to be careful! The amount of dead bodies has been so overwhelming that they are bringing in refrigerated trucks and building refrigerated tents outside of the hospitals as make shift morgues.
“I fear that there could possibly be long-term consequences from this practice.”
Due to shortage of n95 masks, face shields, and other PPE (personal protective equipment), we have been advised to keep the same mask and shield for the entire shift and wash it in between. For the entire 12-14hr shift, I am inhaling cleaning products. After a stretch of working only 2 nights in a row I’ve had my nose and throat burning from irritation from the chemicals. The container states that there are no harsh chemicals in the solution, but my body’s response makes me believe otherwise. I fear that there could possibly be long-term consequences from this practice. Usual CDC and JCAHO guidelines require us to dispose of all PPE before exiting an isolation room. Discarding used PPE helps prevent further spread of the infectious organism to other patients or to the healthcare provider. They have become lenient with these guidelines due to desperation. The justification has been that since all the patients are positive, there is no risk of spreading the virus to other patients. That leaves us, the healthcare workers vulnerable. We are at increased risk of contracting COVID-19 because we are not properly disposing PPE. If we don’t have severe symptoms, they are refusing to test us for COVID-19. This means that some of us are potential carriers without even being aware of it. This has heightened fear amongst nurses and doctors. Especially those who are battling illness themselves or have loved ones at home they need to protect. We have become severely short staffed due to nurses getting sick or just straight up refusing to come back to work while this is going on. Last week, I almost became one of those nurses that quit!
On a Friday night, I found myself in the most uncomfortable position I had ever been in as a nurse. Things at the hospital are changing rapidly, but they have been failing to communicate with staff. I was floated to a unit that is typically for patients in step-down level of care. They closed this unit down and turned all the rooms into negative pressure rooms and reopened it as an ICU overflow floor. The nurses who are working on this unit don’t have the training to take care of this patient population. When I was floated there, I worked with another nurse who was floated from a medical unit. He was also uncomfortable, because he doesn’t have experience working with these patients. I was put in charge without having any previous charge nurse training. I had picked up on issues that were overlooked by the day shift staff due to their unfamiliarity of insulin drips and high-flow oxygen devices. Luckily no harm came from it, but the potential for harm was there. The way they’re moving nurses around without proper guidance or information raised concern for me. I thought of the worse case scenario if something happened on my watch because I was placed to look after untrained nurses and a floor full of high-acuity patients. I became fearful for the patients safety, my safety, and the security of my hard-earned nursing license. If my patient on the insulin had died due to being neglected all day after I came on to shift, the hospital would have placed all blame on me and I would’ve been dragged with a lawsuit. Those worse case scenarios kept running through my mind and increasing my fear. The supervisor for that night had tried to put words in my mouth and guilt trip me. He tried to send a patient to us that was in the process of dying with a code status DNR/DNI (do not resuscitate/do not intubate) and I refused. We had already reached our max capacity with patients. He accused me of wanting the patient to suffer and being selfish. I explained to him that this patient was not going to be anymore comfortable here getting ICU level care and we are also no escalating to life-saving measures so it would be inappropriate. He just felt that I was being selfish and didn’t care about the patient, when in fact the patients best interest was at heart. Moving a patient who is on comfort care from a medical unit to an ICU unit will only add to the patients discomfort. I brought this issue to the attending physician and he agreed with everything I told the supervisor. The patient can’t be moved without the attending’s approval, so that patient stayed on their current unit while being made comfortable.
“We are watching our coworkers fall like dominoes.”
The emotional toll this has taken on many of us is unexplainable. We are aware of the fact that not everyone is going to live and we cannot save everyone. We are also trained to do everything that we can to save lives. Not being able to do anything to save most of these people has been very hard. It feels like we are just watching people suffer and die at an alarming rate. This is not our usual everyday experience coming into work. I have had so many nights that I was so convinced that we could save some of these people, only for them to end up not making it through the night. These people are all alone and afraid. I’ve spent a lot of time in the room holding hands and trying to comfort them the best that I can. I wish they could at least have their loved ones by their side, but this is too contagious to even risk it. We are watching our coworkers fall like dominoes. It’s almost like looking in the mirror when I see another healthcare worker on a ventilator from this virus. The thought comes to mind that “that could be me if I’m not careful.” I get chills every time I hear of someone being out sick with COVID-19, or worse. Just the other night, one of my favorite nurses to work with had passed out and been rushed to the emergency room. I fear for my loved ones, especially my parents and oldest sister. My father and sister are both cancer survivors and this is the last thing they need attacking them.
I am now anxious every time I have to go into work. I go because I know that I am able bodied and that the job needs to be done. They constantly need more and more nurses. We have a load of travel nurses coming to help out. I have been helping with training them and giving them insight on how I managed to learn their very different system at this hospital as a traveler. The high pay is attracting a lot of people to NYC. But I want everyone to be aware that the pay is increased for a reason. Crisis rates are there because they are desperate for more hands as we continue to lose nurses and gain an overwhelming amount of patients. Just be mentally prepared to have to jump in on your first day and take a patient assignment without any training. ICU ratios have been as bad as 5:1. New units are opening up specifically for COVID-19 patients and to keep healthy patients away from those who are infected. They have been desperately opening up new nursing units without the staff to run them. I haven’t worked on the unit I was hired to in over a month because they need at lease 1 ICU nurse to be in charge of these units. It has been a lot of pressure , but I am someone who works well under pressure. I want other nurses to know about these experiences and to also know that is is okay to put yourself and your health first. I have seen a lot of controversy behind nurses leaving their jobs to protect themselves. People are saying, ” this is what you signed up for”. No one predicted us having a pandemic and mass casualties! We are nurses, we signed up to heal. We are not soldiers. If we are not well ourselves, how can we care for and help heal others? In emergency rooms, they are running out of space for new patients and have had to resort to rolling dead bodies on the floor. This amount of death isn’t healthy for anyone psychologically no matter what they signed up for. To all the other nurses who are out there fighting this; take care of yourself, stay strong, and don’t make the money your only motivation to do this!
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