Covid and Hospitals: How are things now?

JBMmom, MSN, NP · Jan 8, 2022

We've now hit the highest number of COVID cases in our hospital since the pandemic started. We've received word that all critical care nurses will have a 3 patient assignment for the foreseeable future because there are critical care patients in our unit, in the progressive care unit, the PACU and the ER. We will be sent to all the units to cover. And my friend said there are 4 patients on the med-surg unit maxed on high flow that will likely be intubated by the weekend.

My hospital also uses mandation to cover short staffing. Three times in the past two weeks my eight hour shifts have become two twelve hour shifts and one sixteen hour shift. Nurses that are barely PCU trained have had their patients intubated on their shift and then stay on their assignment because there's no critical care nurse to take the patient. I feel awful for those nurses, the chaos on the PCU was palpable the other day, Only one critical care trained nurse with six patients on vents. It's crazy. And yet, the elective surgeries still carry on, ridiculous. You couldn't pay me enough to be a patient in the hospital these days, people are coming up COVID positive all over the place.

They finally changed the visitor policy to one visitor per day and only four hours. But even still yesterday we had a visitor come in and lie about having symptoms to visit their COVID positive adult child. They sat outside the room coughing up a lung and blaming allergies. When finally pressed about getting tested they said they were positive earlier in the week but still decided to come in and expose us and everyone in the hospital, in order to see their intubated son. So frustrating.

Tweety, BSN, RN · Jan 8, 2022

I live in Florida. Delta has burned through this past Summer and now Omicron is the dominant variant. Hospitalizations have went from 68 to over 400 in a couple of weeks. What management is saying is many are caught when coming to the ER for unrelated symptoms. They have also treated and sent "thousands" (their word) from the ER.

The issue right now is not just the patients but staff. Every department has a huge number of staff out with covid right now. Almost as soon as someone comes back from their five or so days out, someone else falls. I just heard today my coworker for this weekend has it.

Fortunately all the people I know with it had mild symptoms, but for one that got her but kicked like a bad flu but managed to get well quick.

Wuzzie · Jan 8, 2022

We hit 256 patients but what I don’t know is if they are admitted for Covid or incidentally found to be Covid positive and asymptomatic. I think that’s an important distinction. Like others have said what’s killing us is huge numbers of staff out sick or quarantined. Even worse is some of them had it earlier this year and are getting it again so we have no idea when it will end. Right now it seems like it won’t.

Editorial Team / Admin · Jan 8, 2022

47 minutes ago, JBMmom said:

And yet, the elective surgeries still carry on, ridiculous.

Hospitals gotta make money so they can pay what’s left of their staff. At least that’s the rationale that’s been shared ?. Never mind the poor care all patients are getting and I’m sure readmission rates are skyrocketing because people are being discharged early

gere7404, BSN, RN · Jan 8, 2022

On a travel assignment to a town in the Seattle/Tacoma area. Seeing tons of positive cases, but nowhere near the acuity of delta. Tons of asymptomatic cases. Our waiting room is packed with mildly symptomatic people here to be swabbed, scared to death they’re going to die because OMG it’s covid. 6 hour wait in the ER is the norm because the twenty covid positive people waiting for the provider to see them and discharge them because emtala says a doc has to see them.

we used to be vigilant about putting covid patients in actual rooms, now they’re in our hallway beds and fast track chairs area because omicron spreads so virulently and if you’ve been in the ER, you’ve been exposed.

We’ve got tons of positive people admitted, but very few are actually here because of their covid diagnosis. They just happen to have covid on top of their chief complaint. Just got an email saying because we’re on crisis staffing levels we can come to work with covid as long as we don’t have immune compromised patients.

Wuzzie · Jan 8, 2022

^ This.

Same thing I posted earlier. Nobody is keeping track of admitted for Covid vs admitted for something else but Covid positive and often asymptomatic. It’s a huge distinction. Interestingly enough our ICU Covid case numbers have remained flat for months. Doesn’t mean we should let out guard down but people should not be flooding the EDs simply on the basis of a positive home test. I blame the media for freaking people out.

JBMmom, MSN, NP · Jan 9, 2022

On 1/8/2022 at 12:23 PM, Wuzzie said:

Interestingly enough our ICU Covid case numbers have remained flat for months.

Our numbers are the highest they have been, and the acuity is also higher. We only have 12 ICU beds. Right now there are 20 intubated patients in the hospital and 13 of those are COVID patients. On Wednesday night we admitted a 33 year old with no known comorbidities who was only mildly overweight. He came to the ED with O2 sat in the 30s, was still talking but said he didn't feel well, and he was intubated. He coded and died on Friday. I'm not saying that the media is right to hype things up, and maybe it's just because I only see the critical care population, but I don't see any light at the end of the tunnel yet. (his mother also lied in order to come to the hospital and see him, all the while exposing all of us that are trying to come to work and save these people's lives)

Kitiger, RN · Jan 9, 2022

1 hour ago, JBMmom said:

Our numbers are the highest they have been, and the acuity is also higher. We only have 12 ICU beds. Right now there are 20 intubated patients in the hospital and 13 of those are COVID patients.

You have perhaps enough nurses employed at your hospital to handle only half the critical patients that you currently have. I assume you have travelers, but even that is not the same thing. And then you have to deal with visitors like that mother.

My heart hurts to think of what you're going through.

JBMmom, MSN, NP · Jan 9, 2022

16 minutes ago, Kitiger said:

My heart hurts to think of what you're going through.

Thank you for your thoughts. We have been told all ICU nurses can plan to have 3 patient assignments for the foreseeable future in order to cover all areas with critical care patients. Sadly they have decided that "soft" critical care patients will just be given to step down nurses that may or may not have enough training. I was sitting next to a PCU nurse the other day whose patient had levophed infusing at 26 mcg/min through a peripheral line (we don't do weight based dosing). She did not have the understanding to ask about adding vasopressin to try to reduce the levophed concentration. She didn't understand that we should be pushing for a central line in that patient. And the critical care doctors don't have time to look closely at a patient who is "only on pressors", and the hospitalists don't examine the infusions closely when the patients are followed by an intensivist. There is so much risk for poorer outcomes because of all of these insufficiencies. As much as I'm not thrilled about triple assignments forever, I'm more concerned for the nurses and patients like in this PCU scenario where what the nurse doesn't know isn't her fault, and it's detrimental to both the nurse and the patient.

CrunchRN, ADN, RN · Jan 10, 2022

A time to avoid the hospital if you can. I do not understand why everyone is rushing to medical centers if they have only exposure or mild symptoms. Such a waste of resources.

I sure hope this peaks and declines soon. Thank you to everyone working so hard.

gere7404, BSN, RN · Jan 10, 2022

3 hours ago, CrunchRN said:

I do not understand why everyone is rushing to medical centers if they have only exposure or mild symptoms. Such a waste of resources.

Because they’ve had the idea that if they get covid they will die slammed into their heads every day for the last two years

literally had someone get discharged by an MD from the ambulance last night. 22 year old called 911 because they were exposed to covid and they wanted to be seen. Doctor saw them in the rig and said goodnight.

toomuchbaloney · Jan 10, 2022

3 hours ago, CrunchRN said:

A time to avoid the hospital if you can. I do not understand why everyone is rushing to medical centers if they have only exposure or mild symptoms. Such a waste of resources.

I sure hope this peaks and declines soon. Thank you to everyone working so hard.

Maybe their employers are requiring test results so that they can work.