Covid and Hospitals: How are things now?

[CrunchRN]

Just curious. Here in DFW I see hospitalizations are rising to 14%. How are things in the hospitals? Are things relatively normal? No more furloughs?

Please share. I am not in acute care, but I am of course very interested in the effects on acute care staff.

[toomuchbaloney]

45 minutes ago, JBMmom said:

My point is never to scare anyone into anything. I can only give people the view of the pandemic from my ICU. I see primarily unvaccinated people, or vaccinated/partially vaccinated people with significant comorbidities being put on ventilators. We only put them on a ventilator when it seems nearly 100% likely that not doing so will result in their death- like persistent oxygen saturation levels in the 80s or worse with worsening ABG results and altered mental status. Because the statistics for those on ventilators aren't much better, the majority will die and the deaths are awful. 

I don't know the percentages of patients on the med-surg floor for vax status. I don't know the statistics for those that are discharged, or never come to the hospital in the first place. Sure, I know people in the community both vaxed and unvaxed that have had relatively mild courses of COVID. But the majority of the people I've seen with COVID have been in the ICU and most of them have died. If that scares someone so be it, that's my pandemic reality.

When we intubated our last two patients in the ICU last night we used the last two ventilators available in my hospital. We are apparently awaiting loaned ventilators from other hospitals later today but until then if there's a code, we're out of luck. Someone will be bagging for an awful long time. We have critical care patients in the PACU, the PCU, the ED and our full unit. We've lost nearly half our critical care trained staff in the past year, and four more are leaving in the next month. We are half travelers on nights, with varying levels of skill and ability to integrate into the culture of a small community hospital. It is a dumpster fire. Every shift. And the people hurt most are the patients. 

I don't want to scare anyone, but I don't want to see anyone come to my place of work either. Because no matter what reason you're there, you're probably not getting the care that any nurse knows you deserve, but we're treading water and getting tired.  

This is beautifully written and should be more broadly read than just this forum.  

[ikarus01]

12 hours ago, DesiDani said:

So does that mean if you are not vaccinated and get COVID you are likely 100% (with a few exceptions)  guaranteed to end up in the ICU and then die. That if you do get COVID and if you are not vaccinated you will definitely end up hospitalized. With a few exceptions of course.

I actually laughed at this because I had the same question in my brain.

Quote

They just aren't (with few exceptions) winding up in ICU's.

This could have just been written as,

Some/a few vaccinated patients are winding up in the ICU.

Future politician in the making.

[JBMmom, MSN, NP]

On 1/17/2022 at 3:24 PM, toomuchbaloney said:

This is beautifully written and should be more broadly read than just this forum.

Very nice of you to say. I think that I've been a pretty strong person throughout much of this pandemic, but I admit the past couple months has probably been the toughest of my career. I fall short of saying the toughest of my life because my family and friends are all healthy and well and my work is NOT my life. But the sadness and frustration does seep over into my personal life these days, which makes things a little harder. There's a light at the end of my tunnel, though, I'll soon be per diem in critical care and only working 1-2 nights a week, which will probably lighten the load a bit. 

Sorry that was a little off topic...

[Wuzzie]

Lost our first patient, in my opinion, from Covid without actually having Covid. ?

[JBMmom, MSN, NP]

39 minutes ago, Wuzzie said:

Lost our first patient, in my opinion, from Covid without actually having Covid.

Sorry to hear that. So many things going so wrong these days and lives lost needlessly for many reasons. 

[CrunchRN, ADN, RN]

I hate hearing that Wuzzie. My friends in Seattle that are having critical procedures delayed due to lack of bed/staff availability tells the tale thought too.

[Guest219794]

On 1/17/2022 at 3:03 PM, subee said:

There is no actual, honest, intellectual debate going on here.

There is a reason you won't find "arguments" like the ones that dominate here in a discussion among ICU docs, virologists, etc.  

Disclamer- not calling anybody here stupid.  It's a good quote that applies in a lot of situations.

 

[CrunchRN, ADN, RN]

It is a good quote. The point of this particular thread is not really debate, but factual information from nurses working in the hospitals about what things are really like.

[Guest219794]

1 hour ago, CrunchRN said:

It is a good quote. The point of this particular thread is not really debate, but factual information from nurses working in the hospitals about what things are really like.

Yet, somehow......

My place is up and down.  Medical side of the ER has 21 actual rooms.  We have established a 4 chair quick care area, and periodically use hall beds.

I now regularly come into boarded patients with 900 stupid orders.  Some of these people get 20 individually wrapped pills in the morning that require me to go on a scavenger hunt.  ER pyxis, psych ER pyxis, a bin in the med room, at the bedside, on the clipboard, or still in the pharmacy.   Some of these hosptalists think I am going to be suiting up to give 2 units of regular insulin in a Covid room to cover a BG of 140 in a non-diabetic who I just gave a hospital tray to. Our trays are so full of simple carbs, they are the most effective way to treat hypoglycemia, as they are guaranteed to cause a rapid spike in BD with OJ, processed food, white toast and jam.  Spoiler alert- I ignore a lot of admission orders.  It would be smarter for hospitalists to give realisitic orders, but, barring that, I'll use my judgement.

  Despite zero training in inpt nursing (not counting ICU), I am expected to care for up to 5 admits who rely on scheduled care in an environment specifically designed for unscheduled events.

I am qualified to prioritize ER patients.  I have no guidance as to whether to give an admitted PTs vanco late, or whether to spend 20 minutes on a quick dispo of an ER pt to free up a room.  

Sometimes our ER is half full of admits, mostly time consuming moderately ill covid.  This does not stop critical patients form coming in.  Best case with a true critical patient, it takes 2 nurses an hour to stabilize, then 1 nurse may be 1-1 for a few hours.  During that time, elderly are laying in their own waste, dysthythmias are being missed, and meds are late.

And, sometimes, for reasons I can't explain, we look just like the old ER with just a bit of covid thrown in.  We are not overwhelmed every day like a lot of our peers.  Just most days.  I rarely spend the whole shift in full PPE, which is very tiring.

 

[CrunchRN, ADN, RN]

Interesting. How does is compare with pre-pandemic flu season loads and diversion or is there absolutely no comparison at all?

1 hour ago, CrunchRN said:

Interesting. How does is compare with pre-pandemic flu season loads and diversion or is there absolutely no comparison at all?

I would venture that it doesn't compare at all based upon the anecdotal reports of seasoned nurses. 

[JBMmom, MSN, NP]

11 hours ago, CrunchRN said:

Interesting. How does is compare with pre-pandemic flu season loads and diversion or is there absolutely no comparison at all?

I can only give my own experience, but in the four years I've been in critical care we had maybe 1-2 patients per year in the ICU with the flu. Granted that's probably only a N of 2 because the past two years have been in the pandemic. I think we had one flu related ICU admission last year, and we have none so far this year.