COVID: I'm ready to leave the hospital until the end of the pandemic guilt

MunoRN, RN · Dec 1, 2020

On 11/30/2020 at 6:03 AM, DaveMHA-RN said:

No, rhetorical as in "what if".

Here is what Merriam-Webster has to say:

Rhetorical Language vs. Rhetorical Questions

Rhetorical has several meanings which are close enough in meaning that they may easily cause confusion. It can refer to the subject of rhetoric ("the art of speaking or writing effectively") in a broad sense, and may also refer to that same subject in a somewhat deprecatory sense ("given to insincere or grandiloquent language"). But perhaps the most common use of rhetorical today is found in conjunction with question. A rhetorical question is not a question about the art of speaking effectively; it is a question that is asked for effect, rather than from a desire to know the answer. “Would it kill you to stop chewing your food with your mouth open?” is a rhetorical question.

Yes, it's a question asked not to ask a question but to make a point, so again, what was your point?

saraleigh, ASN, RN · Dec 2, 2020

On 11/29/2020 at 1:42 PM, Jack Peace said:

Let me ask you all this: for those of you who work in a hospital setting, are you testing for influenza as well as Covid with or without respiratory symptoms?

In my SoCal hospital we can't test for either of these in the absence of symptoms.

Subee2, BSN, MSN, CRNA · Dec 2, 2020

On 11/22/2020 at 6:38 PM, CardiTeleRN said:

Hello!

I am considering leaving the hospital until the end of the pandemic. Not necessarily because of the ill patients. Mostly because of the politics. I understand that there is a shortage of staff for COVID units. My issue is, the hospital I work for is constantly creating new COVID units for patients that are asymptomatic. I've learned these hospitals are getting additional funding from the relief programs put in place by the government. The hospitals gain additional funding if the patients are placed on vents as well. I've noticed MDs and rr therapists are forcing us to place them on vents even if they do not meet the criteria.....

I am becoming extremely overwhelmed and am sick of what I am seeing. I hate how the system is taking advantage of these extremely difficult and emotional taxing times...I don't want to be a part of this anymore.

Am I wrong?

Contact the state medical board and keep notes.

Gray Fox · Dec 2, 2020

Seriously, if you think there is a collective conspiracy in your hospital to force unnecessary treatment on patients, you should probably take a break from nursing. You may be overwhelmed and losing your perspective.

avado, BSN · Dec 2, 2020

Thank you for speaking up.

Distant family member who was on bi-pap doing well and got off but then had a set back. Second, daughter was told she was getting vented "to let her lungs rest" right then I knew it was a lie to the family. They should of been truthful that this is last effort and that the mortality is high.

Yes, I am a 20+ experienced nurse in ED/telemetry/ICU.

My humbled opinion.

CardiTeleRN, BSN · Dec 2, 2020

1 minute ago, avado said:

Thank you for speaking up.

Distant family member who was on bi-pap doing well and got off but then had a set back. Second, daughter was told she was getting vented "to let her lungs rest" right then I knew it was a lie to the family. They should of been truthful that this is last effort and that the mortality is high.

Yes, I am a 20+ experienced nurse in ED/telemetry/ICU.

My humbled opinion.

47 minutes ago, Gray Fox said:

Seriously, if you think there is a collective conspiracy in your hospital to force unnecessary treatment on patients, you should probably take a break from nursing. You may be overwhelmed and losing your perspective.

I’m not losing my perspective. I’m overwhelmed with the lies in full speed during the pandemic with management. I will be taking a break from acute care though.

ThinkingLikeaNurse · Dec 2, 2020

Hello. The level of thinking here is very short-sighted. Covid units are opened not by doctors but after careful insight and planning based on the current trend of admissions of covid positive patients...and current positivity rates in your community not just by one person, not just by CEOs, but after careful collaboration of different sectors in the hospital affected by Covid. Covid units are opened in anticipation of further surge. Your hospital's covid admissions have already increased, as everywhere else in the country. You do not suddenly open a unit for covid without planning staffing and PPE or infection control. You plan accordingly, and not just respond to sudden surge of admissions when they are all waiting in the ER. If you don't believe in numbers, in the number of covid deaths nation-wide, statewide, or covid admissions or in your hospital statistics of an increase in people dying of positive of Covid, I don't know which planet you are on, when the whole world is scrambling because of the economic impact. The entire government systems are worried, and yet you spread skepticism without doing due diligence. Educate yourself by asking management, doctors and nurses on your actual hospital how decisions are made, and not on forums where you fuel yourself finding people who are also skeptic of what's going on. Be active in your hospital to understand, and offer yourself to help since you seem to be on the edge that this is not right. It really isn't right for people to die of mismanagement.

Hospitals get more money from easy admissions, like surgeries or procedures, and labs, or imaging studies, or any quick diagnostic stuff....not overwhelmingly prolonged admissions and overwhelming the workforce....staffing, doctors, nurses, RRT's who get absent for getting sick... and quarantining overwhelms further staffing, which may have them find resource staffing which may be another expense on them.

Also, clinical guidelines are just guidelines....not everyone falls on it...the learning for Covid, how it affects other comorbidities are still very dynamic at this point...Medical Providers decide in collaboration with other nurses' monitoring and other medical providers based on the patient's clinical presentation, and anticipation of what is to happen. Patients likewise will likely refuse it especially if they do not feel sick enough to have it, even without any medical knowledge...again because they do not feel its need. Even if they have trouble breathing, the likelihood of refusal is still there because of doubts and lack of information. These patients or their families sign consent based on the trust and understanding of the repercussions, good or bad, but at that point in time, it is needed as a collaborative clinical decision, and because they felt they need it to. Guidelines, are just guidelines, but when you are at the bedside and looking at different parameters, and predictors or trends in your other hospital patients who live in the same community, waiting for respiratory failure increases mortality rather than placing them on vents to support their respiratory efforts and not overwhelm other organ systems of poor perfusion because they do not meet the guidelines yet. You don't wait people to be gasping and dying to try to save them, you anticipate management so you could maintain homeostasis until the body recovers its own functions... so don't have to go there.

Shifting perspectives are key here and not just jumping into conclusions. I could be wrong completely, and I would appreciate any further perspectives as well that are thought of rationally.

You could be right, as well. But if you were the nurse or doctor in the patient's bedside taking care of a sick patient, has reimbursement ever come into your mind, when you are so busy with the number of patients you have. If nurses are working with 2-4 or more patients, busy at bedside and other stuff, medical providers are taking care of floors, collaborating with nurses on these floor of patients, and inputs from other doctors. They have to talk to the patients too and their families as well...again..floors...or it could even be more than one hospital. They talk to other providers to what has been successful in managing these Covid problems since they are still somewhat new...like less than a year of studies out these....Reimbursements, are accounting/coding or management problems --- because probably, Covid does not exist yet in icd 10's to be reimbursed appropriately and they have to find additional funding that's making a simple boxcase of CHF or COPD patient have prolonged hospitalizations from an expected case with predictable outcomes (and funding based on it code) dying because of Covid. These are just my thoughts again.

I don't think it is politics...and you should not quit...I think the hospital is proactive and doing its planning opening covid units..and not simply reacting..which is a good thing...vents....just because they use a vent, does not mean they are intubated...they could be on other types of Positive pressure ventilations...I believe that's what goes on more and not intubations.

These are entirely my opinion by the way...so lend me your thoughts.

Nurse DeAnne, BSN, RN · Dec 2, 2020

Dear CardiTeleRN;

When you say that the MDs are " forcing us to place them on vents", do you mean that you personally have been forced to intububate these patients, who did not meet clinical criteria?

ohbejoyful · Dec 2, 2020

Something that is frustrating is the amount of asymptomatic covid positive patients being admitted. Getting report in an extremely chaotic and short staffed covid unit that multiple patients are on room air and being treated with Tylenol PRN for fevers they don’t have and just being monitored. Then when the covid unit is full, more covid admits are being put on non-covid units to be mixed in with the general population receiving care from a nurse who goes from a covid room to a non covid room. How does any of this make sense?

If it were to come out that reimbursement money was behind it, it would be far from shocking, as it makes absolutely no sense otherwise. Admitting patients who are asymptomatic is putting an extreme strain on healthcare workers and increasing risk of exposure to sick and vulnerable patients who don’t have covid. The only covid admits should be the ones who actually require acute care and are requiring oxygen. But that is not happening.

Nurse DeAnne, BSN, RN · Dec 2, 2020

We don't admit asymptomatic COVID patients at my hospital. There would be no medical justification and no reimbursement. Patients must have symptoms and diagnostics must justify treatment.

ohbejoyful · Dec 2, 2020

4 minutes ago, ShakeShakeShake said:

We don't admit asymptomatic COVID patients at my hospital. There would be no medical justification and no reimbursement. Patients must have symptoms and diagnostics must justify treatment.

Well thank god, that is how it should be! Now let’s get everyone on board with this.

ohbejoyful · Dec 2, 2020

I am sure at some point in ED visit patient met some type of criteria but if not needing o2, no fever, etc no current treatments it no longer makes sense to overrun the hospital. I’m not a doctor and I’m not qualified to decide whether a patient should be in the hospital or not but generally speaking if we aren’t doing anything for you, why are you here? Especially if it is risking the health of other patients by way of overflow on non covid unit and perpetuating a staffing crisis ...