Covid Patients on enhanced droplet precautions in a regular room

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I worked on a stepdown unit and up until a few days ago worked with covid patients that were placed in a negative pressure room.  I didn't have a problem with this, however the other day I was informed I was to expect to admit a covid positive patient on 6 liters High Flow Nasal Cannula into a regular room on enhanced droplet precautions. In other words, they were being placed in a regular room and not in a negative pressure room.  Managements rationale was that the patient "was not coughing" so my exposure should be minimal.  I did not want to accept the patient because I felt that due to the room not being negative pressure, I would be exposed to a high viral load  and I am no Spring chicken, making me more susceptible to serious symptoms if I contracted the virus. Not only that, every time the door of the room would be opened, the air with the virus in it would go out into the hallway were staff are not wearing N95 masks/PAPR's.  Whereas at least with a negative pressure room, when the door is opened, the air wouldn't automatically/immediately go out into the hallway. 

I found this article https://bit.ly/2KyREAp which concluded that "a growing body of evidence that droplet precautions are not appropriate for SARS-CoV-2."  I was told by my manager that I was expected to take the patient. I declined and a younger nurse in her 20's reluctantly offered to take the patient and I took one of her patients, after I said I would resign there and then and go home. The next morning I tendered my resignation as I was advised I was expected to take these patients in these rooms.  What also bothers me is that management didn't bother to tell us that we were going to start getting these patients in regular rooms on enhanced droplet precautions, we were given no chance to have input into the situation....it was just dropped on us....it felt sneaky.   I called my union rep who advised we "had no choice" in the matter and that the med surg units were already doing it.  Meanwhile the other week management had no problem converting half the step down unit to negative pressure rooms, so why didn't they just do it to the entire stepdown unit?  Anyway, I would appreciate any thoughts/feedback on this issue.  

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Specializes in NICU, PICU, Transport, L&D, Hospice.

I'm sorry that you were put in that situation. 

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Specializes in Pediatrics, Pediatric Float, PICU, NICU.

I've been floating to COVID-only units since this started in March, and majority of the patients were not in negative pressure rooms in my pediatric hospital. We don't even have enough negative pressure rooms in our entire (large) hospital to house the number of COVID patients we have at one time, and I know its even worse in adult world.

Regardless of right or wrong, I'm sorry you were put in that situation and respect that you made the decision that you felt was best for you.

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Just an FYI, most places are not putting their patients in negative air flow rooms.  It’s not feasible.  There’s just too many.

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We don't have anywhere near enough negative pressure rooms. I mostly just wear an N95 and face shield full time.

Been neck deep in covid since April and havent gotten it somehow, as far as I know.

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Specializes in Cardiology.

We originally had everyone in negative pressure rooms but now it is not a requirement. In fact the CDC says you do not need to place them in a negative pressure room unless they are receiving aerosol treatments which my hospital has discontinued for this population. We still wear gowns, gloves, and PAPRs into the rooms though. As someone pointed out since this began a majority of hospitals did not place them in negative pressure rooms.

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On 12/19/2020 at 12:07 AM, telenurse2009 said:

What also bothers me is that management didn't bother to tell us that we were going to start getting these patients in regular rooms on enhanced droplet precautions, we were given no chance to have input into the situation....it was just dropped on us....it felt sneaky.  

That is the inappropriate part.

It is why I don't feel sorry for hospitals and their troubles right now. This is how they operate and no matter how desperate things get they staunchly refuse to consider that there could be a better way. The problem is not the workload, it isn't the difficult emotional/physical nature of the work, it isn't even poor treatment by patients/families or anything else. It is the disregard that telegraphs very well and plainly, coming from executives and administration--people who should know better and absolutely have the resources to do better.

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Specializes in Critical Care.

It is simply about money.  The fact that they already had made more rooms negative pressure means they are more than able.  They are simply refusing to spend the money.  I'm sure if any staff gets COVID though they will blame it on community exposure not the job!

They've been doing the same thing where I used to work, sometimes even putting the covid patients on the same wing as regular patients and mixing them together.  Now most of the covid units do not have negative pressure rooms.

The CDC has provided cover for hospitals back when it said simple masks were OK and now the Republicans are trying to pass corporate liability to make sure any workers infected due to poor working conditions would have no recourse!  Pretty sad state of affairs all together.

For me I eventually did the same thing as you and resigned.  I don't know what the future holds, but I don't regret it.  The peace of mind and lack of stress I now feel is well worth it.  I no longer have to feel dread at going to work and wondering how I'm going to get thru my shift due to unsafe working conditions and lack of staff and equipment.  Honestly, my only regret is I didn't do it sooner!

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Specializes in NICU, PICU, Transport, L&D, Hospice.

Does anyone believe that is accidental rather than intentional action that hospitals were so poorly prepared?

Trump Team Killed Rule Designed To Protect Health Workers From Pandemic Like COVID-19

Quote

When President Trump took office in 2017, his team stopped work on new federal regulations that would have forced the health care industry to prepare for an airborne infectious disease pandemic such as COVID-19. That decision is documented in federal records reviewed by NPR.

"If that rule had gone into effect, then every hospital, every nursing home would essentially have to have a plan where they made sure they had enough respirators and they were prepared for this sort of pandemic," said David Michaels, who was head of the Occupational Safety and Health Administration until January 2017.

 

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Specializes in Critical Care.
On 12/25/2020 at 11:14 AM, toomuchbaloney said:

Does anyone believe that is accidental rather than intentional action that hospitals were so poorly prepared?

Trump Team Killed Rule Designed To Protect Health Workers From Pandemic Like COVID-19

It goes right along with the Republican's war against workers, where corporations interests must be protected at all costs.  Can't afford to protect workers ie cancelling OSHA protections, this corporate immunity from liability clause they want to add etc.  Even healthcare workers were excluded from the paid leave in the original Cares act.   So sadly it doesn't surprise me at all!

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On 12/25/2020 at 10:48 AM, brandy1017 said:

They've been doing the same thing where I used to work, sometimes even putting the covid patients on the same wing as regular patients and mixing them together.  Now most of the covid units do not have negative pressure rooms.

They did what? That's reckless as hell!

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On 12/25/2020 at 2:29 PM, NurseBlaq said:

They did what? That's reckless as hell!

Not  necessarily.  Any rule-out unit is going to be mixed.  The PUI patients move to regular floors if they test negative, or the COVID floor if they test positive (space permitting because there's not always room on the appropriate unit).  The PUM patients never go to clean floors (unless, I suppose, they are there long enough to qualify for a quarantine).  Many (hopefully most) of them are negative, but they're still in a unit with COVID+ patients for their stay.  I don't like it, but I also can't think of a better option.

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