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Nurses are Pushed to the Brink

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Nurse Beth Nurse Beth, MSN (Columnist)

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

Mounting COVID nursing crisis - When will it end?

No one knows for sure when things will get better but right now, in California, itā€™s a mounting crisis. Itā€™s bad and itā€™s getting worse. COVID is crippling the stateā€™s healthcare system.

Nurses are Pushed to the Brink

Greetings from California šŸ™‚Ā The situation is dire here, and nurses are spent. I hope it's better in your area. I have an idea of how to make things a little better that I just can't shake.

It's a simple idea. Tell me what you think.

Short of Beds

Patients are lying on hard gurneys inside tents hastily assembled on concrete hospital parking lots. Meanwhile, inside, hospital beds are pulled up from basement storage inĀ  and pushed to the end of MedSurg hallways with a privacy screen, a commode, and a handbell. Thereā€™s no TV, no call light and of course no bathroom.Ā 

GI labs and surgery waiting areas are being converted to ICU overflow beds. Patients are even being held in lobbies and gift shops of hospitals that have run out of beds.

Short of Nurses

Nurses are calling out in droves. Nurses who arenā€™t sick drag themselves in to work but are physically and emotionally fatigued. Suffering moral distress, some have seen more deaths in the last few months than in their entire career. Holding an ipad so their dying patient can face-time their loved ones to say goodbye is heartbreaking, but thereā€™s no time to recover, even after their patient dies. Arrangements have to be made and the room turned over.Ā AnĀ ED patient is waiting in queue for that bed.

Nurses talk quietly among themselves about who is the latest one of them to come down with COVID. Even though coworkers are getting sick, vigilance occasionally wanes because itā€™s exhausting to be on guard for months and months. On guard through Spring, Summer, Fall and now Winter.Ā  Most times in break rooms thereā€™s only 2 people eating lunch at opposite ends of the table. But not always.

In illogical denial, on one level some healthcare workers believe they wonā€™t get COVID from their bff at work, but at the same time, worry constantly. ā€œHowā€™s my taste? Can I still smell OK? I have a headache. Is this it?ā€ And in the back of every nurseā€™s mind is the very real fear of infecting their own family.

Inside hospitals, everything except for staffingĀ has fallen by the wayside. Education classes are not attended, staff meetings are canceled.Ā  Nurses are called to work every day, sometimes twice a day, and offered varying amounts of crisis pay.Ā 

But $50.00/hr extra is no longer an incentive for nurses who are exhausted as never before.

Short of Travel Nurses

Hospitals are desperately trying to hire crisis travelers. Federal, state and county government agencies are trying to get healthcare workers to hospitals. The National Guard sent crisis workers. The state sent crisis nurses to work for 48 hrs but some of these nurses had been retired for years (read about crisis nurses Hippy Harry and Geriatric Barbie in Day in the Life of an Educator).Ā 

Even with lucrative contracts of $180.00 per hour base pay, there are not enough travelers to meet the need.

California Ratios

In California, nurse-patient ratios were waived by the California Department of Public Health (CDPH). Here are the changes:

ICU ratios went from 1:2 to 1:3

Step Down units went from 1:3 to 1:4

MedSurg went from 1:5 to 1:7

Tele went from 1:4 to 1:6

ED went from 1:4 to 1:6

In reality, itā€™s a moment by moment staffing. Two nurses may take a team of 13 patients, with 1 nurse giving meds and the other doing assessments. If lucky, they may get a ā€œhelper nurseā€ from the OR because surgeries are canceled, but OR nurses arenā€™t familiar with the meds, have never barcode scanned medications, and have limited experience with computer documentation.Ā 

Why Not Hire A LOT of Nursing Assistants?

If RNs have to double their patient loads, work 16 hr shifts, come in on their days off, and be exposed to COVID, then they should be given all the help possible.

Today, in the midst of a national emergency where nurses are central, RNs need to focus on RN tasks. Not clerical tasks. Not housekeeping tasks.

Over the years, hospitals have cut nursing assistants and PCTs to the bare minimum, and RNs have picked up the slack. RNs spend a lot of valuable time chasing down supplies, answering phone calls, answering call lights, wheeling patients out for discharge, helping patients and families, sometimes even cleaning beds and turning rooms over.

But what if RNs didnā€™t have to answer call lights? What if all patients were toileted and bathed, ambulated, turned and proned, with water pitchers full and vitals taken? What if? If the RN could focus on RN tasks, she/he could safely handle a higher workload.

This isnā€™t about RNs being too good to perform non-RN tasks. Itā€™s about patient safety and maximizing RNs when theyā€™re overburdened. Would it be helpful if a surgeon on his way to perform an emergency surgery stopped to answer a call light, make and serve coffee?

How about turning the buzzword ā€œworking to the top of your licenseā€ into a reality?

Iā€™m talking about hiring a lot of nursing assistants and PCTs. Flood the units with them. Is there really no money to hire unlicensed personnel? Paying RNs $180.00 per hour while having 1 nursing assistant per 15 patients is stepping over a dollar to pick up a dime.

If a massive number of nursing assistants had been recruited and hired just a month or two ago, there would be some relief today for nurses and more help for patients.Ā 

Hopefully, it can still happen. What other ideas might help? Having clinical pharmacists pass meds? Have lab techs perform all draws, or as many as able?

GI techs and OR techs can go to the floors and help patients call their families, or run to Distribution to pick up supplies.

Just my thoughts, thanks for reading.

What do you think?

Be well and stay safe.

Best wishes,

Nurse Beth

Beth Hawkes, author of "First-Year Nurse" and best-selling "How to Land Your First Nursing Job...and your next!"

129 Articles   2,331 Posts

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31 Comment(s)

I agree with you. Hire those nursing assistants, pay them well, assist them to become certified if they need it and you will go a long way toward easing a lot of strain. And how many of those nursing assistants will get motivated to pursue a nursing license?Ā Probably more than we would think. I also can see pharmacists or pharmacy technicians passing meds. If they can give me a flu shot at Rite Aid or Walgreenā€™s they can do a lot of good at med pass time in many facilities. Ā This is all thinking outside of the box. Need more of it. Then some action.

CaliRN2019, BSN

Has 3 years experience.

YES! Please hire some ancillary staff! The hospital I work at in the Central Valley got rid of their CNA's 7 years ago for a few bucks pay raise for the RNs. I can't believe the RN's and union let this happen. We are understaffed, ICU patients remaining on the tele floor, lots of chaos and lots of death. We have no CNA's, LVN's, break relief RNs, or help of any kind. RT's only come for emergencies and to set up high flows and Bipap but we otherwise manage it all. It's reckless and dangerous and we burn through staff at a huge rate.

spotangel, DNP, RN, NP

Specializes in ED,Tele,Med surg, ADN,outpatient,homecare,LTC,Peds. Has 32 years experience.

I agree! Great idea! Maybe we can put it forth unions and to management.

When I was pulled from the clinic to the hospital to work the bedside, there were a few issues. The last time I did bedside was in 2006! Even though as management I have stepped in to help since then, I had not done a full shift! I did not have access to their system, scanning meds, barcode for meds and narcotics.However, I used my basic skills to good use! I worked at the bedside-fed the pt,dumped old trays,cajoled the pt to eat a little, changed the pt, did vitals and finger sticks, suctioned them,Ā  watched vents, changed dressings, relieved the 1:1 for break,removed the trashbins to the corridor for housekeeping and watched the callbells like a hawk!

Ā  I also called family, face timed them and tried to motivate and comfort the scared pts. It was a huge help to the RNs. Eventually I even took report from the ED or gave report for the primary RN who was running around like crazy daily working! When I had a little respite, I would stock up the corridor slots with PPES and wipe down some of the equipment. I even remember going floor to floor looking for body bags when we ran out of them----! There is a lot of bedside help needed.I basically worked as a CNA and didn't mind. I was bone tired and limped out daily with calluses on both of my flat feet ---! It was the March-April, the height of the first wave in NY. Also as a seasoned nurse, I comfortedĀ  the 2 year under the belt RNĀ  charge nurse who was stressing out and motivated her for one day at a time. I then would go home and cry by myself in the middle of the night from the stress! They loved having me and I tried my best every day. Most of these tasks can be done by a NA.

So lets go for it and ask for help in this time when RN's are stretched thin!

Ā 

bitter_betsy, BSN

Specializes in Emergency / Disaster. Has 2 years experience.

We are currently fully staffed in our department with RNs but not support staff. Other areas in our hospitals are not staffed and here shortly our department will not be staffed either - now that they are getting vaccinated, everyone is leaving to go travel nurse. Ā We will be left with only new grads who do not have enough experience to travel. Ā Instead of paying travel nurses to come and pick up for the nurses that we had that liked their jobs and hospital - why don't we pay our nurses better to stay and continue the fight at home? Ā It seems that the same amount of money they shell out to bring travel nurses in, they could pay a hazard differential and hire additional support staff and still come out ahead - and keep nurses happier at home. Ā Just a thought...

scribblz, BSN, CNA, LPN

Specializes in Med Surg, Tele, Geriatrics, home infusion. Has 14 years experience.

I think you are 100% on the money! Given this time of crisis all those nursing students who are being denied their clinical could come be SNAs instead and Gain valuable experience and be a huge help to their local healthcare facilities. People always say it's so hard to get in to hospitals as a new grad, but SNA's are almost guaranteed to get in for preceptorships and new grad RN positions. If ever there was a time for a mutually beneficial relationship to be invoked now is the time! Also there are tons of elective department such as GI RNs that are looking at using up all their unemployment time when we so desperately need our ends of any kind they could be buddied up with experienced Med surg RNs so that we can handle the ridiculously large assignments we have been given these days. At this point I don't want more money; I want more staff. I want to feel like I'm not endangering my nursing license, sanity and conscience every single day when I go to work.

Ā 

Edited by scribblz
Typos šŸ¤·ā€ā™€ļø

Maybe cnasĀ can get trained at the bedside to be able to do more skilled care so the RNs can have more help. We are dealing with a crisis so can't that be considered for this type of change.

Red Shirt 6, CNA

Has 2 years experience.

The localĀ Colleges and institutesĀ and other cancelled all of the CNA, programs. So the city where I am at is getting hit with a shortage of CNA's and other support personal. While more and moreĀ of the CNA's that I work with are going PRN andĀ completing educationĀ to get out of health care orĀ leave theĀ bedside.Ā 

SomeĀ fix's would be national registries for Nurses all levels, PCT's CNA's. Improvements on working conditions and incentives for the for the less desirable locations, and specialties.Ā 

Nurse Beth, MSN

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

6 hours ago, Red Shirt 6 said:

The localĀ Colleges and institutesĀ and other cancelled all of the CNA, programs. So the city where I am at is getting hit with a shortage of CNA's and other support personal. While more and moreĀ of the CNA's that I work with are going PRN andĀ completing educationĀ to get out of health care orĀ leave theĀ bedside.Ā 

SomeĀ fix's would be national registries for Nurses all levels, PCT's CNA's. Improvements on working conditions and incentives for the for the less desirable locations, and specialties.Ā 

Great ideas. At my hospital we are hiring new grad nurses to work at CNAs for a couple of months before they start their residency program. It's a win-win bc they are getting experience whereas otherwise they'd be at home waiting to start.

We're making it super easy to getĀ them to the floors- onboarding 1 at a time if needed.

Nurse Beth, MSN

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

Update fromĀ Los Angeles:

On Jan 4 2021 in the LA Times, the article headline read ā€œAmbulance crews told not to transport patients who have little chance of survivalā€ and included a directive from the L.A. County Emergency Medical Services Agency to withold oxygen from patients with an 02 sats of 90% or higher.

scribblz, BSN, CNA, LPN

Specializes in Med Surg, Tele, Geriatrics, home infusion. Has 14 years experience.

1 minute ago, Nurse Beth said:

Update fromĀ Los Angeles:

On Jan 4 2021 in the LA Times, the article headline read ā€œAmbulance crews told not to transport patients who have little chance of survivalā€ and included a directive from the L.A. County Emergency Medical Services Agency to withold oxygen from patients with an 02 sats of 90% or higher.

Oh my goodness. 2021. Not last April. And we're still working like Covid just hit. Blows the mind.

Nurse Beth, MSN

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

Just now, scribblz said:

Oh my goodness. 2021. Not last April. And we're still working like Covid just hit. Blows the mind.

It really does. You have to wonder if ventilators will be rationed.

scribblz, BSN, CNA, LPN

Specializes in Med Surg, Tele, Geriatrics, home infusion. Has 14 years experience.

15 minutes ago, Nurse Beth said:

It really does. You have to wonder if ventilators will be rationed.

I think we'll run out of nurses who know how to take care of vented patients first šŸ˜© and if this ship doesn't turn around soon we probably will be rationing ventilators by Feb-March.

Nurse Beth, MSN

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

1 hour ago, scribblz said:

I think we'll run out of nurses who know how to take care of vented patients first šŸ˜© and if this ship doesn't turn around soon we probably will be rationing ventilators by Feb-March.

That's a good point. I think finally it's sinking in how indispensable nurses are

49 minutes ago, Nurse Beth said:

That's a good point. I think finally it's sinking in how indispensable nurses are

Maybe in some post pandemic world that will translate into better wages, better staffing models and more autonomy for RN'S...we are maxed onĀ responsibility, accountability and necessity.Ā 

On 1/4/2021 at 7:29 AM, CaliRN2019 said:

YES! Please hire some ancillary staff! The hospital I work at in the Central Valley got rid of their CNA's 7 years ago for a few bucks pay raise for the RNs. I can't believe the RN's and union let this happen. We are understaffed, ICU patients remaining on the tele floor, lots of chaos and lots of death. We have no CNA's, LVN's, break relief RNs, or help of any kind. RT's only come for emergencies and to set up high flows and Bipap but we otherwise manage it all. It's reckless and dangerous and we burn through staff at a huge rate.

My hospital tried that years ago and the RNs said "NO THANK YOUšŸ˜’!"

20 hours ago, Nurse Beth said:

Great ideas. At my hospital we are hiring new grad nurses to work at CNAs for a couple of months before they start their residency program. It's a win-win bc they are getting experience whereas otherwise they'd be at home waiting to start.

We're making it super easy to getĀ them to the floors- onboarding 1 at a time if needed.

This is great, but in my observation most new grads/ nursing students arenā€™t nearly as ā€œstrongā€ as experienced CNAs.
Ā 

Entry level CNAs need more pay. Ā As it is, they make the same or less than working teenagers.

NurseSpeedy, ADN, LPN, RN

Has 18 years experience.

1 hour ago, Queen Tiye said:

This is great, but in my observation most new grads/ nursing students arenā€™t nearly as ā€œstrongā€ as experienced CNAs.
Ā 

Entry level CNAs need more pay. Ā As it is, they make the same or less than working teenagers.

Agreed-and with COVID being a reality, who the hell would want to work for the same amount they can make at a grocery store with a lot less risk-yeah itā€™s still there too but coughing in public is almost like a crime now. Patients arenā€™t wearing masks.Ā 
Ā 

Some people may really need a job, but many are not willing to deal with the craziness of COVID without some incentive for putting their own lives on the line.Ā