Staffing On Covid Unit

[RNKPCE]

What is the staffing like on your covid unit? What level of care med/surg , step down , tele ? 

Has the staffing varied? Are you in a surge? Do you have ancillary help such as CNAs , phlebotomists, housekeeper, ward clerks? 
 

Do you change isolation gowns from patient to patient? Are you provided scrubs? What other PPE do you wear? 
 

Do you have core staff or a constant rotation from all over your facility? 

[MeganMN]

I am in a small critical access hospital. we had a few weeks of awfullness, but right now things are okay. We have a small ICU where each nurse has up to 2 patients. They Med/Surg nurses have up to 4-5 patients during the day and 4-6 at night. We have had shortage of staff and everyone is getting burned out by picking up shifts to cover. When we have enough staff (aides, ward clerk, Tele tech, housekeeping) things seem okay, but it has been tight at times and it feels unmanageable. 

We have to bring our own scrubs. We have washable gowns and change them between patients. We wear surgical masks and face shields with every patient. With Covid we wear a gown, N-95, bouffant, face shield, and gloves. We are currently using one surgical mask all day and re-use our N95 for five shifts.  

We have a core staff. 

 

[toomuchbaloney]

12 hours ago, MeganMN said:

I am in a small critical access hospital. we had a few weeks of awfullness, but right now things are okay. We have a small ICU where each nurse has up to 2 patients. They Med/Surg nurses have up to 4-5 patients during the day and 4-6 at night. We have had shortage of staff and everyone is getting burned out by picking up shifts to cover. When we have enough staff (aides, ward clerk, Tele tech, housekeeping) things seem okay, but it has been tight at times and it feels unmanageable. 

We have to bring our own scrubs. We have washable gowns and change them between patients. We wear surgical masks and face shields with every patient. With Covid we wear a gown, N-95, bouffant, face shield, and gloves. We are currently using one surgical mask all day and re-use our N95 for five shifts.  

We have a core staff. 

 

What region of the country? Is the MN Minnesota or Masters in Nursing? LOL

[MeganMN]

Rural Minnesota!  We had a surge a few weeks ago and I keep waiting for it to hit again but it has not. Now we are just waiting.

[OUxPhys, BSN, RN]

It's bad now. 3-4 pts a piece and a lot of them are heavy (totals, spinal cord, psych). There are usually anywhere from 1-3 aides on the floor. They usually have a ward clerk during the week, sometimes on the weekends. EMS does go into rooms and clean them during the day but not during off-shifts. Lab does go in and gets labs. Dietary does not even step foot on the floor, they leave the trays outside the unit. The staff have surgical scrubs they change into. They use PAPR's to go into the rooms. The floor was originally converted to all negative pressure but they have since stopped. The people who stock the stock room still come up. 

Overall not too much different than pre-covid other than pt population. 

[ccharlonne, ADN, BSN, RN]

Work on Progressive Care, we are surging. Our dedicated Covid unit is usually full, our ICU is about half Covid patients, my unit is 30-50% Covid patients. Lots of requests to work extra shifts, short on RNs and CNAs. Day RNs who should have 4 patients are caring for 6. Nights also have 6 patients. Often no CNA, so not only do we have more patients, we are doing our work and the CNA's work. Everyone getting burned out. We have had Covid outbreaks among staff, not sure of specific sources but lots of gossip. 18 people out, what an impact on staffing. On my unit we had a patient who tested negative via a rapid test, treated and discharged, became symptomatic after discharge and was readmitted Covid positive. Multiple staff who cared for this patient tested positive, but admin says it was staff-staff transmission, not from the patient. We wear surgical masks our whole shift except when we eat (if we eat). Full PPE when caring for Covid patients.

My recent assignment of 6 patients, with no CNA assistance, was 2 Covid patients - 1 with mild dementia, 2 complete cares in restraints (pulling lines/tubes etc) 1 was a stroke, one was chronic post accident mental status change both with g tubes and tube feeds, a cardizem drip and a heparin drip (Covid causes blood clots, several of my recent Covid patients also had PEs.) The doctors speak to the Covid patients on the phone, they don't go in the room to see the patient. Convalescent plasma transfusions keep me in a Covid patient's room for a while and I hope nothing bad happens to my other patients while I am unavailable. It feels like we have had an increase in falls, but I don't have data to know for sure. Every shift is so stressful and we feel unsafe for patients. There is little we can do except pick up extra shifts to try and help out. Management is paying incentive pay for extra shifts now, they have to to get people to keep picking up shifts. Nurses crying has become a common sight. I get so angry when I see the irresponsible behavior of people, and hear Covid is a hoax. I am dreading the post-Christmas surge that is coming - will this be my breaking point? I am in a serious moral dilemma regarding this situation and have seriously considered leaving nursing as a result. I wear my mask, I social distance, I stay home only to be called a sheep for following the guidelines, and know I will have to care for the selfish, ignorant people who don't follow the guidelines because they have "rights"  who come to the hospital when they get sick because they have a right to healthcare. As bad as I feel it is on my unit, I see on the news others have it worse.

I don't know what the future holds, when this is over will there be help for frontline workers who develop PTSD or other health issues? Or will we be treated like soldiers after a war and neglected or discarded? This country does not have a great track record for caring for veterans, we'll see how the healthcare industry cares for workers post-Covid. I guess that is the end of my rant, just need to keep on surviving till it's over. 4 more courses to complete my MSN, hopefully I will be able to finish it. Took a break from school to work extra shifts.

 

 

[Trigeminy, RN]

I'm currently a neuro nurse who's floor got transformed to the 'back up COVID floor' which filled with COVID patients the day they told us this.  Our COVID training consisted of 'here is how you mask and gown'.  He have had all covid patients since.  All of our rooms were converted to negative pressure.  We handle 4-6 positive patients per shift and are lucky to have an aide here and there.  Over half our nurses quit so they closed another med-surg floor and combined our staff.  We have a ton of nursing schools so the majority of our nurses have less than two years experience and my heart goes out to them trying to deal with everything.  We are short staffed daily and our PPE rules are atrocious.  We are to wear our gowns from room to room unless soiled and our N-95's are to be worn until they break.  We've been lucky here in western PA until the past two month when COVID came down on us like a hammer.  I work in a large facility that seems to think nurses are easily replaceable and are starting to realize that isn't the case.  Sorry for my rant, but I needed to vent.

[Kitiger, RN]

Wearing gowns from one room to the next might be OK when you don't have enough PPE. I don't know. But I am concerned because gowns - unlike masks - are likely to touch the beds.

If every patient had the same strain of COVID, maybe the cross-contamination wouldn't be as bad? Cohorting the patients is sometimes done. 

But what if one of them has this new, highly transmissible strain?

[JBMmom, MSN, NP]

I'm in ICU, generally 2-3 patients at this point. Our 12 bed unit currently has 7 COVID patients, and our inpatient units (about 200 beds), have 47 COVID positive. So we're not overrun, but we're busy. We have two floors deemed "clean"- our ortho floor and cardiology, so they don't have patients with COVID or admitted under suspicion of COVID. We are short staffed like everyone else lately. Med-surg is 4-6 patients on days and 5-7 on nights. PPE is reasonable at this point. N95 can be changed every shift. Shields are cleaned and used for as long as possible. Gowns and gloves are changed after every room. They stopped providing us scrubs when elective surgeries were restarted because they couldn't afford the uniforms for OR staff and floor nurses. I'm in Connecticut.