The Real War Against COVID-19 in America

[nataliadab, MSN, RN]

By Natalia Dabrowska, MSN-CNL, RN

Change for the Future

In all the craziness in the midst of COVID-19, it is easy to only focus on the present, but we cannot forget to elicit change for the future as well. If we don’t do it now, it may never be done. No more pushing it off or putting it on the back burner with, “Well this is how it’s always been.” That clearly does not work.

Shortages of Staff and Equipment

I am currently working across three different hospitals navigating this pandemic. Like everywhere else in the country, there is a shortage of masks, equipment, PPE, possibly ventilators and beds. There is also already a shortage of nurses and staff on a GOOD day, without these huge spikes of hospitalizations flooding in. Well here’s some news that nurses have always known: There is not actually a shortage of nurses—There is a shortage of nurses willing to work UNDER THESE CONDITIONS.

Case and point: While we are being called to the front lines without proper gear, being rationed protective equipment, we ourselves are not being rationed. For instance, my main job is as a pediatric pulmonary nurse coordinator. I have two other nurses who share this same role with me. Usually one of us is in the office, one of us is with patients, and the third may work on the Cystic Fibrosis registry and research. In an effort to reduce exposure to patients, we cancelled all non-urgent appointments, testing, research, etc. This put all THREE of us coordinators in the office the same day.

One of our doctors was fuming. She said each of our chances of contracting COVID-19 is OVER 50% and if one falls down we ALL fall down. Still, administration and management did not budge. They continue to lead “updates” via zoom meetings, where they sit on camera in sweatshirts from the comfort of their own homes while we put ourselves at risk.

This article is featured in the Spring 2020 issue of our allnurses Magazine...

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A Time for Change

This is the first sign that it is time for change. There is no room in healthcare for people who choose to sit at home rather than jump into the trenches when patients and entire communities need us. The reason our Healthcare System so often fails us is because there is NO room for it to be business-driven and for-profit for a small group of individuals ready to cash it all in.

Why Weren't We Ready?

THAT is why we were not ready for something like this. We should have been ready. There is no excuse. Yet we weren’t because we have non-medical people making decisions along with medical people who somehow never even put hands on a patient. These are the people we let run the show and it is shown time and time again that this FAILS.

We are one of the most developed first world countries on this planet and we continue to have one of the worst healthcare systems. We have high rates of maternal mortality, infant death, and others. There is NO excuse for this. We work short-staffed or with unsafe assignments while “higher up” people don’t care.

What they care about is apologizing to the patient who had a meltdown because the cafeteria put orange juice on their lunch tray instead of apple juice by mistake. They don’t support the patient’s nurse who gets blamed for this even though she kept a very sick patient alive that day while juggling 5 others for 12 or 16 hours. It is too often a thankless job. And yet, the nurse who does this day in and day out is the one who does NOT get listened to about making changes and improving workflow, patient care, and safety.

Who Cares About Employees' Health?

We give all of ourselves for a system that does not even realize it would collapse without us. This is even better shown with this example during this pandemic: One of our CRNA’s worked side-by-side a doctor during a five-hour surgery. This doctor later became symptomatic and tested positive for COVID-19. The hospital told the CRNA that he was exposed but could not get tested and that he should self-monitor—but come to work still. This group of CRNA’s later bought their own respirators because the hospital could not provide them with enough. Instead of applauding this, the hospital told them they cannot wear them because IT MIGHT MAKE PATIENTS AND VISITORS NERVOUS. So, who cares about our employees’ health as long as we minimize any concern for everyone else (who is in even more danger if our exposed employees are walking around unprotected)?

We are at war during this time with COVID-19. We are at war and we are not properly equipping our soldiers. We are at war and our generals are sitting at home hoping that not all of us fall while fighting their battle for them. We are at war and having to sacrifice ourselves.

Make no mistake- medicine is built off of the sacrifices of our soldiers. We give up bathroom breaks, lunch breaks, holidays with families, weekends, sleep, and more. We even risk ourselves when we know we shouldn’t. I once ripped my gloves off at a micro-preemie delivery when it was believed mom had an unknown infection. We had finally gotten the tiny endotracheal tube in the right spot, about 6cm at the lip, and I had to tape it in place, with what you can imagine was a tiny, tiny piece of tape. This is always a rush to ensure we do not lose the tube and get the baby stable as soon as possible. The tape kept sticking my gloves and I couldn’t peel it off, so I finally ripped off the gloves and thereby exposed myself to this baby covered in maternal fluid.

I did this and do things like this, because we all do at some point in our careers, because in this game of life and death we try to win at life as much as possible. We do this because when we have a really hard shift or a death, part of what heals us is being able to look back on the situation and say, “I did everything I could have possibly done. I gave it my all. We all did our best.”

My fear is that we may not be able to say this when we look back at COVID-19. We are already at a loss and drowning. We don’t have the equipment to do our best and we may get knocked out in the process. So we while we continue to try the best we can with what we have, we cannot forget that when this war is over, our war on the healthcare system is just beginning.

Enough is Enough

We have to continue to come together and rise. We finally have to say enough is enough and not back down anymore. We have to storm the streets and government buildings the way we are storming the hospitals to fight this thing. We have to demand safe staffing ratios. We have to demand appropriate compensation. We have to demand a complete reform of the structure. We have to demand putting selfless, medically competent people in charge to pioneer our hospitals—those who come into the trenches with us when we need leadership and all hands on deck. We need to make our healthcare system something better than using drowning nurses as pillars and Press Ganey scores as the entire foundation while our “leaders” sit on top in the ivory tower.

Now More Than Ever

The time is now. No, actually, the time was yesterday, was years ago, but the next best time is now. We owe it to ourselves and we owe it to our patients. We owe it to our communities and to all those who will be joining this humbling workforce after us. These burdens we have been carrying on our backs can be eased with a paradigm shift. It is time to rebuild.

This war may be our hardest and most challenging one yet, but it is the most necessary, now more than ever.

[TriciaJ, RN]

Amen, sister. We have long spoken sardonically about the "pumps-and-pearls" crowd. I guess now they're the sweatshirt crowd. They have NO place in healthcare.

If they have their position by virtue of medical training, they need to be part of the scrubs crowd. No more leading from behind. They need to be in the trenches or they need to make their money in another industry.

[LittleOldLadyWho, ADN, BSN, LPN, RN]

Would that all these things could be resolved. But we know how this will turn out... Nurses, doctors, healthcare providers who give a damn, will continue to sacrifice for the community they serve. CEOs and others upper administration will continue to take all they can in salary, bonuses, and other benefits. We make our choice and live with the consequences. It's hard to walk out on patients who need you. God bless us everyone.. ?

[MSO4foru, ADN]

I am ' hoping' this will be huge wake up call. My area has few cases- only one in hospital and the powers that be already restricting PPE use. OK- sorry if I am being selfish- but CNO, you can don some scrubs and reuse a mask that's been in an Influnza A room for a 12 hour shift. This mess is not even Really in my area yet and this is what we're doing. Oh yes- am sure more PPE on the way. I just fell off radish truck and believe that?

[HandsOffMySteth]

The healthcare system is a mess and has been a mess for a long time. I think there is just too much money to be made to keep corrupt individuals away from it. When someone has a huge paycheck and a ton of authority (like an administrator) don't expect them to fix anything. They are comfortable with their lifestyle, why should they "work"?

I sure hope when this crisis is past that there will be a renewed vision for healthcare operations. There needs to be some accountability.

[Myrtle1061RN, BSN]

The public may never be more ready to hear this message. We all need to spread the word on every social platform that NOW is the time to fix healthcare for ourselves and future generations.

We need to let them know that the alarm has been sounding for years that we needed to prepare for a pandemic, but our hospital leadership, and our local, state and national government officials ALL failed us, as a nation.

The public needs to be educated that what they perceive as “choice” in choosing their healthcare is a lie. There is no real choice when hospitals charge what they want (just try to get an estimate on what your gallbladder surgery will cost you!) Is it really your choice when insurance companies profit off of your suffering? And the whole medical establishment drowns the patient in red tape, arcane rules and nonsensical policy.

Never before in history have there been so many highly paid hospital administrators and CEO’s. And what do Americans get in return from all these healthcare ‘experts’? As one of the wealthiest industrialized nations in the world, our healthcare is an embarrassment.

Maybe now, while our fellow Americans are seeking medical knowledge and care we can educate them and changes can be made.

[skylark, BSN, RN]

Your comment about being at war sums up this whole situation perfectly.

The lack of PPE is just plain dangerous. Even the financial management must be able to understand that if a nurse gets sick because of a lack of PPE, they are going to talk to a lawyer, and also its going to cost to get an agency or travel nurse to replace them.

But the bigger picture is that healthcare in the US is unlike anywhere else in the world.

Its a BUSINESS.

Not a public service, not a community facility, just a business. And for decades, American healthcare has been a ticking timebomb, because facilities are built for the sole purpose of making money.

Everywhere else in the world, hospitals are designed to serve the local community. And for that reason, their facilities include dedicated isolation areas.

Most hospitals in other countries have their isolation rooms in a separate suite on the top floor.

It has a separate entrance, so patients don't get brought in via ER and wheeled right through the hospital.

It has proper anterooms and segregation, so staff gown up and then dispose of PPE without any risk to themselves.

It has disposal chutes, so linen and trash drops down a chute to a waiting dumpster in the basement.

Compare that with your typical American hospital.

No dedicated isolation suite, maybe a few rooms scattered around the hospital that are capable of have controlled air flow.

Shared access, so "isolation" patients are transported via ER, through the main hallway, and in the elevator alongside "clean" staff, visitors and patients.

Trash and linen is removed by the regular environmental team, dragged along the hallway and taken downstairs in a regular elevator.

But because the American healthcare "system", if it can even be called that, does not have any of these facilities, covid will continue to be a problem here, long after the rest of the world has wrapped it up and moved on.

This is not going to go away. Healthcare needs these facilities, but because it is simply a series of separate businesses, nobody sees it as their responsibility to build them.

We do not have healthcare as the rest of the world has it. And you cannot separate it from politics, until such time as we finally have a system that works.

[waufah, BSN, RN]

• We have turned our hospitals into five star hotels and nurses are the scapegoat maids when there are problems
• Enough of the two tiered health system that increase health disparities.
• Enough of unsafe patient ratios that are not based on patient acuity or skill levels of the staff
• Enough with the open door visiting hours which do not improve patient outcomes
• Enough of basing Medicare/Medicaid reimbursements on patient satisfaction scores
• Enough of million dollar,state of the art machines that only inflate the real cost of health care
• Enough of for profit hospitals that cut employee benefits to increase their profit margins and big bonuses
• Enough of big pharma,insurance companies lobbying and controlling health care in America.

[ML1376]

So how to get organized to effect real and lasting change? Where to begin? I agree 1000% with your post, but the idea of making it a reality seems overwhelming and sadly unrealistic being how firmly rooted and how tied to everything else the system is. Thoughts?