What is it like in your hospital right now?

ClaraRedheart, BSN, RN · Apr 14, 2020

We're still preparing for "the surge", but our COVID floor has gone to 25% of what it was 2 weeks ago... and it hasn't gone up. I wish I knew how many COVID patients our county hospital was admitting, because likely, EMS are filtering them to there. This is two weekends in a row where we've gone from 8 patients on a COVID unit to 5 the next week, coming down from a high of 20+.

LM NY · Apr 14, 2020

On 4/9/2020 at 2:13 PM, turtlesRcool said:
The nurses posting here are the nurses whose facilities haven't been hit. The nurses experiencing the surge are too exhausted to come and post here. Many parts of the country are still in the very early stages.
It's ramping up here. On Tuesday, the med-surg COVID unit I was working on had three patients (out of about 40) die within about an hour of each other. By that point, they had all been made CMO. Around 7:15 am, I went in to find one gentleman on a non-rebreather with sats in the 50s-60s with respirations in the 40s. The doctor didn't want a fast team, as they'd been moving towards comfort with the family. Really, the only thing left to do was to intubate, but he was DNI. Poor guy was struggling to breathe, and kept trying to take off the mask, I think because he felt like it was stifling. Anyway, we were able to get him comfortable after the family agreed to CMO, and he was one of the patients who passed that evening.
One of the nurses was near her breaking point, and said, "I just can't deal with having a patient die every shift." Fortunately, no one died yesterday, and this nurse has a long weekend off (was supposed to host Easter this year), so hopefully she'll be able to regroup before coming back next week.
Once the volume of COVID patients goes up in your hospital, you'll start seeing that uptick in deaths.

"The nurses posting here are the nurses whose facilities haven't been hit. The nurses experiencing the surge are too exhausted to come and post here."

You are absolutely right my friend. I work in a hospital in NYC. My unit started out with one R/O four weeks ago and we are about 60 positive on my unit alone. Our bed capacity is 68, so you can imagine. All day long, all you hear on the loud speaker are codes in different units. It is real. So many deaths per shift that there are no more body bags. Morgues are filled to capacity. There is a refrigerated trailer outside for the bodies. Some of these patients are walking and talking to you in the morning and by the evening they have deteriorated so quickly. There have been a few that got discharged. I wonder how they're doing.

Katniss88 · Apr 14, 2020

Recently we had to start reusing gowns. My reaction to that is, what's the point of even wearing a gown then. If you've been in a COVID positive room, that gown is contaminated, no matter if you don't touch the outside of it. It's a pain in the butt trying to put them back on too. Having to reuse N95 masks over and over is awful. Such an ordeal trying to take it off and put it back on without touching the front of the mask or the straps touching it. I don't fault my employer, it's not their fault that they cannot get a hold of much needed supplies because every hospital in the country is needing the same supplies at the same time. In normal times we would not go through this much PPE in such a short time. Everyone's schedules were changed to best suite the needs of the hospital, we normally self schedule. Initially I was very nervous working on a COVID floor for the first time, now it doesn't bother me much. I'm doing the best I can to prevent myself from getting sick or anyone else.

turtlesRcool · Apr 16, 2020

On 4/14/2020 at 12:38 AM, LM NY said:
You are absolutely right my friend. I work in a hospital in NYC. My unit started out with one R/O four weeks ago and we are about 60 positive on my unit alone. Our bed capacity is 68, so you can imagine. All day long, all you hear on the loud speaker are codes in different units. It is real. So many deaths per shift that there are no more body bags. Morgues are filled to capacity. There is a refrigerated trailer outside for the bodies. Some of these patients are walking and talking to you in the morning and by the evening they have deteriorated so quickly. There have been a few that got discharged. I wonder how they're doing.

It's so crazy how fast some go downhill. Two days ago, I had a patient whose O2 sats were 95-97% on 5L nasal cannula in the morning, and 92% on 15L non-rebreather by 2pm.

One nurse on the r/o COVID floor was dealing with an irate family member who was angry her mother didn't get a meal, and was very angry when a nurse explained she was dealing with a dying patient and didn't have time to round to see which other patients had a tray yet. Family member was not happy at being told that dealing with a dying patient was more important, and said, "I don't believe there are patients dying on the floor my mother is on." Nurse wasn't quite sure what to say - had this lady not heard that were in the middle of a damn pandemic? Even in normal times, every floor has patients pass now and then, and she doesn't believe there are deaths in the middle of a pandemic?

Of course, some get well and go home or to rehab. Now our overhead speaker is playing "Here comes the sun" every time we discharge a COVID patient. It's kind of like the lullaby they play when a baby is born.

Unfortunately, we've seen some of the COVID patients come back. Thought they were stable enough to leave, but weren't.

FloatFNP-C, BSN, MSN, NP · Apr 16, 2020

still in the denver metro area, still hardly any covids and the rate is decreasing dramatically.

bjz003 · Apr 16, 2020

Well I've been off but the last time I was off I was working ICU which the converted step-down to ICU. We had a few beds open, 3rd floor is a non covid floor, 2nd floor covid no vents, and 1st floor was closed. I came back after being off, 1st floor full all floors full, and moving patients into the PACU if a vent is needed. When I left a few passed, one was on comfort care and 2 more were placed on comfort care. Most were nursing home patients. No family allowed in the hospital so we use tablets an zoom so they can see their loved ones. So sad families saying goodbye through zoom. Last night my husband and I got news that my mother in law, who is in a nursing home, tested positive for covid. Someone needs to step in and come up with a solution for nursing homes. They have no visitors so either staff is bringing it in or those going out for dialysis. South Jersey

CJC · Apr 17, 2020

I am float pool. We have all been canceled these past 2 weeks. No one has worked due to low census. The last time I worked was 3/19. We are not getting paid PTO or time off since we are not benefited employees. I have applied for unemployment. Yes we have not been laid off or let go but we have not worked or had any income since low census, so we have been effected due to the Corona Virus. We were told that are company is planning to let go of travelers. I think we as Float pool will be let go second if census doesn't pick up. In the mean time I will continue to File unemployment every Sunday till I get hours at work.

Ado Annie, ASN, RN · Apr 19, 2020

I'm working on a surgical floor. Our census is lower, most of the time, but because elective surgeries are not happening, the patients we do get are those that are really sick. The workload on this particular unit can be overwhelming even under "normal" circumstances.

I've been floated to the Covid-19 rule-out unit once and those patients were mildly ill and waiting for results.

Transferring, discharging, and directly admitting patients has become considerably more difficult.

malamud69, BSN, RN · Apr 19, 2020

Update: Major city hospital/trauma center-close to NYC

Hospital/corporation attempted to make people reuse PPE-Union fought back-policy immediately discontinued.

“Hazard pay“ initiated by hospital more as a CYA attempt by management-in actual reality it would most likely never be initiated based on current circumstances and how it was written.

Still under-staffing/canceling/mandating more hours to full-time employees while having Perdiem’s fight over the crumbs

Current staffing policies changing daily/sometimes shift by shift… Causing confusion among staff

Employee testing basically at zero unless they are extremely ill-multiple employees walking around with the sniffles etc...and depending on what political bent they seem to have sometimes wear their masks sometimes don’t and some just don’t seem to care while others 100% care…

Drive-through testing tent limited to the number of tests and results take days

Most patients that come through emergency are C19 patients yet amazingly still a trickle of the “frequent fliers” with complete nonsensical complaints being allowed in because still no effective pre-triage tent/set up initiated

MD/PA shifts and pay cut

Due to the lack of staffing when things do get heated/busy things become dangerous and people are not clear as what to do/what not to do -not to mention LTC/similar facilities constantly send residents that they want tested knowing that we cannot test them in that capacity causing more danger for everybody as most every single facility that they are sent from has positive staff and residents

Sometimes it feels very calm and sometimes it’s a cluster$&@“

Sadly some staff have become ill w/ C19

Sadly many of us exposed with no follow up because we have very little mass testing capacity...

hiidontspeakenglish · Apr 20, 2020

I work in a medical floor turned into a corona ward / floor for the time being, meaning we only admit covid-positive or covid-suspects, and if they turn into negative we may transfer them or treat until discharge, depending on the sit. Most of the suspects and positives still have other medical problems which brought them into hospital.

I just started this job a few weeks ago, before this I worked in a nursing home. Which was/has been hit with corona -- at least 3 residents have deceased and the whole place turned into a nightmare.

I write from a northern European country btw, so pardon my english. It has been interesting reading how corona has been experienced in healthcare elsewhere. And of course, really sad. I am seeing many tragic situations in my country/hospital and in my daily work, and can only imagine, how much more devastating it is in the places that are worst hit.

A few days ago I took care of an elderly cancer patient who was turned into a palliative case, it was determined that he wouldn't be able to go home anymore. He came to us as a covid-suspect but his tests (3 of them, our doctor orders sometimes 2 or 3 tests for a patient depending on the clinical picture) came back negative, and he was treated in an 1-person isolation room (but after tests came back negative, nurses treated him without PPE -- as is our rule, you don't have PPE for negative patients, although it did make me feel bad as this man was very immunocompromised and weak and in normal times, PPE would probably have been used with this kind of patients at least during the flu season ). His family could not come there, as all visits in corona unit are forbidden. His family then made arrangements, with our staff (me included) to arrange him a palliative home placement. He was going to get one -- until, the palliative care home declined to admit him based on the fact, that he has been in a corona ward (albeit tested negative for corona). So sad, to be dying alone inside a ward that cannot offer you good palliative care , not to be able to see family. Well, actually the fight went on and it was arranged, that he eventually got to go to the palliative care home.

It was just one example how tragic situations can evolve for all kinds of patients and their family members, even those who not have the corona themselves.

I am interested to find out, do you others use PPE with covid-negative, but immunocompromised patients, especially inside a corona unit?

Kaylight, MSN · Apr 20, 2020

I work on a corona unit that is a combination of Med-Surg, PCU, and ICU all in one unit. All of ours are positive except that we did have one guy come in for a heart attack (the unit was previously a coronary unit), and he was tested for Covid. He had some symptoms, but we weren't sure yet. They did use PPE because they weren't sure. We had one negative test, but we try to get them off the floor as soon as possible.

Normally if we have someone who has lowered WBC's or immune compromised they are placed on neutropenic precautions, which means they wouldn't have live flowers, and fresh fruit. I sometimes wear a mask to protect them from me.

Delia37, MSN · Apr 21, 2020

Hi,

I work at a teaching facility in OC, Southern Ca. So far, we are still waiting for the influx of patients; however, we are in the process of cross training our step down and PACU nurses to work in ICU in case we become overwhelmed in the ICU's. We currently have 2 designated COVID units and last I heard we have 35 COVID (+) staff. So far, my facility is offering 220 hours to anyone needing to time off related to COVID. Even though, there is tension in the air, I think my facility is doing everything they can to help us care for our patients; the community around us has also been very generous and supportive.