Last year nurses were really excited about 2020 being the year of the Nurse. It is Florence Nightingale’s 200th birthday, and there would be lots of great opportunities to honor her and all nurses. Fast forward to pandemic mode, where all celebrations are off the table, and nurses are knee deep in ever changing policies surrounding the worst case scenarios they have seen since the 1980’s , when HIV first reared it’s ugly head. In retrospective, HIV was a picnic comparatively, as we soon found out how it was transmitted. Viruses though are nasty beasts, they cannot be cured through antibiotics, most of them are a wait and see approach and supportive care, so it is a very tense this tincture of time, for treatment to take effect.
Nurses have been the cornerstone of healthcare for as long as healthcare has been around. The normal shift is twelve hours, so they get to know you pretty well. They see and trend your vital signs, labs work and little nuances that even you don’t sometimes recognize. But we all work as a team, a symphony if you will. Everyone has a part to play and without one part, it would sound different, not quite right. Doctors,Nurses, Respiratory Therapists, Physical Therapists, Occupational Therapists, Pharmacist, CNA, Dietary, Environmental Services, Engineering, Secretaries, Material Management,IS, Communications I mean the list is full of services that a Hospital, Nursing Home, Doctor Office and others provide for patients. But the nurse is the director, the one in the middle , organizing all these parts for the patient. The career is rewarding but can take its toll.
As COVID hit, nurses were really ill prepared, they took what plans they had for Ebola preparation, the patient they never got, and modified it to fit the COVID population. When the recommendations came in ,they changed policies. They brought nurses in for classes, and while the classes were going on, as they were teaching them, they were changing policies, so the teachers were getting emails as they were teaching, and changing as they went. This is how resilient nurses have to be.
People realized quickly, that Personal Protective Equipment (PPE) was running out . Many had to change policy for other patients, to conserve PPE. The guidelines from National organizations kept changing, you do not have to wear masks regularly, unless you are in COVID rooms, wait, now you do. COVID rooms now have to have N95 masks, the ones we use for Tuberculosis, but they quickly were scarce. People were told to reuse them. Then it was said to use to ultraviolet light to eradicate the COVID on them. There were contradictory claims that this would degridate the mask fibers. Imagine being a nurse, would you feel safe wearing a used mask?
As all these policies were being updated, changing and changing again, nurses were on the floors dealing with many unknowns. Treatments started with hydroxychloroquine, zinc, and supportive therapies, such as oxygen, if necessary intubation ( a tube that passed through the vocal chords into the lungs and is connected to a respirator/ventilator).As blood pressures went down, many IV drips were added that the nurses constantly had to titrate up and down. Then some of the patients develop Acute Respiratory Distress Syndrome(ARDS), and need to be on their stomach or proned. This takes a few nurses to achieve .The nurse has to maintain all these therapies, and every time anyone enters the room you must don ( or put on) PPE gown, gloves N95 mask or Capper Shield. You have an observer to make sure it is done properly. and when you leave the room you doff, or take off the PPE in a certain manner. you then must clean all the equipment used. There are many pictures online of what the masks do to the face, sores behind the ears and on the nose, rashes on the face as well.
As there were more patients, there were more needs for PPE, and more nursing needs. Mentally, it takes its toll. The gear has to be perfect, every seal has to be perfect, because this is extremely contagious. They think about their kids, their aging parents. one rip one tear, and it could be over, and that is where the line gets fuzzy. They are questioning whether it is worth it. Nurses are having to choose their life over their profession now. And for some it is not a easy choice. 2020 is not only the year of the nurse but the year that many are up for retirement. Some were going to wait a year or two, now many are deciding to retire early. They are thinking that it is not worth risking their lives.
In a survey of over 100 nurses, 93 sated they knew someone or they themselves were quitting their job due to COVID, only 15 stated they did not know anyone who was quitting, and 12 stated they were retiring early. Some cited lack of proper PPE to do their job, child care issues with online school, mandated overtime, poorly run hospitals that don’t care about staff, and some say they are they are changing professions all together. Many say they would quit if they could.
Staff are also leaving because of COVID, but in a different way, they are going to work for travel agencies specifically to take care of COVID patients and making triple money than what they are as a staff nurse, for taking care of the same patients. This puts a different edge to a problem and that is attrition of staff due to competition. What happens in these situations, is that then the places they left has to hire travelers that end up making lots more than the regular staff doing the same job, then they get disgusted and leave to travel, you get my point, pretty soon you have a bunch of units with all travel nurses. That is not bad, travel nurses have great skill sets. Usually seasoned nurses continue to stay permanent positions because they have been there so long for the benefits.
There is no way to know for sure, but The Guardian is stating that there are as many as 821 healthcare workers deaths are due to COVID 19. Nurses are scared, scared of dying and worried about passing it on to their children, spouses and parents. Many of them are essentially living separate lives from their families, staying in apartments, or basements and not interacting with their families due to fear of transmission, especially if they have loved ones with immuno-compromise. Many nurses themselves have secondary diseases such as high blood pressure, diabetes, they do not know if the person they are taking care of is positive, as now testing is not coming back for days. Working is essential to put food on the table, there are many single parents, they will not be able to get disability or any money to stay home. so they are stuck trying to do the best they can praying , hoping the vaccine will come soon, and that it will work. They are so torn, they know they must be there to help patients, for if they are not then who? So they continue kissing their kids through windows,undressing outside before they enter the house, spraying down their shoes with handmade lysol, looking for a miracle, normalacy.