Comment: Covid has changed things for hospital staffing

Beyond the disease, the demands for care for non-covid patients have increased. Staffing must increase, too.

By Andrea Hardestry / For The Herald

As a nurse working in the largest hospital in Snohomish County, not only am I seeing patients directly affected by Covid-19, but many more patients are being affected indirectly by the virus.

In the first few months following the onset of the pandemic, we initially saw a decrease in our patient population. Essentially, we were seeing patients with Covid-19 symptoms and patients with traumatic illness and injuries. Only patients who had absolutely no other choice were seeking care. For many months we were overstaffed. The opportunity to take time off for respite was available and heavily used in the spring. As the cases of Covid-19 declined locally, we began returning to a normal workflow with surgical and procedural patients.

I work on a surgical floor. Patients are admitted to our unit from the emergency department, or elsewhere in the hospital for us to prep them for surgery. Following surgery, patients return to our unit for recovery. In a typical year and under “normal” circumstances we can balance nurse assignments with one or two high-acuity patients and two or three stable, less acute patients.

This is not a typical year. These are not normal circumstances. We are seeing patients that are sicker than ever and not from Covid-19. Patients have not seen their primary care doctors in over six months. Patients have not seen the specialists handling their chronic health conditions like heart failure, hypertension and diabetes.

Either they or their care providers have been too afraid to carry on business as usual the last six months. So now they are in the hospital with festering wounds, undiagnosed fractures, anemia, hyperglycemia, hypertension, gastrointestinal bleeding, and an unbelievable amount of confusion related to acute metabolic encephalopathy. What is that you ask? Encephalopathies are a result of abnormal brain chemistry due to lack of glucose, oxygen or metabolic cofactors (which are usually vitamin-derived) and those due to peripheral organ dysfunction. Not only are patients very sick, they are confused and impulsive.

In the coming months Providence Regional Medical Center and the nurse’s union represented by UFCW 21 will be in the middle of negotiating a new contract. Everyone involved is preparing for a fight. Even support staff not involved in contract negotiations are vested in the outcome.

There is a staffing shortage at the hospital. Across all specialties staff are overworked and many are underpaid. While there is some talk about hazard pay related to the lack of appropriate personal protective equipment (PPE) and the pandemic, most nurses just want more staffing, appropriate staffing to ensure not only patient safety but staffing that ensures the health of our patients improves while in our care.

Our current staffing ratio model is built based on a typical year. This is the worst year. We need staffing models based on the acuity of patients being seen now. We need staffing models based on no visitor policies. Having a support person bedside, whether family or friends improves patient outcomes.

It improves patient safety. Family members can reorient a patient and prevent injuries from happening.

Patients who are confused are at the highest risk for fall injuries. Patients no longer have safety nets or moral support. This now falls solely on the nursing staff.

Our nurses are experiencing moral distress. Every day we are forced to forgo providing the best patient care and only providing minimum care. We are seeing more near misses. Instead of detecting patient deterioration early and providing interventions, we are calling more codes for cardiac arrest or a code known as an ASAP. This is a situation where the patient’s status is so precarious, that a team of an ICU nurse, respiratory therapist, and the doctor converge to make urgent and sometimes life-and death-decisions.

Instead of providing comprehensive nursing care, we are running from patient to patient narrowly preventing falls and injuries from occurring. Patients are so sick and out of their minds they require two nursing staff to provide care.

Often three or more patients in the nurse’s assignment require this level of care. Many of the patients require a mechanical lift mounted on the ceiling to move them from a bed to a chair to eat meals. We must move them in order to avoid bed sores from developing, so leaving them in bed is not an option.

These same patients require help turning every two hours and need assistance with feeding themselves, not to mention toileting.

Why am I telling you this? We are not staffed appropriately. I want the public to know, that I am grateful to have a job. Every nurse I work with is grateful to be working. Many are now the primary breadwinner in their household. I want the public to stand behind the nurses when we meet to negotiate the terms of a new contract with Providence. Yes, we will ask for raises. We have worked tirelessly in some of the worst conditions to keep your loved ones safe and alive. This has come at the cost of our own health and wellbeing. The stress and the fatigue have deteriorated our physical and mental health. More than anything, what we want are safer conditions for our staff and patients.

The hospital should be the safest place for your family member. At the end of October, the contract between Providence Regional Medical Center and the nurses’ union expires. We want more staffing in order to deliver the best possible care to our patients.

Andrea Hardesty is a registered nurse and a certified nuclear medcine technologist at Providence Regional Medical Center Everett.

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