As April passes with some showers and May is anticipated for flowers we are yet again in the midst of a strict lockdown. As a nurse I am certainly dismayed by the rising column of ICU patients, requiring care from an increasingly tapped out health care workforce. I hear it in the voices of friends and colleagues who practice in the acute care sector. The reflection how did we get here will likely be explored for many years to come, until the next pandemic.
As we are currently in the COVID-19 pandemic we are left to ponder what was needed in February or early March to stem the incline of critical care patients. Experts agree there is a lag time in number of cases and those who progress to a worsening state. Let me say our critical care beds are close to 100% occupancy during “normal” times and now a number of the hospitals provide nursing care in non-traditional areas. This is a key point patients are not just occupying a bed–they are in need of close monitoring, specialized treatments provided by critical thinkers, Registered Nurses, who right now in ICUs all over the world have been working in a different reality for weeks.
Vacations were for the most part left to accumulate in their banks, statutory holiday hours have also accrued. Overtime, there is no budget line, it’s however, whenever, whoever can be asked, cajoled, begged to stay or go in for another shift. The resources needed for ICU patients is usually one nurse to one patient. This pandemic requires a different ratio a number of ICU patients are grouped in 3-4 (or more) to one ICU nurse. To assist the ICU nurse another 1-2 nurses will be drawn from other areas of the hospital. They will provide the observations, assessments, clinical judgment, skills, etc. that extend the precious resources of experienced ICU nurses. Understand in critical care you can be critically stable (life support, medications, nutrition, other treatments) to critically critical (multi-organ failure, dialysis, proning, minute to minute adjustments, and the previous list of tasks). This is where a community provides care to each patient; physician, RN, Respiratory Therapist, physiotherapist, consulting services, support staff, and sadly no family members.
Families are updated by phone, face to face used where possible, but the anguish of lives lost has and is shouldered by RNs and the health care team. It is they who hold a hand, stroke a shoulder, wish them well on an unknown journey called death. Tears are near, and many of my friends and colleagues to paraphrase “I don’t have any more tears to give…..fatigue does not capture how I feel…so much loss, so much pain, so much….”
So yes for the lockdown I go to work and I come home, okay golf courses and ranges are closed, shopping is minimal. People please think very carefully before hopping in your vehicle to go out your decision could be costly. To members of the public and to the many health care team members who are beyond tired, burnout is apparent–the cost of this pandemic is not fully known. Namaste
Registered Nurse Storyteller, Healer, Scribe, Transformational Leader
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