Life as an ICU Nurse in New York City During the COVID-19 Pandemic

Photo by Jonathan Borba on Unsplash

It happened about a month ago. We received the first patient to test positive for COVID-19 in our ICU. At that point, we had already seen a handful of “rule-out” patients come through the unit, but they had all turned out to be negative for SARS-CoV-2. This first positive case was just the beginning of our battle with this seemingly indomitable enemy.

Yesterday, 100% of our ICU patients were positive for the virus, with many more in the emergency department waiting for ICU beds. I have witnessed firsthand that COVID patients are dying quickly and in large numbers every single shift. Each week, I come to work to find that our patient census is almost completely different because many patients from the previous week had died from complications associated with COVID-19. It’s important to mention that not all of them were elderly, and not all of them had pre-existing health conditions. The effects of this virus are serious and unpredictable.

The most difficult part of my job during this crisis has been seeing patients dying all alone.

Due to the high risk of infection associated with the virus, my hospital and many other hospitals in the city have suspended visitation for all patients. Exceptions have been made only for pediatric and labor & delivery units, which are allowing one family member to be present at limited times.

Because COVID patients have been deteriorating so quickly, for those who die from the disease, their family members are unable to be with them in their last moments. For patients whose family members live far away, the bodies are sent directly to the morgue because of the need to make room for patients awaiting beds. Even if one or two family members are able to come to the hospital, they are not allowed to come close to the patient’s body because of the infection risk, removing the opportunity to say goodbye. And because of social distancing guidelines, funerals cannot be held. This heartbreaking “new normal” has been devastating to see every single day.

In addition to the emotional and mental toll this pandemic has taken on healthcare providers, the physical exhaustion and burnout is putting us at risk for compromised immune systems and disease. Each 12-hour shift I’ve done over the past month has given me three “normal” shifts’ worth of fatigue and stress. The increased patient volume and acuity has kept us on our feet almost nonstop for 12–13 hours at a time. Nobody has been able to take their full meal break because of their patients’ labile conditions.

It has taken me weeks to finish and publish this article because I have just been completely exhausted in every capacity from being on the front line — at the epicenter — of this pandemic in the U.S. Yet I feel that writing this article was necessary to reveal the real working conditions of healthcare professionals during this horrific crisis.

The Hospital Staffing Crisis

Right now, hospitals in NYC (and likely everywhere else) are experiencing staffing shortages and are struggling to operate effectively because of it. The main factors contributing to the staffing crisis are:

  1. Nurses (and their families) are becoming ill due to the SARS-CoV-2 virus. Nurses spend the most time at the bedside providing patient care. Every nurse that calls out sick closes hospital beds. For example, each ICU nurse takes care of up to two patients, so a nurse call-out closes two beds. Nurse-to-patient ratios in the different units of a hospital are based on patient acuity (the measurement of the intensity of nursing care that is required by a patient). Each nurse in other units, such as step down or medical-surgical units may take care of 4 or more patients. Thus, it is the nurses who determine a hospital’s patient capacity. Ventilators are useless without nurses to operate them.
  2. Hospitals have increased their patient capacities without a corresponding increase in staffing (of nurses, doctors, respiratory therapists, patient care assistants, phlebotomists, pharmacy techs, unit clerks, environmental safety employees, housekeeping, etc.) Hospitals have not been able to hire and mobilize additional staff as quickly as this crisis has required. Recently, temporary field hospitals, such as the hospital tents in Central Park, the Javits Center, and a navy ship have begun operations in New York City, and yet healthcare staffing has not caught up. The government has even resorted to putting out advertisements encouraging retired healthcare providers to return to work in order to help alleviate the strain in hospitals.
  3. Hospitals do not have enough critical care nurses. A large number of COVID patients are requiring intubation, meaning that they need ventilators to assist their breathing. Not all nurses are trained to manage these machines. However, in an attempt to meet the staffing needs, hospitals have been floating nurses from their regular units to COVID units. But because they don’t normally manage critically-ill patients, the burden still falls on the critical care nurses present to manage the ventilators, suction endotracheal tubes safely, titrate vasopressor infusions, assess patients’ sedation levels, manage continuous renal replacement therapy (CRRT) machines, and so forth. Floated nurses are put at risk when they’re forced to manage patients that they have not been trained to care for, and critical care nurses are being pushed beyond their normal patient ratios because nobody else can manage these patients.

Regardless of the cause, the results of a staffing shortage are the same: staff burnout, compromised patient safety, and dangerous working environments. As the emergency department (ED) becomes overwhelmed with patients waiting for inpatient beds, hospital administrators been pushing patients to the ICU and other units anyway, knowing that staffing is inadequate. This results in delayed medication administration, dirty medical equipment and hospital facilities, delayed lab results, and so forth.

If a patient codes (goes into cardiac arrest), this requires most of the nurses to stop what they’re doing and help out, further delaying interventions that they were already running behind on due to lack of support. Codes are very messy, leaving patient bodily fluids as well as medications lying all over the floor because of the emergent interventions required all at once during the code. Without adequate support staff, most of the floors are saturated and trash bins overflowing with these hazardous wastes for hours.

When there are not enough transport staff, nurses and doctors have to transfer patients (pushing the stretchers, IV poles, and ventilators) themselves from one unit to another, pulling them away from all their other patients. The list of consequences goes on and chaos ensues.

The Personal Protective Equipment (PPE) Shortage

There has been widespread media coverage on healthcare workers being forced to care for COVID patients without the proper protective gear. Yet this problem persists. The lack of PPE is resulting in more and more healthcare providers acquiring the infection, transmitting it to their co-workers and family members, and ultimately dying from the disease. By not providing adequate PPE, hospital administrators are only creating more patients.

Yesterday in my ICU, we had only a few boxes of N95 respirators, face shields, and protective gowns left for our entire unit. It hasn’t helped that the Centers for Disease Control and Prevention (CDC) approved the use of alternative PPE such as bandanas or scarves when the face masks run out. There is no protection provided by such homemade masks. The only acceptable solution is the production and distribution of more PPE.

Hospitals forcing their staff to re-use N95 respirators, goggles, and face shields for a week (despite the PPE being designed for single-use only), actively endangers us all. In light of this reality, it shouldn’t come as a surprise that the number of positive cases in New York state jumped from just hundreds to almost 150,000 over just a few weeks.

We are risking our lives every time we enter a COVID patient’s room, because the virus is in every droplet in that room — droplets that the PPE is meant to protect us from. Nurses in particular, are the ones who are swabbing patients for COVID-19, essentially providing the numbers for their hospitals. If we’re performing all of our duties using dirty PPE, we will become infected, and most of us probably already are. Unless healthcare workers are protected, the number of casualties to COVID-19 will only continue to rise.

The Lack of Testing Among Healthcare Providers

Surprisingly, it is very difficult for a healthcare provider to get tested for COVID-19, at least in NYC hospitals. Even though we’re exposed to patients who have tested positive, our hospitals are not testing us unless we become symptomatic. This means we may be unknowingly infected but continue to come to work, spreading the virus amongst each other everyday.

Even more alarmingly, hospitals are telling employees that they can continue to work even if they test positive for COVID-19. This is evidence of blatant disregard for healthcare providers’ safety and wellbeing, and is a counterintuitive approach to preventing further transmission of the virus. This practice must be stopped. We’re already inadequately protected from the virus at work because of the lack of PPE, staffing shortages, and unsafe working conditions. The final straw is that we are denied testing for the virus that we are constantly, forcibly exposed to.

How We Can Overcome COVID-19

  1. Protect healthcare providers by providing sufficient PPE, safe staffing, and adequate compensation (including hazard pay). Listen to healthcare providers who are voicing their concerns about the real situations in their hospitals despite the fear of being disciplined or dismissed by their workplace.
  2. Increase testing capacity. There are not enough COVID tests for everyone who needs to be tested. The federal government must increase funding to produce and conduct more tests. Hospitals should provide free testing to their employees who have been exposed to COVID-positive patients.
  3. Continue and extend social distancing mandates as necessary to flatten the curve. As of today, not all states have implemented social distancing guidelines and even those that have are seeing that people continue to ignore them. This will only result in a continuous increase of cases as asymptomatic carriers of the disease expose others by leaving their homes for non-essential activities.

When this pandemic is over, my hope is that healthcare workers — especially nurses — will be recognized for putting their lives at risk, and consequently receive better treatment from their organizations. The state of our healthcare system in America is being illuminated by this pandemic, and it is evident that many changes must be made in order for healthcare providers to be able to do their jobs safely and for patients to have access to quality healthcare.

It’s disheartening to see that other professions, such as those of athletes, actors, and musicians are paid millions of dollars for the economic revenue they generate, while healthcare providers can’t even get masks and adequate compensation for saving lives. This must change now.

Our nation must come together and overcome this difficult challenge with resilience and integrity, so that lives can be saved and given the chance to begin again.

Thank you for reading.

*Disclaimer: All opinions expressed in this article are my own.

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Manhattan ICU Nurse and incoming MS1 (Class of 2025). Website: www.thepostbac.com

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The Postbac

The Postbac

Manhattan ICU Nurse and incoming MS1 (Class of 2025). Website: www.thepostbac.com

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