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On COVID and Being Cancelled
Here in my area, we’ve been lucky (maybe prepared) enough not to get a surge of novel coronavirus patients. And with the lack of elective surgeries, my hospital census is getting shockingly low. We’ve shut our dedicated COVID floor because the few patients we have can be accommodated elsewhere without increasing infection control risks. Our “disaster ICU” was open for 2 nights as a trial—it worked—and now even the idea of needing it seems so remote that the assignment board was dragged back to the normal ICU.
And since we got our first case in that first week of February, we’ve never had more than about 8 COVID patients at one time in the unit. Sure, there was the one day in late February when lord-knows-who approved 9 surgeries and EVERY.SINGLE.ONE came to the ICU afterwards because they developed a fever intra-operatively and now needed to be ruled out for… you guessed it … COVID. Surgical services finally got their socks on the right feet, though, and now we screen everyone pre-op.
But wait, this is a lot of story for a post that seems to indicate it will be about getting cancelled. I needed to set the stage. That day in late February when surgery sent us all their patients—that was the last time our ICU was full. 36 patients. Do you know how many nurses it takes at a minimum to run our 36 bed ICU? 25. That’s our base staffing number—the number of nurses that is recommended to be scheduled every shift. It’s actually pretty hilarious how many nurses we actually need; sometimes 25 nurses for 25 patients. And that’s not really uncommon…
Last night, however, we were already overstaffed when I arrived at 19:00, and patients just kept getting transfer orders and going upstairs to less acute floors. We had cancelled about 5 people before the shift and then at 23:00, 2 more people needed to go home. I volunteered because it made sense with my assignment, but many people are starting to get worried about how slow it is. The per diem staff are getting cancelled every shift, and unless they’re willing to work at a moment’s notice & odd hours, there’s no work some weeks at all for them.
Benefitted staff generally fall into 2 categories: the ones that work their set hours (no more & no less) and the ones who love overtime (and in some cases need it to pay the bills). It’s a hard situation. People want to maintain their financial security, especially with high-profile West Coast hospitals making the news, such as Stanford cutting salaries across the board by 20%.
As nurses during a pandemic, we didn’t think we’d be sheltering-in-place, worried about losing our jobs like the rest of the economy’s workers. But now, at a time when treatment protocols are in flux, when drug regimens are changing quickly, when we ourselves as nurses fear that we will get COVID and perhaps die, we are getting cancelled. We are left to sit at home. We thought we knew one thing: there is work for us to do. But now we’re not even sure about that.
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Common sights in the ICU
Snack of champions, and sometimes dinner too. Peanut butter on the spoon.
No PHI, it’s been cut off when portioned for scrap paper use. Nobody said we aren’t frugal. Also, nobody said the patient that telemetry strip belonged to lived. No pulse with that rhythm…
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When all you do is ask ask ask
Last week was brutal. For some reason, the day shift medicine team consisting of one Intensivist in charge and something like 2 to 8 interns & residents (baby docs, as I call them) did NOT make a very good “plan of care” to guide our decision making. And so midnight rounds was like the blind leading the blind, except most of the blind had left the hospital and there were no instructions for the other blind— and so the baby docs just stood there like frightened drunk toddlers while I (the charge nurse who had no time for coddling) barraged them with questions. Is the patient negative? Would you like them to be? Are they NPO because you plan to extubate tomorrow? On 80% Fi02??? Well, maybe we should at least give some LASIX and improve their chances? At first, the night time intensivist tried to defend them, he being another doctor and all— but by the end of rounds, he was furrowing his brow and calling for LASIX too. So, when I couldn’t sleep later that day (the same day, for those of you following night shift calendars and my run-on sentences are home), I made a meme…
And by my third night in a row, this little meme was pinned on every nurse and taped sarcastically to every WOW. Point made? Not at all… the baby docs are oblivious to this. But we found it funny.
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Always practice safe nursing
My sister was cleaning out the office while I was napping on this lazy Sunday afternoon (typical nurse move on my part) and she found this old pin. I spied it in the trash later and fished it out to snap this picture—still makes me chuckle.
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Rubber ducky, you’re the one…
I don’t know who is doing it, but someone keeps putting little things around the unit to cheer it up. I suspect I know who, and this person (when they were on nights) used to be my partner in crime for decorating the ancient X-ray display at our old building with crazy-themed cling film decals at St. Patrick’s Day and hand cut snowflakes during the winter holidays. About a week after this COVID mess started, when the ICU was still in chaos with the “rules” changing every few hours, tiny adorable flowering live plants started showing up at the nurses stations. Some of them have taken a turn for the worse now— I suspect the cyclamen is suffering from too much love and water— but most of them are doing great.
Cue today… a random Friday night shift (and I don’t normally work Fridays) — and I come in to find small armies of decorated ducks carrying small greetings on toothpick flags all around the unit, in groups of threes and fours. Simply adorable, and certainly a sight that made me smile. And that’s always good in the otherwise possibly bleak and sterile environment of the modern ICU.
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Hello world!
This is this first post of what I hope will be many, and really just a piece of data to make this website publish. If you’re reading, you’re very early to this party— or a completist. Either way, thank you and welcome!