The COVID-19 pandemic has stressed hospitals and nursing staffs across the country, and Labette Health’s experience is no different.
As the virus counts grew in Los Angeles, ambulance crews have been ordered to limit the use of oxygen to patients with oxygen saturation levels less than 90%. They also were ordered to not transfer to hospitals patients who have no chance of survival, according to the Los Angeles Times.
ICU at Labette Health has five beds, with the ability to add a sixth bed if needed. Since September, nurses say the ICU has had a steady count of four to five patients.
Brian Williams, hospital administrator, said that the hospital’s census has grown to three times normal and hospital stays are much longer. The average hospital stay pre-COVID was 2.4 days. COVID-19 patients have stayed five, six or seven times that. One COVID patient from Texas stayed at the hospital 18 days. She was flown to Labette Health from Texas because Texas and Oklahoma had no bed for her, Williams told hospital trustees this week.
She was recently discharged to Texas and Williams said the discharge paperwork is complicated for a patient two states away without insurance and without transportation.
The number of patients on oxygen at the hospital have strained the system, too. One morning in the last few weeks oxygen alarms were going off at 3:30 a.m., so facilities and respiratory therapy staff came in to deal with the issue to keep oxygen levels steady for patients with COVID.
Williams told trustees that ICU looks like a battlefield operating room at times.
He told trustees that nurses and other staff working with COVID patients are exhausted. The long hours are exacerbated by COVID-related isolations and quarantines among staff.
The Christmas holiday was especially harsh as COVID patients died who had been in the facility for a time, Williams said. He spoke to an ICU nurse who was in tears, exhausted, wondering if she could continue the hard work to help COVID patients with lungs scarred from the virus, making it difficult for oxygen to get into the blood.
Chelsea Smith, registered nurse, has worked at Labette Health for 13 years and has worked in the ICU since 2012. She is interim director of the unit, assisting director Becky Hunn.
Nurses work three 12-hour shifts a week. The ICU used to staff two nurses per shift, but they’ve increased that to three nurses per shift. She said nurses have been working 50 or more hours per week because of the patient numbers, the acuity of the illness seen in COVID patients and their longer stays.
Staff exposed to COVID-19 or getting ill with COVID have made scheduling difficult and some have taken extra shifts to help out.
Smith said the ICU began to get busier in September as COVID numbers grew in Labette County and elsewhere.
She said staffing used to be one to one for super critical patients. Now that’s one to two or sometimes one to three.
Smith has been training with Hunn in administration, but that takes a back burner sometimes.
“Because patient care is always going to come first,” Smith said.
She agreed, as did Peggy Hoisington, another registered nurse in the ICU, with Williams’ statement that the staff is exhausted.
Hoisington said she’s worked 50-hour weeks for the last six weeks.
“We’re all working at least one extra shift per week,” Smith said, and the 12-hour shifts easily turn into 13 to 14 hours to allow time for charting patient care or other duties. “Everyone’s just exhausted and trying not to get run down and sick.”
Hoisington said the nurses have sometimes leap-frogged during the pandemic. One person comes back to work from COVID isolation or quarantine then another goes home because of it.
“It is getting us, too,” Hoisington said of the coronavirus.
Labette Health only allows one visitor per patient, but COVID patients don’t get any visitors unless the patient is near the end of his or her life. Then one family member can dress up in full protective gear and visit.
Most of the visiting for ill COVID patients is done via FaceTime on an iPad with nurses helping the process. This is helpful for patients whose families live hours away.
“We’re getting patients from six and eight hours away fixed-winged into our airport. And those families can’t make it here,” Hoisington said.
Longer patient stays mean the staff gets to know the patients and their families.
“We get very invested in these patients. We had a patient recently for over a month. And we’re …,” Smith said, trailing off.
Hoisington finished her sentiment: “We’re still dealing with that.”
“You come to know these family members so intimately, become so invested in the patient and their care. The poor outcomes just hit us so hard,” Smith said.
Hoisington said the staff was working with a patient who knew he was going to die. He would FaceTime with his family as often as possible. One night she was leaving after completing her shift. The patient was on his side in bed, alert, and he waved good-bye to Hoisington. He died the next morning.
“So that’s what we’re dealing with,” Hoisington said.
Smith said in ICU they don’t see many good outcomes in COVID patients. Some do get to go home, but a few return in two weeks and get readmitted.
Some COVID patients require 100% oxygen and various methods to get the oxygen into their lungs. Smith and Hoisington said lung scarring, or fibrosis, is so bad in some patients that their lungs will not absorb enough oxygen even with high-flow masks or BiPAP (positive pressure ventilation). Those are difficult conversations to have with patients in respiratory failure and their families.
Some patients don’t have the fight in them, they said.
“At some point they just don’t tolerate the BiPAP even. They decide, ‘I just don’t want to do this anymore. I just want to be done,’” Smith said.
Smith said last week that she’s seen the COVID battle from the nurse side and the family side as her grandfather is in a Tulsa hospital with COVID. On the family side, she doesn’t have the same control she is used to having over care.
“It feels like we’re fighting a losing battle all the time. We get so dejected some days,” Smith said.