“The care was spread very thin. Anything could have happened.”

Part of a series: COVID-19 — Nurses’ Notes from the Front Line

by Joe Escareno, RN

When I started studying for a career, I thought I wanted to be a teacher. I love learning and passing on knowledge. I had a friend at the time studying to be a doctor and realized I loved medicine. I decided to become a Nurse. I also realized that as a nurse, I would be a teacher: constantly educating patients, their families, myself, my colleagues. I’m currently in a master’s program in leadership to eventually pursue a career in nursing education.

I fell in love with nursing.

But right now, it’s emotionally draining. I have to go the gym or take a run before every night shift. It helps me prepare. We are facing too much.

Teaching moments…

There are certain moments of the pandemic that I’ll never forget. Let’s call them teaching moments. Like when we saved an older man last summer, back when most of us still didn’t have the proper PPE, even though we were several months into the crisis. He came into our ER in respiratory distress. We all worked together to help him — even though some of us lacked the goggles, gloves, masks necessary to protect us. He survived. It felt so rewarding. We knew he would likely be dead without us. But afterwards we talked together about how we needed to do more to ensure we also protect ourselves. We realized that if we got COVID, we could infect patients…and once we fell ill, who would be there for our patients?

Then in December, when the surge slammed into our hospital, our supervisors took advantage of the relaxed enforcement of safe nurse-to-patient ratios. Our ICU filled up. Ambulances lined up outside the ER, unable to bring patients in until we could make room. It was out of control.

Joe in front of the ER.

Because our ICU was full, we had ICU patients in the ER. Title 22 regulations say that a Nurse should only care for one or at the most two ICU patients. One night, I had two ICU patients, both with COVID and both diabetic with out-of-control blood sugar that left them in danger of organ dysfunction and, of course, COVID complications. When I got the first patient, I had to do constant sugar checks, manage several IV bags, insulin bags…and then I got the second patient who required the same level of constant care. Really, those should have been 2-to-1 patients. But on top of that, I was given an elderly patient with dementia who kept on trying to get out of bed. It was a huge juggling act that made it incredibly dangerous for all three critically ill patients. Insulin is extremely time-sensitive and there was tremendous risk of falling with my elderly patient. And he didn’t have COVID, so that required me to doff my PPE whenever I need to be in his room, and put all the PPE back on to attend to my other patients. At one point, I caught him in the nick of time with his legs over the gurney trying to get out of bed on his own.

Luckily nothing happened.

The frightening thing is that if anything had happened to my patients that night, I would have been responsible. That’s frightening both on a human level — the guilt and grief and forever wondering if I could have somehow been in the right place at the right time — and on a professional level. It could have cost me my license, my career.

I brought up my concern of being out of safe nurse-to-patient ratio with leadership. But sadly, our hospital was simply not adequately prepared. Instead of anticipating a winter surge (which all public health agencies warned was coming), our hospital didn’t time their staffing efforts properly. The brought in travelers when there was no surge. Then when we were in the middle of the surge, we didn’t have enough traveler contracts in place. They offered incentive pay to staff after the numbers started coming back down.

Another shift that I’ll never forget was one night when my colleague and I were working the “hot zone” — where all the COVID patients were in our ER — and we had seven patients between the two of us, several in severe respiratory failure and on bipap machines. I had four patients, three on bipap and one sitting in a chair managing IV medications. At the same time, the two of us were responsible for the eight COVID walk-ins that came within an hour, all of whom needed us to check vitals, oxygenation, do EKGs, make sure they were breathing okay — all while taking care of our other critically ill patients.

The care was spread very thin. Anything could have happened.

As bad luck would have it, I was ill with COVID and was out for three weeks at the end of November and into December. Like so many other healthcare workers, I was constantly exposed at work. I did have an N95 that day, but remember: we are using them for an entire day, not the way we were originally taught, one mask for one visit into an infected patient’s room. And another thing to remember: the “95” in the mask’s name means that there’s a 5% chance of transmission. One of my last patients before coming down with symptoms was a code blue in the ICU dying of COVID pneumonia and I was doing chest compressions.

This past year was, as we all know, unlike anything we’ve experienced.

I hope we learn from it.

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RNs like Joe support California Assembly Bill1422 — the proposed “Patients’ Right to Know” law, which would expose hospitals’ dangerous practice of sidestepping nurse-to-patient ratio regulations.

We are RNs and other healthcare professionals in California committed to supporting working conditions that allow us to provide quality patient care and safety.