SAN FRANCISCO (AP) – Nerissa Black was already struggling to care for four patients with COVID-19 who need constant cardiac monitoring. But because of the shortage of staff that affects hospitals across California, their workload has recently increased to six people infected with the coronavirus.
Black, a registered nurse at the cardiac telemetry unit at Henry Mayo Hospital in Valencia, north of Los Angeles, barely has time to take a break or have a meal. But what really worries her is not having enough time to be with each of her patients.
Black said she rarely has time to help patients brush their teeth or go to the bathroom because she must prioritize whether they receive the drugs they need and do not develop bed sores.
“We had more patient falls (in December) compared to last year, because we don’t have enough staff to take care of everyone,” said Black.
Overburdened with COVID-19 patients in the country’s most populous state, Black and many other exhausted nurses are now caring for more patients than is normally allowed by state law after the state began issuing exemptions that allow hospitals to temporarily ignore a strict nurse – patient proportion law – a measure they say is taking them to the brink of exhaustion and affecting patient care.
California is the only state in the country that requires by law a specific number of nurses for patients in each hospital. It requires hospitals to provide a nurse for every two patients in intensive care and a nurse for every four patients in emergency rooms, for example. These proportions, nurses say, helped reduce errors and protect the safety of patients and nurses.
Nurses overwhelmed with patients because of the pandemic in other states are demanding fees required by law. But so far, they have failed to obtain them. In Massachusetts, Pennsylvania and New York, the nation’s first pandemic hotspot, nurses have been demanding minimum staffing standards required by the state for months. Voters in Massachusetts in 2018 rejected mandatory nurse fees for patients.
In the 10 minutes that Black stays with each person every hour, she has to look at lab work reports, imaging reports, report any abnormalities to the doctor, document her interventions, coordinate with those responsible for the case, and in many cases, arrange for the hospital chaplain, she said.
“It’s very busy, the nurses and not only the nurses, but the assistants, we are all exhausted. Morale is very low, ”she said.
Governor Gavin Newsom’s Department of Public Health began granting temporary waivers from the law for the second time in December, after another wave left hospitals in southern California and the San Joaquin Valley agricultural area with what is considered to be no intensive care facility. for lack of staff. The department had requested all non-urgent and elective surgeries and issued a general 90-day exemption from the proportion of patients last spring.
So far, at least 250 of California’s nearly 400 hospitals have received 60-day exemptions that allow ICU nurses to care for three people and emergency room nurses to supervise six patients. The exemptions apply only to intensive care units, observation units, cardiac monitoring, emergency and surgical care units. But Newsom has so far not canceled elective surgeries during the recent surge.
Kaiser Permanente, which has 36 hospitals in California, requested exemptions from 15 of them to plan emergency needs, said spokesman Marc Brown. He said the health giant avoided asking for more layoffs by canceling elective and non-urgent surgeries, paying nurses overtime and working with them to change their shifts and locations.
“We take existing indices seriously,” said Brown.
California Hospital Association spokeswoman Jan Emerson-Shea said hospitals are requesting exemptions only after they have no other choice to care for the patients they have.
“We are literally in the worst crisis of this pandemic so far and we are seeing a number of cases that we have not seen so far,” said Emerson-Shea, adding that hospitals are just trying to overcome the crisis. “Nobody wants to have our team emotionally and physically exhausted. But we have no choice. People need care. “
California hospitals often look for recruiting agencies and travel nurses during the winter, when hospitalizations increase and medical staff get sick from the flu. But California is now among the states across the country that vie for medical personnel, especially trained ICU nurses.
Stephanie Roberson, director of government relations for the California Nurses Association, criticized hospitals for not preparing better by training registered nurses and not hiring more staff – including itinerant nurses – during an autumn lull in COVID-19 cases, despite an expected increase drop in hospitalizations.
“In some of our hospital systems, if they were lucky to have travelers, they shooed travelers away because they were told they were not in crisis and that these travelers went elsewhere because they had better shows elsewhere,” said Roberson.
Black, who has been a nurse for 10 years, said she has relied on her husband to take care of her family’s needs so she can rest and sleep as much as possible on her days off. She has also consulted a therapist to deal with work stress.
She said she is doing everything she can to take care of herself, as she is committed to helping her patients. But she finds her working conditions increasingly unsafe.
“Many people say that we signed up for it and no, we didn’t. I signed up to help take care of people, not to throw myself in the fire, ”said Black.
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Associated Press writer Don Thompson of Sacramento contributed to this story.