Health officials in Austin are considering opening a makeshift hospital as its intensive care units fill up. Patients in North Texas are being treated in lobbies or in hallways. And hospitals around Laredo, Abilene, and College Station have three or fewer intensive care unit beds open, according to state data.
A week into the new year, hospitalizations in Texas have well-surpassed a deadly summer wave that overwhelmed health care workers in the Rio Grande Valley. Health experts have long warned of a dark winter — with a public tired of following safety precautions, a raging pandemic, and cold weather drawing people indoors where the virus can more easily spread. Add to that holiday gatherings and increased levels of travel, which health officials say are already being reflected in the growing numbers of hospitalized coronavirus patients.
The dire figures come as two vaccines, produced in record time, have rolled out to health care workers in a massive undertaking so far beset by confusion and mishaps. The state has reported at least 28,545 fatalities tied to the virus, available intensive care unit beds are at a low and health experts say Texans can’t vaccinate their way out of the current surge. On January 14, the first known case of a new and more contagious coronavirus strain was reported in Texas.
“There’s Physically No Space.”
On April 6, the state started reporting the number of patients with positive tests who are hospitalized. The average number of hospitalizations reported over the past seven days shows how the situation has changed over time by de-emphasizing daily swings.
“Right now, probably half the patients I see never make it out of the waiting room… just because there’s physically no space, and when we do have space it’s limited — nurse staffing also is an issue,” said Dr. Robert Hancock, who works at hospitals in North Texas, Amarillo and Oklahoma. “We’re doing the best we can, but it’s to a point where we’re not providing the care we’d like to.”
In Central Texas, Austin-area health officials forecast the region might run out of intensive care unit beds in the coming days and could start to set up a pop-up hospital as soon as this week. They erected a health facility in the Austin Convention Center as infections soared this summer, and a solicitation obtained by The Texas Tribune in June showed health officials were recruiting volunteers to “provide hands-on care to COVID + patients.” It never took in patients.
Now, “the state is in surge. The state is in crisis,” said Dr. Mark Escott, interim health authority for Austin and Travis County. “It seems very clear to us that we are going to run out of hospital beds, and that we are going to have to stretch resources in order to meet the needs of our community,” he added.
“We’re Admitting Patients Into Areas That Don’t Typically Hold Patients”
Some hospitals in North Texas are holding patients in emergency rooms that are not designed for long-term care because there’s no space in the intensive care units, said Hancock, who is president of the Texas College of Emergency Physicians. It’s nearly impossible to transfer a patient that needs more advanced or specialized care elsewhere — for those patients: “you’re out of luck. There’s nobody that’s going to accept you,” he said.
Hospitalizations lurched upward after Thanksgiving, worsened after Christmas and Hancock expects the situation will continue to deteriorate for the next month.
The hospitals are so crowded he is sometimes treating patients in the lobby and then discharging them because there are no available beds.
Around Fort Worth, some hospitals are running out of both intensive care unit beds and regular beds, said Dr. Justin Fairless, an emergency room doctor and an assistant professor of emergency medicine at a medical school in Fort Worth established by Texas Christian University and the University of North Texas Health Science Center.
At the two hospitals where he works, there are coronavirus patients in the hallway “because there’s nowhere else to put them,” and nursing staff who typically do administrative work are helping see patients, he said. Some health care workers who have the virus have returned to work because there’s not enough staff, he said. They are approved to do so under Centers for Disease Control and Prevention guidance that permit it after symptoms have improved and a certain number of days have elapsed.
During Fairless’ shift Tuesday, patients were being treated in pockets of the hospital not normally used for patient care, like a pre-operation area used by health care workers performing an endoscopy. He sent several patients home that ordinarily would have been admitted to the hospital because of the possible risk that they’d be exposed to the coronavirus.
“We’re admitting patients into areas that don’t typically hold patients and on top of that,” he said, adding that some are being held in the emergency room for up to 48 hours because they “have nowhere else to go.”
The president of the Dallas-Fort Worth Hospital Council said hospitals in the area “have capacity issues, staffing issues and are anticipating another COVID-19 surge in late January.” Elsewhere, in Lubbock, hospitals are full, but the numbers have lessened since the area saw a crush of patients this fall.
Statewide, more than a dozen regions called Trauma Service Areas have surpassed a “high hospitalizations” marker that Gov. Greg Abbott set out and that requires businesses there to scale back capacity to let fewer patrons in. Under Abbott’s order, the business limitations kick in in regions where hospitals are more than 15% full with coronavirus patients for seven-days. The number of people allowed into businesses is reduced from 75% occupancy to 50%, and open bars must close — though many have begun to sell more food to qualify as restaurants.
A Texas Tribune analysis found those remedies set out by Abbott have done little to quash the virus in areas already seeing hospitals fill up.
In Harris County, which had to ratchet back business capacity under Abbott’s order earlier this week, Judge Lina Hidalgo said she was concerned the “threshold has not yielded the necessary change in other areas.”
“Reaching the threshold — activating the rollbacks — doesn’t in and of itself change the trajectory. That’s something that’s in all of our hands,” Hidalgo said.
In the Austin and Travis County area, where there’s been a 160% increase in new hospital admissions since December, Escott said he doesn’t think that “rollback to 50% occupancy at retail and restaurants is doing the trick.”
“I think it was forward-thinking to set those benchmarks, but I think we have to assess the situation and identify whether or not the strategy is working or not — it’s clearly not working,” he said.
Local officials there, he added, have “reached the limits of what we can do under state law, and under the executive orders.”
Abbott’s mandates have barred local officials from taking more aggressive actions, and over the holidays he took aim at an Austin-area curfew that tried to ban late-night dine-in and beverage service for a few days to lessen the virus’ spread.
A spokesperson for Abbott said local officials have “abdicated their authority and refused to enforce existing protocols” by leaving violations unpunished, “further endangering the health and well-being of Texans.”
“Increased restrictions will do nothing to mitigate COVID-19 and protect communities without enforcement,” said spokesperson Renae Eze. “And even states with increased restrictions and lockdowns throughout the pandemic have done little to mitigate the virus, such as California and Rhode Island, which have the highest COVID-19 infection rates per capita in the world, and New York, which is leading the nation in COVID-19 deaths.”
In the meantime, hospitals in parts of the state are full with patients, and vaccine doses are being gradually doled out to health care workers and other vulnerable groups.
Fairless, the emergency room doctor, said the hospital was becoming a more and more “unsafe environment” and was excited to get a second dose of a Pfizer vaccine Wednesday. Driving to the hospital, he said: “I can guarantee I’m going to see the parking lot totally full of people.”
“I’ve gone through H1N1 and all the other flu pandemics,” he added. “I’ve never really seen it this busy — especially at these smaller hospitals.”
In a year in which so many nurses displayed bravery, suffered hardships, and shone in countless ways, DailyNurse might easily have featured a “Nurse of the Day” instead of a Nurse of the Week.
Nurses have always gone the extra mile to communicate with patients and make them feel more comfortable and cared for, and we all know former patients who were so inspired by their nurses that they decided to enter the profession themselves. As 2020 raised the curtain on the Year of the Nurse, though, no one could have anticipated it would be a watershed year in which nurses became global icons of hope and courage.
Whether You’re a Hero, or Merely Awesome, Take a Bow…
The public has long admired nurses, but this year, the world has watched nurses brave the pandemic to work in seemingly impossible conditions, act as stand-ins for patients’ absent families, and leave home to speed to the relief of overwhelmed hospitals all over the US.
Nonetheless, many of our 2020 Nurses of the Week (NotW) eschewed the word “hero.” If you glance at remarks from our 2020 Nurses of the Week, you might note that while they take pride in their work, few sound like they are ready to accessorize their mask with a Superman cape. Naturally, they are happy to see their work recognized, but nurses constantly go out of their way to make patients feel less frightened and alone. As frontliner Tabatha Kentner said, “This is what we do. This is why we’re here.” Nurses save lives—and when they cannot, they comfort patients in their final hours and console distraught families. It’s not an occasional phenomenon; it is an everyday occurrence. The name and photo in Wednesday’s NotW feature could easily be your own because your expertise and empathy make you a Nurse of the Week every day of the year.
On the last Wednesday of 2020, DailyNurse salutes the Nurses of the Week who made their mark during the Year of the Nurse!
Great (and Caring) Communicators
A recurring theme is nurses who use their unique talents to raise patients’ and staff members’ spirits. Some, like Marc Perreault and Lori Marie Kay, shared their musical gifts. At Lenox Hill Hospital during the height of the New York City outbreak, Emily Fawcett helped boost morale in her ICU by meeting with staff for positive-thinking “hope huddles” before starting their shifts.
Danielle Fenn applied her language skills to comfort non-English speaking Covid patients. Others, like Tabatha Kentner, have been acting as “angels” (the word angel comes from the Greek angelos, which means “messenger”) and facilitating virtual visits so patients and their loved ones can commune even in isolation (and when necessary, say their final goodbyes).
Advocates and Public Servants
2020 was a year in which nurses stepped forward, spoke up, and got involved in public and civic health. Expect to see more of this in 2021 and years to come (we hope!). Metastatic breast cancer survivor Stephanie Walker is tirelessly advocating for cancer patients and patient education in North Carolina. Another indefatigable advocate, Andrea Dalzell, is on a mission to invite wheelchair-bound people to enter the nursing profession.
NYPD’s new Special Victims Unit head Michael King is a veteran SANE—and he is determined to improve the treatment of rape victims by police and other first responders. American Academy of Nursing (AAN) “Living Legend” Mary Wakefield is sharing her public health expertise and experience in the Obama administration with the Biden-Harris transition team.
Another AAN “Living Legend,” 85-year-old Marie Manthey, is promoting frank, open dialogues between Black and White nurses, and calling upon all White allies to combat structural racism and unconscious bias.
Tens of thousands of nurses this year packed their bags and took off to lend a hand in the nation’s hotspots. Reports on horrific conditions in hard-hit city hospitals were a virtual Bat-Signal for many nurses. They stashed extra masks in their suitcases, said goodbye to their loved ones, and flew to the most dangerous hotspots in the country (even nurses who had never been on a plane before!).
Texas nurse Anna Slayton, who parted from her family to spend 77 days on the New York frontlines, felt compelled to help, telling DailyNurse, “I ultimately knew it was my duty.” And in April, after flying from Tennessee to a desolate—but noisily grateful—NYC, ED nurse Kirsten Flanery declared, “I made the right decision on coming up here. I’m ready to make a difference!”
Difficult Takes a Day, Impossible Takes a Week
Many nurses combine massive multitasking efforts with hard work to pursue their studies, and some fight to overcome dire health and financial obstacles in their quest to start a nursing career. Felicia Shaner was so drawn to the profession that she embarked on her nursing studies while living in a homeless shelter… with a toddler and a baby on board! degrees while working as hospital custodians. Rebel NurseJalil Johnson (of Show me Your Stethoscope fame) had spent his last $5 when he enrolled in an LPN program. And Brianna Fogelman had a lung transplant in her junior year of nursing school and took her nursing finals with a tube in her chest.
Is There a Nurse in the House?
2020 was also a year in which nurses acted as first responders in unexpected times and places. Pamela Zeinoun saved the lives of three premature infants after the devastating August 4 explosions in Beirut. Indiana trauma nurse Colby Snyder rushed to the assistance of two people who collapsed in public within a 3-week period: the first had a seizure at her grocery store, and the second fell while Snyder was volunteering at the polls on Election Day.
Former CCN/cardiac care nurse Hollyanne Miley (whose husband is Joint Chiefs of Staff Chairman Mark Milley) is also a good person to have at hand when out-of-the-blue seizures occur. And VA nurse Maria VanHart impressed “official” first responders by her swift, efficient, and empathic treatment of survivors at the scene of a fatal highway accident.
DailyNurse salutes all of its readers, and all nurses. If you know of someone who warrants a Nurse of the Week nod, send your suggestion to firstname.lastname@example.org. Best wishes for a happier, healthier, evidence-based New Year!
In Part Two of the DailyNurse interview with Texas Nursing Association (TNA) CEO Cindy Zolnierek, PhD, RN, CAE, we discuss the importance of including a nursing perspective when forming healthcare policies and the TNA’s goals for the coming year. (Click here to read Part One, which covers the impact of Covid-19 on the Texas healthcare system.)
DailyNurse: The TNA seems to be very committed to encouraging nurses to get involved in policy and civic action. You have an annual Nurses Day at the Capitol event, and have been instrumental in getting certain laws passed.
Zolnierek: “We’re very engaged in policy. In fact, that is that’s kind of what we believe our niche is, because there are over 100 nursing organizations in Texas. Every specialty nursing group, school nurses, nurse executives, faculty members, ER nurses, ICU nurses, they all have their own groups. The TNA is more generalist, but we are particularly involved in policy around health care, and specifically nursing. Things that affect nursing and nursing work environments, because if nurses have the right work environment, they can accomplish great things, but often they’re not in charge of their environment. So we work to establish laws and regulations that help support a healthy and positive practice environment for nurses.
That said, we’ve been very engaged. [The TNA is part of] a healthcare industry taskforce with about 14 health care organizations such as the Medical Association, the Hospital Association, US Homecare, long-term care, and other groups. We also work with representatives from the governor’s office and the commissioner of Texas Health and Human Services, John Hellerstedt, who is basically our state COVID czar.
DN: What are your current legislative priorities? Are you also working with nurse practitioners to expand their scope of practice? That would seem to be a no-brainer in Texas.
Zolnierek: [Chuckles] “Yes, we we work very closely with them. In fact, we’re part of an APRN alliance made up of CRNAs, nurse midwives, clinical nurse specialists, nurse practitioners, and the TNA. We all coordinate efforts around advancing nursing and removing barriers to advancement. We’re also part of a Texas coalition for health care access that is trying to remove barriers to advanced nursing practice. Again, it should be a no brainer, all the evidence is there, it’s really more of a power and philosophical issue that doesn’t really serve the public interest.
So, this legislative session, we are going to. . . Click here to read the full story on our TexasNurse page.
The Texas Nurses Association (TNA) has a rich history of accomplishments and has played a key role in setting educational and workplace standards for nurses in the state. Today, the TNA is still tirelessly advocating for nurses and patients in Texas. As the state struggles with a frightening surge of Covid-19 cases, DailyNurse asked Cindy Zolnierek, PhD, RN, CAE, CEO of the TNA, about the most pressing healthcare issues in America’s second largest state. In Part One of this two-part interview, Zolniek spoke about the challenges of fighting Covid-19 in Texas. (Part Two will publish tomorrow.)
DailyNurse: Some aspects of Texas geography must present serious healthcare challenges even in the absence of a major public health crisis.
Cindy Zolnierek: “We do have these great expanses, and they tend to rely on critical access hospitals. [Critical access] hospitals take care of basic emergencies, but they’re very used to shifting patients off to larger facilities and other communities. This has long been standard practice in the areas of the state that have those largest expanses like West Texas. After you leave that El Paso, you go a long ways before you hit another decent sized city. [It’s] the same with Amarillo and Lubbock, Laredo, and the Midland Odessa area, which are some of the hardest hit areas [by Covid-19] in Texas. And now, with those hospitals being full, overflowing with patients to critical access, hospitals are left with no place to send their patients to. So it’s not just the communities themselves that are impacted—it’s the whole system, the whole infrastructure for providing health care, and care for cases like strokes and heart attacks and highway accidents is being impacted significantly.”
DN: So the whole healthcare system is being placed under severe strain during the pandemic?
Zolnierek: “Well, [normally] patients go to the nearest facility, like a critical access hospital, which patches them up, does the assessment and anything you need to do for life-saving. They then send the patient to a trauma facility. [During the pandemic] the problem has been. . . Click here to read the rest of this article.
Many stories about frontline workers have come out since COVID-19 began. But Anna Slayton’s story as a relief nurse is quite different. Slayton, BSN, RN-BC, works as a registered nurse with two hospital systems in the DFW Metroplex—Baylor Scott and White Emergency Hospital as well as Methodist Health System. She’s also building her own business, Kardia Wellness, through which she will provide holistic-based virtual health coaching, as well as some in-person consults, to people who either don’t have access to or need a more optimal way to see a health care provider. She’s also working on earning her Master of Science in Nursing from Walden University.
While all that is quite a lot, Slayton did more. She left her family in Texas to work in NYC, where COVID-19 was worse. She answered questions about her story. The following Q&A has been edited for length and clarity.
What made you want to leave and work in NYC as a COVID-19 relief nurse? How did your family take it? Did you have to take a leave of absence from your current job? Were they supportive?
My husband and I were coming home from vacation with our kids over Spring Break in March 2020. As we were driving home from Gulf Shores, social media began to flood with news of the coronavirus outbreak in the United States. We listened to the news station on the radio while driving home—about cities starting to shut down and the case numbers increasing.
I started to become so nervous about returning to work the next week. I work at a micro-hospital where staffing is minimal and patient ratios are smaller. I knew if the facility began to see COVID cases, it would all be on me. We did end up having two positive cases that gave me experience in caring for COVID patients and the ability to see the effect it was having on them. Thankfully, that helped me start to understand the treatment plan and protocols that were unfolding. Since everything was so unknown at the time, my family and I decided it was best to keep some distance while I had to work in case I were to bring COVID home.
While watching the news at work, I saw the USNS Comfort pull into the New York City harbor and knew that as a wife, a mom, and a nurse, this was my opportunity. Several of my colleagues had taken the call, so I decided to as well. I have a skillset that not everyone does that could be utilized to help save lives, so I ultimately knew it was my duty. As far as logistics, everyone was supportive and my kids have a great dad and stepdad, so I knew they were in good hands during my absence. My husband and I have six children between us, the youngest three who live with us are 16, 11, and 8.
I did have to leave my job to take the assignment in New York, but they graciously took me back when I came home. As far as being a nursing student, I had just finished the clinical requirements for the course I was taking at Walden University before leaving and was able to work on the didactic portion of my class after work as usual. I just continued to press on in my MSN degree program.
Explain the particulars to us.
I left on April 15, when everything was still so overwhelming at the hospitals in New York. Staffing agencies were being used to staff the FEMA crisis needs. This was a paid position, but it was not easy whatsoever. We did not have a choice where we would work. The initial contract was for 21 days, but I extended for a full 11 weeks. All the nurses were accommodated in different hotels close to Times Square. I flew back home to Texas on July 2, after my 77-day assignment.
Did you work in the ED or in another branch of the hospital?
We were not assigned to a particular unit before leaving, so flying in, you didn’t have a clue what type of unit you would be assigned to work in. My assignment ended up being in a long-term care facility on the COVID-assigned floor for residents who tested positive for COVID or those who were there for rehabilitation after being hospitalized for COVID.
On a crisis assignment, you are expected to work every day until further notice, so for several weeks straight we had no days off. As a night shifter, we were expected to be on the bus on the way to our assignment by 6 p.m., report by 6:45 p.m., stay on patient assignment until 7 a.m., and then return back to our hotel to sleep and repeat.
I have worked night shift for the majority of my nursing career. I’ve always been a night owl. Honestly, working nights has been the only way to spend the most time with my kids as a working mom. When I had my babies, I was able to nap and breastfeed during the day. As they have gotten older, I slept while they were in school and drank my coffee waiting in the school car line, rocking my pajamas and sunglasses. Life as a nurse isn’t glamorous at all, but it is a great career to have when you are supporting and raising a family.
What were your biggest challenges during this time as a relief nurse?
There were also a lot of very sad cases on our unit, which is always difficult. One was a woman, in her late 80s, who had several comorbidities and was in the dying process. I had to help her daughter say goodbye to her mother over the phone, listening as she sang her mother songs and said her goodbyes. Since she wasn’t able to be there in person, I made it my priority to be there in her place.
Over a few days, I held the woman’s hand and stayed at her bedside as much as possible until it was finally her time. It was a night of grieving, not only for my patient and her daughter, but in memory of all the loved ones I had lost not long before my son passed away. In only three short years, I had lost two uncles and both of my maternal grandparents, then shortly after, my youngest son, Gavin at 2 and a half years old.
I am not a stranger to death, but because I am around it so often, it doesn’t always sting the way that it does with most. Many nurses can understand this. Being next to this dying woman, I wept and cried over my own losses, holding her hand in place of those that I wasn’t able to. Once she took her last breath, I called her daughter and wept with her as well. I won’t ever forget that night.
What were your greatest rewards?
I’m grateful for the time this journey gave me to heal after the death of my youngest son, Gavin, and to reflect on my own personal self-work and journey. I made friendships and connections that I will never forget, and I had the opportunity to work with people from all over the world. There were staff and residents from China, Haiti, Jamaica, the Philippines, Mexico, and more. It was rewarding to know that I was able to work and help in this crucial moment of history. I am so thankful that I was able to gain so much insight into COVID-19 by being immersed in the epicenter, in a medical mission that God brought directly to me.
Many states are going into red zones again and shutting down. Would you work as a relief nurse again?
I would, but I would stay local instead. The hospital systems in the metroplex are being overrun right now, and my current jobs are so short-staffed. Giving back to my own community and being available here is my priority.
What would you say to other nurses who may be thinking about helping at hospitals in states or cities with the greatest need? What should they know and keep in mind?
I think they should absolutely go for it, but don’t follow the money. Working in this COVID crisis is hard work. They must be ready to face frustrations against a virus for which we are still trying to find a treatment that will work.