As hospitals across the country weather a surge of COVID-19 patients, in Seattle — an early epicenter of the outbreak — nurses, respiratory therapists, and physicians are staring down a startling resurgence of the coronavirus that’s expected to test even one of the best-prepared hospitals on the pandemic’s front lines.
After nine months, the staff at Harborview Medical Center, the large public hospital run by the University of Washington, has the benefit of experience.
In March, the Harborview staff was already encountering the realities of COVID-19 that are now familiar to so many communities: patients dying alone, fears of getting infected at work and upheaval inside the hospital.
This forced the hospital to adapt quickly to the pressures of the coronavirus and how to manage a surge, but all these months later it has left staff members exhausted.
“This is a crisis that’s been going on for almost a year — that’s not the way humans are built to work,” said Dr. John Lynch, an associate medical director at Harborview and associate professor of medicine at the University of Washington.
“Our health workers are definitely feeling that strain in a way that we’ve never experienced before,” he said.
Until the late fall, the Seattle area had mostly kept the virus in check. But now cases are rising faster than ever, and Washington Gov. Jay Inslee has warned a “catastrophic loss of medical care” could be on the horizon.
“This is the very beginning, to be honest, so thinking about what that looks like in December and January has got me very concerned,” Lynch said.
Lessons Learned From Spring Surge
When the outbreak first swept through western Washington, hospitals were in the dark on many fronts. It was unclear how contagious the virus was, how widely it had spread and how many intensive care beds would be needed.
Intensive care unit nurse Whisty Taylor remembers the moment she learned one of her colleagues — a young, active nurse — was hospitalized on their floor and intubated.
“That’s really when it hit — that could be any of us,” Taylor said.
Concerns over infection control and conserving personal protective equipment meant nurses were delegated all sorts of unusual tasks.
“The nurses were the phlebotomists and physical therapists,” said nurse Stacy Van Essen. “We mopped the floors and we took the laundry out and made the beds, plus taking care of people who are extremely, extremely sick.”
A lot has changed since those early days.
Staff members besides just nurses are now trained to go into COVID rooms and be near patients, and the hospital has ironed out the thorny logistics of caring for these highly contagious patients, said Vanessa Makarewicz, Harborview’s manager of infection control and prevention.
How to clean the rooms? Who’s going to draw the blood? What’s the safest way to move people around?
“We’ve grown our entire operation around it,” Makarewicz said.
The physical layout of the hospital has changed to accommodate COVID patients, too.
“It’s still busy and chaotic, but it’s a lot more controlled,” said Roseate Scott, a respiratory therapist in the ICU.
Harborview has also learned how to stretch its supplies of PPE safely. And as cases started to rise significantly last month, the hospital quickly reimposed visitor restrictions.
“In the past, we’ve had visitors who then call us two days later and say, ‘Oh, my gosh, I just came up positive,’” said nurse Mindy Boyle.
Boyle said months of caring for COVID patients — and all the steps the hospital has taken, including having health care workers observed as they don and doff their PPE — has tamped down the fears of catching the virus at work.
“It still scares me somewhat, but I do feel safe, and I would rather be here than out in the community, where we don’t know what’s going on,” said Boyle.
‘We’re All Tired of This’
Preparation can go only so far, though. The hospital still runs the risk of running low on PPE and staff, just like so much of the country.
During the spring, the hospital cleared out beds and recruited nurses from all over the nation, but that is unlikely to happen this time, with so many hospitals under pressure at once.
“All things point to what could be an onslaught of patients on top of a very tired workforce and less staff to go around,” said Nate Rozeboom, a nurse manager on one of the COVID units. “We’re all tired of this, tired of taking care of COVID patients, tired of the uncertainty.”
Already, COVID’s footprint at Harborview is expanding and bringing the hospital close to where it was at its previous peak.
“The fear I have personally is overwhelming the resources, using up all the staff — and the numbers are still going to go up,” said Scott.
And she said the realities of caring for these desperately ill patients have not changed.
“When they’re on their belly, laying down with all the tubes and drains and all these extra lines hanging off of them, it takes about four to five people to manually flip them over,” Scott said. “It feels intense every time. It doesn’t matter how many times you’ve done it.”
Hospitalized patients are faring better than in the spring, but there are still no major breakthroughs, said Dr. Randall Curtis, an attending physician in the COVID ICU and a professor of medicine at the University of Washington.
“The biggest difference is that we have a better sense of what to expect,” Curtis said.
The few treatments that have shown promise, including the steroid dexamethasone and the antiviral remdesivir, have “important but marginal effects,” he said.
“They’re not magic bullets. … People are not jumping out of bed and saying, ‘I feel great. I’d like to go home now,’” Curtis said.
Taylor said nursing has never quite felt the same since she started in the COVID ICU.
“These people are in the rooms for months. Their families can only see them through Zoom. The only interaction they have is with us through our mask, eyewear, plastic,” Taylor said. “We’re just giving their body a runaround trying to keep them alive.”
This story is from a reporting partnership that includes NPR and KHN.
Republished courtesy of KHN (Kaiser Health News), a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
There is a nationwide call for travel nurses during the COVID-19 pandemic, and with the demand comes offers of substantial financial compensation for those willing to care for patients under conditions of extreme risk. Across the US—especially in states such as California, New York, and Washington—crisis pay for travel nurses is at record highs. The increased pay is tied to the rising hazard of working during the pandemic, but travel nurses are at least receiving better compensation for the risks they take.
nurse pay has risen by 76%, and has gone up by as much as 90% in
Washington state, the original hotspot of COVID-19. Further, the
healthcare industry news site HIT Consultant states
that “Hospitals are paying Crisis/Pandemic rates up to $4,400
weekly to quickly staff up for the caring of COVID-19 patients.”
registered travel nurses, already high before the pandemic struck, is
also spiking. Massachusetts, in which demand has quadrupled, appears
to be in the greatest need so far, and demand has doubled in
California and New York. The latter two states also display the
sharpest rise in pay, although Washington is still the location
offering the highest salaries. On average, according to HIT
Consultant, pay for emergency department nurses has almost quadrupled
with the spread of the pandemic.
Among the travel
hospitals are trying to fill, ICU RNs, ED RNs, and Respiratory
Therapists are particularly coveted. NuWest Group, a staffing company
placing travel nurses in New York, says that they are “Urgently
staffing ICU and Respiratory therapist travel nurses for NYC Health
CNBC notes that “As demand spikes, staffing agencies are offering unprecedented incentives for nurses willing to enter hot zones” and cites staffing agency NuWest as offering travel nurses as much as $10,000 in crisis pay, with relocation bonuses and tax-free housing and food.
For an extensive
assessment of the market for travel nurses right now, see this
story on HIT Consultant.
Our Nurse of the Week is Karin
Huster, a Seattle-based nurse and field coordinator for Doctors Without Borders.
Huster spends six to 12 weeks at a time away from home, helping the world’s
most vulnerable populations. Most recently she was in the Democratic Republic
of Congo (DRC) helping battle Ebola outbreaks.
Even though she regularly encounters dying patients, Huster tells seattletimes.com, “It’s the best job in the world. And I don’t mean this lightly…My goal in life is nothing else but to try to improve people’s lives.”
Ebola has killed over 2,000
individuals and sickened almost 3,000 individuals in the DRC since August 2018.
The World Health Organization declared the outbreak a global health emergency
in July 2019 while Huster was on her fourth trip there.
Helping those in need has been
Huster’s dream since she was a child. She grew up on Réunion
Island, a French island in the Indian Ocean, and in 1991 she moved to Seattle
for a job translating English to French for Microsoft. Feeling unfulfilled, she
left her job at Microsoft to enroll in nursing school at the University of
Washington (UW). She spent eight years as a nurse in the intensive care unit at
Harborview Medical Center before going back to UW to earn her master’s degree
in global health. In 2012, Huster went to Lebanon on a trip with UW to work
with Syrian refugees. It was there that she found her passion for traveling to
help the world’s most vulnerable populations.
learn more about Karin
Huster, a Seattle-based nurse and field coordinator for Doctors Without Borders
who considers her job battling Ebola outbreaks in Africa the “best job in the
world,” visit here.
Washington State University (WSU) Health Sciences Spokane is teaching students in its medicine, pharmacy, and nursing programs how to care for patients suffering from opioid addiction. A two-hour class developed by faculty at the university will teach teamwork and communication to provide an effective approach to treatment for these sensitive patients.
The Washington Department of Health funded the development of the program. Almost 350 students from WSU and Eastern Washington University took the class in January and February. WSU will eventually be making the curriculum freely available online to any university that wants to offer the curriculum to its health sciences students and a follow-up grant will allow the university to adapt the material for use by rural health clinics.
Barbara Richardson, PhD, RN, an associate clinical professor in WSU’s Elson S. Floyd College of Medicine, tells news.wsu.edu, “We know that a lot of times when patients run into problems with opioids its because there’s poor communication on the health care team. People can fall through the cracks; our goal is to build a system where the cracks don’t exist.”
The curriculum on how to create a team approach to opioid addiction covers roles and responsibilities, appropriate language, and conveying patient information to other members of an interprofessional healthcare team. To learn more about Washington State University’s new curriculum for teaching a team approach to opioid addiction to health sciences students, visit here.
Washington State University (WSU) Health Sciences Spokane has invited seventeen Native American and Alaska Native high school students from multiple states to attend the 24th annual Na-ha-shnee Summer Institute. The attendees are rising sophomore, junior, and senior students who plan to pursue careers in nursing and health science.
The Na-ha-shnee Summer Institute is a 12-day event where students learn about a range of health science topics and receive college admissions information. They are fully immersed in scientific challenges and receive hands-on learning experiences taught by health care providers, faculty at WSU Health Sciences Spokane, and health sciences college students.
Topics covered during the Institute include anatomy, timely information on opioid addiction and response, basic nursing skills training and simulation, and a visit to the university’s pharmacy lab. Students will also receive CPR and first aid certification and are eligible to receive up to 65 Career and Technical Education (CTE) credits after completing their twelve days at the Institute.
To learn more about Washington State University’s Na-ha-shnee Summer Institute where seventeen Native American and Alaska Native high school students from multiple states have met to learn about a range of health science and nursing topics, visit here.
The University of Washington (UW) has announced a new dual degree program offering a Doctorate in Nursing Practice (DNP) in Population Health and Master of Public Health (MPH) in Global Health. The three- to four-year program aims to expand the skills of public health nurses and nurse scholars to work in partnership with populations and health systems to ultimately improve access to health care and help achieve health for all.
Pamela Kohler, associate professor with the UW Departments of Global Health, Psychosocial and Community Health, and Schools of Public Health and Nursing, tells Washington.edu, “Graduates of the new concurrent degree program will be equipped to lead sustainable change in collaboration with health systems, communities, and populations; and will have the skills to evaluate program and policy impact.”
The DNP program will prepare registered nurses for advanced practice roles, nursing leadership, and the application of evidence-based decision-making models to nursing practice. The MPH in global health will provide social justice and practical skills-based frameworks for achieving health equity through partnerships with a focus on health conditions that transcend borders.
Students must complete two sets of degree requirements to earn both degrees and can apply to both programs at the same time or to the second program at a later date. To learn more about the University of Washington’s new dual degree program offering a Doctor of Nursing Practice and Master of Public Health, visit here.