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While coronavirus has turned the health care field upside down, with general practitioners, specialists, and even urgent care facilities turning to telehealth as much as possible or limiting hours, we wanted to know what it’s like in one of the more difficult places to work in a hospital: the ICU.

Rachel Norton, RN, an ICU travel nurse with NurseFly, is currently based in Denver, Colorado. She’s been a nurse for 13 years, working her entire career in critical care.

Norton answered our questions to provide a glimpse into an ICU during COVID-19.

What’s it like to be working as an ICU nurse now? How does this differ from how it was to work as an ICU nurse before COVID-19?

This pandemic is by far the worst experience that has happened during my career. I’ve never seen nurses as anxious and fearful as they are right now. Working in an ICU has been tough, especially when the number of admissions to the ICU is still well above what we would see on a normal daily basis.

As ICU nurses, we worry a lot about lack of personal protection equipment (PPE), supplies, and the survival of our patients. A recent NurseFly survey found that 70% of nurses are concerned about personal safety with their assigned hospitals. I’ve spoken with nurses from all over the country and the general sentiment is: “I am terrified. I am scared for my patient’s livelihood. I am scared for my life.”

In the ICU, I have also seen a lot of change with our doctors. Our doctors are running nonstop as they are trying to care for the rapidly declining COVID-19 patients and also trying to care for the other patients in our unit. This means that we are still taking care of patients with heart attacks, strokes, and all of the other patients that we would see on a normal daily basis.

The patients that are being admitted are requiring an excess of resources—staff/equipment/medication—to care for them. With hospitals running lean for years with staff and equipment, this has only caused additional strain on ICU nurses.

One of the major differences between now and before COVID-19 is the lack of family members at the bedside. Families have instilled their trust in us to care for their loved ones and that is such an act of bravery, and it is an honor to be a part of. Nurses have been voted the most trusted profession for 18 years straight, and this only shows why we remain at the top. We are taking care of humans. We are serving the country like never before.

What are the working conditions like now with COVID-19? How is this different than they were before? 

Day in and day out, our ICU is consistently full. Almost 75% of our patients are still confirmed positive for coronavirus. While the media paints one picture of the type of individual most vulnerable to COVID-19, my patients fall within all age ranges and not all have comorbidities or other medical problems. This virus does not discriminate.

Given the volume of patients that come in the door, it is impossible to keep everyone in negative airflow rooms. We are keeping one negative airflow room vacant to use for emergent “aerosol generating procedures.” We are about to open off-site units to accommodate the influx of patients. Nurses are asking: Do we have enough ventilators? Enough IV pumps? Enough medication to keep these patients comfortable and alive throughout their illness?There are no good answers. As health care professionals, we have to adapt our practices to give care with limited resources and supplies.

While we have found ways to adapt, we need a solution that will fix these questions and issues in the long term—we cannot wait until we have another pandemic or public health crisis to acknowledge and fix this.

Currently, hospitals are still cutting nurses. Travel nurses are scrambling for contracts and rates are becoming less competitive as the desperation rises. Yet, hospitals are still short staffed. In fact, NurseFly’s recent survey found that 30% of nurses do not believe their current placement or full-time position is secure for the next 2 months. Patients still need care. We cannot treat health care as a business and decrease the number of workers as the needs are still present.

Before the COVID-19 crisis elevated, our working conditions were already less than ideal. Many facilities often ran short staffed or made last-minute changes to the staffing to accommodate needs. This is stressful for nurses. Now, just as we are beginning to see an improvement, staffing is being cut again. Companies like NurseFly have been working to fill needs that are being posted. Yet, hospitals and health care systems continue to cut staff at alarming rates.

Describe your typical work day. How does this differ from the ICU before COVID-19?

My typical workday is a 12-hour shift and I work 7:00 a.m. – 7:30 p.m. I arrive at work at 6:45 a.m. and count the positive patients listed on our staffing board.

Staffing at our hospital has survived so far, but as we prepare to open additional ICU beds in off-site areas, many questions are being asked about who is going to take care of those patients.

On an everyday basis, our jobs are inherently fast-paced and demand a lot of physical and emotional resources. I am feeling the most anxious I have felt in a long time, maybe ever. ICU nurses are generally high-energy people with an ability to handle enormous stress levels, but this is different from what we’ve seen before.

How are you managing your own stress during this time?

My day-to-day job involves stressful and emergency situations. This level of stress has been heightened during the pandemic, where it is my responsibility to control, contain, and treat coronavirus patients, and where I am at risk of being exposed. Many nurses are feeling the same way—NurseFly’s recent survey found that nearly 80% of health care professionals feel more stressed in their day-to-day job since the COVID-19 crisis elevated.

However, as ICU nurses, it is our duty to stay healthy, mentally prepared, and protect ourselves and keep our patients safe—it’s crucial for health care workers to take 5-10 minute mental health breaks to refocus and re-center our thoughts. This is one of the ways that I manage my own stress.

In terms of managing stress from my day-to-day role, I stay focused on routine nursing care and continue to provide safe and adequate care. This can be especially challenging in this crisis, as there is extra work in donning and doffing personal protection equipment (PPE) constantly, which is particularly exhausting, but so important.

Another way I maintain calm and manage my own stress is by staying organized and advocating for myself and my coworkers—this is more important now more than ever. We always need to make sure we have adequate PPE supplies, that we cluster nursing care to avoid multiple re-entries into patient rooms, and decrease the amount of people necessary to enter each room.

With patients’ families and friends not allowed to visit, how has that changed the care that you provide? Are you having to help keep them calm/relaxed?

One of the hardest things to experience is not allowing patients to have visitors, but this is absolutely critical to stopping the spread. Being a support system for the confirmed and ruled out patients is just as important as basic care but can be even more emotionally taxing. It breaks all nurses’ hearts to watch people suffer and have no one to help them cope with this illness.

As nurses we treat the patient as a whole person and try our best to help patients keep calm and relaxed. We know how important human interaction is, and we are trying our best to connect patients and family members. We are doing what is necessary to protect ourselves and the immunocompromised patients we are caring for. Of course, exceptions can be made in life-or-death situations, but we are dealing with something like we have never dealt with before.

Is there anything else that is important for our readers to know?

There are no solid predictions on the course of this pandemic. Nurses need to stay vigilant and continue to treat every patient as a possible positive. The public needs to stay aware and stay protected. Masks reduce the risk of one person passing it to another and are a great way to prevent the spread.

As places start to reopen, stay smart. We cannot return to “normal.” I know this is frustrating, boring, and economically depleting. But is it worth the cost of human life? Is it worth burning out our health care system? We are not prepared to accommodate another massive wave of cases.

If you are asking yourself, “Should I cancel?” the answer is yes. Cancel and reschedule routine appointments and stop the spread. The most likely way to stop this virus is containment.

And most importantly, advocate for what is right for our health care teams. We actively and knowingly are putting ourselves at risk to help those that can’t help themselves. What we are doing is unprecedented. Consider our perspective and do what is right. And thank you for trusting us serve you.

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