'Mental hell' for nurses on covid19 frontline

Nurses who have to care for symptomatic covid19-positive patients are going through physical, emotional and mental “hell.”

They are tired, stressed, and worried about the well-being of their families.

Sunday Newsday spoke to a nurse who works at a hospital caring for covid19 patients.

She said the general public was not thinking about the nurses, but were being careless with their lives by not following the health protocols. People, she lamented, just expect the nurses to do the job without any consideration for their lives.

At her facility, they work four shifts to make a 40-hour work week, usually two days and two nights with two days off.

“We’re not fully rested and then we have to go back there. You’re in the hot zone in PPE (personal protective equipment) for a whole shift and a lot of the times it’s you alone in there. But there may be two nurses on a shift, if you’re lucky, to care for how many ever patients.”

She said one nurse described Couva Hospital as “hell” not only because they were short-staffed, but because, after a while, the metal on the masks painfully dig into their noses because of prolonged use.

The PPE, she said, is only supposed to be used for about four hours, but they have to wear it for a whole shift. Additionally, they claim the quality of the PPE is not as good as it was during the first wave so the nurses are concerned for their lives.

She said they now have to wear thin surgical gowns, the foot coverings are inferior, and the face shields were soaked in bleach and reused.

“They (Health Ministry) keep stressing that they’re going by the World Health Organization’s requirements but I don’t think that’s safe at all. To be honest, I think there is a shortage of PPE right now.”

She believes better should be done, especially for the nurses as they are constantly in contact with patients and therefore the most at risk. She claims the doctors may see a patient to draw blood for tests or visit the hospital to give the nurses a new treatment plan for a patient, but they see the patients as little as possible before leaving.

“They will see you struggling there and just write up a new plan, tell you to follow it and they gone. They tell us, ‘Come on, don’t spend more than an hour in there, hurry up.’

“I mean, some doctors genuinely care and they try to do their best with what they have, but the majority of them care as much as the layman on the street. I think they fear covid so they are thinking more about protecting themselves than taking care of patients.”

'Strain on our family life'

In addition to their own work, the nurse said she and her colleagues have to do the job of others. She said the intensive care unit (ICU) is supposed to have a physical therapist to help those who need to remain in bed for long periods, and orderlies to help them move the patients around, but the nurses have to do it. If they need medication or equipment, nurses have to go get it.

“It’s a very stressful job. When you are finished with the ICU you’re supposed to get some therapy, but we don’t have that. I started to get anxiety attacks. In the night I can’t sleep because all I’m seeing is these patients who are, more or less, dead on these ventilators. It is horrible. We go home with these images and memories and there’s nobody to counsel you.

“Remember it’s you alone in there, or maybe one other person, and there’s only so much you could do. And we’re there every day except for a day off.”

After a shift, the nurses are sprayed down with chemicals to kill the bacteria on the PPE and then they shower before leaving for home. They are not quarantined but go home after every shift, and most nurses are concerned about bringing the virus home to their families as many of them have children.

Their personal lives were also affected.

For her and other nurses, when neighbours find out they work at these facilities, they do not want to get close to them. Taxis do not want to pick them up.

Also, since no daycares are open, she has to get someone to come into the home to care for her child but, again, because she deals with covid19 positive patients, some people refuse to enter her home.

Thankfully, her family helps.

“The day they can not help I have to stay home from work. And with online school coming it’s going to be difficult. I had a strict study regime with my child but that’s gone out the window. Sometimes I don’t even have the energy to cook because I’m so worn out.”

She expressed concern for nurses with school-aged children, especially those who do not have family or friends nearby to help. She hoped, but did not expect, that children of medical professionals would get some kind of official support during the school term.

'Doctors need to help more'

A nurse at another facility said she, like many other nurses, were drained and reaching “burn out.” And the main reason behind that was not the work itself, but nursing management as they were almost always short-staffed, and issues they brought up were mostly ignored.

She explained that shifts were between eight to 12 hours long, but the administration was attempting to change to 12-hour shifts which would allow for longer rest periods. Nurses were also concerned about the amount of time being spent in the “hot zone” or the areas in which covid19 patients were housed.

“Most days when working an eight-hour shift you can spend your whole eight hours in the hot zone due to short staffing which puts a toll on your body and can lead to you calling out sick just due to burn out. It’s very difficult to spend six and more hours in PPE alone so imagine doing it when it’s also short staffed and you’re stretched even more thinly.”

She said being tired and knowing the management was doing nothing to fix the situation decreased nurses’ morale and willingness to do extra duties. However, she was hopeful the new general manager of nursing at the North Central Regional Health Authority would deal with these issues soon.

She added that support from management would be nice. She said there was a group chat where managers only complained or gave criticism, but rarely showed appreciation for the sacrifices the nurses were making to serve the people of TT.

Like the previous nurse, she claimed the doctors were not much help now that things were “hectic” although they were helpful during the first wave.

“The doctors aren’t as helpful and understanding to our concerns as you’d like to think either. They do not spend nearly as much time as the nurses in the hot zone. And with knowledge of how short staffed the nursing department is you’d think that they’d actually utilise teamwork and help out. Instead it’s more like we have to battle by ourselves. We (nurses) are all stressed out and trying to save lives as best as we can.”

'Trying our best with patients'

Despite the various issues she said nurses have been doing “an excellent job” and running themselves ragged to do so, even staying back after their shifts were done to help their colleagues.

She said each patient needed different types of care.

Some of the asymptomatic just had to go through routine checks and nursing care, while the treatment of others had to be tailored. The more critical patients had a range of underlying conditions but the most common were respiratory, renal and cardiovascular conditions. The staff treat the underling conditions to ensure the risk of deterioration is reduced.

She said most need some type of psychological support. The healthier patients usually need someone to talk to and reassure them, while those with more severe symptoms need more professional help because they were both sick and scared. She said there are several posters around the hospital with numbers both the medical professionals and patients could call if they feel they need counselling.

She, however, believes she has yet to reach that stage.

“There are days when I feel like I can just quit and never come back but then I remember the days laughing with patients and having them pray for you and thank you for your service. Every single one of them touched my heart and I’m grateful to have been able to make such an impact on their lives.

“I love seeing them get better and leave to go home with their loved ones. And even the ones who didn’t make it… I just want to let their families know they weren’t alone. We were right there with them, holding their hands, and paying our respects to them even though they lost the battle with covid19.”

Since she lives alone, she does not have to worry about bringing the virus home to her family members. But she said she gets lonely because she has to self-isolate and so does not get to see her family much.

Covid19 has also “messed up” her sleeping pattern. “I work mostly night duty so I’m like a zombie during the day… It’s very hard being exhausted to the point you can’t even function and still have to worry about cooking food most days because there are no cafeterias so your options of food are pretty limited to non-existent at work if you don’t walk with food. I end up missing meals due to that exhaustion which isn’t good at all.”

To those not obeying the public health guidelines she said: “It’s not only yourself you have to think about. It’s more than you. It’s bigger than you. You’d rather pay a fine or have a machine breathing for you than wash your hands, social distance, and wear a mask? It does not make sense! You’re prolonging something that we all want to end. Now is not the time to be selfish. Now is the time to be your brothers’ keeper.”