As cases rise in several areas of the country, Texas has become the new NYC and New Jersey. Hospitals in Dallas, Houston, San Antonio, and Austin have exceeded their standard ICU capacity and have implemented surge beds. The same is being seen in several areas of Florida and Arizona.
As a nurse, we take pride in the quality of care we are able to provide and we use this knowledge as a coping mechanism for when people die. Compassion fatigue is real, and we balance the exhaustion we feel with the knowledge that we did our very best in an attempt to prevent the patient’s death. We rationalize that it must have been their time and that death won this battle, and we gave him the absolute best fight we could.
Most of the population have never seen someone die, have never invested their heart and soul into trying to preserve life, only to see that individual die. Most people’s exposure to death is the finality of a funeral. They have never watched an individual take their last breath, let alone understand the weight this has on your emotional or psychological well-being.
With this pandemic, we are seeing the toll this has on nurses. There has been a rise in nursing suicides. There is a fatigue in knowing that we are just beginning with COVID-19, and unless we find an effective treatment or a vaccine soon, many more are going to die. Nurses are experiencing the constant fears of bringing COVID home to their families, separation from their loved ones, and no end in sight. But all of this pales in comparison to the psychological damage rationing care and disaster medicine has on a healthcare providers, including nurses. When you’re forced to decide between three, four, or five incredibly sick individuals which one gets your attention and the necessary care to heal them, it takes a toll on you. When we are forced to prioritize care and can’t give the best care possible due to being overwhelmed, inexperienced, or in an unfamiliar environment it hurts us also.
We have had months to prepare for the spread of SARS-CoV-2 throughout the USA. We have had time to gather protective equipment (PPE), to amass the medical equipment we need to care for the onslaught of patients (ventilators, CPAP/BiPAP, IV pumps, beds, etcetera), yet we have failed to invest in the hardest to create and replace: ICU/Critical Care Physicians, Respiratory Therapists, and ICU trained nurses. We aren’t even doing a good job on the PPE front, as many hospitals are still rationing PPE, trying to make the available protective equipment last longer.
The lack of experience with critical care and higher patient to nurse ratios are known to increase bad outcome and fatality rates, even before COVID-19. Surging ICU bed counts beyond the normal count requires the hospital to double their ICU staff, either through traveling nurses, increasing the number of ICU patients to each ICU nurse, staffing ICU beds with non-ICU nurses, or a combination of the three options. The troubling part is we know that all three of these options are associated with increased poor outcomes and fatality rates, and we as a society and healthcare system have done little or nothing in an attempt to change this, even with the knowledge that this alone will cause more people to die.
We still aren’t seeing a coordinated response, we aren’t seeing an effort to train additional ICU nurses, and governments have been lackluster and some downright derelict in their duty to lead in the best interest of society. We continue to see fragmented or a complete lack of preparations and planned response for the inevitable surge that will come.
I fear for my fellow nurses. Many are already making great sacrifices for their communities (most will never tell you about their sacrifices or the pain that they’re going through), yet we see elected officials and individuals within our communities which seemingly care little about the whole of society. The simple things (like wearing a mask) that we can do within our communities to decrease the spread aren’t being used and have become a politically charged debate.
We have seen the devastation of what happens when we aren’t prepared in Italy, NYC, and New Jersey, and we are watching it being played out again in other areas of the country. Our heart aches for those we will see die, especially since the surge won’t allow us to give the best care we can. We feel for our fellow nurse who will suffer and have PTSD from the surge of patients. When we take away nurse’s coping mechanisms for death, we are left with the haunting of those who are gasping for breath and those who we will watch die. It haunts us in our dreams and we see it in the faces of our community, and we don’t see an end to this.
Please do your part to slow the spread. Please allow us to give the best care we can. It’s one of our main coping mechanisms for death and when we can’t do everything possible, we lose our ability to know we put up a good fight, even if we lost this battle.
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