Across the state of Wisconsin and the nation there is a high number of hospitalized COVID-19 patients being cared for by staff who, while dedicated, are feeling the stress of the high number of very ill patients. Vernon Memorial Healthcare is no exception.
VMH has seen a steady increase in the number of hospitalized COVID-19 patients from October through December. In October there were 12, in November 24 and in December the total was 25.
The increased number of isolated patients increases the workload on all inpatient staff, including patients, nurses, nursing assistants, lab, pharmacy, etc.
Chief Nursing Officer Kristy Wiltrout said there was one instance where emergency room patients had to be diverted due to the pandemic because space was needed in the ER for higher-care COVID-19 patients who were waiting for transport. (VMH doesn’t have an intensive care unit.)
Wiltrout said Hollie Hoffland, medical surgical manager, has received calls from Gundersen Health System, among other hospitals, asking if VMH has swing beds available for patients because nursing homes are full; sometimes beds haven’t been available.
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Hoffland said every day is a balancing act with acute care, rehabilitation, the number of staff and bed space. She said sometimes patients who need further care in a nursing home may have to be held longer in the hospital until there is staff and bed space available. “The nursing homes have been spectacular to work with.”
Bobbi Johnson, emergency room/respiratory therapy manager, said over the last six months the ER and Urgent Care have seen the monthly average of patients increase from 500 to 900. She said a lot of the patients are there for COVID-19 testing and COVID-19 symptoms. She said with the high volumes of patients, it’s difficult for staff to see patients in a timely manner.
“We are seeing very acutely ill patients; not just COVID patients,” Johnson said. “People have to wait longer (due to the high patient volumes).”
Wiltrout said VMH wants the community to be aware that even though the hospital may be short on staff and beds, staff is still available to offer care to whomever needs it.
Wiltrout said at this point, there is adequate staff for elective surgeries and VMH has not needed to say “no” to those surgeries. She said patients who need surgery on their joints now have same-day surgery, rather than spend two or three days in the hospital in order to free up inpatient beds.
Hoffland said staff is resilient and the number of shifts they take is “phenomenal.” “In November there were 58 additional shifts; in the first 15 days of December there were 45.”
Wiltrout said VMH is a 25-bed critical access hospital. Ove the past few months, they have been consistently providing inpatient care to a substantially higher number of patients than usual. Not only are there more patients, but they are also more acutely ill than usual, and staying longer due to the care they need.
Hoffland said VMH has 41 regular part-time and full-time nurses, 16 PRN (limited part-time) nurses. “That speaks to their dedication.” She added they have not had “massive amounts” of employees who are sick because they understand the need to follow safety protocols to keep themselves healthy and be there for patients.
Hoffland and Johnson said it takes a team, not just nurses, to care for patients. That team includes everyone from those working in the lab and laundry to those who clean the rooms. “We couldn’t do it without them,” Johnson said.
Johnson said everyone is tired and they look for situations that are bright spots. Hoffland said not too long ago she heard someone laugh for the first time in a long while; she said that was a good day.
Hoffland said staff can sometimes feel frustration due to the increased demands of the job, but they continue to display compassion to their patients.
Johnson said in the ER, they are taking care of sicker patients than in the past. “We are keeping intubated patients comfortable in the ER.” She said respiratory staff on are on 24 hours both in the ER and on the patient floors; they weren’t in the past. “They are there to give the best care before patients go (to a facility) that can give a higher level of care.”
Hoffland said during this pandemic time, self-care has been a challenge for staff. She said there is a lot of donning and doffing of PPE (personal protective equipment), which can be physically exhausting, and staff may not take time to drink enough fluids. She said a goal is to focus on self-care.
Wiltrout said the nursing leaders are the “boots on the ground,” making sure nurses take care of themselves and get what they need.
Although staff is tired, there have been examples of staff members showing extra compassion and kindness.
Johnson said an ER nurse had been caring for a patient with COVID-19 who improved and was moved to a COVID room; he ended up having to come back to the ER for a higher level of care.
“The patient wanted to give up,” Johnson said. “The nurse took it upon themselves to go in and wash his hair and made sure he had something to eat. The nurse took time with him and went above and beyond. The patient went home and said that was a pivotal moment when he could not do simple self-care for himself.”
Hoffland said she didn’t have a special story to share about extra compassion shown to patients because she sees examples every day.
Wiltrout said staff reached out to each other during the holidays with treats for their co-workers.
Hoffland said when she asks new staff the 90-day question, “What’s the best thing about the unit?” they say their peers’ kindness and how they help them grow.
Tracey VanPelt, obstetrics/operating room manager who also oversees the GI and infusion clinic, agreed with Hoffland. “The care for each other at VMH is outstanding. Teams look out for each other. I see a thread of caring, especially in OB, which is one of my units. When the discussion of central monitoring of OB patients comes up, the reaction is it would take time away from the bedside with patients.”
Johnson said respiratory therapists are putting in more time than ever to take care of very sick patients and everyone else. They take night shifts in the hospital to give extra respiratory support.
“They are leading like they’ve never led before,” Hoffland said. “They are experts in all thing respiratory,” Johnson added.
Wiltrout said the pandemic has thrown them a lot of curveballs and they have adapted.
“In a lot of ways it’s forced us to grow,” Hoffland said. “Each day is an opportunity to learn,” Johnson added.
Advice from the frontlines
Johnson advises the public to seek care if they have an urgent need. “We’re here to serve you. The ER is open. We’re here for you day or night.” She also advises people to take care of themselves and see their providers for checkups and keep up-to-date on wellness screenings such as mammograms and colonoscopies.
Hoffland reminds people to stay home if they aren’t feeling well. “It’s not about toughing it out; it’s about keeping people healthy and separating yourself (from others when you’re not well).”
Hoffland said everyone should also be respectful of others and their wishes; she added there are people who are strongly for COVID-19 vaccines and those who are strongly against. “It goes both ways. It’s been a big separator….”
VanPelt said the pandemic has made people realize that it’s OK not to go to work when they aren’t feeling well and it’s OK to stay away from others. “You are supporting the team. You don’t need the tough guy attitude. It’s better if you don’t go in; you’re doing others a favor.”
Wiltrout said washing hands and wearing masks are still important safety measures. She also advises people call their providers during office hours if they believe they are feeling COVID-19 symptoms and not wait to make that call.
Hoffland added that if people have to come to the hospital it’s important to be kind and show grace if they have to wait.
Wiltrout said the visitor policy has been a struggle for people to understand. Hoffland said when people have a loved one in the hospital they are scared and sometimes become frustrated when they can’t visit. Hoffland said she empathizes with them and tells them the hospital needs to have the staff available to care for their loved one and in order to reduce coronavirus exposure to staff, the number of visitors has to be reduced.
Wiltrout said all patients are tested for COVID-19 prior to surgery and anyone entering the hospital is screened at the front door.
Angela Cina can be reached at email@example.com.