Nurse recounts organizational chaos at care home

Nurse describes organizational chaos at CHSLD Vigi Mont-royal facility

Mary is a critical care nurse. She volunteered to work two shifts at the CHSLD Vigi Mont-royal this month. Long-term care facilities have been hit hard by COVID-19 and are struggling to get the help they need.

Mary wanted to help. This is her story.

Mary (not her real name) had been warned in advance to bring her own personal protective equipment; PPE at the facility was in short supply.

So she arrived with extra face shields, gloves and masks and looked for a place to suit up, but there was no dedicated, disinfected change area. So she and a colleague disinfected at a cafeteria table, stood on it, dumped their street clothes into a garbage bag and pulled on scrubs.

“It’s a good thing I’m not overly modest,” Mary said.

Their names weren’t on the replacement list, but they were assigned a unit on the spot. With zero orientation.

“Critical care nursing and working in a long-term care facility are two entirely different worlds,” Mary said. “We were thinking we would be working as orderlies.”

With one or two exceptions, the staff on that day were also filling in, which added to the confusion. Who was who, in what room and in what condition?

The situation was complicated by the fact that at least two patients had somehow ended up in the wrong room. This meant using identity bracelets, which not all patients wore, and verifying photos in patient files before taking vital signs or giving medication.

It took four hours to take the vital signs of around 50 patients.

“In the hospital, taking vital signs usually takes one hour,” Mary said.

There was one vital-sign machine with one thermometer, plus one rectal thermometer. One machine to check respiratory levels was shared with another unit. And because the staff filling in weren’t familiar with the patients, they had no baseline. Was the patient getting sicker? Was there an infection? Had the patient had a stroke? Or was the patient stable? They gleaned information as best they could from orderlies, who were working as fast as they could to keep patients clean.

COVID-19 patients were sharing rooms with non-infected patients. And there weren’t enough gowns available to adhere to the protocol of changing every time she changed rooms, so Mary wore the same gown in more than one room. The glove supply was also limited.

“I don’t know if it was a problem with distribution or with supply,” she said. “It was so unsafe in terms of nursing care.”

The one housekeeping employee kept the floors clean, but there was no time to wipe down frequently touched surfaces, which was a concern because two infected patients tended to wander and touch things.

“You need someone wiping down surfaces all shift long,” Mary said. “Nobody was wiping down.”

A team of volunteers from another medical facility showed up on Day 2. It was their task to make sure the right patient was in the right room. But because the team didn’t co-ordinate with the nursing staff, Mary had to start from the beginning when she arrived, once again identifying patients using file photos or identity bracelets.

What was needed was leadership, organization and teamwork. Instead, it was the blind leading the blind.

“We were giving out medication at 3 p.m. which should have been given at 8 a.m.,” she said. “I felt like a person who was drowning and calling out for help. What was needed was leadership, organization and teamwork. Instead, it was the blind leading the blind.”

Mary said the orderlies tried to keep patients clean, fed and hydrated, but it was an impossible task. So she would try to get the patient to nibble at something or take a drink while she was taking vital signs or giving medication. But if it took a patient 20 minutes to properly chew a few mouthfuls, she would just run out of time. Bedridden patients were supposed to be turned every two hours to prevent bedsores, but Mary said no one had the time.

“I went home the first night and was so angry,” she said. “I was angry with the government. I was angry with society, who doesn’t seem to care about these people who can’t afford the luxury of private care. It was heartbreaking.”

The second day, there was a doctor.

“She broke down,” Mary said. “Everybody is trying their best and everybody is failing. The phone rang off the hook all day. There was no one to answer. Even if one of us had answered, we wouldn’t have been equipped to answer their questions.”

Why speak out?

“I felt I had to say something. If I didn’t, I would be condoning abuse,” she said.

Vigi Mont-royal owner Vincent Simonetta could not be reached for comment.