Nurses stand strong as they confront COVID’s 2nd wave
ICU staff on front lines of pandemic
NEW HAVEN — As the numbers rise again, this time the medical staff is better prepared to deal with COVID-19, but it’s been a long slog in the hospital intensive care units.
Nurses on the front lines at
Yale New Haven Hospital and other medical centers are treating patients as they continue to learn about the disease they are battling.
While the second wave of COVID cases in Connecticut is far higher than in the spring, nurses also say the number of inpatients is more manageable. Better treatments, using the drugs remdesivir and dexamethasone, are helping more patients recover without intensive care, though some still require invasive procedures to give their hearts and lungs a rest.
“We definitely have a better idea of how to care for these patients,” said Sue Falbo-Mac
Connie, a 33-year registered nurse, specializing in surgical care, who has worked at the St.
Raphael campus since before it became part of Yale New Haven.
“It’s a little more controlled and a little less crazy than it was back in March,” she said.
As of Friday, there were 1,210 COVID-positive patients hospitalized statewide, below the April 21 peak of 1,972, according to the state Department of Public Health. A total of 5,363 have died since the pandemic began, with 36 on Thursday, the latest data available. On April 21, the worst day in Connecticut so far, 114 people died.
Dr. Thomas Balcezak, chief clinical officer for Yale New Haven Health, said the health system is caring for a similar COVID caseload as it was in late March. But overall, the staff is stretched more because nonemergency cases have not been suspended as they were in the spring. The result of that shutdown was that people are coming to the hospital with more advanced cases of cancer or heart disease, he said.
Added to more than 450 COVID patients, “the hospital is much, much more full overall,” Balcezak said, further testing the staff. “The staff are tired. We all have fatigue of nine months of pandemic.”
‘ There for the patient’
Falbo-MacConnie is caring again for COVID patients who have filled the 24 beds on her surgical unit at St. Raphael, as she did from March to May. The unit was converted again before Thanksgiving, she said. But she said it is not as intense now.
In the spring, “it was a little chaotic, a little hectic because we didn’t know what we were dealing with,” she said. Patients got sicker, faster. “Very quickly they would decompensate and be stepped up to the ICU. … I’m not going to lie,” she said. “It was a little bit jarring at first and a little scary.”
Now “care bundles,” consisting of protocols, recommended medications and other guidelines for each patient, guide the nurses. “There’s goals for titrating their oxygen, what their oxygen levels should be,” Falbo-MacConnie said.
COVID is a complex, unpredictable disease in many ways. “You really have to expect the unexpected when you come to work every day. You have to be flexible,” Falbo-MacConnie said.
Having strong personal boundaries is important.
“I have the ability, when I leave work, I can actually leave work at work,” she said.
Another advantage now is there are plenty of masks, gloves and gowns, “so if you do the right things, I feel you are protected,” she said. “Back in March I think we were all very afraid of bringing it home, giving it to our spouse or parents or children.”
Now that visitors once again are not allowed in most areas of the hospital, patients also rely on
nurses for more than medical care.
“We’ve really become their surrogate families,” Falbo-MacConnie said. “I’ve had to hold the phone up to a patient’s ear while their family said goodbye, and that’s been really difficult,” she said.
Not even a clergy member was allowed in the room. “At the same time, I was grateful that I could be there for the patient,” she said.
“Nurses really spend a lot of time with these patients. We’re having to take on a lot of responsibility in addition to our own roles,” such as changing linens or delivering meals in order to minimize exposure to aides, she said.
But Falbo-MacConnie said increased communication from management, including regular town hall meetings, has given the staff a feeling of having more control over the pandemic.
“I feel Yale’s been good about that. There’s been a lot of opportunities for us,” including wellness check-ins, she said. “But I think the biggest support for me has been my co-workers. … There’s plenty of opportunities for us to vent to each other.” There is also a buddy program for staff to support each other and the hospital chaplains have texted daily blessings to everyone.
Darcy Hennessey, patient services manager on the unit, said, “I’m so proud of my team and especially Sue. Sue’s a leader on the unit, and when I can’t be there, Sue is able to lead the team, so there is a sense of calmness and control, and that’s where we’ve been able to excel as a unit.”
Megan Munroe, a registered nurse for 10 years who works in the cardiothoracic ICU at 20 York St., now is caring for some of the sickest COVID patients as well. Her unit in the West Pavilion is now a hybrid ICU.
The 18-bed ICU is physically divided by an anteroom, so CO
VID patients are on one side and those who have had heart transplants, bypasses or valve replacements are on the other.
Here, COVID patients are put on an extracorporeal membrane oxygenation machine, or ECMO. “It’s a surgical intervention for these patients, especially in the COVID population, when mechanical ventilation is exhausted,” Munroe said.
Blood is diverted from the body to the ECMO machine, which removes carbon dioxide and adds oxygen, then pumps the blood back into the body, relieving both the heart and the lungs.
Cristina Santiago, the patient services manager who is Munroe’s supervisor, said the cardiothoracic ICU nurses are most familiar with the ECMO device, “so that’s why we became hybrid.” Perfusionists run the machines, assisted by respiratory therapists and the nursing staff, she said.
While considered short-term therapy, some patients may spend weeks on ECMO, Santiago said. The difference between surgical and COVID patients is that with those who have had surgery, within 24 to 48 hours, “we know the outcome” and how long patients will take to recover.
“In a COVID situation, it’s totally different,” she said. “You can’t put a timeframe on them. It’s put a toll on the nurses. … It’s a weird time, to tell you the truth.”
There are far more patients on ECMO than before the pandemic. “At one point, we were actually up to 10 ECMOs at one time, and this is unprecedented for us,” Munroe said. A normal number is two or three a week, she said.
Santiago said the 97 nurses in her unit, as elsewhere in the hospital, work 12-hour shifts three days a week. “Pretty much the care is one to one and a maximum of one to two,” she said.
She said, though, that “because of the acuity of the patients that
we’re taking care of,” the nurses are not able to take part in the wellness check-ins the hospital offers. “If you actually have your days off, it’s kind of hard for them to come back and go to that clinic,” Santiago said. “It’s very hard because the priority is to take care of our patients.”
Hospital social workers do make rounds to consult with the medical staff, she said. “I’ve been seeing them regularly to check in … with the staff to see if there’s any support they can offer,” Santiago said.
Munroe said she does feel management has kept in touch with town hall meetings and a weekly COVID-related email “that gives us updates on staffing and PPE distribution and changes in the COVID CDC guidelines.”
While many patients have been lost, even with ECMO, there also have been patients “that were able to get off the ECMO machine and move to other units,” Munroe said. “There was obviously sadness that we felt during this process, but there was also a lot of hope,” when patients were able “to come off the ECMO machine and transition to other areas of the hospital that would lead them to recovery.”
As the second surge has begun, “we haven’t reached the capacity yet that we had in the first wave,” Munroe said. So far there have been five ECMO machines in operation at any one time.
Still there has been a personal toll, Munroe said. “I myself have a family at home, a husband and two little boys. It’s presented a challenge to balance both work life and home life,” she said. “But with the help of my family I was able to make it through the first time and we’ll make it through stronger the second time.”
Santiago said the hospital has learned much from the pandemic. “We are ready. We have been preparing for this,” she said.
None of her employees has come down with COVID.
And the work is intense. “The only time they get a break is when they get a lunch break and bathroom break,” Santiago said.
As difficult as it’s been the last nine months, nurses and other health care workers know a medical crisis is always a possibility, according to Ena Williams, chief nursing officer for Yale New Haven Hospital.
“What we do as nurses is what we do every day. A nurse goes into the profession knowing maybe one of these days will come,” she said.
There have been other challenges, such as the Ebola outbreak of 2014. At that time, Gov. Dannel Malloy ordered anyone returning from three west African countries to quarantine for 21 days. “We were able to contain that much quicker,” Williams said. “I think the challenge with COVID is it has gone on for so long, and when you feel like it should be getting better it just gets worse.”
The pandemic also has been wearing because of the number of fatalities, with Yale New Haven Health recording more than 600 deaths by October. “We had a tremendous amount of death in a short period of time,” Williams said. “You feel somehow you failed this family; you failed this patient. Nurses have been dealing with what we call moral distress.”
The coronavirus also is extremely contagious, which is why personal protective equipment is so important. But that brings its own stress, Williams said.
“If you understand that a nurse has to get dressed up several times a day in these very tight masks … goggles, [caps] on their heads, gowns on — it’s a lot to carry around when you’re caring for a patient,” she said.
That, combined with precautions to keep family members safe, means that, for a health care worker, “This is no longer about caring for COVID patients; this is now a new life that I’m living,” Williams said. And unlike in the spring, when “everything was in lockdown, nobody was out on the streets … now, everybody’s out and about,” increasing the chance of spreading the disease.
“The nurses, the caregivers here, are absolutely incredible. They are resilient; they are incredibly well trained and well prepared,” Williams said. “They are some of the finest nurses that I have worked with in my career.”
Still, they need the support of the community to keep their workload from becoming overwhelming, she said.
“We would ask that our communities really help us by following the guidelines and the rules … Wear a mask, social distance and not have social gatherings. If you know of a nurse anywhere … take a moment to say thank you because what they’re doing is really God’s work.”