STAFF BURNOUT

The last two (2) days, on the other hand, have been absolute hell. The issues are numerous for the staff there so much that I do not know where to really begin. One very noticeable problem: there is staff burnout and they are exhausted, to the point where it is hard for them to really function at all. The ICU I was assigned to was split into three (3) parts: an 8-bed intensive care unit, an 8-bed cardiac care unit (which is, for all intents and purposes, another normal ICU right now), and an 8 bed ICU step-down area. The hospital has a sizable residency program, so they put me and another nurse practitioner in the ICU step-down area. About 75% of our patients are COVID pneumonia patients who are unstable but not on a ventilator, the other half is composed of more routine patients who are just well enough to be extubated. The hospital serves primarily impoverished and underserved people, so the 25% who are not COVID patients are there with an illness associated with poverty.

The unit is essentially what I expected with regards to patient needs, but the organization and staff camaraderie on the unit is non-existent. Staffing is about the same as it normally is here, but the patients are far sicker than the nurses typically manage in the step-down and non-critical care areas. We often have patients whose oxygen levels or blood pressures abruptly drop. I try to respond to the crisis or help manage problems that are not typically even brought to my attention. I suspect the staff is just exhausted from the constant chaos of trying to care for the crashing patients. It’s been like this for ten (10) months without a reprieve now. Patient volumes have started to increase again, and there’s just no end in sight. It’s like running on a treadmill that you can’t control, but someone else keeps increasing the speed.

There’s immense pressure from the unit manager, as well as the house supervisors, to prematurely discharge patients from the ICU stepdown so they can treat another acutely ill, half-decompensated patient who looks like they’re ready to imminently die. We had one patient we were strong-armed into discharging prematurely yesterday, a lady in her early 30’s on Bipap with 100% oxygen who still had a respiratory rate about three (3) times the normal limit and oxygen levels well below normal. She was put off our unit for about two (2) hours before she suddenly worsened again in the medical/surgical area, an area where nurses get 5-6 or more patients each and cannot closely watch any individuals. She came back to our unit; in transit, it was discovered that her oxygen had never been plugged in. Today, she was still on our unit, but slowly getting worse. We taught her how to put herself in a prone position, laying on her stomach, but she continued to gradually get worse even with that. It seems likely she will need to be placed on a ventilator within the next 24 hours; her lungs are already horribly scarred from COVID itself, so the ventilator is a last resort. She is only 34 years old, but I’m not sure she will even live. If I were gambling, I would estimate her odds of survival are about 50/50 at this point, but even that feels generous. Despite the tremendous pressure to transfer patients to lower acuity areas of the hospital who are not ready, I’ve had several patients with genuinely safe transfer orders who have been waiting for a lower acuity bed for days. I discharged two (2) of them today, both non-COVID, but never got a bed in the less acute areas. We don’t have any beds available, but neither do any other units where we can reasonably transfer people to, so we’re stuck in this pressured limbo in which we’re being told to move people who should not be moved to make room for stable ICU patients, then to move people around again when the failed transfers have to return to us. It is a colossal waste of everyone’s time and poses far more risk to patients, both individually and in aggregate, than it provides benefits. It also exhausts our staff and makes it harder for them to care for all the other patients because they’re being overburdened with extra work in an already-untenable environment.