A week in the life of a night nurse treating coronavirus patients in New York City's top hospital, where she says space is running out for patients and nurse staffing is starting to run thin
- One New York City nurse shared her experience treating patients positive for COVID-19, some in critical condition.
- New York state had over 100,000 coronavirus cases as of April 3. Hospitals and healthcare providers previously told Business Insider they are working with limited ventilators, a shortage of masks, and without enough staff.
- The nurse told Business Insider she had not received a formal protocol from New York-Presbyterian Hospital on how to treat COVID-19 positive patients.
- "The highest priority continues to be the health and safety of every patient in our care, as well as the entire staff," a New York-Presbyterian spokesperson told Business Insider. "We are continually implementing new measures to increase capacity and taking every step to safely conserve personal protective equipment and other critical supplies."
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New York state just confirmed it has more than 100,000 positive coronavirus cases - and New York City has more than 57,000 cases alone, stretching hospitals and health systems to their limits. Nurses are tasked with caring for many of these patients.
Business Insider followed one nurse who works in New York-Presbyterian Hospital for one week, or five night shifts, using calls and text messages. In 2019, US News and World Report ranked New York-Presbyterian Hospital No. 5 in the US and No. 1 in New York, its 19th-straight year at the top of the state's ranking.
The nurse, who wished to remain anonymous for fear of losing her job, said she had not received a standard protocol from her health system on how to treat patients who are positive for COVID-19, the disease caused by the virus. Though her hospital has enough masks and workers on the floor, she said her ICU does not have space for many critical care patients.
Business Insider confirmed the nurse's identity and her position at New York-Presbyterian Hospital in New York City prior to writing this story.
"For all of us, the highest priority continues to be the health and safety of every patient in our care, as well as the entire staff," a New York-Presbyterian Hospital spokesperson told Business Insider. "We are continually implementing new measures to increase capacity and taking every step to safely conserve personal protective equipment and other critical supplies."
Note: To preserve the nurse's anonymity, the pictures used throughout this story were not provided by her.
Thursday night shift: March 26, 2020
Total confirmed cases in NYC: 23,112
The nurse worked with three COVID-19 positive patients during this shift. She said she had not received any communication from the hospital's administration on how to treat these patients. Instead, nurses had spoken to each other about administering oxygen and using hydroxychloroquine, an anti-malaria drug being used to treat coronavirus, she said.
New York-Presbyterian Hospital did not comment on whether it had communicated a standard treatment plan to nurses.
The nurse said the hospital followed the CDC's recommendation to wear a face shield and goggles to treat COVID-19 patients. That recommendation has still made nurses feel unsafe, she said, as the CDC recommendation doesn't require airborne particle-resistant N95 masks in non-emergent cases.
Though the US currently has a shortage of N95 masks, the nurse said her hospital does have the proper protective equipment and will order more. But, like many other nurses across the country, she said the hospital had been rapidly changing the protocol for wearing masks: in mid-March, only nurses treating COVID-19 patients had to wear a mask, and now all nurses are doing so.
"Nurses I've talked to are concerned because we see staff getting sick who have all followed these recommendations and of course we do not feel safe," the nurse said.
Friday night shift: March 27, 2020
Total confirmed cases in NYC: 26,697
The nurse continued treatment on her three COVID-19-positive patients by administering antibiotics and oxygen. She said her patients were in critical condition, but the hospital had no more beds in the intensive care unit. New York-Presbyterian Hospital did not comment on whether there was a shortage of ICU beds.
She said the hospital advised nurses to spend as little time with COVID-19 patients as possible, but she ended up spending nine to 10 hours in their rooms to treat their respiratory distress and respond to their questions. She said all three of her patients were Spanish speakers, but the interpreter line takes too much time to use, so she has had to rely on her limited knowledge of the language.
She said there were no nurse aids during this night shift, and the hospital had pulled nurses from other departments to help with COVID-19-related cases. The nurse said she ended up talking to one patient's family because the doctors and physician assistants were too busy.
The nurse described this shift as overwhelming. She said she felt foot and back pain from working with high-intensity patients, plus a headache from her tight N95 mask.
"I kept having these little moments of tearing up. I'm not totally sure why, but I think it's a combination of how surreal, overwhelming, unfair, and unpredictable it all feels," the nurse said. "And it's horrifying to think we're not even close to the peak."
Sunday night shift: March 29, 2020
Total confirmed cases in NYC: 33,474
Two nights later, the nurse had three new COVID-19 patients to care for, including another Spanish-speaking patient. She said she found it difficult to tell him not to spit on the floor or cover his mouth when he was coughing, due to the language barrier.
The nurse said she felt less frustrated and overwhelmed on this shift, but still felt exhausted on her hour-long commute home. Since city trains have stopped running express and that has made getting home take longer, the nurse said she has been thinking about applying for apartments and dorms that the hospital had offered to clinicians.
The nurse said there was enough staff on her shift this day, but multiple nurses had already tested positive for coronavirus on her floor. She added that she was worried that as more nurses test positive, the hospital will have less nursing staff to treat patients.
"I worry that there is more of that to come as well, and we will be even more understaffed as the population grows in number and acuity," the nurse said.
Monday night shift: March 30, 2020
Total confirmed cases in NYC: 38,087
The nurse treated two COVID-19 positive patients on this shift.
She said that because of the shortage of beds in the ICU, doctors and nurses were discussing bringing critical care patients to non-ICU parts of the hospital that aren't equipped with the same machines. Business Insider's Lydia Ramsey has reported that the country has a limited supply of life-saving ventilators. According to the Society for Critical Care Medicine, there are roughly 95,000 ICU beds in the US.
No nurse on her floor took a break during this shift, she said, and many nurses worked overtime.
The nurse said she was continuing to feel back pain, and that she had headaches at the end of her shifts. Her biggest fear now, she said, is the staffing shortage once more nurses start contracting COVID-19.
"Will I be able to take care of these patients properly? How many more people will die? It feels more out of control as the days pass," she said.
Tuesday night shift: March 31, 2020
Total confirmed cases in NYC: 38,936
For this shift, the nurse was moved to an intensive care unit, where most patients were being treated with COVID-19. Since the nurse herself does not have ICU training, she helped other nurses on the floor.
Most of her patients were intubated and did not need as much round-the-clock care as her other shifts for the week had, making the night relatively and easier for her.
"But obviously it was very sad to see so many people sick," she said.
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