California COVID-19 surge leaves hospital nurses frustrated over staffing shortages

Roughly a year into the pandemic, healthcare workers across the country are taking care of record numbers of COVID-19 patients, and many are doing so without access to optimal personal protective equipment, testing, safe staffing levels and other infection control policies.

In California, which has surpassed three million cases, nurses are facing an especially daunting task of caring for the more than 20,000 hospitalized COVID-19 patients amid dwindling intensive care unit capacities, according to state COVID-19 data.

Members of the California Nurses Association, an affiliate of National Nurses United, met with members of the California Congressional delegation Thursday to express the dire situation in the state's hospitals and to demand comprehensive federal policy changes.

"The pandemic is surging out of control in California," said Bonnie Castillo, RN, the executive director of the California Nurses Association and National Nurses United. "We are dealing with an absolute catastrophe throughout the state."

Castillo cited that over the past two weeks, California has experienced increases in COVID-19 cases by 19%, hospitalizations by 9% and deaths by 82%.

"Despite this unprecedented surge in infections and hospitalizations, the state has left nurses unprotected," she said.

WHAT'S THE IMPACT? 
EXPERIENCES ON THE FRONT LINES

The members of the California Nurses Association painted a grim picture of what it's like working in hospitals during a surge.

"In my decades of nursing, I have never experienced so many patient deaths, and I've stopped counting how many people have died due to COVID," said Amy Arlund, RN, an ICU COVID-19 unit nurse at Kaiser Permanente Fresno. "We are beyond capacity and overflowing with critically ill patients."

In addition to the rising number of patients, Arlund's ICU is consistently short-staffed.

"During the pandemic now, we are short four to six ICU nurses every shift," she said. "We are stretched way too thin and when this happens patients suffer accordingly."

Prior to the pandemic, California required by law that hospitals maintain certain minimum nurse-to-patient ratios to ensure that nurses aren't overworked and patients get the level of care they need.

With the rise in infections, however, the state began issuing waivers to allow hospitals to bypass those ratios.

Kaiser Permanente Los Angeles Medical Center, the hospital where Tinny Abogado, RN, works, recently received one of these waivers.

Under the safe nurse-to-patient ratio law, Abogado would care for no more than three patients at a time. With the waiver, she has started caring for an average of four patients at a time, but has been asked to take more.

"It is so frustrating when you know how to care for your patients well but you don't have the resources you need," she said. "It makes me anxious every time I get ready to go to work. I say to myself 'What am I walking into today?' I feel like I'm walking on thin ice. At any time anything could happen."

Last month, Abogado's father died of COVID-19 at a Los Angeles hospital that had a ratio waiver.

"I learned that the nurses who were caring for him in the ICU had four patients," she said. "They're supposed to have just two."

Laura Wheatley, RN, works at St. Mary Medical Center in Long Beach, which also has received a state ratio waiver. Normally, emergency room nurses would each have two ICU-level patients. But now, she says, that ratio has been bumped up to six patients for every one nurse.

"A ratio of six to one provides 10 minutes of care per hour, max, for someone who may be barely grasping to life," Wheatley said. "There is no way for one nurse to safely care for six patients when any of them are ICU.

"We need Congress and the Biden administration to forcefully take action at the federal level to get this pandemic under control and protect our nurses and patients."

NURSES CALL TO ACTION

Understanding the needs of California's nurses, along with healthcare workers across the nation, National Nurses United released a comprehensive federal plan to combat the COVID-19 pandemic that was shared with the state's Congressional members on Thursday.

The plan has three overarching demands: Protect nurses and other essential workers, create effective public health infrastructure and programs and address health inequities.

Within these categories, National Nurses United insists that more specific measures be taken, such as increasing the supply of PPE, creating a regular and frequent testing program for healthcare workers, ending crisis waivers, collecting and sharing publicly reliable COVID-19 data, disbursing extensive economic stimulus support to all people in need, and making all COVID-19-related care free.

Additionally, Zenei Cortez, RN, the president of the California Nurses Association and National Nurses United, and a nurse at Kaiser Permanente South San Francisco, urged the Congressional members to immediately pass President Biden's $1.9 trillion American Rescue Plan.

"We know that by working together, we can control this pandemic and save lives," Cortez said.

Twitter: @HackettMallory
Email the writer: mhackett@himss.org