An ICU nurse at Jersey City Medical Center provided Jersey City Times with an account of nursing work at the hospital under Covid-19. Only certain personal details have been changed to protect the staff member’s identity. Explanations of certain abbreviations have been provided.
Where the Nurse Works
“I work in the critical care division, which is both ICU and cardiac care unit. The physical units are next to each other and have blended to care for 100% COVID-19 patients with overflow going to extra space in the cardiac cath (catheritization) lab. Patients who would normally require ICU-level care but have complications that are not COVID are being kept separately in the post anesthetic care unit. All of the patients in ICU are vented (on ventilators).”
The Numbers
“A lot of the questions regarding numbers is operational and changes from day to day and isn’t really given to staff outside of those working in operations itself, so it is difficult to give a precise number of patients. Additionally the overflow is not present on the unit, but we have somewhere around 40-50 patients between the units and the overflow. There are also a tremendous number of COVID+ patients (patients who have tested positive for the coronavirus) hospital-wide as well as PUI (persons under investigation) with over 100 positives and around 80 under investigation. The hospital website says there are about 200 beds, so these are big numbers. We have obviously created more beds during this surge, but there appears to be 20-30 patients admitted to the hospital but being held in the ED (emergency department) due to lack of beds at any given time.”
A Shortage of Personal Protective Equipment
“PPE situation has changed day over day. As the ICU and CCU ran out of negative pressure rooms, patients had to be placed in regular rooms with curtains, so the whole unit is exposed to the aerosolized virus due to the ventilators. We are given one N95 mask per day and expected to use it for the entirety of the shift. They have started collecting the masks for sterilization and reprocessing (back to the employee who used it) in case the shortage continues further. We have run short on gowns at times and were expected to reuse them. We are very short on sanitizing wipes, and generally any cleaning supplies provided are not the ones we are used to having.”
The Facility is Stretched
“Due to the lack of negative pressure rooms, the rooms with curtains have HEPA filters which are industrial sized and extremely loud. The sound of them all going on the unit is deafening, and it makes it hard to communicate to other staff or sometimes even hear the alarms of an IV pump or a ventilator. It’s hard to hear anything at all.”
The Staff is Stretched
“Staff is definitely short. They have pulled nurses from other areas that are now closed like endoscopy or interventional radiology to help with ‘team nursing’ so where we would normally be at a 2:1 ratio, we may be assigned to 4 patients but have another nurse who may not have a critical care background on the unit to help with other nursing tasks. Some nurses from other areas have previously worked in critical care and have returned to the bedside to take a full patient assignment. We are being told we have 13 critical care nurses out with symptoms, so that definitely strains staffing. Other departments have felt the effects as well with large surges in staff and doctors getting sick.”
Available Treatment
“The treatments we are using are the hydroxychloroquine and azithromycin. Evidence on any treatments across the board is limited, so it feels like this is all we have. From ICU, we have yet to really see many people get better.”
The Numbers Going Forward
“The big surge of patients hit us over the last weekend and has continued for the week. New Jersey is predicting that this week and next week will be our worst, and so far that has been true at the hospital. Most patients seem to get worse before they improve, so we tend to see patients who have been admitted to the regular medical floor then decline, get intubated, and then come to ICU.”
“Stay Home, Wash Hands” poster by Dylan Egon
Nurses’ Safety
“At home I follow regular measures to protect myself and my family but nothing drastic. It is not realistic for us to stay separate for this time, and it is likely I have already been exposed given how many nurses on the unit tested positive before we were even universally wearing masks. My scrubs go straight in the wash and I wipe down my phone and things in my pockets, my shoes have always stayed outside. I avoid all errands and send family members in a mask and with hand sanitizer if we really need something (I still need fresh food for work!)”
Support From Hospital Administration
“I think the difference between myself and other coworkers is that l genuinely think the hospital is doing their best. Some people feel frustrated by the admin and feel they (staff) are not being protected. But we are in a global health crisis, and that is the reality of it. If admin could give us what we need, they would have done it. They brought in vents we have never seen before because they got them from somewhere, and they are doing that for PPE when they can. The situation is not ideal, and it’s important that other nurses have spoken out because that gets us things like donations. Nurses mostly have voiced that they haven’t been compensated fairly considering it is a hazardous environment.”
Two nurses tell their stories as union rep says ‘conflicts between hospital administrators and medical staff’ are increasing
This story was written and produced by NJ Spotlight. It is being republished under a special NJ News Commons content-sharing agreement related to COVID-19 coverage. To read more, visit njspotlight.com.
Pam Tavarone, a veteran ICU nurse at St. Mary’s General Hospital in Passaic, suited up for work last Friday in the makeshift safety uniform she had been wearing for the past week and a half — a white Tyvek painter’s suit, goggles and an industrial-grade respirator mask — all of which she had acquired herself. Supplies of personal protection equipment at the hospital were in short supply. The heavy-duty mask had left bruises on each side of her nose from her 12-hour shifts.
But on this particular day she was uncommonly troubled. She had been experiencing tightness in her chest and shortness of breath for three days. “I could feel something was going on. It was knocking me out,” she said. Her “gut” was whispering bad news. She has a history of asthma; two of her three daughters have underlying conditions — diabetes and asthma. She needed to be tested.
At first, “they didn’t want to give me a test, because I didn’t have a fever. But I pushed, and they gave in.” The results came back Saturday: Her gut was right; she was positive.
Now, Tavarone is quarantined in her home. At first, the hospital refused to prescribe medication for her, she said. But again, she “pushed” and they relented. She is taking hydroxychloroquine (Plaquenil), the experimental anti-viral drug, which has yet to be confirmed effective for COVID-19.
Tavarone blames no one
Tavarone is stressed, she is afraid — more for her children than herself — but remains resolute in her optimism, a common trait of ICU nurses. She blames no one. She did everything she could to protect herself, and she harbors no ill will for a hospital outmatched and overrun by the pandemic. An administrator told her that reinforcements in the form of nursing volunteers will arrive Tuesday. And “they keep tell us they’re trying” to get more gear,” she says.
Not all of her colleague feel the same way. At least three nurses at her hospital have already contracted the coronavirus, Tavarone said, and four have resigned out of fear — two walked out and two have given notice. Nurses there are given one mask and one gown per shift. Some have taken to wearing garbage bags over their flimsy plastic gowns. Fear has consumed the hospital. Morale, she says, is “sub-zero.”
“During this current COVID-19 outbreak, we are experiencing the same trials and challenges as every hospital in New Jersey and the nation,” wrote Vanessa Warner, a spokeswoman for St. Mary’s. “We are completely focused on the safety of every member of our staff and each patient they so valiantly care for.”
The depletion of personal protection equipment (PPE) and a shortage of nurses, has caused anxiety to rapidly escalate among frontline health care workers throughout New Jersey and beyond. It is a problem that won’t be solved until more PPE can be produced. But hospitals like St. Mary’s can’t close down in the middle of an outbreak because they lack protective equipment. They must soldier on.
Some nurses told to store masks between shifts
“When COVID patients first began arriving at our members’ facilities, medical workers changed gowns and masks after each encounter with an infected patient,” said Douglas Placa, executive director of JNESO District Council 1, the union that represents 5,000 nurses in New Jersey and Pennsylvania, including Tavarone (who is her local’s president). “Soon, they were instructed to keep their protective gear on until the end of their shift. At some hospitals, nurses are now being told to store their masks in a paper bag between shifts.”
For reasons hard to understand, the dearth of masks, gloves and gowns continues to plague America. The federal stockpile is deficient and the manufacturers thus far have been unable to meet the overwhelming demand. Hospitals and state governments are engaged in international bidding wars to purchase masks for exorbitant prices. President Trump has invoked the Defense Production Act, but has not yet ordered U.S. manufacturers to produce more medical supplies.
For New Jersey nurses, it certainly did not go unnoticed when two New York city nurses died from COVID-19 in the past two weeks. New York is the epicenter of the coronavirus in the U.S., and New Jersey is ranked second. Passaic County, where St. Mary’s is located, ranks fourth in the state with 3,227 cases and 42 deaths. Cases continue to spike and both states expect that to continue for weeks.
Nurses here wonder if Europe is providing a terrifying preview of what’s in store. In Italy, France and Spain, where hospitals have been overrun by the pandemic, more than 30 health care professionals have died of the coronavirus, and thousands of others have had to self-isolate. In Italy alone, more than 11,000 medical personnel have been infected.
The message from Italian doctors
A group of doctors from a hospital in Bergamo, Italy — treating more than 4,000 COVID-19 patients with just 48 ICU beds — offered this sobering account in the New England Journal of Medicine:
“We are learning that hospitals might be the main Covid-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patients. … Health workers are asymptomatic carriers or sick without surveillance; some might die, including young people, which increases the stress of those on the front line.”
While Tavarone and her colleagues have been jerry-rigging their own safety equipment, one South Jersey nurse was reprimanded and sent home for bringing in her own mask — the coveted N95, which is in short supply across the country.
Dawn Kulach, a nurse at Virtua Voorhees Hospital in Camden County, was elated when she was recently informed her COVID-19 test result was negative. She had been placed in mandatory quarantine, suffering only from pneumonia. It meant that not just she, but her spouse and son were OK. But her relief and her sense of well-being were short lived.
When her fever subsided, she returned to work last week. Knowing the hospital was also perilously short of PPE, she turned to her personal supply. She knew the precious N95s were being kept under lock and key at their hospital and given only to those dealing directly with infected patients, which she was not. She had been able to accumulate a couple dozen N95s on her own.
As she was preparing to leave for work, her 10-year-old son started crying. He pleaded for her not to go, Kulach said. She showed him her mask, and assured him it would keep her safe.
‘Thinnest mask I have ever seen’
Upon her arrival she was taken aback when no one took her temperature, or anyone else’s, before she entered the building. She reported to her unit, a pulmonary unit that included coronavirus patients and was handed “the thinnest mask I have ever seen.” She wasn’t assigned any confirmed COVID-19 patients, but three of her patients had heavy coughs and fevers. “All safety protocols have been thrown out of the window,” she said. She put that mask over her own N95.
She was soon confronted by a supervisor, taken to a conference room with a security guard standing silently by. She was told to remove her unauthorized mask. She refused, saying “if the hospital can’t protect me, I have to protect myself, my patients and my family.” She said her manager then ordered her “to clock out and go home.” And then the kicker, according to Kulach: “She strongly suggested that I rethink my career.”
“Conflict between hospital administrators and medical staff is becoming widespread,” Placa said. “The main topic of concern is the appropriate use of PPEs and safety of our members and their patients.” Placa said he was informed by one nurse that “she was given a mask and management told, ‘Use this for the week.’”
Kulach is scheduled to meet on Tuesday with her superiors to discuss her employment status. She fears she will be fired.
She will be accompanied by a union rep and intends to tell hospital officials that “this is not what I signed up for. … I didn’t go into disaster nursing, and we are not getting any disaster pay. … I have the right to protect myself and my family. I didn’t refuse to treat patients. … If I have the means to protect myself, I’m going to.”
The collective good
If they don’t let her wear her own N95 mask, she said she simply will not return to work. “I promised my son I would wear the mask. … Maybe I will have to rethink my career.”
Dr. Reginald Blaber, executive vice president and chief clinical officer for Virtua Health, Virtua Voorhees’ parent company, declined to comment on Kulach’s situation, but did offer this: “The collective good must supersede any individual’s choice or desires during these challenging times.
“Like all health systems in the country, we are working with a limited supply and an ongoing shortage of N95s and other forms of personal protective equipment.
“Recognizing the global shortage of supplies, we must be meticulous stewards of our resources so we never find ourselves without what we need.”
Told of Kulach’s story, Tavarone was supportive: “I guess they would have sent me home every day.”
In the meantime, Tavarone is riding it out in quarantine. But now her husband has developed a cough, and she said she will “push” to get him tested. And when she recovers, she said, she will return to work.
She had lost track of the death count at St. Mary’s, but last week, before she was tested, she and her colleagues “celebrated our first success story” when one of their ICU patients became well enough to be discharged from the unit.
Header: Photo by Jeff Rhode / Holy Name Medical Center
Active nurses, student nurses and retired nurses — including a state assemblywoman — are volunteering to go where needed, from critical care to pop-up hospitals
This story was written and produced by NJ Spotlight. It is being republished under a special NJ News Commons content-sharing agreement related to COVID-19 coverage. To read more, visit njspotlight.com.
Before COVID-19 reached New Jersey, Holy Name Medical Center in Teaneck had a 19-bed intensive care unit and 33 critical-care nurses. Now it has added four ICUs and is treating 45 patients, 40 of them on respirators. To satisfy the growing demand, about a dozen nurses have been reassigned from other units that have been temporarily closed, and a handful have been hired.
Bergen County, particularly Teaneck, is the coronavirus epicenter in New Jersey. On Tuesday, the number of COVID-19 patients at Holy Name reached 151. Thus far, 25 patients have died. Nurses there are running in a triage marathon, a race in which no one can see the finish line.
“They’re holding up … Morale is good,” said Michele Acito, Holy Name’s nursing director. “Every single nurse has risen to the occasion, and beyond. They are amazing. It’s a crisis none of us have ever seen.”
Nurses — a proxy of hope
Photo by Jeff Rhode / Holy Name Medical Center
Critical-care nurses are a special breed. Their job requires a highly specialized skill set and an extraordinary emotional IQ. Candor and compassion. In addition to administering meds and operating a variety of complex medical devices, they are the patient’s only connection to their family. At Holy Name, nurses keep the family informed by phone, and also connect them with the patients via iPad. In the course of their duties, the nurses supply their patients with medical information, small talk, encouragement and solace. In short, they are the patient’s proxy of hope.
As for their inventory of personal protection equipment (PPE) — N95 masks, gloves, gowns and face shields. “We’re doing OK. We’re good for at least a couple of days,” Acito said. And they have been able to acquire enough ventilators — at least for now. “ Our materials guy has worked magic.”
There has been a taxing nursing shortage in New Jersey for many years, primarily because an aging population is creating more need for medical care. And with nursing schools unable to keep up with the number of retiring baby boomers, the problem gets more serious. Add a pandemic, with the number of the infected still spiking and four field hospitals being rapidly built, and you have a crisis.
On Friday, Gov. Phil Murphy issued an unprecedented plea for medical volunteers. The response was swift and remarkable: As of Monday, 4,764 responded to the call. Nearly half were nurses, many responding to a call for help from the New Jersey State Nurses Association. This is the breakdown of that response, as of Tuesday:
1,425 nurses with active licenses
520 student nurses
125 retired nurses
State Assemblywoman Nancy Munoz, a retired critical-care nurse, photo courtesy Nancy Munoz Twitter
State Assemblywoman Nancy Munoz (R-Union) was one of them. She is a retired critical-care RN.
Two weeks ago, she was driving in her car, listening to New York City Mayor Bill de Blasio on the radio making a public plea for more medical staff. That prompted her contacts in the governor’s office to see what New Jersey was doing on this front. She soon hooked up with the Union County Emergency Corp, signed up to volunteer and promptly found herself swabbing people Saturday at a COVID drive-up testing site at Kean University.
“I didn’t hesitate” to volunteer, she said. “I am not sleeping well. I’m tossing and turning. All I can think about is what can I do?”
Munoz retired from nursing in 2002, after a 30-year career as a critical-care surgical nurse with a master’s degree in adult primary care.
At Kean, she joined about 30 other volunteers, including nurses, pharmacists and the National Guard. Outfitted in double hair nets, double faces masks, triple gloves and a plastic shield, she and her colleagues took samples from hundreds of people in makeshift tents.
Because of her training and protective gear, she had no fear, but “some of the people were terrified. A 6-year-old boy was crying. We reassured all of them,” she said.
At the end of the day, she returned to her Summit home, through the basement, where she put all of her clothes in the laundry and then showered. She said she plans to return to Kean and offer more help this week. In the meantime, she’s making surgical masks on her home sewing machine.
As of Saturday, Hackensack Meridian, the state’s largest health care provider, had 1,400 COVID-19 patients at its hospitals, according to CEO Robert Garrett. A third of them are in ICU and more than 300 are on ventilators. Garrett said Health Commissioner Judith Persichilli has instructed all hospitals to prepare to double their ICU capacity in the next three to six weeks.
The number of infected people in New Jersey is doubling every six days. If things continue unchanged, New Jersey will run out of ICU beds to care for coronavirus patients within the next two weeks, Murphy said Monday.
“We have enacted several practices to concentrate staff in our emergency departments and ICUs as this pandemic continues,” said Dr. Daniel W. Varga, chief physician executive at Hackensack Meridian. “For example, we postponed elective surgeries, which is increasing capacity by 20% and permitting us to redeploy nurses. Our administrative teams are also hiring more per diem staff and inviting retired clinical personnel to return to aid in treating our patients.”
Getting rid of red tape
To accommodate reinforcements, the state has also waived a host of regulatory requirements to allow out-of-state and retired nurses, doctors and other medical professionals help. The Department of Consumer Affairs intends to grant applications within hours of receiving the form. The waivers also will facilitate the work of health care staff of the National Guard who have been deployed in New Jersey to assist with the response to COVID-19.
As of Tuesday, the DCA had licensed an additional 674 nurses, who can now report to work. That brings the total number of licensed nurses in New Jersey to 170,728.
Nurse takes temperature of visitor at Christ Hospital, photo by Jennifer Brown/City of Jersey City
Persichilli has also signed a directive that permits hospitals to use advanced practice nurses, paramedics and physicians assistants to care for patients in noncritical areas, so that the intensive-care doctors, pulmonologists and critical-care nurses can stay at hospitals to care for the most severely ill COVID-19 patients. And Murphy also authorized the immediate payment of more than $140 million to health care providers to prepare them for COVID-19-related expenses, including expanding capacity.
To monitor the pending crisis, the state’s 71 acute care hospitals have been ordered to provide the DOH daily reports on bed space, staffing levels, ventilators and PPE stocks. The state is working to add bed space — reopening one closed hospital and setting up three temporary facilities — and seeking to amass more PPE and ventilators from closed surgery centers and a federal stockpile.
Rutgers New Jersey Medical School in Newark announced over the weekend it would expedite the graduation of about 200 students who will then be eligible to begin their residencies to help out state hospitals. Students would normally have completed their required courses in April and graduated in May, but now the 192 students will graduate between April 10 and April 21.
Officials are also turning to the private sector to help them find nurses — to people like Paul Ruderman, CEO of All American Healthcare, a health care staffing agency in Newark specializing in temporary employment for nursing personnel.
“Pre-COVID, the demand was tremendous. Now it’s through the roof,” says Ruderman, who continues to hire additional internal, administrative and operational staff to keep up with the ever-increasing demand for nursing personnel, particularly during the crisis.
Ruderman said he has also been asked by the health department to help recruit nursing personnel for several of the pop-up field hospitals that are opening across the state. The response from nurses and others has been overwhelming, he says, with more than a thousand nurses and nurse assistants ready to deploy in the coming weeks.
The Rutgers University School of Nursing in New Brunswick is also recruiting contract RNs for intensive-care units and emergency rooms. A posting on the school’s website reads: “We have immediate contracts of 8-13 weeks in duration at a compensation at $90/hr … The schedule includes 12-hour day and night shifts, 4-days a week. The positions also qualify for overtime (OT) pay.”
Not enough gear to go around
For some, more troubling than the staffing shortages is the critical shortage of equipment — ventilators, N95 masks and gowns.
Photo by Jeff Rhode / Holy Name Medical Center
“There’s just not enough,” says Doug A. Placa, executive director of JNESO District Council 1 IUOE-AFL-CIO, a labor union that represents professional 5,000 health care workers, mostly nurses, in New Jersey and Pennsylvania. “We’ve been working with the governor’s office to rattle some cages in the federal government to get supplies to frontline workers. And we mean now.”
“Do we have enough PPE? The answer is “no,” and we know that,” Persichilli said. “We haven’t had enough PPE for a long time, and I know that the workforce perspective, that’s the thing that is concerning them the most.”
After the governor closed all state universities last month, Rutgers University School of Nursing Dean Donna Nickitas had to put all of the school’s classes online for home instruction. She also decided to cancel all practicums, or onsite clinical placements, needed for graduation.
“I had to do it for their safety,” Nickitas said. “They just weren’t fully prepared” for the sudden dangers that would face them. Instead, students are now satisfying the practicum requirements with an interactive software platform that offers a virtual clinical experience in a simulated patient room.
Hurry up and wait for one ‘near nurse’
Meanwhile, Jessica Dybus, a 24-year-old from Williamstown, is sitting on her hands.
On Jan. 16, she attended her pinning ceremony as a graduate of the Rutgers-Camden nursing school, eager to launch her career. At that time COVID-19 was barely on her radar. She had heard reports about it in China, but she, like most of America, had no idea what was in store. She assumed she would be working in the field in a couple of months.
But the day before she was scheduled to take her licensure exam in March, she received an email, informing her it had been cancelled because of the pandemic. Now, she is hoping to take it in May, but that remains uncertain.
“It’s awful,” says Dybus, whose mother is a nurse. “I want to be out there helping people.”
Dybus is an EMT and has experience in ER and trauma. She plans to become a doctor. “This is my dream,’ she says. But she’s ready to work right now, and if they put her in an ICU with COVID-19 patients, that’s fine. “Wherever I can help,” she says.
