Nurses on the Front Line

In our August/September 2020 and April 2021 issues, we interviewed Shannon Cotton, an ICU nurse at UC San Diego Medical Center, Hillcrest, to get a firsthand account of the challenges health care workers have been experiencing over the past 18 months. Since then, the number of positive COVID-19 cases in San Diego County has been on the rise. For the third installment in this series, we checked in with Anna Sindelar, a registered nurse in the step-down unit at UC San Diego Medical Center, Hillcrest, about what they’re seeing now.

Our unit is the primary COVID-19 unit for patients who aren’t ICU patients. They’re coming directly from the ICU or from the emergency room. We’re the convalescent period—where people are hopefully getting better, but are sometimes getting worse and ending up in the ICU. And when the ICU is overloaded, that affects other parts of the hospital. When the ICU is full, those patients stay on our floor. We end up taking them and keeping a really close eye on them. That’s what happened in January 2021. We were taking care of patients who were much sicker than we normally take care of.

We’re having a hard time with discharges for COVID patients, because they need to go to a place where they can isolate if they’re still in the infectious period. That can also be difficult for some of our patients because of their living situation, and also there’s a shortage of home health services—those are nurses who go into people’s homes and provide care. In our unit, the patient population definitely seems younger, in their forties, which I don’t recall seeing before.

From what I understand, the Hillcrest ICU is filling up—we’re reaching that point again where we might have to open up other parts of the hospital for ICU beds. As far as the ER goes, the last time I went to work, there were 11 ambulances lined up out front to drop off patients—but being a floor nurse, I’m not privy to all the ins and outs of why that is.

The main issue is staffing. We’re much more full with COVID patients. We definitely started to see an uptick in mid-July, and it’s stayed steady for the last few weeks. When we have that many patients with COVID, we usually have extra staffing to facilitate the donning and doffing of PPE. When you’re in an isolation room, you’re not able to keep an eye on your other patients—you need extra staff to watch them and help bring you supplies and medications.

We’ve been short-staffed since December, and that hasn’t gotten better. It’s not just fewer nurses. It’s fewer phlebotomists [people who draw blood]. It’s fewer nurse assistants, who help with the daily care of these patients, keeping them clean, helping them walk, helping them turn to prevent pressure ulcers.

I think it’s hard to say why we’re understaffed. The administration is telling us they’re having a hard time hiring qualified nurses. That tells me that people maybe don’t want to come back. Before COVID, UCSD was one of those sought-after places to work. So it’s really surprising to me that they’re having a hard time finding anyone to even take a traveler position.

The shift is more demanding than it would’ve been. Every day you have off, they’re asking you to come in. At other hospitals, you might be required to come in—at ours, you’re not required to—but you know that your coworkers are needing help. You feel the pressure to help out when you’re off. So it’s that type of constant stress, but you also need to take care of yourself.

My coworkers are tired; they’re frustrated. They love their jobs. They are there for their patients. When people are sick, they’re at their most vulnerable (and at their most cranky, sometimes) but that’s what we’re there for. At the same time, it’s disheartening to see that this is all happening again, and there’s no changes being made [as of press time] in public health policy in San Diego. Our hospital is not the only one, and there are units at our hospital that are struggling even more.

Nationally, we have a shortage of safe and comfortable work environments for nurses. That’s the problem. If you have the appropriate help, the appropriate PPE, it’s a great job. I love being a nurse. But when you don’t have anyone to help you turn a patient, it’s your body on the line—an actual physical injury, from doing that multiple times. I think that’s part of the reason why we have tons of people going to nursing school, but then we also have people leaving.

Right now we’re just trying to get through today. We’re hoping that they hire more staff—our manager is trying really hard to help us—and we’re hoping that more people get vaccinated so they can stay out of the hospital.

If you’re eligible and you can, please, please get vaccinated.

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