COURAGE CHALLENGES
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I am of certain convinced that the greatest heroes are those who do their duty in the daily grind of domestic affairs whilst the world whirls as a maddening dreidel. Florence Nightingale
EMERGENCY DEPARTMENTS MOUNT COURAGE TO FACE PANDEMIC CHALLENGES
The madness created by the novel coronavirus whirled around the staff in the Emergency Departments of Excela’s three hospitals while they mounted the courage to face the daily grind, including a late autumn surge and staffing shortages. Already exhausted from seven months of protocols and procedures related to suspected and positive COVID-19 patients, the staff in the EDs found themselves in unusual situations. The need for ICU beds and ICU staff created a challenge and patients were often held for days in the EDs where nursing staff would deliver inpatient care and charting while providing emergent care to COVID and non-COVID patients alike. Throughout much of November and December volumes climbed in the EDs at Frick, Latrobe and Westmoreland hospitals. All three departments intermittently recorded National ED Overcrowding (NEDOC) scores at Level 5 (Severely Overcrowded) and Level 6 (Dangerously Overcrowded) during the final 60 days of 2020, requiring staff to care for more patients’ circumstance than normal. “High NEDOCS scores meant the department was extremely busy,” said Jim Jellison Jr, RN, Clinical Nursing Coordinator at Excela Health Latrobe Area Hospital. “The higher the score, the more likely you were to see patients in hallway beds getting ER treatments and boarding in the Emergency Department as admitted patients. High NEDOCS scores meant staff had to take more patients than they usually do.” 40
According to Jim, during the post-Thanksgiving surge, it was common for nurses to walk into a shift and be busy non-stop, caring for six or more patients, which were higher in acuity. And this would take a toll on staff. “Constantly watching patients fight for air, knowing they are in need of a ventilator and an ICU bed, which could be next to impossible to find. Nobody outside of the profession will ever truly know how it feels to not only watch fear and pain in the eyes of so many patients, but to walk into the nurse’s station and see the same look in the eyes of your colleagues,” he said. With high census and higher acuity patients across the system, staff became overwhelmed and shortages were a reality that had to be faced. They increased their pace, missed breaks and meals, and went home feeling not only exhausted, but sometimes defeated according to Jim. “Many days, messages were sent out asking for those who were off to come and lend a hand. Staff picked up shifts, came in early, stayed late, doubled back, and traded shifts to cover the schedules,” he said. “Many staff would bring in food or have deliveries made to make sure their coworkers got something to eat, even if it was a grab-and-go style meal.” From an education standpoint, Rebecca Soike, MSN, MS, RN, notes that during the pandemic, Evidence-Based Practices were changing constantly regarding COVID-19 policies and procedures, requiring staff to be flexible and adaptive.