This summer, Ellis Medicine’s COVID-19 unit closed for a brief weekend. At the time, the last patient with the virus was able to go home, leaving the Schenectady hospital with no positive cases, said Erica Crandall, an RN who works as a charge nurse in Ellis Medicine’s COVID-19 unit.
“There were a few days where we didn’t have anyone that was COVID positive, and we were all like ‘Oh, my goodness. Wow,’” Crandall said. “We didn’t think ‘we did it,’ because we knew that something was going to happen, but I was never prepared for what ended up happening.”
We now know that what ended up happening was another surge in COVID-19 cases, first from the delta variant and then from the omicron variant, once again increasing hospitalizations and further straining an already stressed healthcare system. The state’s death count stood at 61,242 on Thursday, up from 59,280 at the start of December, according to federal data. Meanwhile, daily case counts in the state have reached their highest levels ever, eclipsing the previous peak seen about a year ago.
The boomerang between highs and lows is indicative of the trials Ellis nurses have faced in 2021. What started as a year of hope with the rollout of the vaccines has ended as a year of sadness, frustration and exhaustion, nurses say, with the future seeming less certain than ever.
“It’s frustrating that we have these waves. There are times when it is really good, and there is some hope, and then all of a sudden we hit the next spike and it’s like we’re right back to where we were,” said Brooke Macisco, an RN in the Emergency Room.
All of it has left Ellis nurses feeling exhausted as they find themselves in the midst of another grueling period in the pandemic.
“We moderate, we change it up. We try to help them as much as we can,” Crandall said. “But I think I’ve seen more loss in the last couple of months than I did when I first started [at Ellis] 14 months ago.”
Caring for COVID patients
The COVID-19 unit is a special area in the hospital that has vents to create a negative-pressure environment, limiting airflow from person to person. The unit can handle 20 patients at a time, Crandall said. Patients can range from needing no oxygen to needing a BiPap breathing machine, a level of assistance that is very demanding on nurses, Crandall said.
In addition to taking the time to put on all the necessary personal protective equipment — from gowns to goggles to gloves to masks — helping a patient breathe with a BiPap is very time-consuming and labor-intensive, according to Crandall.
“It’s pushing against you, forcing you to breathe, in and out and in and out,” she said. “It’s hard. It’s very uncomfortable. So it’s a lot of going in and holding hands and just coaching them to breathe and breathe and breathe.
“That’s the last step prior to having to be intubated. So if we can help them avoid getting to that high need of oxygen, it’s the best,” Crandall added. “It’s just very time-consuming.”
That time-consuming work is occurring when there simply aren’t enough nurses. Throughout the pandemic, a nursing shortage has placed added burden on people in the workforce. Statewide, there are more than 9,300 openings for registered nurses, according to a Dec. 22 press release from Governor Kathy Hochul’s office. The release was announcing the governor’s “Nurses For Our Future” scholarship, which would help address the labor shortage by covering the tuition for 1,000 new or current healthcare workers to earn an Associate’s Degree in Nursing (ADN) or Bachelor’s of Science in Nursing (BSN) at a two-year or four-year New York state public college or university.
Philip Schwartz, a spokesperson for Ellis, said when Ellis is short on staff, the healthcare facility employs per-diem nurses, which is a more costly option but ensures public safety. He also noted Ellis has long used a “flex and surge” strategy that moves staff to high-priority units. In addition, Ellis works with regional healthcare facilities to find care for patients.
Still, nursing units are stretched thin at Ellis, and overtime has become the norm. Typically, nurses like Amanda Frodey, an RN in the Emergency Room, work three 12-hour shifts in a week. But during the pandemic, Frodey said she has made it a routine of adding an extra 12-hour shift. What’s more, the caseload for ER nurses is up to about six patients per shift instead of the typical four, Frodey said. That increase limits the amount of time nurses can spend with each patient, especially the patients who aren’t as critical.
“You’re stretched so thin,” Frodey said. “You’re, unfortunately, in and out, and you don’t always get that extra second to make that connection with your patient. We don’t get to be as personable with them as we used to.”
“Code lavender” is a good illustration of how Ellis nurses are pushed to the max. The code refers to a declaration healthcare workers can make to tell co-workers that they need a break. There’s a designated room where hospital staff can go for momentary respite.
“It’s a quiet space for any staff to go to just take that second, decompress and kind of get their mindset to where they need to be to keep taking care of patients,” Frodey said. “It was put in place during the pandemic just to help us with our mental state because it’s very trying.”
But nurses say they are typically too busy to take advantage of the space.
“We don’t have the time nor the staff nor anything to even try to utilize that,” Crandall said. “It’s probably a great idea, maybe when they have extra staff available. But to even leave my floor sometimes is very hard. Physically, even to go downstairs and get a sandwich, I don’t always have the backup to leave the floor.”
The worst of times
With everything nurses are facing, they could, no doubt, use the break. Macisco, a 23-year-old nurse in the ER, has only known nursing during the pandemic. She started her career in August and said she was drawn to the fast pace and variety of the ER setting. Now she’s dealing with trauma on a daily basis that friends her age can’t imagine.
“I feel like it’s hard to explain what’s going on to people who haven’t seen it firsthand,” Macisco said. “Until you’re in the situation — when I’m walking into work and there are 45 patients in the waiting room and you know that you are going to walk back and the entire unit is full and they are all very, very sick — it’s just hard to put that into words.”
Macisco said one of the toughest situations she’s seen is a husband and wife who came to the hospital with COVID. But once there, they couldn’t be together, and the wife had to be intubated.
Macisco said it was especially hard “knowing that they were in the same unit and weren’t able to be together, and were really, really sick.”
Those are the moments that bring her to tears — not every day, but often.
“It still affects me. I hope that it continues to affect me,” Macisco said. “I don’t want it to get to that point where I’m hardened to that type of thing. I think it’s important to have emotion about it.”
She said that she uses her roughly 30-minute drive home to reflect.
“On that drive home, I just kind of think about everything, and then let it go as much as I can.”
After more than two decades in the field, nurses like Crandall say it can be hard to let everything go. She said this year has been especially frustrating because many of the sickest patients have been unvaccinated.
“A year ago, I thought I was being a hero. Now, they could be vaccinated and my job would not be as hard as it is right now.”
Crandall said on her worst days, she is dealing with multiple deaths.
“There are plenty of very hard days. One of them, recently, I had a couple patients at a time that I really worked hard on. Let’s breathe with me, let’s get into this position, let’s try to do this, let’s do that. And, unfortunately, the COVID takes over.”
She said losing a patient never gets easier.
“The 74-year-old unvaccinated patient that I lost recently, to the 95-year-old who just chose to say, ‘I don’t want to fight it,’ to the 29-year-old that I’ve worked with,” she said. “It’s devastating. You never want to lose a life, no matter what.”
‘We do have the good times’
Ellis nurses say they have a variety of coping strategies. Crandall snowshoes and knits. Macisco talks to friends about anything but COVID. And they all say they lean on each other.
The nurses also try to remember the patients that they were able to help.
Crandall said she recently worked with three COVID patients who were all able to be discharged, and one of them sent a thank you note along with a Buffalo Bills ornament, celebrating Crandall’s beloved football team.
“It uplifts you, and I keep [such notes] with me so that on the days where you just feel defeated because everything you’re doing isn’t working, you read that and you remember that there are the good times. We do have the good times,” Crandall said. “It’s an up-and-down ladder. There are days when I have to find my joy again, and there are days when I have found my joy. When you work so hard and you keep someone from having to be intubated, and they walk out, there is great satisfaction in that.”
Frodey said, after everything, she’s still committed to her profession.
“I still love nursing. I love what I do and I love who I do it with. We become a family, especially in the Emergency Room. We see very hard things every single day. And we work together,” she said. “I feel horrible for all of the new nurses who this is their first experience to nursing, because it’s not always like this. And I try to reassure them that it will get better.”
But young nurses like Macisco remain undeterred. In fact, Macisco said she’s never once contemplated quitting.
“I really do like it,” she said. “It can be stressful, and chaotic, but I really do like it.”
Andrew Waite can be reached at [email protected] and at 518-417-9338. Follow him on Twitter @UpstateWaite.