Name: Traumatized by the amount of death, some NJ nurses unsure they can face another COVID-19 wave
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Traumatized by the amount of death, some NJ nurses unsure they can face another COVID-19 wave

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NorthJersey.comView CommentsThe lawn signs call them heroes. And like veterans of any war, many nurses who have fought COVID-19 in North Jersey’s hospitals dwell less on their heroism than on the trauma they have witnessed.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;They appreciate the signs, but they don’t think you know how it felt.&nbsp;&nbsp;&nbsp;How it felt when, because so many were dying so fast, the hospital ran out of body bags and toe tags. How it felt to place one corpse — an 80-pound female — into an Army bag big enough to hold eight. To cut up manila folders for toe tags.&nbsp;&nbsp;&nbsp;How it felt when the wife and son of a ventilated, comatose patient,&nbsp;who were&nbsp;watching him remotely through an iPad&nbsp;at the foot of the hospital bed, implored, “Please don’t give up on him.” And to have&nbsp;not&nbsp;given up, but lost him anyway.&nbsp;&nbsp;&nbsp;&nbsp;How it felt to be so busy setting up intravenous lines, attaching monitors, helping physicians start to ventilate a new patient whose oxygen levels were crashing that you didn’t tend to the two other patients in your charge, and&nbsp;to know&nbsp;there wasn’t&nbsp;anyone else&nbsp;to suction, feed and turn them. To wonder still: Did it make a difference?&nbsp;How it felt to see refrigerator trucks parked outside, away from public view. To go an entire shift being too&nbsp;afraid to remove&nbsp;a&nbsp;face mask to take a sip of water.&nbsp;&nbsp;To drive home, buzzed on caffeine and adrenaline, seeing double, anticipating not a hug — too dangerous — but only a fitful rest, broken by nightmares.&nbsp;They are relieved the surge has passed. But with the potential for future waves ahead, New Jersey’s hospital nurses aren’t sure they can face it.&nbsp;&nbsp;Many are disturbed, and possibly traumatized, by the amount of death they have witnessed. They feel anxious about their own health, their exposure to the virus and the contagion they may bring home. Some worry about layoffs or furloughs, and whether image-conscious hospitals will punish them for speaking out.&nbsp;&nbsp;They want changes next time, if there is a next time: They want to be heard. To be prepared. Above all, to be protected.&nbsp;&nbsp;Lawn signs to the contrary, many of them don’t feel heroic.&nbsp;&nbsp;“I really felt a failure,” said an intensive care nurse who has worked for years at Englewood Health.&nbsp;“I took care of patients I could not do my best with. … Things would have been so different if we had more support.&nbsp;“I love what I do,” she added. “But I feel so damaged right now.”&nbsp;&nbsp;“It was the blind leading the blind, under the worst possible circumstances,” said another longtime nurse&nbsp;at the hospital.&nbsp;“The public is out there calling us heroes and sending us meals, yet I feel like a fraud.”&nbsp;&nbsp;More nurses have resigned or retired&nbsp;in&nbsp;recent months than usual, according to representatives of two large nurses’ unions. Nineteen nurses at St. Mary’s General Hospital&nbsp;in Passaic&nbsp;have left or plan to do so, said Doug Placa, executive director of JNESO District Council 1.&nbsp;&nbsp;&nbsp;Debbie White, president of the Health Professional and Allied Employees, said leaders of union locals at 27 hospitals and other health care facilities have told her their members were resigning&nbsp;because they were afraid.&nbsp;Others quit rather than deal with the stress.&nbsp;&nbsp;&nbsp;A Valley Home Care nurse, 45, resigned in May after 10 years. “This was not something I took lightly,” she said. But a nurse’s aide who worked with her died. And when Valley Health was short of disposable gowns&nbsp;for visits to nursing homes or patients’ homes, she said, it offered her&nbsp;one fashioned from a shower&nbsp;curtain.&nbsp;&nbsp;“I’m somebody’s mother, somebody’s wife —&nbsp;if I don’t care about myself, I care about them,” she said. “I just felt they weren’t looking out for my health.” Valley said all nurses received appropriate protective equipment when caring for patients with COVID-19.&nbsp;Some nurses described a moral injury: they felt&nbsp;they failed to provide the compassion or quality of care they consider integral to their identity as nurses. Rather than pride, they feel guilt and shame.&nbsp;&nbsp;The latest coronavirus news:'If you think too much, you cry':For such front-line caregivers, “the emotional wounds of the surge will need treatment,” said Dr. Ramon&nbsp;Solhkhah, a psychiatrist with Hackensack Meridian Health, whose 14 hospitals treated more than 10,000 COVID-19 patients.&nbsp;&nbsp;He likened&nbsp;the suffering of these health care workers to that of 9/11’s first responders.&nbsp;&nbsp;“We can expect years of mental health impacts in the form of post-traumatic stress disorder,” he said, “and we are already starting to see it.”&nbsp;&nbsp;&nbsp;Most of the 11 nurses interviewed for this story are members of unions — Health Professional and Allied Employees and JNESO. Although union contracts provide some job protection, each asked not to be identified by name for fear that their employers would penalize them for speaking out.&nbsp;&nbsp;Pressure on staff to remain silent during and after the recent crisis has been intense and explicit, as hospitals strive to convey a sense of normalcy to returning patients and&nbsp;to&nbsp;avoid questions about their preparations for,&nbsp;and performance during,&nbsp;the pandemic.&nbsp;But hospital workers have paid an enormous — and largely unrecognized — price.&nbsp;&nbsp;&nbsp;Even their deaths are not fully acknowledged.&nbsp;&nbsp;Story continues below galleryAlthough the state tracks, no such tally is available for hospital staff. It’s an information gap that Debbie White, president of HPAE,&nbsp;calls&nbsp;“despicable.” Hospitals should be legally required to report such information, she said.&nbsp;&nbsp;The state Department of Health expects to have such data compiled soon, a spokeswoman said.&nbsp;&nbsp;A&nbsp;.&nbsp;JNESO reports a similar number.&nbsp;Although information from hospitals has been scant, the&nbsp;JNESO&nbsp;union’s records show that&nbsp;some 200 of its 5,000 members&nbsp;were unable to work because of COVID-19,&nbsp;Placa&nbsp;said. And hundreds of HPAE’s members were exposed and sickened, White said.&nbsp;&nbsp;COVID-19:For subscribers:Workplace confidentiality often keeps even those who worked side by side from learning the cause of a coworker’s death.&nbsp;&nbsp;“I know of one person that was lost in our department,” said an Englewood nurse, “and it’s never ever been acknowledged. It’s like their life didn’t matter.”&nbsp;&nbsp;At The Valley Hospital, many nurses learned of the , when the human resources department circulated a memo offering them the opportunity to donate unused paid time off as a memorial contribution. Her friends created a GoFundMe page for her sons.&nbsp;Hospitals say they recognize and appreciate the emotional and physical toll the pandemic has taken on their staffs and&nbsp;offer&nbsp;many&nbsp;ways to help.&nbsp; "We acknowledge how very stressful this has been and recognize that our front-line&nbsp;staff went above and beyond," said Valley's spokeswoman, Maureen Curran Kleinman.&nbsp;“Our concern for our team was and continues to be paramount,” Kathleen Kaminsky, Englewood’s chief nursing officer, said in a statement. Nurses' resilience, at Englewood and beyond, “will ensure that our community receives the very best care safely and with compassion.”&nbsp;&nbsp;Englewood, like every health care organization, experienced "significant staffing challenges," she said.&nbsp;“Our nursing leaders innovated with our teams to develop solutions almost overnight.”&nbsp;&nbsp;The hospital brought&nbsp;in 120&nbsp;outside&nbsp;‘’travel nurses’’&nbsp;and reassigned staff members during the pandemic. "We were all learning how to care for the sickest patients together,” she said.  &nbsp;At St. Mary’s hospital in Passaic, a “very small number of employees …decided to leave due to the inherent risk” of caring for coronavirus patients, a spokeswoman said. But “nearly 99%” of the hospital’s workers kept working, and last week, a large group of newly hired nurses and patient care assistants underwent orientation, said Vanessa Warner.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Englewood, Valley and St. Mary’s each said through spokeswomen that all staff members received appropriate personal protective equipment, in accordance with guidance from the federal Centers for Disease Control. Those protocols changed during the pandemic.&nbsp;&nbsp;Valley and others stressed the variety of support available to front-line staff, including weekly drop-in sessions, confidential counseling through the employee assistance program&nbsp;and webinars.&nbsp;&nbsp;Nurses are used to death, but not the amount they witnessed during the coronavirus surge. There were days and nights when 10 or more&nbsp;patients died during a single shift.&nbsp;&nbsp;“We ran out of toe tags,” said an Englewood nurse redeployed to a COVID unit during the crisis. The nurses cut up manila folders as substitutes to ID the bodies. “You felt like the only discharges were deaths.”&nbsp;One nurse estimated half her patients died. “Nobody was getting better,” said another. “Nobody.”&nbsp;&nbsp;Phones rang and rang with family members asking about loved ones. “These patients — they had mothers, fathers, brothers,” said a nurse redeployed from a different unit to the Englewood ICU. “Nobody was getting back to them.” The critical care physicians and residents were too busy; physicians to whom the task was delegated hadn’t&nbsp;actually seen&nbsp;the patients.&nbsp;&nbsp;“I told them we’re doing the best we can,”&nbsp;the Englewood nurse&nbsp;said, as she began to cry. “But even the best we can&nbsp;do&nbsp;is not good enough.”&nbsp;&nbsp;No masks — then no contact:‘Five minutes in the car to cry’:Another told of holding the phone for a patient’s last conversation before&nbsp;he was sedated and intubated. “They’re deteriorating. You don’t know whether they’re going to come off the vent. They’re trying to talk to family, but they can’t really talk, they can’t breathe.”&nbsp;The nurse paused, catching a breath. “These are the scars we bear —&nbsp;you can’t really talk about it to somebody who hasn’t seen it.”&nbsp;&nbsp;Death in the hospital for coronavirus patients&nbsp;meant&nbsp;no family members stood at bedside to stroke their head or hold their hands. This searing loss for patient and family also wounded the nurses who made possible&nbsp;remote&nbsp;words of goodbye. They knew they were lesser&nbsp;stand-ins for a circle of loved ones; they, too, wished it were otherwise.&nbsp;&nbsp;&nbsp;&nbsp;“I held her hand, I held the phone up to her ear,” a redeployed nurse at Englewood said. “It was scary.”&nbsp;&nbsp;In recent weeks, nurses have described anxiety, depression, helplessness and even suicidal thoughts, said Barbara Rosen, an HPAE vice president. “We cannot call them heroes only to treat them as disposable as the paper masks on their faces.”&nbsp;The “unmeasurable burden” borne by front-line workers will have “a lingering impact … on both their physical and mental health,” Debra Koss, a psychiatrist and president of the New Jersey Psychiatric Association, recently told the Assembly Health Committee.&nbsp;&nbsp;&nbsp;She urged legislators to provide support for front-line workers’ mental health:&nbsp;“Protecting their wellness must be a priority.”&nbsp;&nbsp;The anxiety of facing potential infection&nbsp;by&nbsp;a&nbsp;life-threatening virus while supplies of personal protective garb were short was heightened when colleagues fell sick or were quarantined because of exposure.&nbsp;Those who were diagnosed themselves were all too familiar with the frightening potential for severe illness, because they had seen it firsthand. “I didn’t want to become one of those numbers,” said an Englewood nurse who had COVID-19.&nbsp;&nbsp;&nbsp;Pam&nbsp;Taverone, a nurse at St. Mary’s in Passaic, contracted COVID-19 and was home for days. After the chest pain and gastrointestinal symptoms abated, she thought she was better, but then was hit with two weeks of severe muscle and joint pain. Now she&nbsp;has headaches, and&nbsp;doesn’t know whether they’re&nbsp;a new symptom — or a sign of anxiety.&nbsp;&nbsp;The novelty of the virus means protocols for follow-up care are unclear and evolving. No one knows if those who were sick could become&nbsp;reinfected. Nor is it clear if a positive antibody test means someone is immune, or if so, the duration of that immunity.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Even today, protective masks and gowns are in short supply at some hospitals.&nbsp;At St. Mary’s, they are kept under lock and key.&nbsp;Taverone&nbsp;said she gets one N95 mask, which filters out 95%&nbsp;of particles, and a surgical mask to wear over it, for each shift in the ICU.&nbsp;&nbsp;“The day before I go to work — the entire day — all I can think about is, I have to wear that mask tomorrow. I feel short of breath. My heart gets palpitations,” she said. “You don’t know what you’re going to walk into. A good day? A bad day? You just don’t know.”&nbsp;&nbsp;An Englewood nurse described an entire 12-hour shift without a drink of water. “They provided us with one mask per shift,” during the surge, she said.&nbsp; “It's impossible to take it off without contaminating yourself.” Rather than leave it on for 12 hours straight, she spent $240 on 30 masks, so she could eat or take a drink of water mid-shift.&nbsp;&nbsp;Everyone —&nbsp;including&nbsp;doctors and nurses — was learning about the disease for the first&nbsp;time, testing and refining treatment as experience grew. “Proning” ventilator patients, or rolling them onto their chest to improve oxygen intake, had seldom been used before. Nurses at Englewood said they wanted to see the protocols in writing as they&nbsp;evolved, and&nbsp;want to be trained in them before another wave hits.&nbsp;&nbsp;&nbsp;For nurses who were redeployed from other areas of the hospital, the challenge was even greater — compounded, in some cases, by switching from night&nbsp;to day&nbsp;shifts or vice versa.&nbsp;&nbsp;Nurses in an ICU have been trained to manage powerful drugs that sedate and paralyze ventilator patients,&nbsp;alleviate pain and anxiety, and stabilize heart rate and blood pressure, among other tasks. Those reassigned from other departments usually haven't received training in all of those tasks. They “could scan drugs into the computer and change IVs,” said one nurse, but they didn’t know how to respond to every beep and alarm.&nbsp;&nbsp;So&nbsp;they learned on the fly.“It was like I was a&nbsp;brand new&nbsp;nurse in school,” said one who had been reassigned to the ICU at Englewood. “I’m not skilled in intubation, not trained in the equipment or pushing drugs.” After doing it three days in a row, “I got the gist of it.”&nbsp;As they watch New Jersey’s economy&nbsp;opening up&nbsp;and stay-at-home restrictions lifted, nurses say they feel&nbsp;stress, and wonder what the fall will be like. “People who think this is ridiculous, that mask-wearing is unnecessary,” should see what she has seen, said&nbsp;Taverone.&nbsp;She, like the other nurses, wants her hospital to be prepared, and to have plans in place for additional staff when needed. Above all, she never wants to run short of PPE and feel exposed to a lethal virus again.&nbsp;&nbsp;“Protect your nurses first,” she said. “You need to keep us safe at all costs. Without us, you have nothing.”&nbsp;Lindy Washburn is a senior healthcare reporter for NorthJersey.com. To keep&nbsp;up-to-date&nbsp;about how changes in the medical world affect the health of you and your family,&nbsp;.Email:&nbsp;&nbsp;Twitter:&nbsp;&nbsp;View Comments

NorthJersey.comView CommentsThe lawn signs call them heroes. And like veterans of any war, many nurses who have fought COVID-19 in North Jersey’s hospitals dwell less on their heroism than on the trauma they have witnessed.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;They appreciate the signs, but they don’t think you know how it felt.&nbsp;&nbsp;&nbsp;How it felt when, because so many were dying so fast, the hospital ran out of body bags and toe tags. How it felt to place one corpse — an 80-pound female — into an Army bag big enough to hold eight. To cut up manila folders for toe...

Traumatized by the amount of death, some NJ nurses unsure they can face another COVID-19 wave

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