!It's 2020 again --- agk's diary 18 January 2025 @ 04:06 UTC --- posted from Evy's GPD Micro PC at kitchen table with nettle, lemon balm, key lime, cayenne tea after work, before sleep --- Hi L--, I understand you're responsible for infectious disease control. If I'm wrong, can you please help this email get to the person who is? The infectious disease outbreak on unit 1, compounded on the high census and the lack of a daytime house supervisor, is overwhelming our ability to provide basic humane nursing care. We need a plan to make sure patients get seen, and potentially some public health measures beyond handwashing encouragement (in an overcrowded unit with one bathroom). As far as I know, COVID and flu tests have been negative on this unit, but we are overwhelmed by the census, the behavioral acuity, and the medical acuity on the unit, so it's possible we've done the tests wrong. Today I was alarmed when several of my patients went from headache to paroxysmal coughing, to vomiting observed by staff, to reporting vomiting blood. I was also alarmed when another patient requested his albuterol inhaler, scheduled for PRN Q6h, 2 hours after he first used it. My morning med pass (with 33 patients and lots of panic anxiety and medical PRNs) lasted until 1300.[^1] By the time I next spoke to him, his bronchial sounds were audible from across the room, he was obviously short of air and distressed, his O2 sat was 92% (he does not have COPD). Kirsten had already left the unit, but on phone call Dr. Bacha ordered a duo- neb, CXR, and mucinex. The pt was already on mucinex, so the order was doubled, and we were not able to find any duo-nebs in the hospital. We considered sending him to the ED. I gave him his inhaler early, a now dose of mucinex, and forced fluids. He still sounds terrible, and his sats remain low, but he's less distressed. It's very easy to drop the ball on someone like him because he suffers mostly in silence, especially when we're so overwhelmed. [1]: ICU nurses carry 1-2 patients per nurse, progressive/telemetry unit nurses carry 3-5, med-surg nurses 4-7, long-term care and psych work different, we do group nursing. One nurse might carry 7 or more. I carried 33 patients' meds. Charge nurse carried staff management, admits and discharges, assessment and docu- mentation, and communicated with families, providers, and therapists of 33 patients. Morning med pass should take at maximum 0700- 0900. I was telling L-- I was still passing morning meds four hours later. All beds on our unit are full. 8 of our patients sleep on the substance abuse detox unit. There are more patients on the unit than chairs. I count 16 people in the suspected outbreak of whatever it is, although my notekeeping was poor as I was doing my best to keep up with an overwhelming millieu. New cases by day (per Med consult book): 1/8: AW 1/10: WT 1/12: IW 1/14: DP 1/15: HO, NG 1/16: TJ, TC, TR, WH 1/17: RL, JB, BR, HI, BA, CG DP is still feverish (101.1) today (day 3?), WT still not eating with a low fever (99.3). Most patients haven't gotten a fever. Common symptoms are splitting headache and body aches, paroxysmal coughing (which seems to be mostly non-productive), diarrhea, and nausea. The patients are crowded, miserable, and scared, and the staff are over- whelmed. Today first shift we were staffed with one charge nurse, one med nurse, one 1:1 MHT, and 2 unit MHTs, and a float RN. Over the course of this shift we had, I think, 32 patients, 8 discharges, and 2 admissions.[^1] As I'm leaving there are 4 pending admissions. Staff are starting to get sick, which won't help our staffing situation. ^1: Each discharge is worked on by a therapist, a psychiatrist, and a nurse. It takes at least 20 minutes of a nurse's time to do one. Admissions take nurses one to two hours. We have several patients with additional risks. Yesterday we admitted a woman with lupus. Today we admitted a woman with a 3-month-old bottle-fed infant at home. WT has diabetes. We are not systematically masking or testing. We are not instituting any kind of quarantine or pause on admissions. We are not even able to give patients any social distance, care, or medical attention in a reasonable timescale. All shift long there is wretched paroxysmal coughing up and down the hallway. Calls from angry family members are increasing. Four patients filed formal grievances. Tonight a behavioral emergency code was triggered by a patient whose anxiety about her sickness and the near-neglect we're forced into escalated over the course of over an hour before she became assaultive to a patient who was defending our honor and two staff who responded, then was put in a hold. Please help. --- Update 1/20: Unit 1's still overcrowded (thirty patients), understaffed, and admitting at its usual crazy clip. Any bed cleared by a discharge's filled within an hour or so. But for a day Unit 1 patients were quarantined from gym, cafeteria, and art room. Looking at the book, I think we got more on top of the now 10+ med consults per day. I don't know how the MD keeps up with the case load. There's only one of her, this is only one of six units, and another unit is sick now, too. Quarantine lifted. Staff masking's now mandated. I wore one of Evy's KN-95s; the hospital provides only surgical masks. But what a relief! It isn't 2020 anymore! Management moved in days not months!