When Covid-19 hit the United States in 2020 and hospitals became overwhelmed with patients, they had to think fast and try and slow the spread by shutting down hospitals and nursing homes for family visits. Looking hindsight, particularly with nursing homes, took a terrible toll on the elderly residents and caused major depression, loneliness, helplessness, and further cognitive decline. As the country watched families try and make the best out of a bad situation, we saw children and grandchildren seeing their family through windows, from the outside looking in. For hospitals, there was also no visitation protocol on Covid-19 designated floors which created much trauma for both the hospital staff and families as the nurses became the conduit between dying patients and their families last moments.
I firmly believe that the nurses on the frontlines from the beginning of 2020 to today serving as surrogates for family members as patients take their final breaths, so they will not die alone have or will have trauma and psychological scarring now and into the future. We need to be aware of this, and we should take care of them.
As the United States thought they got past the corner with vaccine availability at the end of 2020, hospitals and nursing homes began to relax visitation protocols and slowly let families visit for short periods. I do not think it has yet to get back to "normal" visiting hours as I was in the hospital in October for 12 days and the rules were one person for a half-hour a day and nobody in the emergency room. Today, it is all over the news that hospitals are going back to full restriction protocol again because of the delta variant that seems to be spreading quicker and to a larger population of vaccinated and unvaccinated patients.
Additionally, hospitals mandating that their staff get the mandatory vaccination for Covid-19 or face possible termination, weekly testing, increases in their contribution to healthcare benefits, etc., is causing many nurses to walk off the job or be terminated.
Between a nurse shortage and family visitation suspended in most cases unless it is with a pediatric inpatient, end of life situations, exceptions made at the clinical team's discretion, and in maternity, the patients are not getting the care they need. We are headed for a perfect storm and healthcare crisis. As you will read in #notinvainapromisekept, my family had to be there a lot when my Mom was battling ovarian cancer. You can't put a price on advocacy and family. Depending on the unit and the amount of care you need, your nurse will generally visit a patient every hour. It could be a quick do you need anything, are you ok, or to give you scheduled medications. The nursing aids come in and take vitals and will often pass any messages, complaints, or needs that the patient has to your nurse in charge for that day. The nurses will push your requests or needs up to your doctor or the hospitalist. If you are lucky and ask for something before a shift change, you may get what you need in a couple of hours or less. I'm not trying to be negative, but it is a reality. Somethings can go over a day to get an answer. This is my experience. My Mom's experience is an entirely different sore subject that you will read about.
Why is this a perfect storm? If your loved one is very ill, and you as their family are there and alternating visits, you have your eyes on them for a large amount of time. You are unofficially part of their care team. Why?
You know if they had breakthrough pain
How long they may have waited for their medication
If they ate their meals (food services do not check to see that you ate, they throw out the uneaten food)
You know if they had breakthrough nausea
You know if they look sicker or more themselves because to the nurses, they are a stranger
You know how they are mentally because you know their "normal"
You know if they are being transparent to the doctor or nurse (i.e., maybe bending the truth of symptoms to get released because they hate to be in the hospital)
You know how they were before they got sick, activity level, responsibilities, career information, daily routines.
You know if they live a healthy lifestyle or sometimes know if they are compliant with their medications at home.
You know what food they will eat and not eat
The list is endless.
You cannot put a price on the value of the list above. In some cases, it is life-saving. In my Mom's case, while she lost the battle, I cannot tell you how many times we had to inform the nurses and doctors of missed stuff they were unaware of, and unfortunately, many mistakes. One that sticks in my mind is she was on chemotherapy. One of the main side effects of chemo is nausea. My Mom never wanted to "burden" people, so she never really asked for help. She was prescribed a Zofran drip, and the nurse never opened the IV. So she sat an entire day and puked, and we did not figure out why until I got there and realized the bag was full and clipped off. While this is human error, mistakes happen; when someone is puking all day and critically ill, it is a big oops.
The absence or limited presence of patient support systems are creating, once again, additional strains on an already stressed system and particularly on nurses. This leaves room for more unintended consequences like falls, mistakes, missed care, or someone not noticing a patient decline.
As we learn more and more every day about this virus, I hope they will rethink the risks to the patient and, quite frankly, the toll on the hospital staff when creating visitation rules. I have said it many times, nurses to me are the team captain. They are the most important person on the team for the day to day. I hope we learn our lesson from the lockdowns of the past and what they have done to these professionals and our loved ones.
See the attached article. It is a good overview of the storm we are approaching.