File images of nurses and doctors in surgery
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COVID 2021

‘Such a burnout’: As workloads rise, nurses hope new testing guidelines, vaccines, bring relief

As COVID-19 surges, nurses in Santa Cruz County are being stretched to their limits. And getting tested for many has been just as challenging as it has for the general public. Will new testing protocol and a vaccine lesson the burden?

When Celia de los Reyes got the call that she had tested positive for COVID-19, she was terrified. “I seriously thought in my head, ‘Oh my God, I’m going to die,’” she said. “Because you never can tell how your body’s going to react to it, until you get it.”

Reyes, a 50 year-old nurse who lives in Felton and works at the Santa Clara County jail, received this call while she was at work. As upsetting as it was, she was glad to know the results fewer than 24 hours after she was tested.

A few days earlier she had been working in the jail infirmary, and one of the nurse’s aides — who had spent hours with her and others in the small room where they did all their paperwork — had tested positive. Luckily, Reyes’s employer, Santa Clara County, allowed her to get tested any time she wanted.

Celia de los Reyes
(Provided photo)

“If we didn’t have that testing, I probably still would’ve gone to work for a little bit,” said Reyes, who is now in the middle of her quarantine and is fighting congestion and fatigue. “I would have exposed more people, if I [hadn’t been] able to just walk in and get a test.”

This isn’t the case for all nurses and health care workers who deal with COVID-19 patients in California. But this week, a new testing recommendation issued by the California Department of Public Health at the urging of the California Nurses Association, took effect. General acute-care hospitals are being asked to test all inpatients, and all health care workers, once a week.

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“CDPH strongly recommends [hospitals] implement a program of weekly screening testing for SARS-CoV-2” for health care professionals, the recommendation states. All health care professionals “should be included in the weekly screening testing program to maximize the strategy for prevention of outbreaks.”

Previously, hospital workers who didn’t have access to testing through employer-sponsored health plans had to jump through the same hoops as the general public to get tested.

“There’s been some pushback statewide on this, [but] … our hospitals feel they can do it. The testing capacity in these hospitals has grown,” said Dr. David Ghilarducci, medical director of Santa Cruz County’s emergency medical services. That’s because county funding has allowed the hospitals to expand their capacity for in-house testing, he said.

Recommendation, not a requirement

Still, the testing guidance from the state isn’t a requirement. And, so far, some health care systems are short on specifics as to how they’ll get it done.

Dr. Nanette Mickiewicz, Dominican Hospital’s president, said the hospital started offering COVID-19 tests to asymptomatic employees this week. The results from a self-administered nasal swab are available within 48 hours, she said in a statement Dec. 18.

“This routine COVID-19 testing is not mandatory and is completely free, and employees can be tested up to once a week,” she said.

Dan Brothman, the CEO of Watsonville Community Hospital, told Lookout that “Nothing has changed at all yet. We’re aware of the changes, but we haven’t done anything at all yet.” He said they are “focusing on having enough supplies to be able to test every patient who comes in and needs a test.”

Kaiser Permanente, which has physicians who see patients at facilities in Watsonville, Scotts Valley and Santa Cruz, said it already offers regimented testing for its staff who work there.

“Kaiser Permanente provides testing for patients upon admission to the hospital and prior to surgeries and procedures. Testing is also available for health care workers as part of a comprehensive employee health program to protect them throughout the pandemic and during this current surge,” a KP spokesperson said.

Kaiser Permanente’s health care facilities are “evaluating” the Department of Public Health’s guidance “to determine if any additional changes are needed.”

Sutter Health Maternity & Surgery Center did not provide specifics on its plans to fulfill the state’s testing recommendation.

While the pandemic surges to its highest peak in Santa Cruz County, and Bay Area ICU capacity fluctuates close to the 15% mark, staffing continues to be an issue across the state. The more patients are hospitalized, the more nurses are needed to attend to them. The sicker a patient is, the more staffing is required to care for them.

The state adjusted its nurse-to-patient ratios on Dec. 11 to mitigate staffing shortages. In ICUs, step-down units, telemetry units, EMS and medical and surgical units, nurses can now be assigned to one more patient — a 1-to-3 ratio instead of the former 1-to-2 ratio. But many nurses are unhappy with this change, including at the Watsonville hospital, where nurses are planning a protest on Thursday afternoon.

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Gov. Gavin Newsom also announced changes on Tuesday to the state’s health care worker quarantine protocol during critical staffing shortages.

Health care, emergency response and some social service workers exposed to COVID-19 will be required to quarantine for only seven days (instead of 10 days, as was called for previously). They can then return to work, as long as they get a negative test result on day seven, Newsom said.

California is also looking to expand its existing health care workforce, by contracting with state and federal agencies and dipping into reserves of recently retired healthcare workers who could temporarily help with staff shortages.

Hopes for safety in weeks ahead

Christine Loeffler, 36, an ER nurse at Dominican Hospital, said at times during the pandemic, it’s been as challenging for her and other front-line health care workers to get tested as it has been for the general public. Getting tested once a week will help her feel safer at work, she said.

Christine Loeffler
(Courtesy Dignity Health)

“I think it’s amazing. I’m super grateful that this is where we’re at now, mainly because I think it’s a little bit crazy that we haven’t been able to get tested, really” she said. “Everybody in the hospital is really essential and precious and we don’t want to be passing anything around, even if we’re asymptomatic.”

Dignity Health, the parent company of Dominican Hospital, employs some 1,700 health care workers in Santa Cruz County alone, according to Mickiewicz.

This week, as the first round of COVID-19 vaccine doses made their way to hospitals across California, leaders are still worried about the weeks ahead. Health care workers like Loeffler and Reyes are at the top of the priority list to receive the vaccine, but it’s still unknown if the vaccine will stop those with COVID-19 from transmitting the virus to others. That question looms over health care operations, which rely on a healthy workforce.

Reyes is currently in day seven of her isolation. It’s the first time off she’s had since the pandemic, and it will probably be her last for a while.

“I know I’m working Christmas Eve and Christmas this year and I’m sure I’m going to have to pull extra shifts if I can, but I don’t think I’m going to be in the mood to pull any extra shifts,” she said. “It’s just such a burnout. When you go in, and you’re dressing up like this, and you’re putting yourself at risk. We can’t really even visit with each other.”

Burnt out as she is, in almost the same breath, Reyes thinks about going back to work, and how she can make her new antibodies useful. She’s already donated plasma.

“Maybe I’ll tell them to put me in the infirmary, where all the COVID patients are, to give someone else a break,” she said.

Updates:

12:06 PM, Dec. 18, 2020: This story was updated to include new information on Dominican Hospital’s employee testing program.