DETROIT -- Krysti Kallek has worked for the past decade in the emergency department at Detroit’s Sinai Grace Hospital. But she’s never experienced anything like Michigan’s coronavirus crisis.
The number of patients. The severity of their symptoms.
The emergency department is bursting to the seams, day after day, night after night.
“We’ve run out of stretchers. We’ve run out of body bags,” said Kallek, who is a nurse.
Patients end up in the emergency-department hallways using oxygen tanks, she said. One night, they even ran out of oxygen tanks, so staff ran oxygen tubing from patient rooms to the people in the hallways.
And the COVID patients who come in are so, so fragile.
“We’ve never had patients like this, who crash so fast out of nowhere,” Kallek said. “One minute they’re smiling and the next minute they’re down.”
And when the patients are put on ventilators, which many are, it’s hard to keep them calm and sedated, she said. “So you have to put them on multiple drips, which brings down their blood pressure and you have to monitor that, and they’re still waking up and having things happen out of nowhere.”
The situation is so fraught that emergency-department nurses are afraid to take a meal break because that leaves even fewer nurses to monitor so many patients, she said. “I couldn’t tell you the last time I took a break.”
To make matters worse, the fact that coronavirus is highly contagious means patients can’t have family with them, and the medical staff has to worry about being infected themselves. Kallek said a colleague who has coronavirus is now on a ventilator struggling for his life.
It’s in this environment, she said, that she and other nurses on the night shift staged a walkout Sunday. When the shift began, there were six nurses, including one still in training, expected to care for 68 patients already there — not counting those likely to arrive during the night.
“We needed to do something drastic to get people’s attention,” Kallek said, adding the nurses who walked out had the full support of day-shift nurses who agreed to stay on to care for patients.
The biggest complaint: understaffing, which Kallek says has been a long-time issue at Sinai-Grace, whose clientele tends to be disproportionately low-income and more likely to have underlying health issues such as asthma and diabetes.
“High patient volume is creating an increased need for staffing, especially nurses,” said a statement provided to MLive by Detroit Medical Center, which operates Sinai Grace. “The DMC is using a variety of resources to help to supplement nursing staff.“
Kallek says Detroit Medical Center, which operates Sinai-Grace, should increase incentive pay and do whatever it takes to increase permanent, adequately trained staff, especially in a crisis that has pushed Sinai-Grace to a breaking point.
“It’s been like this for the past two, three weeks,” Kallek said. “And once it started, it has not stopped.”
Unrest around the state
Kallek is far from the only Michigan health-care workers anxious and upset these days.
Across the state, there are concerns about staffing. Worries about shortages of personal protective equipment. Fears about their own health.
Doctors on front lines of coronavirus: ‘It seems like the sky is falling’
At least three Michigan healthcare workers have died from coronavirus.
Officials at the Beaumont Health in metro Detroit said on Monday that 1,500 of its 38,000 workers, including 500 nurses, were out sick with COVID symptoms. The Henry Ford Health System said about 600 to 700 of their 31,000 workers have tested positive. At University of Michigan’s Michigan Medicine, 110 workers out 728 tested positive for the coronavirus. Two-thirds of those who have tested positive for COVID-19 in Bay County are health care workers, according to the Bay County Health Department.
In Detroit, there was the walkout at Sinai Grace. In Kalamazoo, nurses at Borgess Medical Center are alarmed by the specter of temporary job transfers to the east side of the state. In Mount Pleasant and Lapeer, McLaren hospitals are being criticized by the Michigan Nurses Association for not doing enough to protect and support employees.
“If we don’t take care of our nurses, who will be left to take care of COVID-19 patients?” said Christie Serniak, a nurse who is a local union president at McLaren Central Michigan Hospital in Mount Pleasant.
Hospital officials say they are doing the best they can in an unprecedented crisis.
“Our team members are our greatest asset and their health and safety is a top priority,” said a statement from Henry Ford Health System.
A McLaren spokeswoman said her hospital system is working with the nurses’ union to address their concerns, and officials are “moving quickly to address the fluidity of this crisis to keep patients and staff safe.”
Nonetheless, there are ongoing issues with staffing levels, access to coronavirus testing for staff and a shortage of personal protective equipment, or PPEs, such as masks and gowns, acknowledged Ruthann Sudderth, a spokeswoman for the Michigan Health and Hospital Association.
“We’ve been laser-focused” on getting more PPEs in the midst of a nationwide shortage, Sudderth said. “Hospitals are doing everything they can and using all of their purchasing power to get more supplies.”
There also is a shortage of coronavirus tests and test supplies such as throat swabs and reagents used in the testing, she said. While testing of symptomatic health-care workers is considered a high priority, she said, the shortages have made that difficult.
“We want to do more, but we need more stuff,” Sudderth said.
As for staffing, “that has been and remains one of our primary concerns,” she said. “Adding beds without additional staff who are trained to provide that level of care doesn’t help a whole lot, so staffing continues to be a challenge.”
The influx of COVID-19 patients into hospitals is exacerbated by the number of healthcare workers who are also out sick, she said.
“It’s not a huge percentage of their overall workforce,” Sudderth said. “But these are people that we absolutely need to be able to report to work so the system feels that.
“And what these people are doing showing up to work every day is nothing short of heroic.”
Mandatory transfers?
Those words of encouragement are cold comfort for Jamie Brown, president of the Michigan Nurses Association, the state’s largest union representing registered nurses, who said she’s hearing from worried colleagues around the state.
Coronavirus has Michigan nurses worried about protective equipment, sick leave
“There’s so much uncertainty when we walk into the hospital, and we don’t know that we’re going to be able to keep ourselves safe ,” she said.
But it goes way beyond worries about having enough masks, she said.
A critical-care nurse at Ascension Borgess Medical Center in Kalamazoo, Brown is battling a situation at her own hospital in which some nurses are being told they’re on a list for mandatory, temporary transfer to Ascension hospitals in metro Detroit.
“If they don’t go, they could be terminated,” Brown said.
“The union has been trying to sit down with Ascension to figure out a voluntary program if we need to send people to the other side of the state,” Brown said. “We don’t want to have to mandate that, when it doesn’t take into account personal needs or family needs.”
For instance, she said, some nurses are single parents who don’t have a good option for someone to watch their children if the parent was in metro Detroit.
“My biggest fear is that our nurses are going to be burned or sick, and we’re not going to have enough staff when we need them to take care of patients,” Brown said. “Hospitals need to sit down and talk with us and come up with a solution.”
Ascension Michigan issued a statement saying it has not implemented “any mandatory reassignments to southeast Michigan," but doesn’t appear to rule it out.
“As we continue to navigate providing care during this global pandemic, emergency response plans are in place for ensuring we have the resources required to provide care to all who need it,” the Ascension statement said.
Lack of testing
Meanwhile, a resident physician for Beaumont Hospitals in metro Detroit says he and many of his fellow residents at Beaumont are worried about spread of coronavirus within the hospital.
“Beaumont has over 400 resident physicians and the administration has basically been really pushing us to work even in situations that aren't safe,” said the resident, who did not want his name used because residents have been told not to talk to the media.
“For example, personally I was out sick with COVID symptoms, and I have the employee health department at Beaumont,” the resident said. “I asked to be tested, and they said, ‘No, we’ll just wait until you’re three days asymptomatic and then you can come back to work.’ How do I know I’m not spreading (coronavirus) around the hospital?
“One of my colleagues had a fever and she was really sick,” and was refused testing three time, the resident said. “The last time, they told her, ‘You can only be tested if you can’t talk, so basically like if you’re near intubation.”
To be clear, the resident said, Beaumont tells workers to stay home if it’s obvious that they’re sick. “But if it’s cough and shortness of breath that’s not severe, they tell us to wear a mask,” he said.
The Beaumont resident said he’d like to see Beaumont do a better job of minimizing staff, saying that with elective surgeries and procedures canceled, “there are way too many residents, and people like social workers and nurse practitioners who are around and getting exposed when they don’t need to be."
“We also should be offered testing as needed if we’re complaining of symptoms,” he said. “They should test us immediately, rather than just say, you can be asymptomatic for a couple days and come back to work.”
He said many of the front-line workers “feel like we’re on a different page” from hospital administration.
“Our main priority is protecting the patients and the staff,” he said. “It feels like administration’s main priority is just getting through this with minimal monetary loss.”
Overwhelmed and worried
A nurse in the intensive-care department at Sinai Grace said he’s reaching his own breaking point.
He just put in his two weeks notice, and is taking a job at another metro Detroit hospital.
The understaffing at Sinai Grace has become so problematic, he said, that he worries that patients may have died because he can’t provide the level of care they require.
Sixty beds in the two ICU units compared to the normal 40, and these days, it’s common that every bed is taken.
The nursing staff hasn’t increased, which means each nurse is often assigned three patients instead of the usual two. That’s especially worrisome because some of the people are so sick that in normal times, a nurse would be assigned exclusively to that patient.
Do the best you can, the nurses are told. Just do the best you can to keep people alive.
But this has been going on for several weeks now, and it’s only getting worse, says the nurse, who asked his name not be used because the hospital has fired staff who speak to the media without permission.
The patients keep coming, and there’s talk of adding 20 more beds to the critical care units.
And it’s not just the exhaustion and frustration that comes with too many critically ill patients and too few resources. The hospital has stopped contributions to 401K plans during the crisis; with elective surgeries and procedures canceled, revenue is down.
But it’s not really about his compensation, he said. “It’s about the patients, and that’s the biggest issue for me.”
Kallek is staying at Sinai Grace, at least for now. But the challenge, she said, is formidable.
“I love working there. I don’t want to leave,” Kallek said, saying she loves the tight-knit community of nurses and doctors in the emergency department.
“But right now, people are just dying in the hall in front of us, and there’s nothing we can do about it,” she said. “We’re all going to need therapy after this. We’re used to death. But this is a whole new thing.”
CORONAVIRUS PREVENTION TIPS
In addition to washing hands regularly and not touching your face, officials recommend practicing social distancing, assuming anyone may be carrying the virus.
Health officials say you should be staying at least 6 feet away from others and working from home, if possible. Carry hand sanitizer with you, and use disinfecting wipes or disinfecting spray cleaners on frequently-touched surfaces in your home (door handles, faucets, countertops) and when you go into places like stores.
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