In a questionnaire circulated by The Bee, registered and vocational nurses, respiratory technicians, a physical therapist, a lab tech and a housekeeping aide described the situation in their workplace as stressful, hectic, awful, unpredictable, chaotic and exhausting. Responses came from workers in Fresno hospitals such as Community Regional Medical Center, Clovis Community Medical Center, Saint Agnes Medical Center, Kaiser Permanente and Valley Children's Hospital.
Hospitals throughout the state are flooded with patients and struggling to adequately staff their facilities, an issue San Joaquin Valley hospitals have dealt with long before the coronavirus pandemic.
So far this month, Valley hospital intensive care unit bed availability hovered between 1.5 and 0% as hundreds of staffers from hospitals are quarantined from either being exposed or testing positive for COVID-19.
The Fresno Bee questionnaire asked hospital staff: Do you think patients in all departments are receiving adequate care?
While some respondents answered yes, many answered no. They cited the higher nurse to patient ratio as the leading cause.
Dr. Danielle Campagne, the vice chief of emergency medicine at UCSF Fresno who works at CRMC and as the medical director for American Ambulance, said the current surge in COVID-19 patients stems from Thanksgiving gatherings. She worries it could get worse after Christmas and the New Year holiday.
"We don't want to become like a New York (situation) where we can't care for everybody," she said. "We've been spoiled in Fresno, as long as I've been in this position, that we've never had to say 'Who gets a ventilator?' and 'Who doesn't?"
"I definitely think that could be a possibility in Fresno County if our surge continues," she said.
Staffing shortage
Staff at Fresno's hospitals are stretched thin right now caring for a higher number of patients. Part of the staffing constraints is due to large numbers of the workforce being quarantined.
That means patients might not see their nurse as often.
Besides seeing an influx of COVID-19 patients who are really sick, staff still are seeing patients for heart failure, gall bladder issues, strokes, broken bones or psychiatric holds.
Some patients can be monitored remotely with a heart monitor. But if someone needs a blood transfusion, for example, a nurse must stay with that patient for 30 minutes.
"As a nurse when I get there to my shift, I'm walking in to five patients I have to assess and take their vitals and decide who I'm going to help first," said one licensed vocational nurse who works at Community Regional downtown. The Bee agreed not to name her because she feared retribution for speaking up.
"We're doing what we can with what we have. We are definitely feeling the pressure of being understaffed," she said. "We're really having to work 150% during our 12-hour shift because there's no time to not be doing something."
Katie Meyers, a physical therapist who works at Community Regional, said she spends a lot of time answering phones because no one else is there to answer.
Hospitals also are running out of room for patients. They've erected makeshift rooms but those are filling up. Keeping COVID-19 patients separate from non-COVID patients is becoming difficult. Hospitals are also using alternate care sites at Community Regional and in Porterville.
Campagne, the medical director for American Ambulance, said paramedics also are responding to more calls with fewer staff due to COVID-19 exposure. But emergency medical technicians started wearing masks early in the pandemic and over 80% of American Ambulance workers got a flu shot — both important measures that have prevented illness, Campagne said.
To provide additional staffing to its hospitals, Community Medical Centers onboarded over 40 contracted staff this week with the help of state and county partners, said Carla Milton, Community Medical's senior vice president and chief human resources officer.
To help alleviate staffing concerns at Kaiser Permanente, Wade Nogy, the senior vice president and area manager for Fresno, said the hospital brought on temporary nursing staff. Elective and non-urgent surgeries that require a hospital room are being canceled to free up staff as well.
Quality of care
Hospitals are used to dealing with a high census during flu season. But this year is different because "patients are getting sicker, faster," Campagne said.
Nevertheless, patients are receiving great care and are grateful for it, she said.
Kaiser Permanente Respiratory Therapist Kerri Neufeld said it's been difficult to watch patients suffer mentally and emotionally without their families. Family support and love are important parts of healing, she said.
But because of the pandemic, no families are allowed in the hospital. Her patients are isolated in a no-pressure room with a wind-tunnel sound from the air being pulled out of the room. They see no one except for staff dressed in personal protective equipment.
"They're scared to death. A lot of them think they're going to die," Neufeld said. "And that increases their stress levels."
Her COVID-19 patients are "air hungry," she said, and it's difficult to get them to oxygenate. By the time she sees most COVID-19 patients, their hypoxia is difficult to treat.
"Early treatment hasn't happened, and early treatment is key," she said.
It's not happening because clinics and doctor offices aren't seeing patients in person, and when people begin to feel coronavirus symptoms, they're told to stay home, she said.
At Community Regional, Meyers' physical therapy patients have had less movement than they normally would.
"Staffing shortages mean therapies don't see the patients as often, and that is often the only opportunity a patient has to get out of bed," she said.
It's hard to make sure patients feel like they're well cared for, she said.
The LVN who spoke to The Bee said patients notice staff is stretched thin.
"Most of them start with 'I know you're super busy, but ... '," the LVN said. "You still have to have this sense of customer service. You're not only nurses, it's being like social workers. We're having to carry this confidence with us. When we start showing our patients that we're completely overwhelmed, they either get really upset or want to leave."
Neufeld spoke to The Bee on her day off, and she felt guilty for not being at work.
"I need to rest," she said. "Instead of picking up more days, I work more when I'm there already so I can have days off."
Feeling unappreciated
Meyers and the LVN at Community Regional said managers need to step up.
"Managers, educators and administrators should be helping on the floors," Meyers said. "Answer phones, help patients eat and go to the bathroom. Help your staff so they can get a full lunch break."
The LVN said managers doesn't show their faces often, and it seems like all of the support and appreciation is coming from the community.
"My manager is super lucky because all the nurses he hired are very compassionate and do whatever it takes to get the job done," she said. "We show up and give 110%."
Nurses who get sick with COVID-19 are burning up their paid time off and sick days, the LVN said.
"Some nurses are starting to get burned out, but they still show up and do the job," she said.
A number of Community Medical nurses who responded to The Bee's questionnaire said they'd like hazard pay or some kind of incentive or acknowledgment of their work.
"This crisis is hard on all of us, there is no way around that," Milton said. "Our team has risen to the challenge in amazing ways over the last 10 months and they continue to provide extraordinary care under the most challenging circumstances."
Community Medical gave recognition bonuses to employees in November and is offering premium pay to those willing to pick up extra shifts outside of their normal schedule, Milton said.
Community Medical created a committee to look at ways to recognize and care for the well-being of its staff. The hospital system launched new employee assistance and wellness resources, including a mobile and desktop app with wellness content. The chaplaincy services also have been increased for both patients and staff. Concierge services are available to help coordinate employees' weekly groceries and errands, Milton said.
Kaiser Permanente provides special benefit and wellness programs, including a mental health resilience program, extended paid sick leave and weekly child care grants.
"We are in this fight together and we remain committed to protecting our valued care teams, who are at the front line of care, as we continue to ensure the safety of our patients and staff," Nogy said.
COVID-19 is different at a children's hospital
Things look a little different at Valley Children's Hospital in Madera.
A registered nurse at Valley Children's spoke to The Bee about what she's seen. She also asked not to be named in fear of retribution.
Early on in the pandemic, the hospital was almost empty, she said. Then there was an uptick of babies who were victims of child abuse. When school started, there was a wave of suicidal patients. Many of the patients with severe COVID-19 cases have other underlying conditions.
Staffing for COVID-19 and managing patients' parents has been tricky, the nurse said. When someone enters a COVID-19 room, they're not allowed to leave or go to other areas of the hospital. Some rooms don't have private bathrooms, and parents opted to relieve themselves in front of their children.
Plus, really young patients don't understand the pandemic, the nurse said. They're not allowed to walk around and visit other parts of the hospital.
Zara Arboleda, communications director for Valley Children's, said parents are allowed to use nearby restrooms. The hospital also started a delivery service to rooms from Starbucks and the cafeteria.
While patients can't wander the hospital the same way they used to, they can still leave their rooms to access the playground and classrooms, Arboleda said.
For nurses, when they care for a patient, they are stuck in the room with them in full PPE for hours and take on all bedside care as well. "You can't run in and out super easily," the nurse said.
ICU nurses care for one patient at a time, which also puts a strain on resources. But the nurse was confident patients are receiving excellent care.
At the same time, the emergency department is slow and staff are being sent home.
As schools remain shuttered, children are home more and getting sick less.
"It just goes to show how this (coronavirus) hits adults so much harder," she said.
To date, the hospital has not had a case of COVID-19 transmission from a patient to a healthcare worker or vice versa, Arboleda said, thanks to safety protocols developed by the hospital's pediatric infectious disease experts.
How the public can help
There are many easy ways the public can help relieve the staffing shortages and patient volume at hospitals.
First off, don't gather for Christmas and New Year's, Campagne said. Thanksgiving gatherings are a factor behind this surge, and she worries it could get worse.
"So if you think about it, you couldn't miss one holiday, but you will not be able to see your loved ones because we don't have any visitors during COVID," she said. "Communication is really hard and your loved one is sick in the hospital.
"The loving thing you can do for your family is to not get together," she said.
She encouraged people to wear a mask, stay home and get the vaccine when it's available to them.
Nogy from Kaiser Permanente said that the vaccine will take time to reach everyone, so the safety measures are extra important.
"We are committed to educating our members, workforce, customers, and communities about the safety and effectiveness of the vaccine and to promote understanding of how a vaccine — coupled with continued public health measures — can help control and ultimately bring about the end of the COVID-19 pandemic," he said.
Neufeld, the respiratory therapist, said people can take their health into their own hands by maintaining a healthy lifestyle. Eat healthy, exercise, and get your Vitamin D, she recommended.
If you want to get tested for coronavirus, seek options that aren't at a hospital, the CRMC LVN said.
"Don't come to the emergency department and use our resources just because you've been exposed," she said. "The county has done such a good job at creating all of these free testing sites. They're out there and there's a lot of them."
If people have a runny nose or scratchy throat, rethink that trip to the grocery store or meeting someone for coffee, Campagne said.
"Really try to think outside the box," she said. "Say, 'Do I really need to go, or do I just want to go?'"
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