‘It just keeps coming:’ KRMC workers have COVID fatigue
KINGMAN – Each day at Kingman Regional Medical Center, health-care workers suit up in personal protective equipment ready to serve their community for a variety of medical needs. However, COVID-19 continues to fill the hospital rooms in the least vaccinated county in Arizona, where health-care workers prepare for another year of devastation and exhaustion.
Going into 2022 short on staff with the omicron variant creeping up in numbers, KRMC nurses shared they feel like they’re preparing for battle. With spikes in recent weeks, Sarah Schritter, RN, KRMC manager of nursing practices, said currently 34.48% of COVID-19 positive individuals are hospitalized, or one out of three positive cases. On Tuesday, Jan. 4, the hospital had 56 new positive cases and in the last 30 days it had 736.
Since November, 38-44% of patients at KRMC have been COVID-19 related and 75% of the 14 ICU beds have been occupied by COVID-19 patients.
While workers are picking up extra shifts and are accompanied by an agency staff to help with vacancies, it’s not enough, said Leslie Martin, KRMC assistant chief nursing officer.
“They’re tired, and they’re burned out and they’re struggling, to be honest,” Martin said.
Currently, KRMC has over 20 nursing positions and 12 intensive care unit and progressive care unit positions available, said Jim Wells, chief nursing officer at KRMC. Due to COVID-19 and the care each positive patient needs, the hospital is stretched thin. KRMC is licensed for 235 beds, however, that does not mean they can staff those 235 beds, Wells said. Health-care workers from other departments have been redeployed to help with the surge of COVID-19 patients at KRMC.
With COVID-19 patients, Wells said that the nursing ratio differs. For example, one group of six COVID-19 patients currently requires two nurses versus the normal one nurse.
“Part of that staffing issue that I don’t think people understand is that ... because of all the additional work and attire we have to put on, which requires more nurses,” Wells said.
To ensure the safety of health-care workers, PPE must be worn when caring for COVID-19 patients, which takes time to put on and sanitize. Schritter said every aspect of the hospital has had to adjust to COVID-19 to keep personnel and patients safe. From ICU to reception to the kitchen, the hospital community has to constantly navigate how they provide care.
“It creates a lot of stress on the organization, trying to manage all of this while protecting all of our patients in the hospital,” Wells said.
Schritter also said COVID-19 patients are coming in sicker, staying in the hospital longer and using more oxygen. Dr. Will Urueta, hospitalist director at KRMC, shared X-ray images of “COVID-19 lungs” compared to healthy lungs.
Healthy lungs, which show black speckles on an X-ray, show normal blood tissue and air. However, COVID-19 lungs look milky or like a whiteout due to a snow storm. The infected lungs give off a milky look because they aren’t able to exchange oxygen the normal way.
While the respiratory illness is sometimes compared to the flu or cold, the comparison is inaccurate because the illness attacks an individual's lungs, Urueta said. COVID-19 can also produce long-term effects that are relatively unknown and can impact cardiac function, taste and smell, and cognitive functions.
Adam Dawson, Innova emergency department medical director, said that worker shortages along with COVID-19 at KRMC have become so dire that they are sending some patients with COVID-19 home with oxygen if they meet proper levels.
“Something we’ve never done before, some of these patients are going home with new oxygen requirements,” Dawson said. “So we’re actually sending oxygen tanks and equipment to their house with the patient.”
With nurses and doctors stretched thin, ER rooms backed up and sick individuals occupying rooms for longer, the hospital has less flexibility to accommodate the sick and injured. While they do not turn anyone away, the hospital is deferring non-urgent surgical procedures to a later time due to stretched resources.
Urueta said from a human perspective, the last couple years have been extremely tolling on health-care workers. Wells said a nurse who retired last week said she has seen more death in the last two years than throughout her entire career.
“We have had physicians cry openly about the situation that’s going on,” Urueta said. “And despite that, they continue to provide care.”
Will McConnell, KRMC president and CEO, said they’re experiencing fatigue because there hasn’t been a break from COVID-19.
“That’s where the majority of the fatigue comes from. It just keeps coming,” McConnell said.
Urueta said the highest number of ICU patients and deaths are unvaccinated individuals. He said another challenge they face is mistrust among patients. By consulting pharmacists, new data and experience, health-care workers aim to display care and information every day.
“They question the treatments we offer; they suggest treatments that are unrealistic or unproven,” Urueta said. “And we have to navigate all of that professionally, as much as we can.”
Once an unvaccinated individual gets to the ICU, the mortality rate is “extremely high,” Urueta said. Prevention is the best way to avoid getting to a dire stage. According to Urueta and Schritter, monoclonal antibody therapy is available, but patients have to qualify and have symptoms within the past 10 days. However, vaccines are the best way to prevent hospitalization and death.
“We want the community to do very well in Kingman and we want them to be at a healthy level and not in this unnecessary situation,” Urueta said.
Inquiries for ivermectin have been received by KRMC staff, however, KRMC and many medical associations do not support treatment with ivermectin for COVID-19. McConnell also mentioned the manufacturer of ivermectin, Merck, has said the drug should not be used to treat COVID-19.
The Mohave County Department of Public Health has yet to report an omicron case, so the hospital does not know how the variant will play out in a predominantly unvaccinated county. KRMC nurses and doctors ask the community to take preventative steps to stop the spread of COVID-19 so they can have access to resources for other health-care needs or emergencies, such as heart attacks.
The health-care workers reiterated, no matter if a patient is vaccinated or not, they will receive care. As an apolitical entity, the job of the hospital is to provide care to patients no matter their beliefs or background.
However, it is also their job to provide information and resources that can prevent people from suffering from a preventable outcome, Urueta said. This includes accurate information, and access to approved medicines and vaccines to treat and prevent COVID-19.
“We will always provide the safest care that we can,” McConnell said. “We are entering an environment where if the surge continues, we don’t know what the true impact of that (will be) until we’re in it.”