When Heather Tomazin, RN, a medical-surgery nurse living in New York City, heard that her hospital was setting up a new, designated unit for COVID-19-positive patients and needed more staff to help out, she immediately stepped up to volunteer to work in that unit for five consecutive shifts. Since then, she has been working with patients who have COVID-19 every single day at work.
Tomazin, 22, has only been working as a nurse for six months, and never thought a pandemic like this would happen in her career, let alone at the very beginning of it. Although she is not disclosing the name of her hospital to protect privacy, she says she feels lucky that her hospital so far has resources and the administration seems invested in helping its staff stay safe and well.
Even then, Tomazin worries about the health and well-being of herself and her fellow health-care workers as the COVID-19 crisis continues to escalate. She’s not sure (and no one is, really) if what they are doing now to protect themselves will be enough. There are not enough negative-pressure rooms (rooms with specific ventilation and airflow patterns designed to limit the spread of air-borne illnesses) for every patient with the disease, and her hospital’s staff is told to use masks and other supplies conservatively, even if they are constantly in contact with infected people.
It’s people like Tomazin, and other nurses, doctors, and even sanitation workers, who are on the front lines and facing an enormous amount of risk every day to go to work and help save the lives of those hit by the coronavirus.
Below, she shares what she wants you to know and answers all of your questions about what it’s like to be a nurse fighting COVID-19 in one of the most hard-hit areas of the country.
Well+Good: As the situation has gotten more serious in New York, how has your job changed at the hospital?
Tomazin: Around March 18, when we had the first influx of a ton of positive patients coming in, I decided to work overtime on our first COVID-positive designated floor. I volunteered because I felt like the nurses that worked on that floor didn’t sign up for this when they started working there and they were the first to be exposed to this. It was really scary at first and I just wanted to help out because they needed all the support they could get.
My unit that I work on right now [after working overtime on the original COVID-positive floor] has just been designated as an official COVID-19 unit. In my unit, we take care of four to five patients, where an ICU nurse would take care of one to two patients typically. Thankfully, in NYC, our staffing ratios [nurse-to-patient ratios] are mandated, but things have been changing with the coronavirus… I have a friend that works in the same type of unit in a different hospital in NYC, and she’s taking care of seven patients, and I have a friend that works in New Jersey and she is taking care of seven patients in the same type of unit. These COVID-19-positive patients can either be doing fine or they can decompensate, which is when their condition changes very rapidly, very quickly. So when you are taking care of [that many] patients and you don’t know which way it’s going to go, it can actually be very dangerous.
We were hoping when this began that these patients would stay in our newer, more high-tech building that has one patient per room, and they have negative-pressure doors which keep the aerosolized particles in the room. But because of how many patients we have, they are basically all throughout our hospital now. We were hoping they would be on designated floors [to contain the spread of the disease] but now we are all taking care of them.
There’s also this problem with nurses that work in other types of niche care—like labor and delivery, or pre-op or operating room nurses. Elective surgeries are being canceled, and [these nurses] are being moved to our unit because [the hospital] needs them to start working on medicine and critical care floors. We’ve had some nurses “float” to us and they’re like, “I don’t know what to do, I’ve been a nurse for 30 years and this is the first time I’ve worked in a medical-surgery unit because I’ve only done pre-op care.”
What does your routine look like when you first get to the hospital? And what about when you get home?
When I get to the hospital now, I still wear my scrubs there, but I put my hair up immediately. We put what we call a bouffant cap on—it’s like what the [operating room staff] wears in surgery—and we put on a mask immediately. And you wear that mask the entire shift, and you keep it because you don’t know when you will get the next one. We take it off and put it in a brown paper bag for later.
The pathogens are carried on your clothes so we do take our gowns and protective equipment off inside the room [with COVID-19 patients] right before we leave. You might be more than six feet away from a patient, but if they cough or something—there’s just so much gray area that you can’t see and we can’t predict.
When I come home, I take my shoes off before I go inside the apartment, I take all of my clothes off as soon as I get inside, and I put those in a trash bag and tie it. And then I do laundry as soon as my shifts are over. I clean my phone, my watch, my badge, my pen that I use with virucidal wipes [medical-grade disinfecting wipes used in hospitals and labs] before I get home, and when I get home, I clean them again. I shower immediately in boiling-hot water, and wash my hair every shift. Before I would wash it every other day.
A lot of my coworkers are bringing a change of clothes to work and changing out of them to go home. They’re doing this for the safety of other people and ourselves, because a lot of people will look at you differently if you walk down the street in scrubs now, so they want to change and I totally get that.
What happens when someone comes to the hospital with COVID-19 symptoms?
A lot of people will come into the ER with symptoms, and anyone who has those symptoms is being isolated and put in a specific room. I’m not an ER nurse, so I don’t know the specifics. But anyone who has a fever is being isolated and tested immediately. This is a protocol that’s been changing because we just got the ability to test inside the hospital like a week or so ago. Tests used to take three days to come back; now we are able to get results within 12 hours.
[We’re trying to] have people and our employees call in to a doctor to talk about their symptoms and then decide if they should be tested or not from there. It’s more dangerous to be having all of these people come into the emergency department when their symptoms are mild, and that’s why we are telling people to stay home and only come to the ER if it’s completely necessary—because it puts you at risk, too. If you are at the ER and ask for a test, and then it’s negative—but guess what, you just came into contact with someone who is positive, then you may get it.
Even though you don’t always work in the ICU, you mentioned that patients can often take a turn for the worse really quickly. Are you seeing this with your patients, even with younger, seemingly healthy people?
Yes, we are seeing younger patients that have no known past medical history that need advanced oxygenation therapy and need to be intubated and ventilated [in order to keep breathing], and that’s not something you typically see. Even with something like the flu, people usually do well with that at home, but a lot of young people are coming in with shortness of breath, they can’t physically breathe or have severe pain when they try to breathe, and they have really high fevers and a cough—so they need therapy, treatment, and to be monitored.
Although they have better outcomes than our elderly patients, it is looking very serious for all age groups. We’ve had patients in their 20s that are not doing great, and then a patient in their 80s who can sit up and talk to you and is recovering, then another 80-year-old patient will die.
Have you had access to the protective N95 masks or are you mostly using surgical masks?
We are using both. It’s complicated because the patients on our floor are on droplet and contact precautions [safety protocols used to prevent transmission] so what is involved with that [for me] is wearing a surgical mask, a face shield that covers your whole face, and blue plastic gowns and gloves. We [typically] are not doing procedures that involve aerosolization of particles [which is how the virus spreads]—those procedures are if [a patient] is ventilated or intubated. If there’s an emergency and they do crash and have to be intubated, then we would need to use the N95.
But the protocol right now is that if they are only getting oxygen therapy through a nasal cannula, you don’t need to wear the N95. That’s the official stance… it’s kind of controversial because you see other people [at other facilities] wearing N95s and you’re like, “Wait, should I be wearing one of those?” It’s difficult. I’ve had access, I know we have them because I’ve seen them. But we are trying to conserve them…
There’s a difference between the airborne and droplet protocols—the nurses treating the patients that definitely needed to be on airborne protocol were receiving the N95s. The rest of us treating COVID-19 patients were getting surgical masks and face shields. We were struggling about a week ago to get resources and [the hospital] resolved that. We got masks to our unit but they are still being conservative because they don’t know how long it’s going to last. That’s difficult because I was wearing the same surgical mask for five days—and this is a one-time use mask; it is supposed to be changed when you are in and out of one patient’s room. Then there was a change in the policy that you are allowed to wear them in between patients’ rooms. Then it advanced to not only are we wearing these in between multiple patients rooms, but hang on to this because you never know when you will get another.
I see both sides and get how it’s difficult for the administrators to hand [masks] out to everyone, but nurses are getting sick left and right. I just found out today that another coworker tested positive. It takes much longer to produce health-care workers than it does to produce masks. We’re trying to be generous with each other and protect each other, too—we don’t want to be greedy and take all of the masks either.
What’s scary is all of us in health care right now are really just waiting to get sick—we are prepared for the reality that is on the horizon.
Is that one of your biggest concerns as we move into the next several weeks and months of this: that if all of our health-care workers get sick, who are we going to have?
Yeah, exactly. That’s the concern, and that’s why there is such tension and frustration because we are saving these masks, but if we are being taken out by this virus before we even get to use them, then what’s the point of saving them? People are getting sick left and right, why aren’t we using them?
My experience is probably different from other people who don’t have access to them at all, and the CDC is now saying you can use a bandana as a mask [as a last resort], and that’s almost been laughable.
What else is your hospital doing to keep its staff safe?
Our hospital has been emailing us about self care, counseling resources, and ways to decrease stress; they’re allowing us to get tested and they’re giving us resources like, if you have these symptoms, do this. And they are giving us access to hotel rooms the nights of our shifts so we don’t have to go home to our families after going to work, which is hazardous. So my hospital is doing an excellent job, but I am among a very small number of people that say that; I know a lot of people are not being treated this way. I’m very fortunate to work at a hospital that is well-resourced, but I know a lot of the rural communities that get hit are not going to have the same experience.
What frustrates you about how the situation is being handled overall?
I think before we were mandating quarantine, this thing was spreading like a wildfire. We’re treating a crazy amount of positive cases now that were starting in early March that we had no idea existed. So these people were at home for five days with a fever, and think about how many people you can come in contact with in five days if you don’t stay home? That’s why NYC is suffering right now. [It doesn’t help that] our way of life is sitting on top of each other in the subway and buses and we’re constantly surrounded, definitely less than six feet apart. When this all started, I just knew [COVID-19] would hit NYC so hard, because there’s no other city in the U.S. like this.
But I don’t like to look retrospectively, I think that really helps nothing. I think the only thing we can do at this point is be proactive, and be generous and kind to each other. Because the only way out is through, and the only way through is with teamwork.
What is morale like right now among your fellow health-care workers? What’s keeping you going right now?
Our desire is to help fellow human beings. We signed up for this because this is not the only thing we do with risk—and we show up because it’s not just about the patients, it’s about our coworkers and keeping them safe, too. If I decide I’m afraid, and I’m calling in sick and they can’t get adequate staffing for the floor, then another nurse that was going to have four patients now has six patients, and now she’s more stressed, her immune system is not functioning as well, she’s not taking the right [preventative] practices because she does not have time. That’s putting that person at risk.
I think what you will find in health care is that we are very much each other’s champions. Nurses are very much loyal people to each other. We don’t just show up for our patients, we show up for each other.
What do you think is the best thing we can do now to help support health-care workers—do we need to donate money, help get masks made, or just stay home? How can all of us at home help support you all right now?
One thing that can help is there is a lot of direction to stay home and social distance—and I’m going to add to that. I’m going to add to stay healthy and stay well. Continue those practices that make you feel well and feel alive and do them at home. Continue taking your vitamins, eat nutritious food, texting your roommate from college and your mom to check in on them and see how they are doing. Because the more well that you are, the less burden that places on the health-care system that is being so overburdened right now.
This interview has been edited and condensed for clarity.