Nurses on the Front Line

Tired of Covid-19? Imagine being a nurse on the front lines of a two-year infectious pandemic.

“We have had sicker people in this hospital than this hospital has ever seen before,” says Rhonda Mason, Chief Nursing Officer at Cobre Valley Regional Medical Center (CVRMC) in Globe.“We have stretched people further than I thought they were capable of stretching.” 

Mason has worked in hospitals all her 30-year career, most of it in management. It’s her job to know what’s going on – surgeries, schedules, staffing, supplies. For the past two years, it’s been all about Covid. 

“This has taken everybody’s time, from every angle, every hospital (and) employee in the system, and supply chain,” Rhonda says. “It takes a village to make this work.” 

Physical & Emotional Demands 

“We’re not used to so many patients getting sick and staying sick,” says Ryan Antokal, who became a nurse after service in the U.S. Navy as a nuclear chemist. As Case Manager at CVRMC, Antokal ensures that patients have the necessary resources when they discharge. He views every patient’s chart and treatment plan. 

CVRMC has been filled to capacity for months amid a nationwide nurse shortage, primarily with Covid patients. Nurses deal with staffing needs “day by day,” according to Angelica Bravo, Clinical Coordinator. She’s the nurse responsible for tracking all patients coming and going from the hospital, and the staff needed for their care. 

“We’ve increased our patient-to-nurse ratio,” she says. “No one has asked for time off.”

CVRMC has fewer staff working longer hours, traveling nurses employed at unsustainable pay rates, and lots of new nurses. 

“We get a really good group of nurses from Gila Pueblo and Thatcher,” says Antokal. “A lot of them are CNAs while they’re going through nursing school, so we know their work ethic and knowledge base, and we wouldn’t offer them a job if we didn’t think they were stellar nurses.”

Some employees have left CVRMC to seek greater income for their families, but most have stuck it out, taking on extra shifts. Sometimes shifts as long as 12 hours. According to Ryan, people who’ve grown up here and want to stay here are the ones who pass on the opportunity to earn up to $8,000 per week somewhere else. 

“They want to treat their community,” he says. 

Some Covid patients are people they know; some are close to them. With some patients, nurses fall newly in love.

“At the beginning of this pandemic, you kind of lost why you wanted to be a nurse,” says Angelica Bravo, “but then some come around and make you realize, this is why. I want to help you.”

Treating Covid Patients 

On a Wednesday afternoon in early January, things were operating really well, according to Bravo. With only six or seven Covid patients in the ICU, the staff was “getting a breather for a while.”

The hospitalized Covid patients, however, were not.

“They can’t breathe. They’re scared. It’s not pleasant,” says Rhonda Mason.

All patients admitted to the hospital need oxygen. A lot end up with pneumonia. The nurses start them on an antiviral. Push antibiotics. Manage nutrition. 

“It’s supportive care,” says Angelica. “There is no cure.”  

Covid patients are kept in isolation. No visitors. Door shut. The oxygen machine is loud in their ears. Anyone entering the room is covered in cloaked in gown, gloves, and face shield, communicating through a mask.

“As the disease progresses and gets worse, you can’t breathe,” Ryan explains.

Some patients want their oxygen turned off. Family dynamics get difficult. Without oxygen, patients pass within the hour. But the staff has had many successes, too. Some patients go home on oxygen. 

“There have been a few that went through the worst – got intubated – and then got better,” says Bravo.

Though some patients said they wished they had been vaccinated, there is little indication that family losses or CDC facts are motivating the unvaccinated to get the shot. 

“Those that are unvaccinated are very stuck on being unvaccinated,” notes Angelica.

Ryan got Covid-19 in November 2020, a month before the first vaccine was approved. He wasn’t hospitalized but felt bad enough on day 10 that he started to write out his will. 

“I wouldn’t wish it on anyone,” he says.

Vaccination 

Nearly 100% of patients dying at CVRMC from Covid-19 are unvaccinated.

By early February 2022, Gila County had only 49.5% of the eligible population vaccinated. This is one of the lowest rates in the state, despite the county leading the nation in making the vaccine available to the general population a year ago.

Of the people who’ve received Covid-19 vaccinations, only 0.05% (1 in 2,000) have had adverse symptoms. Among those symptoms, headache is the most common.

“For my whole career, the CDC is our best, most reliable source for any infectious disease,” says Rhonda Mason. “The information is constantly moving and changing. It’s hard to keep up on the information. I completely get it.”

At this time, the CDC recommends getting one Covid-19 booster shot. People who received the Pfizer-BioNTech or Moderna Covid-19 vaccine for their primary series should get a booster shot at least five months after completing the primary series. People who received Johnson & Johnson’s Covid-19 vaccine should get a booster shot at least two months after getting their first shot. The CDC continues to review evidence and update guidance as more information becomes available.

Reasons for not vaccinating vary. Ryan Antokal knows that many people hear from their friends who had Covid that it was “just like a little cold.” 

“For a lot of people it was ‘just like a little cold,’” he says, “but for the people that it wasn’t, they really stressed the resources we have.”

The Emotional Impact

“We’re the ones holding their hand,” Angelica Bravo says. “We’re the ones talking to them every day.” 

Some Covid patients stay in the hospital for 30 to 40 days, some even longer. When they die, it takes a toll on the staff as well as the family.

“They become your friends,” says Ryan Antokal. “You see their decline. Watching needless deaths is hard on caregivers.”

For patients with young children, the emotional toll on staff is even higher.

“We’ve had a lot of patients with young children,” Ryan says. “When they expire, it pulls at your heart. You know you did everything you possibly could, but they still didn’t make it.” 

During the last big surge of Covid cases, the hospital administration brought in professional social-emotional support. According to Ryan, a lot of the staff got a lot out of it. 

“Just listening and letting nurses know it’s okay to mourn patients,” he says, “and to be frustrated by outside opinions.”

Ryan has been at CVRMC since 2006, and with 16 years as a medical professional, he’s worked in most hospitals in the region. He was working the ER at Mercy Hill when H1N1 came through. 

“This has been something completely different,” he says. “With Covid, I’ve seen more issues with people saying it didn’t exist.”

Ryan noticed that people polarized from the first two-week shutdown intended to flatten the curve, both regarding the presence of the virus and the approach to eradicating it. Such polarization, he says, does not exist among the CVRMC staff.

“It’s different in the hospital because we see the sickest of the sick,” says Antokal. “We see the numbers.”

As Hospital Incident Command (HIC) Coordinator, Ryan is also responsible for entering and tracking hospital bed data throughout the central region. On a typical non-pandemic winter day, there are 50 people holding in the ER, which means they’ve been admitted and are waiting for a hospital bed. On January 13, 2022, there were more than 400 people holding. Three hundred fifty had Covid.

“It has really impacted everything we do,” Rhonda Mason adds. “We cancel elective surgeries because we don’t have beds.”  

Not long ago, a CVRMC colleague came into the ER and needed cardiac care. She required intervention beyond what CVRMC could provide. They spent two days trying to get her a bed at another hospital for a higher level of care. All hospitals were packed with Covid patients.  

“That’s when I started getting angry about people not getting vaccinated,” Rhonda says. “Because it doesn’t only impact only you or the little nucleus of your family. It impacts people who need their knee fixed and are in excruciating pain.”

The good news is that the number of patients being admitted to the hospital with Covid-19 is on the decline. However, many more Covid tests than before are being conducted in the ER, and positivity rates are on the rise. 

Nursing in a Rural Community

“Rural healthcare allows me to be closer to patients and staff, feeling that I have a greater impact on the care we provide to our community,” says Rhonda Mason.

After big-city jobs in Seattle and Honolulu, Mason moved with her husband and three children to a small town in Washington state and developed a love for rural healthcare. She’s been the Chief Nursing Officer (CNO) at CVRMC for about 3½ years.  

“We’re not looking to the mother ship to tell us what to do,” she says, noting the visitation policy as an example.

“Visitation is all about crowd control,” explains Rhonda. “How many people are in your house, potentially spreading Covid.”

The current policy is straightforward. If you’re not vaccinated, you’re not visiting. Covid patients are not allowed visitors at all. 

“We do make exceptions,” Mason said. Ryan Ankotal and Angelica Bravo agreed with solemn nods. 

If the family is vaccinated and the patient is going to pass, staff will let them go in.

“We explain the risks,” says Ryan. “Even with an N95 mask and vaccination, there’s a chance you can get Covid with Omicron.” 

The family usually accepts that risk.

“What are you going to do?” he asks. “Nobody wants to die alone.”

In Search of a Silver Lining

“As we roll out of this, we’re more capable for our community to take care of them because of Covid,” says Rhonda Mason. “Our staff can set up a vent with their eyes closed now.”

CVRMC staff has had a good supply of PPE throughout the pandemic and knows how to wear it. They’ve experienced “their fair share” of Covid, but not outbreaks; no departments wiped out.

“Day after day after day,” says Mason, “our staff has done an amazing job of protecting themselves from Covid.”

The team of new nurses who started their careers running has seen incredible things, she adds. They’re developing top-notch skills. They’re learning how to be really good critical-thinking nurses. 

“They’re starting out with a skill set that will be positive throughout their career,” Rhonda says.

For now, everyone is ready to get out of crisis mode. There are other things they have to get done. Angelica Bravo wants to train staff in new areas of expertise – ICU, dialysis.

“We have lots of new services for the community that we’d like to focus on,” says Rhonda. “We’ll get there.”