PROVIDENCE, R.I. -- They sound like soldiers, facing an enemy both invisible and treacherous.
At the hospitals, they care for the sick and prepare for a surge of COVID-19 patients. At the nursing homes, they try to protect their fragile residents against a virus that’s sickened and killed dozens of other elderly people.
The nurses know what’s coming. They hope they can be safe. They fear that they won’t have the medical equipment they need. They worry that the public doesn’t understand how bad this could be.
These are their first-person stories from the front lines. (The interviews have been edited and condensed.)
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Amanda Collins, 38, registered nurse, Greenville Center skilled nursing and rehabilitation in Smithfield
The patients have to stay in their rooms. We all have to take extra time to spend with them and talk. We try to keep everything as normal as possible, but they’re scared. I have one patient who says to me, “We’re all going to die.”
The dementia patients are scared, because we come at them with goggles and masks. I have to wear my glasses over my goggles. They know it’s me. One of my patients told me, “I can tell you’re smiling under the mask.”
I had a dementia patient who was trying to get out of bed and walk. The patient couldn’t talk. I realized that the spouse used to visit every day [before the pandemic]. So I called and held up the phone. The patient listened and was calm. So now we have a date on the phone. It’s these little things, and they take time.
Everything PPE [personal protective equipment] is back-ordered. I’m bringing in my own bleach cloths. We’re running out of hand sanitizer. Thermometer probe covers, we ran out of those. We are using the forehead thermometer instead. For one patient, we had to switch brands of feeding tubes because we were out of them. Everybody has only one N95 mask.
Last week, one of my nurses had a suspected patient with COVID, so she needed a gown. I went looking, but there were none in the supplies. I broke down and cried. I took a pack of gowns off my “crash cart,” and said, here use this.
We were at bare bones [with staffing] before and now it’s bare bones plus. Luckily on my shift, we all band together and help everybody.
It’s scary, but we all laugh a lot. The littlest things, and everyone is laughing. We’ve all been there a decade-plus. I sing to the patients: “Don’t you worry about a thing, 'cause every little thing is going to be all right."
But we are in a war zone, and we’re scared for our lives. It’s a combatant we don’t really know about. I get so angry when I go grocery shopping, and I have a mask on and am social distancing, and there’s people walking around like it’s nothing.
This is a plague.
My biggest fear is that my residents are going to get it, and they’re going to die. They are like my family.
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Ashley Ouellette, registered nurse, Butler Hospital in Providence
PPE and support -- those are two things we desperately need. Safety is always our priority, especially in a psychiatric hospital. Our patients often can’t keep themselves safe.
This is a communal setting: Patients share phones, tables, chairs, television remotes, books, and bibles and [for socialization purposes], a lot of them are asked not to stay in their room. So, usually we’re trying to integrate them back into the community, but now we have to ask them to stand back.
Emergencies at psychiatric hospitals are like any other emergency, but they are unpredictable. We treat people, we base treatment on mood and thought and behavior, and it can change on a moment’s notice.
We have 29 beds on our general treatment unit. Our patients line up to get dinner, to get their vitals, and our activity service has to get creative to host a group that can only accommodate five people at a time. The therapeutic treatment is scaled back.
I know the patients are scared. A lot of times with psychiatric patients, [fear] comes off as agitated or aggressive. Staff are scared, too.
Right now, we’re told to wear surgical masks to prevent staff from spreading it. If we have a [suspected COVID patient], I don’t think it’s safe to wait to wear a N95 mask. In communal settings, we’re not protected enough with a surgical mask.
But with masks, we can’t use our facial expressions to communicate with the patients -- a smile or a smirk to show we’re listening.
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Carol Reuter, 61, registered nurse, Women & Infants Hospital, Providence
Birth is so special, and it’s really being complicated by this pandemic. Birth is demanding physically, now we have extra protection with masks and PPE, and it’s really draining.
Everything’s upside down. There are different algorithms, depending on what the CDC comes out with. Moms that are positive are at risk, babies are at risk, staff are at risk. It’s a learning curve for all of us.
We have had our share of positive moms. The hard part of this virus is it’s insidious and everybody in that room is at risk. We have had nurses who had to go out because they were exposed or positive. It shows how important that sick leave is.
At work, we wear surgical masks all day, wash our hands constantly, wash our environment constantly, in addition to what we’ve always done. Everyone is wearing masks now except for patients and visitors who are not positive.
Everybody is screened with questions and a temperature, including staff members. If the birth is longer than 24 hours, the significant other is re-screened. It’s a daily process that’s changing daily.
The hospital is being revamped to prepare for the surge. We had two floors of offices that were turned back into rooms for patients. I set up a room to handle an infant with respiratory needs -- an emergency room for the baby.
Our hospital assured us that we have enough PPE. They tell us we have 14-day supply.
During the Ebola outbreak, we had a lot of training. I don’t know if we even saw any patients with Ebola, but we got more training -- and I don’t recall there ever being a supply issue.
The biggest thing of all is that PPE is even an issue in our country. We shouldn’t have to rely on charity, like the New England Patriots or rich people donating.
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Stefania Silvestri, 36, registered nurse, Greenville Center skilled nursing and rehabilitation in Smithfield
The residents are scared and lonely. They can’t visit with their family members. All they have is us right now. We are their entertainment. I spend some of my time, between passing meds, dancing and singing for them. I Facetime with some of the residents with their family members, because they’re really lonely. Some of them don’t understand the virus. They just know they don’t have their family members there, and they don’t know why.
We have one resident to a table, and the only ones that can come to the table are the ones who are fed or supervised. So the others are just in their rooms. They are not allowed out.
[There is] agitation, restlessness, anxiety, crying, yelling. A lot of demands on nursing staff for things we try to provide.
The CNAs are exhausted. We still have the staffing shortage going on. Now it’s double that. The residents don’t have activities to go to. They don’t have family members to occupy their minds. So they’re sitting in their rooms, and they’re ringing their bells.
When you have 30 patients and three CNAs and a nurse, they are caring for basic life necessities, bathing, brushing teeth. The residents want simple things, someone to talk to them, someone to play a puzzle with them ... and staff members can’t do that.
Before this, they had fine dining, bingo, coffee, and now it’s all gone. I dance and sing because it makes them happy, it makes them smile, it’s why I became a nurse. It’s getting harder and harder to make them smile now. Especially now. It’s like they’re in prison.
I feel for them more than I feel for myself.
I know we’re all getting stir crazy, but we need to be cautious of what we’re doing. The reason [the coronavirus] came here was people weren’t listening. They were going out in public, not washing their hands, touching their face.
I’m exhausted and I’m scared. I’m scared I could bring something home to my family, and I’m exhausted trying to meet all the needs of the residents. My fear is not me getting it: it’s my children. My 4-year-old daughter has asthma.
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Kelli Price, 50, registered nurse, Women & Infants Hospital
Every day at 10 o’clock, we [union delegates of District 1199 SEIU New England] get together with senior management and find out the plans, to keep everybody in the know. Hearing all of it, and getting ready for the surge, that’s when it became real.
Before we had these daily meetings, there was so much rumor and things being said that weren’t true, so they sat down with us. Communication is so important, especially with algorithms changing.
We’ve had a couple of persons under investigations for COVID. We have to be really careful with donning and doffing, putting on the safety gear and taking it off. It changes how you take care of patients and how you cluster care. You don’t want to contaminate yourself or your coworkers. We try to be very meticulous.
People are very nervous. I keep my staff and coworkers up to date on things. We all have family members we come home to that we’re exposing. And we have the occasional coworker who goes out with COVID.
We all know it’s important to be here for our patients, no matter how freaked out we are.
I just want [the public] to feel assured that we are there for them. This is what we do. My son [a medical assistant at The Miriam Hospital] told me that if and when they open up the Convention Center that he volunteered to go there and help patients. He said, “This is what we do.” Maybe we’ve never had to deal with this, but this is what we do.
We need PPE. When the surge comes, will we have it? We’re scared to be in that position where we have to improvise. Our hospital is doing the best we can, but we need it.
Otherwise, they’re putting us in harm’s way.
Amanda Milkovits can be reached at firstname.lastname@example.org