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Wednesday 6 December 2023 Dublin: 8°C
on the frontline

Staff shortages force ICU nurses at St Vincent's Hospital to watch patients with baby monitor

The ICU is at “breaking point”, nurses say.

Screenshot 2021-10-04 15.03.34 The nurses provided this photograph of the baby monitor which is used to keep an eye on certain patients

NURSES WORKING IN the intensive care unit (ICU) at St Vincent’s University Hospital (SVUH) in Dublin have said they are at “breaking point” due to chronic staff shortages in recent months.

The experienced nurses, who have all worked in intensive care units for a number of years, say staff shortages are worse than ever and they have been forced to use a baby monitor to watch patients in two particular beds as there are not enough staff members to cover every ICU bed.

They say attempts by them and their line managers to highlight concerns about staff shortages with senior management at the hospital have not been satisfactorily resolved so they have gone public as “a last resort”.

It is not the only unit being squeezed: one TD told The Journal that hospitals around the country are “under huge pressures”, with the INMO reporting that overcrowding levels are at their highest right now since the pandemic began.

The nurses spoke to The Journal on the condition of anonymity for fear of reprisal at work. They noted that due to the nature of the treatment patients in ICU require, they need to be monitored continuously.

The nurses said the baby monitor has been used since earlier this year to watch patients in two certain rooms as needed. These patients have been in need of consistent and high-level care, they noted.

“If you need to leave a patient for 10 minutes to get the supplies that you need – drugs and other things – your patient might wake up and accidentally pull out their tubes,” one nurse said. “We feel there have been numerous near misses due to the shortage of staff numbers working on each shift.

“Many of our colleagues are understandably burnt out from working through Covid so there is a lot of sick leave right now. The issue is that when we complain to senior management the line is ‘we’re recruiting’ but the staff levels remain inadequate.”

When asked for comment on the nurses’ claims, a spokesperson for SVUH said: “The safety and welfare of patients under the care of St Vincent’s University Hospital is of paramount importance always. St Vincent’s University Hospital rejects absolutely the allegations made concerning patient care in our hospital.

“Management and staff operate to the highest professional standards of medical and nursing care. We provide care for our patients in a safe and secure environment and any allegation or assertion to the contrary will be viewed very seriously by SVUH.

“Management in the hospital are engaging daily with staff from the intensive care team directly to discuss their concerns.”

A number of hospitals used baby monitors at the height of the Covid-19 pandemic to watch certain patients. However, the nurses we spoke to said they have had to use the baby monitor consistently since April 2021 and that it is not an appropriate way to monitor patients who need intensive care, but they have no other option.

They said it was a last resort during the height of the pandemic, but they should not still have to use it. SVUH did not specifically respond to queries around the use of the baby monitor in its response.

The nurses said they are deeply uncomfortable with having to work in the current conditions. They stressed they do everything they can to ensure patients are as well looked after and as safe as possible.

However, they said they have to regularly make “Sophie’s Choice” decisions. One told us: “You’re presented with this unsafe decision and this other unsafe decision. Which one do you want to choose?”

Again, in response, SVUH noted: “The safety and welfare of patients under the care of St Vincent’s University Hospital is of paramount importance always.”

Due to staff shortages, the nurses say their shifts consist of constant “fire-fighting” and making the “least unsafe” decision.

The impact on the staff is incredible. We have staff now – some of our best staff – on leave with stress-related illnesses and anxiety. Who would want to work like this?

One room, in particular, is “in a really dangerous position, it’s really isolated”. The nurses said they are using the baby monitor to keep an eye on whichever patient is in this room because they cannot watch them all the time due to a shortage of staff.

One nurse stated: “Management promised that from March onwards we would always have a float nurse to help with that room, but that hasn’t happened. We’ve 18 beds; we should have 21 nurses, at least, on every shift. We average about 14 to 16 nurses, so we’re at least five or six short. It’s just chaotic.

“It has been relentless, to be honest, since the start of the pandemic. We used to have busy weeks, busy periods, busy winters, now it’s every day. We have had a crazy busy summer. It’s been quite frightening.”

It comes as the Irish Nurses and Midwives Organisation yesterday reported 467 patients on trolleys, the worst overcrowding since the pandemic began. Last week the INMO issued their monthly trolley analysis which showed that it was the second-worst-ever September for overcrowding in Ireland.

‘Under severe pressure’

Sinn Féin’s health spokesperson David Cullinane also told The Journal he’s hearing similar stories from other hospitals around the country, particularly in relation to staffing resources for ICU.

“It comes as no surprise to anyone that intensive care units in our hospitals are still busy and it’s a shame to hear that those frontline staff are still facing such difficult challenges.

“We’ve heard consistently from the INMO about staff being under severe pressure since the pandemic started, suffering from burnout, especially those working in ICU – they’re still working to the maximum and are under huge pressures.”

The Journal has seen a number of recent rosters which back up the St Vincent’s nurses’ claims about staff numbers in the ICU. The hospital did not respond to a specific query about the number of nurses working in the ICU, instead stressing its commitment to overall patient safety.

The nurses said ICU treatment is so highly specialised and requires staff with extensive training and experience. They claim that nursing colleagues are being seconded to the ICU from other areas of the hospital, without proper training, and are unable to fulfil their duties through no fault of their own.

“They’re not used to the equipment, they’re not used to how we monitor patients, they definitely aren’t used to the drugs that we use. The stress that this puts on that individual coming up [into ICU] is so unfair,” one nurse said.

“We obviously will try our best to support them as much as we can and be as nice as we can because we’re very empathetic towards them. But the units are very busy and sometimes they’re left by themselves. You come back and they look like they’re ready to puke. It’d break your heart.”

Managers and trainees are also put on ICU duties when they should not be, the nurses said.

The hospital did not respond to this specific query, but noted that “management and staff operate to the highest professional standards”.

“As a nurse, you can’t just walk into an ICU and start working. You have to have at least six months of training, and even then you would really need years of experience to know what to do,” one nurse noted.

The nurses said management regularly tell them they are recruiting more staff, but retention is the issue due to the stress of the job and “laughable” wages.

The hospital did not respond to The Journal‘s specific query about wages. Some nurses take home about €126 (net pay) for a 13-hour shift.

“We’re constantly recruiting, but the money is so low there’s no incentive to entice people to work overtime.”

The nurses said many of their colleagues have emigrated – and they don’t blame them. The nurses we spoke to said they “love” their jobs but are now at breaking point.

Screenshot 2021-10-06 19.22.06

‘It’s just so difficult’

The nurses also claim that their nurse managers have been “lambasted” when arranging the transfer of a patient to another hospital’s ICU if a bed is free in SVUH’s ICU – despite the nurses making it clear there are not enough staff members on duty to monitor the patient in question.

“It’s just so difficult. It’s been said numerous times, ‘that patient will die if you don’t let them come to ICU’. That’s put back on to the managers and the staff, that kind of guilt,” one nurse said.

The hospital did not reply to a specific query on this.

Another stated: “There has always been a crisis in ICU, but the pandemic broke us. One of the major reasons why we went into lockdowns and level five was because there are not enough ICU beds, there are not enough nurses. The country had to shut down because we literally could not function due to the influx of Covid patients.

“Now we’re seen as these heroes and ‘everything’s wonderful’ but no one seems to actually realise there’s not that many of us and we’re at breaking point, all of us.

“And people are leaving all the time. A lot of our staff don’t work full time. And the junior staff – I don’t know how they’re even coming to work, they’re trying to learn but they’re under so much pressure. They’ll leave as well.”

David Cullinane has called on Health Minister Stephen Donnelly to address the ICU staffing issues around the country, saying “During Covid and in the past few months, the minister promised additional ICU capacity in the form of new beds, but ICU capacity must also include the highly skilled staff to operate those beds. We need to keep those key frontline staff supported.”

‘Acting as undertakers’

The nurses said they’ve also had to “act as undertakers” during the pandemic, dressing patients in their funeral clothes and trying to make them look presentable – tasks “way beyond” their remit.

They do it because they care and they want to support the deceased’s family members, they told us, but it has taken a huge personal toll.

One nurse said:

One day there were four deaths in two hours. We were laying patients out because we were like the undertakers. We were dressing them in the clothes that they were going to be buried in. Some of the family members couldn’t come in because they were immunocompromised and were scared to come into the hospital so we were the nearest and dearest to that person. We didn’t know them but we were all they had.

“The families would send in clothes and we tried to make people’s relatives look as best we could because it was so important that they didn’t see them like that – with all the tubes, not looking like themselves.

“We did our best but it was horrendous, some of the shifts we put in were indescribable.

“Even then we still had somebody saying to us, ‘Listen, that bed is needed, so we need to get that body down to the mortuary straight away’. We have all of that grief, you’re trying to deal with it and then you have to take another patient in.”

The hospital did not reply to this specific claim.

‘Covid bonus’

In recent weeks there have been discussions about a ‘Covid bonus’ for frontline workers to thank them for their service during the pandemic. A new bank holiday is also being considered.

The nurses we spoke to said this conversation is “insulting” and “laughable”. They said it pits public sector workers against private sector workers and detracts from the real issue: the chronic underfunding and understaffing of our health service.

One nurse said the idea of bringing in an extra bank holiday is “an insult to frontline healthcare workers” who regularly work on bank holidays. They know they would get extra pay on the day in question but said they want long-term investment, not one-off gestures.

“If they do give people an extra bank holiday, they should say it’s for the nation to say thank you all for being so cooperative during all the lockdowns, and for the high vaccination uptake rate.

“Don’t say it’s for healthcare workers. That’s an insult.”

One nurse said: “The good has gone out of [the Covid bonus] to be honest because there is now a war on social media pitting us against each other, against other public sector workers or other types of essential workers.

“People don’t really understand what we do. We don’t want a bank holiday. We want to work in a safe environment and be respected for the work we do. We want to be paid properly for the work we do.”

The nurses noted that while the overall level of support from the public during the last 18 months has been amazing and is truly appreciated, they need practical long-term support, not “a clap and to be told to get on with it”.

They stressed that local businesses and members of the public were exceptionally kind to nursing staff at the height of the pandemic.

With reporting by Laura Byrne