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BEHIND LOCKED DOORS

Lia—Registered nurse
Emergency department, private aged care
Metropolitan Melbourne

A day I will never forget: 28 July 2020. A registered nurse with more than eighteen years’ experience, I’m working permanent shifts at the local hospital in metropolitan Melbourne. COVID is a new and daunting experience. I work in ‘pool’ so I can be placed in a different ward each shift, generally at the one hospital, sometimes at sister sites. My current afternoon shift has some residents from a local nursing home. One of the residents has just been palliated, confirmed COVID, doing poorly. This COVID is real and it means business.

During my shift, I receive a text message asking me to pick up an extra shift at the same nursing home the next day. I drive past this facility every day on my way to and from work. Being local, I want to help. I check with my husband to ensure he can juggle our four boys and his work, then I volunteer to help. A colleague and friend, Paula, is redeployed to work the same shift as me.

Before finishing for the day, I check in with the hospital nurse coordinator to make sure adequate and appropriate PPE will be available at the nursing home when I get there. She assures me it will be.

That night, Paula and I tell each other we will be ‘really, really careful’. We decide we will wear clean caps to cover our hair, remove all our jewellery the night before and place our mobile phones into clear zip lock bags—additional infection control precautions.

The next morning we arrive at the nursing home and meet in the foyer, along with a small number of staff from sister sites. Everyone is in the unknown. Tension is high. People are whispering. There seems to be only one staff member in charge, a representative of the site operator. There are no other staff to help. What you see is what you get. We’re told colleagues are expected for the afternoon shift to relieve us, and for the night shift and so on. There will be no regular nursing home staff—this is a complete takeover.

We note very quickly the lack of staff and that the mandated nurse-to-resident ratios are well and truly not met. But most alarming is the fact that there are no N95 face masks. There are whispers around us of people wanting to walk out and leave. The representative gets wind of this and speaks up: ‘You are the only help for these residents. No-one else will be coming this morning. Please don’t go. Please help.’

Colleagues are clinging to each other. Understandably we want to stick with those we know. Paula and I are assigned to a wing of the nursing home together. We double mask our surgical masks—what else can we do? We walk down the long corridor. Doors lock behind us. Minimal night staff occupy the nurses’ station. They give us a brief and hurried handover. We are asked to sign some paperwork about orientation, but there are many things we haven’t been orientated to. I hesitate. I don’t want to sign. I gently push the paperwork aside and ask some last questions. I have worked agency shifts before so I ask some key questions: ‘Where are the progress notes? The contact numbers including the doctor’s number?’ I am told doctors aren’t visiting the facility because of the COVID outbreak.

Orientation is never completed. Paula and I are in a thirty-bed wing where twenty-two of the twenty-seven residents have been confirmed with COVID. The night staff seem to be in a hurry to leave. They’re not nasty, not angry—but maybe they’re a little intimidated by we hospital staff? They give us a handover sheet and tell us names and room numbers don’t match because residents have been moved to accommodate the COVID outbreak. They leave, and it is like a ghost town. No regular member of staff remains in our wing or at the nurses’ station. Resident call bells are already ringing.

This goes against everything we have been taught. How can we be put in a situation like this? Concern and fear about returning home to my husband and four young children is real and scary—my senses are peaked. But we need to move fast, we are well behind as it is. We have the whole wing of residents to the two of us. Ratios? How can we make this work? Do we pair off or divide and conquer?

We locate linen skips and laundry cupboards and give ourselves some more of the orientation we should have had. We note the makeshift infection control stations outside most residents’ rooms—using the residents’ side tables or cupboards. This is certainly not the hospital standard we are used to. There is no cupboard or supply of PPE available to us and we panic. We are used to gowns, masks, face shields, goggles and hospital-grade sanitiser for each and every patient.

We make a plan and prioritise our workload: ADLS and PACs—activities of daily living such as eating, using the toilet, dressing and sitting out of bed, and pressure area care.

It’s absolute chaos.
We laugh a little—otherwise we will cry.
A kitchen staff member comes by in limited PPE and delivers food trays, placing them outside the residents’ rooms on the mediocre PPE stations. We explain that we are from the local hospital, that we have never worked here before and that we are the only two staff members for the whole wing. Shaking her head in disgust, she says, ‘No, this section can’t be done with two staff members. It needs five or six members at least.’ The look of concern and fear on her face is the same as ours.
But we are it.
We nod and keep going.
Head down.
Go. Go. Go.

At 0930 hours—some two and a half hours into our shift—our site operator gives us one N95 face mask. One N95 mask to attend to the whole wing of residents! ‘It just can’t be!’ we think, but it is. We don and doff surgical masks in between residents on top of our N95 mask. It is the best we can do.

Neither are the gowns or gloves up to standard—they are shower aprons and thin, household, multipurpose gloves which frequently tear, so we double glove too. And there are not enough goggles or face shields, so we wipe ours between residents.

Time flies by. The kitchen staff member returns to collect trays. She needs them back so she can continue her day, but we haven’t yet fed all the residents or been able to deliver all their trays. And there’s a buildup of old food and dirty plates in residents’ rooms that we need to remove. She lets us have some trays and returns at morning tea to help a little more.

Pressure area care, toileting, answering buzzers, sitting patients out of bed, locating lifting machines that we’ve never operated… Before we know it, lunch time is here, and we still haven’t seen all the residents. We realise we haven’t had a drink, a tea break or a toilet break. Again we laugh—crying isn’t going to help. We have a scull of water and a toilet break. Then together we continue, one by one, ADLs and feeds to the last remaining residents.

The noise of buzzers going off in the background is constant. We tell the residents all we know: ‘Your staff are all furloughed and we have been sent from your local hospital. We don’t know you, or your friends, or your routines, but we are here to help you and we are doing our very best.’

At 1340 hours we reach the last resident. Together we attend to his ADLs. One of us stays to complete his care and the other starts the cleanup.

Oh, the cleanup! Bins are overflowing with rubbish; the linen skips haven’t been emptied and the PPE stations are a mess. Without any personal service assistants or cleaners, again, it’s just us—and with inadequate PPE, we are not at all comfortable about this. Throughout the morning we have already emptied a multitude of vases with no water and dead flowers that smell like they shouldn’t be in residents’ rooms at all, let alone right by their beds.

Paula and I meet in the corridor. We are sore. We are thirsty. We are hungry. What in the world have we just gone through? Did we just do that last seven hours? Did that really happen?

Many residents have clearly not been receiving adequate care for some time. When we see them, they are dehydrated, delirious and in clear and obvious pain. Some need to be picked up from the floor. Some have new pressure ulcers, wounds needing attention and dressings needing to be changed. The palliative residents need urgent medication.

Together, Paula and I spend a hurried ten to fifteen minutes in the nurses’ station updating the bowel charts, writing brief notes on the most concerning residents’ records—we just don’t have time to write notes for everyone.

When we finally walk up the corridor to exit the facility, it strikes us both: we have not been told the exit codes to any of the locked doors! We are locked in!

To this day, I get a chill down my spine remembering this serious occupational health and safety breach. What if there had been a fire? Or another emergency?

When we at last make it to my car, we scream and yell. Then we talk and talk. What. Was. That? Those poor, poor residents. Our hearts break for them and the lack of care they have been receiving. But we also quickly realise that we have now left other staff members in the same situation. We decide then and there that things must drastically change for these residents and staff and we call the hospital nurse coordinator from the car.

Once we’re finally in our own homes, Paula has a forty-five-minute shower using a whole bar of antiseptic soap. She drinks two litres of water, makes an osteopath appointment and goes straight to bed. I enter my house through the laundry and place all my clothing straight in the washing machine. I then have a shower followed by a bath with essential oils. Later, we are directed to self-quarantine for two weeks.

Over the coming hours, we are updated by the hospital nurse coordinator who has escalated our concerns to the department. She also apologises for the lack of PPE. We learn that our colleagues have already called our union, the Australian Nursing and Midwifery Federation. We do the same.

Over the coming days we receive calls from the Deputy Chief Nursing and Midwifery Officer thanking us for going into the nursing home. She tells us she has personally dropped off PPE to the nursing home, that a geriatrician from our hospital visited residents later in the day we had worked, escalated their care and made contact with some family members.

Paula and I left the nursing home feeling upset and frustrated, saddened that we had walked into such a horrific situation and holding grave concerns for the residents. But we were also honoured to put our experience and skills to work for these neglected residents. The grateful look in their eyes when we attended to their needs still fills us both with pride whenever we reflect on the day.

We are proud that we helped and confident that our infection control was impeccable—we didn’t contract COVID from the nursing home.

Paula and I know we made a difference when we walked into that home. And we know that by escalating our concerns, we continued to make a difference when we walked out. We learnt a lot and we are proud to tell our story. But mostly, we are proud that despite our experience, we remain in the profession. We are proud to be registered nurses.

BEHIND LOCKED DOORS