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US Nurses Leaving Hospital Bedsides  

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“I couldn’t understand how this highly educated, powerful trauma nurse is now the patient.”

A nurse who asks us to call her “Gi” talks about herself. When Gi was working in the emergency room at her community hospital during the height of the COVID-19 pandemic, Gi began to cry inconsolably, unable to speak or function. She had a panic attack and was later admitted to an inpatient psychiatric facility where she was diagnosed with PTSD. Gi is now back at the bedside – as a hospice nurse.

A pandemic of nurses

Gi is not alone. The number of caregivers with mental health problems has increased significantly during the COVID-19 pandemic. A survey by the International Council of Nurses (ICN) shows that the number of nurses reporting mental health problems since the beginning of the pandemic has increased from 60% to 80% in many countries.

“Nurses suffer,” said Howard Catton, CEO of ICN. He cited violent attacks “along with the exhaustion, sadness and fear faced by caregivers who care for patients.”

The American Nurses Foundation says 1 in 3 nurses say they are “emotionally unhealthy.”

“Normal systems break down”

Nurses say the mental distress is due to a variety of problems. The industry was facing a staff shortage even before COVID-19, with many nurses juggling multiple jobs to care for a growing number of patients. Now the recommended ratio of 1 nurse to 2 patients is stretched to a ratio of 1 to 3, to the detriment of patients and caregivers alike.

“Clara”, who has spent her career as a nurse, says she is struggling with “an enormous workload, enormous volume and insufficient resources”. One misstep can be life or death – and possibly ruin a career.

“It’s constant pressure on your shoulders, constant pressure down, you have to move faster, you have to get better, you have to work harder,” she said.

Alex Kaspin has given up her job in the emergency room to take on a less stressful nursing position on a children’s floor. Her stress led to a panic disorder. (Carolyn Presutti / VOA)

Alex Kaspin suffered from panic disorder because he was overworked, overtired and overwhelmed. She recently left a Philadelphia emergency room when the COVID-19 numbers coincided with the city’s rising homicide rate.

“At that time,” says Kaspin, “all normal systems collapsed.” Kaspin says her hospital was operated in a “triage situation”. There weren’t enough nurses to treat patients in the regular rooms. So the emergency room was filled with inpatients and the waiting room became an emergency room.

Philadelphia Police Officer Shawn Wills is investigating a double shootout.  The homicide rate in the city has exacerbated Covid-19 stress for emergency room nurses.  (Carolyn Presutti / VOA)

Philadelphia Police Officer Shawn Wills is investigating a double shootout. The homicide rate in the city has exacerbated Covid-19 stress for emergency room nurses. (Carolyn Presutti / VOA)

“Please give me the vaccine now”

Between the rise in violence in the United States and the rise in COVID-19 patients, Kaspin has felt that she cannot deliver health care according to the standards she has set for herself. In addition to the stress, there were also patients who were not vaccinated against COVID-19.

She is haunted by her memories of several COVID-19 patients in their twenties. “Just before we take off the air tubing, the last thing they say is. “I want the vaccine now. Please give me the vaccine now. ‘ ”

Pennsylvanian Jen Partyka calls vaccine hesitation a willful ignorance she has never seen in her 27 years as a nurse.

“You are deliberately creating a situation that I, as a nursing manager, cannot keep up with,” says Partyka. She’ll always do her best for her patients, she says, but she feels different when she learns they aren’t vaccinated. “You deliberately harm others.”

Experts say that as more people are vaccinated, the number of patients will drop dramatically.

Chip Kahn is President and CEO of the Federation of American Hospitals. He says there is no such thing as a “short-term magic bullet”, but what is needed is “less COVID”.

No more pounding pots of support

Abigail Donley worked in an intensive care unit in Manhattan during the early stages of the pandemic. She quit her job to co-found IMPACT in the healthcare sector to work on policy change for the benefit of workers and patients. IMPACT’s December campaign promotes safe staffing.

Donley says nurses were once considered COVID-19 heroes. “People made the pots for them at seven o’clock, but now they can’t get a raise,” Donley said on Skype. “You can’t get a bonus. You cannot get childcare. They have no maternal health care. ”

Growing numbers of nurses are leaving the hospital bed for a less daunting work schedule and better pay. Travel nursing agencies send nurses where they are needed to stem the dwindling headcount and offer as much as three times the salary other nurses get.

“Michelle” helped set up the COVID-19 ward at the hospital where she had worked for 10 years. This month, she quit her $ 30-an-hour nursing job to work as a travel nurse in an intensive care unit in another city. She calls her new salary “crazy”.

“I’m leaving this system and going to a travel nurse and I’ll be making $ 120 an hour,” she told VOA.

Kahn says agencies “hollow out” hospitals by offering travel nurses such high salaries. He agrees that having a strong in-house team is much better than temporary workers.

When asked why hospitals do not keep experienced nurses by offering higher salaries and other benefits, Kahn says, “No institution can afford to pay the broad base of their nurses anywhere near what they pay for the travel nurses. “.”

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UNC community reflects on impact of mental health this semester

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Content warning: This article includes the mention of death.

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When psychology and neuroscience professor Andrea Hussong entered her youth development course on the first day of the fall semester, she noticed something that stuck with her – no one spoke.

“It wasn’t always like this before – people interacted a little more casually before class,” said Hussong. “And I think it was the first day I said, ‘Okay, everyone, go to someone else and introduce yourself.’ And there was this kind of bubble of energy going across the room. It was like people were waiting to make that connection, but the door had to be opened. “

UNC returned to mostly face-to-face teaching this fall after studying Zoom for over a year. However, the adjustment has exacerbated significant mental health challenges for the campus community.

Mental health in the community

Senior Sonam Shah, a co-founder of the student-led mental health organization Peer2Peer, said she and other peer responders had found consistent issues such as loneliness, social isolation, and academic pressure in students using Peer2Peer services this semester.

“Some would think we’re back in person, it would be a lot easier to hang out with friends, but we’re forgetting a huge number of freshmen and sophomores and even juniors who haven’t been to campus for the past few years.” said Shah.

According to CAPS Associate and Clinical Director Avery Cook, this semester was the first time in 14 years that students seeking ongoing individual advice from Counseling and Psychological Services were put on a waiting list.

A few weeks after multiple student deaths on campus – and in response to the increased mental health needs of students during the pandemic – CAPS announced a partnership with teletherapy service UWill to remove the waiting list for brief one-on-one therapy.

“There is no waiting list for a student eligible for brief therapy,” Cook said in a November interview with The Daily Tar Heel. “They are able to really connect once we meet with them.”

However, some students are concerned about the possibilities of longer term care within CAPS and beyond.

First grader Belamy Counou said she started seeing a CAPS therapist early in the semester. She said her experience started great when the conversation turned on school-related topics. But in the end it just felt like a name on a piece of paper.

“I’ve opened up more and then we come to my fourth session and she tells me that she thinks I’m fine – I wasn’t fine,” Counou said.

Counou said she gradually started talking to her therapist about more serious mental health issues. Then her therapist canceled her last appointment and never came in to check in or make a new appointment. The idea of ​​a referral to a long-term therapist in an outside practice had never been discussed, she said.

The CAPS website states that it provides brief therapy for “problems that are relatively well defined and that can be adequately addressed or resolved in a short timeframe”.

Cook said in a statement through UNC Media Relations that CAPS will never turn away a student in crisis, regardless of the type of care they may need.

CAPS is meant to be a first step in the overall process of determining what type of help a student will need, either immediately or over the long term, Cook said. CAPS offers students a range of services – from individual and group therapies to medication management and referral coordination.

Shah said that she believes CAPS did their best with the limited resources they have, but it is important to explore other therapists with an identity-based or lived experience focus – and options beyond CAPS in Consider such faculties as mentors.

CAPs hired two AAPI consultants in August after a student petition circulated last spring to increase representation from vendors who identify as Asian-American and Pacific Islanders. CAPS didn’t have any before.

“The lack of services is not just a problem for the UNC,” said Hussong. “It’s not just a problem in North Carolina or the US – it’s global.”

I’m looking forward to

In response to growing levels of anxiety and depression in the campus community, the UNC hosted a mental health summit on November 15 with a series of discussions centered on campus culture, crisis services and prevention.

At the summit, the UNC announced its partnership with the JED Foundation, a nationally recognized resource center that provides access to experts and aims to improve the university’s ability to prevent and respond to mental health problems. The university plans to be officially designated as a JED campus in February 2022.

Chancellor Kevin Guskiewicz said he expected to add at least one spa day to the spring semester calendar during a faculty council meeting on November 5th.

Counou said it is important that mental health resources – CAPS or otherwise – are visible and available before students hit a breakpoint.

“It’s really okay not to be 100 percent where we were two years ago and it’s okay never to be back where we were two years ago,” said Shah. “It’s really important to just be where you are and just listen to yourself.”

Mental health resources

If you or someone you know is contemplating suicide, the National Suicide Prevention Lifeline, 1-800-273-8255, is available 24/7. It’s free and confidential.

UNC students who need help during this time can contact the student advisory service and the psychological service, the dean’s office or Student Wellness. CAPS can be reached around the clock at 919-966-3658. University employees can apply to the Employee Assistance Program.

Peer supporters of the student organization Peer2Peer, which provides mental health resources for PhD and undergraduate students, can be reached via an online form. Students can choose to remain anonymous.

The resources were also compiled by the DTH editorial team.

@hannahgracerose

university@dailytarheel.com

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FDA review finds Merck’s COVID pill effective, but flags concerns

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Federal health officials say an experimental COVID-19 pill developed by Merck is effective for the coronavirus, but they will seek independent counseling on the risks of birth defects and other potential problems during pregnancy.

The Food and Drug Administration released its analysis of the pill last week ahead of a public Tuesday meeting where a panel of experts will weigh its safety and effectiveness. The agency is not obliged to follow the advice of the panel.

FDA scientists said their review identified several potential risks, including potential toxicity to developing fetuses and birth defects, which were identified in animal studies with the pill.

Given these risks, the FDA will ask its advisors if the drug should never be given during pregnancy or if it could be made available in certain cases.

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In that scenario, the FDA said the drug would contain warnings of risks during pregnancy, but doctors would still have the option to prescribe it in certain cases where the benefits might outweigh the risks to patients.

In light of the safety concerns, the FDA said Merck had agreed that the drug would not be used in children.

Other side effects were mild and rare, with about 2% of patients suffering from diarrhea.

Regulators also found that, overall, Merck collected far less safety data on its drug than it did for other COVID-19 therapies.

“Although the clinical safety database was small, no major safety concerns were identified,” the FDA reviewers concluded.

In addition, FDA scientists raised concerns that Merck’s drug caused small changes in the coronavirus’ characteristic spike protein that is used to penetrate human cells. In theory, these changes could lead to dangerous new variants, they warned.

The FDA will ask the advisory panel to discuss all of these questions and then vote on whether the overall benefits of the drug outweigh its risks.

All COVID-19 drugs currently approved by the FDA require an injection or IV and can only be administered by health care professionals. If approved, Merck’s drug would be the first drug US patients could take at home to relieve symptoms and speed recovery. It is already approved for emergency use in the UK.

The meeting will mark the first time regulators have publicly reviewed a new drug for COVID-19, reflecting intense interest and scrutiny on a pill that could soon be used by millions of Americans.

The drug molnupiravir has been shown to significantly reduce hospital admissions and deaths in people with mild to moderate cases of COVID-19.

Merck’s drug uses a novel approach to fighting the virus: it inserts tiny mutations into the coronavirus’ genetic code to stop the virus from multiplying.

However, this genetic effect has raised concerns that the drug could, on rare occasions, cause birth defects or even stimulate the development of more virulent strains of the virus.

Pregnant women were excluded from the Merck study, and both women and men in the study were instructed to use contraception or abstain from sex.

Merck says the results of two company studies in rodents show that the drug does not cause mutations or DNA damage at the doses studied.

FDA reviewers also confirmed previously reported interim results from Merck that the pill reduced hospitalization and death rates by about half in patients with early symptoms of COVID-19 who were at increased risk due to health problems.

However, on Friday, Merck announced updated results from the same study showing lesser benefit from the drug. The FDA said it is still reviewing the updated data and will come back with a new evaluation of the drug’s effectiveness on Tuesday.

Among more than 1,400 adults in a company study, molnupiravir reduced the combined risk of hospitalization and death by 30% – less than the 50% originally reported due to incomplete results.

Almost 7% of patients who received Merck’s drug within five days of developing COVID-19 symptoms ended up hospitalized and one died. Of the patients who received the placebo, 10% were hospitalized and nine died.

Merck has not tested its drug in people who were vaccinated against COVID-19. But the FDA will ask the advisory panel to recommend which patients could benefit most from the drug based on their vaccination status and underlying health issues.

While Merck’s drug is likely to be the first pill for COVID-19 in the United States, more are set to follow.

Competing drug maker Pfizer has submitted its own antiviral for FDA review after initial study results showed it reduced the combined rate of hospital admissions and deaths by nearly 90%.

Pfizer’s drug is part of a decade-old family of antiviral pills known as protease inhibitors that revolutionized the treatment of HIV and hepatitis C. They work differently from the Merck pill and have not been linked to the type of mutational concerns raised with Merck’s drug.

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Thousands ‘suffering in silence’ as sleep disorder clinic backlog balloons: Doctors Manitoba

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Sue Moon languishes on three or four hours of sleep a night while waiting for confirmation from something she has long known.

Her loud breathing keeps her husband awake at night. She wakes up exhausted and has little energy to play with her five grandchildren. She is tired all the time.

“I haven’t slept well in two and a half years,” said Moon, 62, who has now been diagnosed with sleep apnea and insomnia.

“It affects your life in some ways. You don’t have the energy to do much. You go out for a couple of hours and that’s it – you just have to get home. You’re just dog tired.”

Earlier this month, Moon arrived at the Sleep Disorder Center at the Misericordia Health Center in Winnipeg, more than two years after she was put on the waiting list.

Now that she has a diagnosis of sleep apnea, she will soon be getting a Continuous Positive Airway Pressure (CPAP) machine, which moves oxygen-rich air through the airways and can improve the quality of sleep.

This is promising for Moon, but she remains frustrated, her quality of life and that of thousands of other Manitobans suffering from the growing arrears.

“There are many patients who suffer in silence,” said Dr. Kristjan Thompson, President of Doctors Manitoba and ambulance at St. Boniface Hospital.

The Physician Advocacy Group estimates that nearly 4,800 fewer sleep disorder tests were performed during the pandemic as resources were diverted to hospitalized patients with COVID-19.

That represents a decrease of 70 to 80 percent and effectively doubled the waiting list to about 9,500, according to new estimates released by Doctors Manitoba last week.

It is said that there are now a total of 136,000 backward surgeries and diagnostic procedures in the province, about 6,000 more than last fall. According to Doctors Manitoba, a large part of the recent bump is being caused by research into lagging insomnia.

“I feel kind of guilty that I finally got my test,” said Moon. “How do you make up such a backlog?”

The province is expected to release details shortly on a task force to address the backlog. Earlier this year, $ 50 million was earmarked for issuance, but few other details have been released.

In an email, a spokesman for Winnipeg’s regional health agency confirmed that Doctors Manitoba’s estimate of the backlog of sleep disorder tests is accurate and sleep studies are now near full capacity.

“Respirologists identify and treat all patients who are considered to be most at risk,” the spokesman said.

Virtual appointments and devices for home studies are also used to deal with the backlog.

Waiting increases other risks

When people with sleep apnea try to rest, the muscles in the throat become relax and repeatedly clog the airways, resulting in poor quality sleep; Studies are needed to establish a diagnosis and treatment plan.

“If you don’t … treat it relatively quickly, a belated diagnosis can basically lead to a poor quality of life and poor work performance,” says sleep apnea expert Dr. Najib Ayas.

Without this intervention, persistent nightly low oxygen levels can lead to higher blood pressure, said Ayas, associate professor of medicine at the University of British Columbia.

Waiting for treatment for sleep apnea can cause or worsen existing mood disorders and create a “vicious circle” for those suffering from depression, says Dr. Najib Ayas. (Submitted by UBC)

Sleep apnea can also increase the chances of developing dementia and is associated with three times the normal risk of cardiovascular diseases such as strokes, heart attacks, arrhythmias, and aortic disease. It has also been shown that patients are three to five times more likely to be in a car or work-related accident, Ayas said.

Waiting for treatment can also cause or worsen existing mood disorders.

“Depression makes sleep worse, and sleep, once worse, makes depression worse,” Ayas said. “It can be a little vicious circle.”

Anxiety, depression worsens

Matthew Molnar, 40, knows it all too well.

“I haven’t slept well since I was … in my 20s,” he said. “I’m always exhausted.”

That exhaustion made his depression and anxiety worse, Molnar said. It is a challenge to keep a job, “to put additional strain on the people around me, my friends, my family”.

Matthew Molnar, 40, has been waiting for jaw surgery since spring 2020 that could resolve his sleep apnea. The latest estimate he’s received is that he could get the trial next spring, but he’s not confident it will happen before the end of 2022. (Jaison Empson / CBC)

He was diagnosed with sleep apnea about a decade ago and has lived with anxiety and depression for years.

He has tried a number of traditional pharmaceutical, behavioral, and physical interventions for all three conditions, but nothing appears to be very effective. He tried a CPAP machine but couldn’t sleep on it.

In 2017, his psychiatrist told him that he must first get his sleep apnea under control in order to qualify for state-of-the-art procedures that could help with his mental health problems. That meant a more recent sleep disorder test.

After waiting for an appointment for more than two years, he paid for a sleep study at a private clinic and was diagnosed with severe chronic sleep apnea. Molnar says that when he sleeps, he stops breathing about 55 times an hour.

He was on a waiting list for jaw surgery that might help early last year. The response to the pandemic prevented this.

Molnar, who has a degree in political science and public administration, wonders if a task force will have a great immediate impact.

“For me, a task force is the political equivalent of ‘thoughts and prayers’. They do not bring any real relief to the suffering people. “

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