What can nurses do that doctors can't

Nurses and doctors on the situation in hospitals: "We hope nothing happens"

It is a question that preoccupies the whole country: Are the intensive care beds in the hospitals sufficient to accept people seriously ill with Covid-19? Or is there a threat of the horror scenario that doctors have to decide who can be treated and who cannot, depending on the patient's chance of recovery?

The STANDARD asked about the situation in the hospitals - also apart from the question of beds. A call to hospital staff to describe the current working reality yielded worrying responses. Although those affected, who all want to remain anonymous, work in different hospitals and wards, many of the reports are the same.

"We feel insecure and left alone," writes a nurse, for example, and a doctor notes: "The overload is massive. We have our backs against the wall."

An overview of where the biggest problems are:

Missing intensive care beds are not the biggest problem, says the senior doctor at a Vienna hospital. The necessary rooms and equipment could be found, more importantly that there is a lack of suitable staff: "This is where earlier savings fall on our heads."

Hospital staff describe what follows as "dramatic restructuring". In order to compensate for the lack of a crucial point, personnel from other wards are now being asked to take over services on the "intensive".

"Although we are very grateful that these colleagues are ready to help us out, we still view this as very critical on many levels," writes an intensive care nurse. Because this actually requires several years of special training. In addition, new staff are usually trained in an intensive care unit for three to six months - none of this is currently possible. For example, those who come out of rehab, the doctor interviewed said, they lack the ability to assess whether a patient is vitally threatened or not, for example.

Everything is based on "learning by doing" with full liability for errors at the same time, says a nurse who was transferred from a recovery room to an intensive care unit. And in this case, failure sometimes means that a patient dies: "You just do your best and hope nothing happens."

Far too much overtime would be accumulated, say the nurses who have reported to STANDARD: "We are told that the Working Hours Act no longer applies, so we have to come to work - and you do it so as not to let your colleagues down and To give the patients some quality. The sick leave is also increasing because we are burned out. "

At the Styrian hospital company Kages, for example, an appeal is now being made to the workforce with reduced working hours to increase their working hours for the benefit of the other employees. The Kages replies: "It is correct that an appeal was made to the more than 5,000 part-time employees of the Kages to temporarily increase the level of employment where possible to cope with this exceptional situation. With the best of intentions, we cannot see anything reprehensible about this."

Every day, medical staff is in contact with people who have tested positive. So it is only logical that the protective measures are high so that the virus does not cause failures or even deaths among doctors and nurses.

However, several nurses from different federal states report inadequate protection: "We get FFP2 masks that say 'non-medical' on the packaging and which are by no means leakproof. We use them to care for corona-positive patients," writes a nurse who works in a house of the Vienna Health Association works in the recovery room.

The health association emphasizes that the imprint 'non-medical' means that these masks are not permitted in the operating theater, where the protection of the patient is concerned: "After we are confronted with many of these questions from the employees, we have for the workforce An internet platform was set up months ago, where all protection products are shown with the respective certificates and their protective effect can be read transparently and verifiably. "

A nurse from a Styrian hospital reports a material defect in FFP2 masks, which means that employees have come into direct contact with people infected with Clovid-19.

The Styrian hospital holding Kages states: "Unfortunately, it is correct that there have also been mask deliveries, some of which were faulty. The employees were and are called upon to discard them."

At the Vienna Wilhelminenspital, people try to uphold morale with humor, as the nursing staff reports: "We put on and take off the expensive protective equipment for the corona-infected ward: we have given it a name of its own: on and off dirndls." Nurses report that there are no FFP3 masks for this ward either.

The summer was overslept in order to make important preparations for the second wave of infections in autumn: This accusation is heard several times on the part of the hospital staff. "We do not get any information from the executives about how many Covid patients we care for in the house, how many wards are considered Covid wards, or other information about the daily situation in the house, which of course would be important for our daily work," says one Surgical nurse in the field of orthopedics and traumatology in a hospital of the Vienna Health Association.

A nurse who works on anesthesia in another Viennese clinic says she is "overwhelmed. With everything." When the numbers rose in autumn, it quickly became clear that the hospital was not prepared for it. "Last week we were slowly informed that at escalation level five we would be the fourth corona intensive care unit in the house. But when, that is unclear. Every time we tremble before we come into service."

The Viennese senior physician questioned criticized the fact that the hospitals lacked centralized bed management in order to be able to distribute the patients efficiently. In order to find out where there are vacancies, she has to call through station by station - and not infrequently argue.

There is a lack of understanding among the staff at the Corona ward in the Wilhelminenspital because visits have been allowed there for a few days. "Up to now that was forbidden. We understand the relatives, of course, but it is an enormous effort, in addition to the work that has to be done, to dress every visitor in protective equipment so that they can enter the ward. We have 26 beds that are almost always occupied . "

Employees report that the hospitals are currently overcrowded because many patients come who could actually be cared for at home. "A woman in her mid-50s who only had a slight cough and a little fever at the beginning stayed with us for two weeks just because she didn't want to go home. Her husband is a high-risk patient," says a nurse.

The senior doctor from Vienna perceives a "mega uncertainty": People would no longer be familiar with the flood of information about the virus - and so 20-year-olds with a sore throat and 37.2 fever let themselves be chauffeured to the emergency room with the ambulance. The onslaught was much greater than with the first wave in spring, when many apparently did not even dare to go to the hospital: "We are being flooded with patients."

The doctor also attributes this to poor preparation. Again and again, patients reported that they were tested after calling the health hotline 1450, but that they waited many days for a result. "They'll throw their nerves away and go to the hospital. On the last day of work alone, I had six cases like this."

Another factor: The strict safety measures burden patients and staff alike, reports nurses from the Corona ward of the Vienna Wilhelminenspital: "We are advised not to spend more than 15 minutes in the rooms and with the patients because of the risk of infection." However, many patients did not understand this and complained of a lack of care.

The new antigen tests bring a quick but unreliable result, says the senior doctor. In about three out of ten cases, supposedly negative patients subsequently turned out to be Covid-positive in the longer-lasting PCR test. This has a huge number of consequences, she reports: If those affected end up in a normal ward because they have symptoms, other patients may have become infected. All contact persons must be in quarantine.

A Styrian nurse describes a similar situation for her hospital: On the one hand, she and others worked for Covid patients, on other days in the surgery department. "In the last few days this has led to patients suddenly becoming positive for surgery, even in single rooms." The workforce was not tested.

In Vienna, too, nurses complain about the lack of tests "despite specific cases". As long as one is symptom-free, the service can be started without hesitation, says one person working in an intensive care unit.

The health association emphasizes that the test strategy of the ministry is adhered to: "While the nursing home area receives support from the health authority, we have to organize the tests in the clinic area ourselves, which is a logistical and organizational challenge in an organization with 30,000 employees represents. " The corresponding test logistics are currently being set up.

Although the nurses at the Wilhelminenspital who have been working on the Covid test station since March, which was converted into an infected station in mid-September, received a 500 euro corona bonus from the health association in the summer, but the infection allowance that the collective agreement actually does for this work, they will be denied. When asked, they were told that they shouldn't expect it either.

A pandemic is an "absolutely exceptional situation for which no health system in the world can prepare itself personally," says the Vienna Health Association, and the Kages is also aware of the problem. "The staff in the hospitals are currently groaning in many cases, and rightly so. Isolation patients bring noticeable additional stress with them."

A nurse working in a Viennese intensive care unit puts all this to the table: "For a long time I have been overcome by a feeling of helplessness, a feeling of not being seen and heard, and of having to give 120 percent without knowing how long mine will last personal capacities are still sufficient for this. " (Steffen Arora, Lara Hagen, Gerald John, Walter Müller, November 14th, 2020)