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A nursery melody plays throughout the halls of Providence Memorial Hospital whenever a baby is born. It can be a jarring reminder at the bedside of a sick or dying patient: life is still happening, someone just gave birth. For nurses, this happens all the time. They’re there when people enter this world and when they leave it, offering comfort through our most vulnerable moments.
This fundamental quality of nursing is part of what attracted Charlotte O’Rourke to the profession. An emergency nurse at Memorial, O’Rourke was first introduced to the world of health care at age 18, when she was hospitalized after a car accident.
“That month living in a hospital was so wonderful for me. I loved the techs, I loved the nurses, I loved the therapists. They made every day great. What 18 year old wants to be in a hospital between high school and college? And yet I walked out of there saying, ‘That was so fun!’ People were so loving and giving. And what a dream come true to do something where you are fulfilled. Because how often do we work and we’re not fulfilled?”
O’Rourke, 43, is a single parent of two teenage sons, who she says are “my everything.” She loves animals, and has three dogs and two cats. When talking with O’Rourke, her genuine interest and care for others is clear. She often gets carried away describing a person or situation, revelling in the sweetness of the details.
“When you put me out somewhere I will talk to anybody and everybody,” O’Rourke said. “I kind of like to say I know everybody in the produce section, everybody in the meat department, because that’s where I’m comfortable. Working in the ER is a place where I feel super comfortable. I say good morning to everybody and I love knowing people’s names. I think it’s amazing how just saying hi and knowing someone’s name brings a smile to their face.”
A nontraditional path to nursing
O’Rourke began her career in health care later than some, starting nursing school at age 35 after first earning a degree in corporate communications and pursuing work in business and education. When she started as an ER nurse in 2013, O’Rourke struggled to balance her job schedule against the needs of her young kids, and eventually shifted to other jobs within and outside of health care. She returned to the ER in February, shortly before COVID-19 turned the world upside down.
“Seeing that teamwork, that love, that commitment nurses make to every one of their patients, it made me realize how much I want to be back in patient care. I want to get to care for these people when they are vulnerable and when a lot of people turn their backs on them. You know? And fight for them, be their advocate, because it’s tough in a hospital,” O’Rourke said.
Returning to the ER wasn’t an easy adjustment, even before COVID-19 hit. O’Rourke found the five to one ratio of patients to nurses at Providence especially challenging.
“Five to one is a lot. You think ‘Oh it’s just one more patient,’ but at Memorial we have a lot of high acuity patients.” O’Rourke said a more typical patient/nurse ratio at El Paso hospitals is four to one. California, the only state to legally mandate safe nurse staffing ratios, set the state ER ratio at four to one.
O’Rourke was still orienting to the job when the COVID-19 pandemic transformed the hospital, increasing the number of tasks for ER nurses. Like many hospitals, Providence Memorial reconfigured its ER to accommodate the anticipated wave of COVID-19 patients. They converted what was formerly the pediatric unit into the COVID ER, and began to assign nurses one side or the other for their shift, COVID or non-COVID.
Twilight Zone in the ER
But at first, the wave didn’t come. “When COVID hit, it got quiet in the ER. Scary quiet, like Twilight Zone. It’s an ER, so even prior to COVID, there could be quiet moments, and then the next thing you know you’re slammed. But when COVID happened and the census dropped, we started getting emails about ‘no overtime accepted’ and ‘don’t clock in too early, don’t stay late.’ As the census dropped, people were being cut more.”
A hospital census is the average number of patients per day, and is a metric that is often used to calculate staffing and budget decisions. Hospitals across the country instituted layoffs, furloughs and other cost-cutting measures as their patient censuses declined in the wake of COVID-19. Tenet Health, the company that owns Providence Memorial, has furloughed roughly 11,000 workers because of the pandemic, even while receiving $345 million in taxpayer assistance since April.
Providence Memorial Hospital has not responded to requests for comment for this article.
O’Rourke says that after the census dropped, support staff for nurses was reduced. They didn’t get techs anymore, and the “Huck” (unit secretary) was cut too. The Huck answered and placed all phone calls in the unit, calls which increased exponentially after loved ones couldn’t visit the hospital anymore.
“All the sudden there were no techs and no Huck. As soon as they took the unit secretary away, the charge nurse was having to answer every phone call. So now the charge nurse is supposed to be managing all the nurses, making sure every patient is OK, answering all the phones, and putting out all the calls. They’re all over the place. I voiced it to our CEO one day. I actually told him, ‘This is not right. We are struggling. You took away our techs and you took away our Huck. And it’s not safe, we are putting the patients’ safety at risk.’ Because we were spread too thin.”
O’Rourke says ER medical workers are overwhelmed because of the staffing cuts. The night nurses recently circulated a petition (which O’Rourke signed) asking supervisors for more support staff, and a lower patient-to-nurse ratio. So far, nothing has come of the petition. In the meantime, the stress is taking a toll on O’Rourke.
“You carry that guilt as a nurse, that I did a disservice to this patient. That I haven’t loved on this patient the way I wanted to today, and they needed the love. They needed to be cared for today, and all I could give them was this half-assed, ‘I drew your blood, sorry I couldn’t talk.’ I think that’s been the biggest change. We are scrambling, and at times our acuity is very high, our numbers of patients seem to be a lot, even if our census isn’t high enough to meet what they need to make the budget. Right now, I feel like we’re not able to give the care that people deserve,” O’Rourke said.
The stress of pandemic health care
O’Rourke reached a breaking point after she was alone on the COVID side of the ER with no support staff, unable to keep up with the needs of patients. That day, the charge nurse had told her she’d have help beginning at 11 a.m., but when a nurse arrived at 11:30, he said he couldn’t help her because he was needed elsewhere.
“I just started crying and walked out of the patient’s room. I said I’m quitting, I cannot do this. I am completely by myself, too many patients, too many tasks, and not a single soul in sight to help in any way. I was so overwhelmed,” O’Rourke said. “And he immediately went over to the director and assistant director and he kind of laid into them.’”
After this incident, supervisors created an ER calendar to ensure that the same nurses weren’t being placed on the COVID side too often, and to make sure a nurse wouldn’t ever have to work the COVID side alone, she said. Working on the COVID side tends to be more intense for nurses. In and of itself, the process of donning and doffing PPE for COVID patients can add a lot of time to patient care and make time management more difficult.
Hospital protocol has continued to shift in response to changing information and constraints connected to COVID-19, and hospital staff are expected to adapt and keep up with changes as they happen. In that sense, it’s been an ongoing learning experience for O’Rourke and her colleagues. Just in the past two weeks, Providence Memorial has augmented their PPE rules, mandating that ER nurses now wear an N-95 mask and eye protection/ face shield with every patient on both the COVID and non-COVID side.
How working on the frontlines plays out at home
O’Rourke has made changes to minimize COVID-19 risk in her personal life. Like many other medical workers, she has a new routine of changing clothes from work and frequent laundry, to avoid bringing contaminated garments into the house. She and her ex-husband also switched the kids’ schedule to a weekly exchange, so that there is less back and forth (before COVID, each parent had the kids for a couple days a week).
O’Rourke says her modified parenting schedule was the result of emotionally charged dialogue with her ex-husband over concerns about exposing the children and other family members to COVID-19.
“There was a discussion of them moving in permanently with him and I just lost it. I can’t, it would crush me. They’re my reason to wake up every day. I love my children. But I very much understood, if the shoes were the other way around, I would probably feel the same way,” O’Rourke said.
“You’ve got to keep living”
As time has passed, O’Rourke and her kids have adjusted to their new COVID routine, and have begun to consider what it means to live fully while simultaneously preventing virus transmission.
“My son is going to go to a camp this summer where he’ll be a counselor-in-training, and someone said, ‘You’re not worried about it?’ I was like, ‘Well no. This camp is doing everything they can. All the counselors-in-training kids and the counselors are coming two weeks prior to the campers, basically doing a two week quarantine.’ There’s this part of me that says, ‘If my son gets it, he gets it.’ I’m not at all saying we should just open everything back up, I don’t think that that is safe right now. But I don’t want people to stop living.”
O’Rourke worries about ways that fear of COVID-19 can be paralyzing or even dangerous, such as with patients who don’t go to the ER when they have severe health issues that aren’t COVID-related. “I think you should always trust your gut and come to the ER no matter how dumb you feel it is, it’s always better to be safe than sorry,” she said.
O’Rourke is passionate about providing care to those in need, even though the past several months have been more challenging than she could have anticipated. The reasons she got into nursing have pushed her to maintain high standards for quality of care.
Talking about her first ER job, O’Rourke said, “I just had such tremendous joy. I don’t know that there was ever a time I left and said ‘I don’t like my job’ or ‘I had a bad day,’ I loved every day. I just love caring for people and helping people. It is just the most rewarding thing, for me.”
Although since COVID-19 there have been days when O’Rourke has left work feeling badly, her dedication to health care is unflagging.
“I love what I do. I work at a wonderful hospital, and I do think that they are doing the best they can. I know that a lot of this comes not from our CEO and our (chief nursing officer) but from Tenet, the corporation. I hate that unfortunately money is the root of all evil, everything is about the bottom line. … But I do feel like Memorial is a great team, I just wish they could see that a little bit more staff is going to help us provide even better care.”