By Lilly Lesperance

I was a Registered Nurse in the Intensive Care Unit (ICU) for well over 20 years at a large community hospital in Ontario. I retired from there in the summer of 2020 and I also recently resigned my Nursing Registration.

From the beginning months of 2020 when COVID19 (SARS-CoV-2, is the scientific name) was starting to become a pandemic the hospital started to go into “high gear” so to speak. There were extra “huddles” at the Nursing station to update staff and allow for Q&A. Frequent mini in-services to reinforce proper donning and doffing of PPE (Personal Protective Equipment) and the reorganization of the ICU patients began.

There were three ICU POD’s set up in the beginning. Sounds like the Bible, doesn’t it? One Pod of 12 beds were dedicated to COVID positive patients, another 12 beds were dedicated to COVID potentials (awaiting swab results) and a third 12 bed POD was dedicated for mainstream ICU patients. This third POD was deemed to be the “clean” unit.

This ICU also has a Step Down Unit created as an extension of the ICU (staffed by ICU Nurses) for the patients who are either still too sick for the regular wards or not quite sick enough to warrant an ICU bed. This particular Step Down Unit is located in an area of the hospital that was to only be a temporary location (since 2011), where there are no windows, no televisions, rarely a clock that worked and curtains to separate each bed thereby defining a patient room.

Hence, the exclusion criteria for this unit included; no patients in isolation, no one on a ventilator or no one with a tracheostomy were to be admitted to this unit. As with most ICU’s we have chronic patient’s. A chronic patient has been in the ICU for greater than 3 months and they normally have a tracheostomy, gastric feeding tube, were often restrained because they’re no longer on medication to make them sleep and spent their day trying to pull out said, trach, feeding tube or IV lines and required total care, ventilator support or a high % of oxygen. These patients were in isolation for any number of reasons ie: ESBL, M.R.S.A or the newest one, courtesy of India, I might add, CPE. CPE is a bad one because all of our antibiotics are useless against it. Since the arrival of COVID a corporate decision was made, as though no more rules existed, and all the chronic patients were transferred to the Step Down unit. We had five chronic patients at the time, yes I said ‘had’ because within 2 to 3 weeks all five of the said chronic patients passed away…ALONE! The one rule they did enforce was the no visiting rule. So, these people, who had families with them EVERYDAY before COVID, passed away, alone. Additionally, within weeks of reorganizing each Pod we noticed that COVID patients were being admitted to all 3 of the Pods. Now they were mixed in with truly NonCOVID patients! What??

If COVID is so deadly then why were the COVID patients being admitted to the same PODs as non-COVID patients? Why did these inconsistencies happen?

We certainly did not receive the volume of admissions as initially anticipated. In fact during my last few weeks of working, prior to my retirement, I was asked on multiple occasions if I wanted to take a vacation day, as there was either a low census (few patients) and or they were over staffed. Did the chronic patients even need to be moved?

On occasion I witnessed the physician’s talking about the inaccuracies of the PCR test and how frequently they were resulting in false positives and they shouldn’t even be used for diagnosing. There were conversations amongst the physicians about when a patient is 60 years of age or older and a decision had to be made as to who gets the ventilator, depending, of course, on the patients‘ comorbidities.

This hospital also made a decision to install a camera in each ICU room. All the camera’s were positioned on the wall opposite the patient as though the doctor would be standing at the foot of the bed. It was understood that this was done so that the physicians would not need to go into the patient’s’ rooms to minimize any exposure to COVID. These camera’s fed to two central monitors located in the ICU education room. This room was not always locked as I learned one day when I walked right in, with no one around. I saw the monitors set up at the back of the room on a table and walked over to clearly see some of the patients visible on these monitors.

This is where the doctor’s would go to view all the patients. However, most of us nurses would cover these camera’s up with either a glove or a piece of paper, taped over the lens. We were all disgusted with the decision of the corporation to not only think of installing these cameras but to have actually implemented such an invasion of privacy. And this in the face of strict corporate policies outlining in detail, their zero tolerance for breaches of privacy. These breaches could elicit possible termination. In spite of management’s continued insistence that the camera’s remain uncovered, we nurses continued to cover up the cameras as soon as the manager would walk away, usually night shift.

With the continued non-compliance and complaints of the nurses about the cameras, I recently learned that all the cameras have since been disconnected. One small victory for nursing!

Hooray for the Nurses who took an ethical stance against the doctors and management.

Another strange occurrence started when all the I.V. pumps used on the patients became managed by the nurses outside of the patients’ rooms! Huh? They were all in the hallway as opposed to by the bedside. To allow for such positioning of the I.V. pumps, the I.V. tubing used is extra long and was designed for the purposes of a patient M.R.I. scan. Regular IV tubing interfered with the imaging. The rationale for the I.V. pumps to be managed in the hallway, outside of the patient’s room, was to minimize the amount of times the nurse would need to go into the COVID patients’ room to either address an alarm on the pump or to change an I.V. bag(s).

There are Standards of Practice all Nurses are to maintain as set out by Registered Nurses Association of Ontario (R.N.A.O.). As observed, there are some standards that are not being met, such as turning a patient every 2 hours. Why not? Due to the reduced amount of times the healthcare staff were required to go into the rooms to provide care of the COVID patient. We were cautioned not to go in unless we absolutely had to, maybe 4 times a shift. Some of the consequences of reduced care can include physical symptoms such as pneumonia and skin breakdown but what about the lack of human contact, the reassurance, caring, touching?

In December, a shipment of COVID 19 vaccines arrived at the hospital’s Pharmacy Department. The pharmacists are not even allowed to examine these vaccines. This Pharmacy department is now under 24/7 Security Guard watch. An additional 15 to 20 security cameras were installed in and around the Pharmacy department for this vaccine, in addition to the ones that were already there when this hospital opened in 2007. Why does there need to be a 24/7 security presence? Why were there so many additional cameras installed? Why are the Pharmacists not allowed to examine the vaccines?

There are a number of reasons for me to retire but one of them was that I could no longer morally be a part of a healthcare system that condones less than adequate standards of nursing care to continue. I loved being a Nurse. I love helping people. Despite being retired I will always help people by speaking the truth….the facts ma’am nothing but the facts!

Lilly Lesperance is a retired Ontario ICU Nurse