Before COVID-19 reached New Jersey, Holy Name Medical Center in Teaneck had a 19-bed intensive care unit and 33 critical-care nurses. Now it has added four ICUs and is treating 45 patients, 40 of them on respirators. To satisfy the growing demand, about a dozen nurses have been reassigned from other units that have been temporarily closed, and a handful have been hired.
Bergen County, particularly Teaneck, is the coronavirus epicenter in New Jersey. On Tuesday, the number of COVID-19 patients at Holy Name reached 151. Thus far, 25 patients have died. Nurses there are running in a triage marathon, a race in which no one can see the finish line.
“They’re holding up … Morale is good,” said Michele Acito, Holy Name’s nursing director. “Every single nurse has risen to the occasion, and beyond. They are amazing. It’s a crisis none of us have ever seen.”
Nurses — a proxy of hope
Critical-care nurses are a special breed. Their job requires a highly specialized skill set and an extraordinary emotional IQ. Candor and compassion. In addition to administering meds and operating a variety of complex medical devices, they are the patient’s only connection to their family. At Holy Name, nurses keep the family informed by phone, and also connect them with the patients via iPad. In the course of their duties, the nurses supply their patients with medical information, small talk, encouragement and solace. In short, they are the patient’s proxy of hope.
As for their inventory of personal protection equipment (PPE) — N95 masks, gloves, gowns and face shields. “We’re doing OK. We’re good for at least a couple of days,” Acito said. And they have been able to acquire enough ventilators — at least for now. “ Our materials guy has worked magic.”
There has been a taxing nursing shortage in New Jersey for many years, primarily because an aging population is creating more need for medical care. And with nursing schools unable to keep up with the number of retiring baby boomers, the problem gets more serious. Add a pandemic, with the number of the infected still spiking and four field hospitals being rapidly built, and you have a crisis.
On Friday, Gov. Phil Murphy issued an unprecedented plea for medical volunteers. The response was swift and remarkable: As of Monday, 4,764 responded to the call. Nearly half were nurses, many responding to a call for help from the New Jersey State Nurses Association. This is the breakdown of that response, as of Tuesday:
- 1,425 nurses with active licenses
- 520 student nurses
- 125 retired nurses
State Assemblywoman Nancy Munoz (R-Union) was one of them. She is a retired critical-care RN.
Two weeks ago, she was driving in her car, listening to New York City Mayor Bill de Blasio on the radio making a public plea for more medical staff. That prompted her contacts in the governor’s office to see what New Jersey was doing on this front. She soon hooked up with the Union County Emergency Corp, signed up to volunteer and promptly found herself swabbing people Saturday at a COVID drive-up testing site at Kean University.
“I didn’t hesitate” to volunteer, she said. “I am not sleeping well. I’m tossing and turning. All I can think about is what can I do?”
Munoz retired from nursing in 2002, after a 30-year career as a critical-care surgical nurse with a master’s degree in adult primary care.
At Kean, she joined about 30 other volunteers, including nurses, pharmacists and the National Guard. Outfitted in double hair nets, double faces masks, triple gloves and a plastic shield, she and her colleagues took samples from hundreds of people in makeshift tents.
Because of her training and protective gear, she had no fear, but “some of the people were terrified. A 6-year-old boy was crying. We reassured all of them,” she said.
At the end of the day, she returned to her Summit home, through the basement, where she put all of her clothes in the laundry and then showered. She said she plans to return to Kean and offer more help this week. In the meantime, she’s making surgical masks on her home sewing machine.
As of Saturday, Hackensack Meridian, the state’s largest health care provider, had 1,400 COVID-19 patients at its hospitals, according to CEO Robert Garrett. A third of them are in ICU and more than 300 are on ventilators. Garrett said Health Commissioner Judith Persichilli has instructed all hospitals to prepare to double their ICU capacity in the next three to six weeks.
The number of infected people in New Jersey is doubling every six days. If things continue unchanged, New Jersey will run out of ICU beds to care for coronavirus patients within the next two weeks, Murphy said Monday.
“We have enacted several practices to concentrate staff in our emergency departments and ICUs as this pandemic continues,” said Dr. Daniel W. Varga, chief physician executive at Hackensack Meridian. “For example, we postponed elective surgeries, which is increasing capacity by 20% and permitting us to redeploy nurses. Our administrative teams are also hiring more per diem staff and inviting retired clinical personnel to return to aid in treating our patients.”
Getting rid of red tape
To accommodate reinforcements, the state has also waived a host of regulatory requirements to allow out-of-state and retired nurses, doctors and other medical professionals help. The Department of Consumer Affairs intends to grant applications within hours of receiving the form. The waivers also will facilitate the work of health care staff of the National Guard who have been deployed in New Jersey to assist with the response to COVID-19.
As of Tuesday, the DCA had licensed an additional 674 nurses, who can now report to work. That brings the total number of licensed nurses in New Jersey to 170,728.
Persichilli has also signed a directive that permits hospitals to use advanced practice nurses, paramedics and physicians assistants to care for patients in noncritical areas, so that the intensive-care doctors, pulmonologists and critical-care nurses can stay at hospitals to care for the most severely ill COVID-19 patients. And Murphy also authorized the immediate payment of more than $140 million to health care providers to prepare them for COVID-19-related expenses, including expanding capacity.
To monitor the pending crisis, the state’s 71 acute care hospitals have been ordered to provide the DOH daily reports on bed space, staffing levels, ventilators and PPE stocks. The state is working to add bed space — reopening one closed hospital and setting up three temporary facilities — and seeking to amass more PPE and ventilators from closed surgery centers and a federal stockpile.
Rutgers New Jersey Medical School in Newark announced over the weekend it would expedite the graduation of about 200 students who will then be eligible to begin their residencies to help out state hospitals. Students would normally have completed their required courses in April and graduated in May, but now the 192 students will graduate between April 10 and April 21.
Officials are also turning to the private sector to help them find nurses — to people like Paul Ruderman, CEO of All American Healthcare, a health care staffing agency in Newark specializing in temporary employment for nursing personnel.
“Pre-COVID, the demand was tremendous. Now it’s through the roof,” says Ruderman, who continues to hire additional internal, administrative and operational staff to keep up with the ever-increasing demand for nursing personnel, particularly during the crisis.
Ruderman said he has also been asked by the health department to help recruit nursing personnel for several of the pop-up field hospitals that are opening across the state. The response from nurses and others has been overwhelming, he says, with more than a thousand nurses and nurse assistants ready to deploy in the coming weeks.
The Rutgers University School of Nursing in New Brunswick is also recruiting contract RNs for intensive-care units and emergency rooms. A posting on the school’s website reads: “We have immediate contracts of 8-13 weeks in duration at a compensation at $90/hr … The schedule includes 12-hour day and night shifts, 4-days a week. The positions also qualify for overtime (OT) pay.”
Not enough gear to go around
For some, more troubling than the staffing shortages is the critical shortage of equipment — ventilators, N95 masks and gowns.
“There’s just not enough,” says Doug A. Placa, executive director of JNESO District Council 1 IUOE-AFL-CIO, a labor union that represents professional 5,000 health care workers, mostly nurses, in New Jersey and Pennsylvania. “We’ve been working with the governor’s office to rattle some cages in the federal government to get supplies to frontline workers. And we mean now.”
“Do we have enough PPE? The answer is “no,” and we know that,” Persichilli said. “We haven’t had enough PPE for a long time, and I know that the workforce perspective, that’s the thing that is concerning them the most.”
After the governor closed all state universities last month, Rutgers University School of Nursing Dean Donna Nickitas had to put all of the school’s classes online for home instruction. She also decided to cancel all practicums, or onsite clinical placements, needed for graduation.
“I had to do it for their safety,” Nickitas said. “They just weren’t fully prepared” for the sudden dangers that would face them. Instead, students are now satisfying the practicum requirements with an interactive software platform that offers a virtual clinical experience in a simulated patient room.
Hurry up and wait for one ‘near nurse’
Meanwhile, Jessica Dybus, a 24-year-old from Williamstown, is sitting on her hands.
On Jan. 16, she attended her pinning ceremony as a graduate of the Rutgers-Camden nursing school, eager to launch her career. At that time COVID-19 was barely on her radar. She had heard reports about it in China, but she, like most of America, had no idea what was in store. She assumed she would be working in the field in a couple of months.
But the day before she was scheduled to take her licensure exam in March, she received an email, informing her it had been cancelled because of the pandemic. Now, she is hoping to take it in May, but that remains uncertain.
“It’s awful,” says Dybus, whose mother is a nurse. “I want to be out there helping people.”
Dybus is an EMT and has experience in ER and trauma. She plans to become a doctor. “This is my dream,’ she says. But she’s ready to work right now, and if they put her in an ICU with COVID-19 patients, that’s fine. “Wherever I can help,” she says.