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Last month, I wrote about how a surge in respiratory illnesses in kids was overwhelming children’s hospitals much sooner than normal. Many of the clinicians I spoke with worked in emergency departments and ICUs that had been at or near capacity since late summer. The precise mix of viruses varied across regions, but all were worried that the onslaught would not slow, especially with flu and covid looming.
Fast forward to now, and much is the same. Children’s hospitals are still overwhelmed, struggling to care for too many sick kids with a thinned-out workforce. That’s forced hospitals to delay elective surgeries, set up emergency tents and even turn some patients away. Rather than writing a similar version of my October story, I wanted to convey what working in an ICU is like from someone on the ground. I ended up speaking with Hui-wen Sato, a pediatric ICU nurse at a children’s hospital in Southern California. As both a bedside nurse and a charge nurse, who helps oversee her department and coordinates care, Sato helped me understand the personal and collective toll the surge is taking, and how many nurses feel less supported than ever.
Jonathan Lambert: What is it like right now in your hospital?
Hui-wen Sato: We are absolutely seeing a surge of respiratory illness in kids. It’s been going on for six or eight weeks. The bulk is definitely RSV, but we have kids who are coming in with other respiratory illnesses like the common cold, but they either were so young that they got hit really hard, or they have other health issues that made them a little more susceptible to needing more support. We also have a handful of covid kids that have come in.
JL: Many hospitals are experiencing a shortage of staff, especially nurses. How has this been at your hospital?
HS: Our capacity has really taken a hit since covid. By and large, everyone is short-staffed. That impacts everything. There might be a long line of patients coming into the ED [emergency department], and we have to transfer patients out of our ICU to a regular medical surgical floor, but if those floors are short-staffed, it impedes our ability to get patients out of our ICU in a timely fashion, which impedes our ability to admit patients from the ED. The overall flow is impaired because capacity is lower. Our hospital has been doing less non-urgent, elective surgeries since we just don’t have as much capacity.
In our ICU, we physically have 24 beds, but because of our staffing, we only have adequate staff for 20 or 21 occupied beds. Just because there are three more physical beds open doesn’t mean that we can safely staff them. We also typically have to hold space for what we call the code bed, that’s used for a code blue [a hospital-wide alert that a patient needs immediate emergency care, often for a cardiac or respiratory arrest]. We try to keep one bed open for when someone inside the hospital has an emergency, or someone comes through the ED and is terribly, critically ill, not just needing oxygen for RSV but they got slammed by a car and need that bed.
Because of the respiratory surge, there’s so many who show up in the ED who need oxygen right now. And we take them, but I always have to think about the other things that can happen. There are still car accidents. There are still patients on the regular floors who suddenly have a medical crisis. Those kinds of things don’t stop just because this respiratory surge is happening. How do you plan when you don’t know when those emergencies are going to happen, and you don’t want to come up short, but you’re always short-staffed?
🩺 Read the rest of our interview here.
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