Hospitals Unprepared for Latest COVID-19 Surge, Nurses Say

Nurse COVID-19

Key Takeaways

  • A survey of about 15,000 nurses finds many of them say their facilities are unprepared to deal with a surge in COVID-19 cases.
  • Nurses say hospitals still aren't properly screening for COVID-19, and many are not receiving the PPE or testing to keep themselves safe.
  • Hospitals can look at community infection rates to try to predict upticks in admissions, and then plan accordingly.

With COVID-19 cases rising, hospitals are feeling the stress. A recent survey of nurses found many feel unprepared to deal with a surge in patients, and say they still aren’t getting what they need to safely care for patients—and themselves.

As of November 20, overall weekly hospitalization rates have gone up since the week ending September 19. They are driven mostly by adults over the age of 50. The percentage of deaths attributed to pneumonia, influenza, and COVID-19 was 10.7%, down from 14.4%% the week before. Still, it’s above the epidemic threshold, according to the U.S. Centers for Disease Control and Prevention (CDC).

National Nurses United (NNU) recently conducted a survey of more than 15,000 registered nurses. They say hospitals botched efforts to prepare for the increase in COVID-19 cases the nation is experiencing now. The nurses also claim that hospitals are underperforming when it comes to basic infection control measures. This puts not only patients at risk—but healthcare workers, too.

Nurses: Hospital Preparedness Lacking

According to the survey results, only 18% of hospital nurses say their facility is prepared to handle an increase in cases.

"Their lack of preparation means they are knowingly sacrificing the lives of nurses and other health care workers,” Bonnie Castillo, RN, executive director of the NNU, said in a statement.

Getting personal protective equipment (PPE) remains a challenge. The survey reports that 16.5% say they have universal PPE in the emergency department where patients may not be screened for COVID-19 prior to receiving care.

More than 80% of nurses say they reuse at least one type of PPE that’s only supposed to be used once. And about 20% of hospital nurses say the hospital recently limited N95 mask use; more than 70% are using N95s when working with COVID-19 patients.

Fewer than half of those surveyed say their facilities are not using respiratory protection when caring for patients who have not been tested or whose test results are pending.

Screening patients is another obstacle or deficiency, as only one in five nurses said all patients were screened for COVID-19 prior to admission. And 43.6% of hospital nurses say all patients are screened for COVID-19 at any point. 

As for dedicated COVID-19 units, 60% of hospital nurses report that their facility had one while 8% report the COVID-19 area closed.

Hospitals Are Hurting

Vineet Chopra, MD, the division chief of hospital medicine at Michigan Medicine, tells Verywell that his hospital system is seeing an increase of cases.

“We continue to have challenges with testing capacity. I anticipate there will again be challenges with PPE as well,” he says.

Hospitals are facing more influenza-like illness which usually increases emergency department and inpatient volume this time of the year.

“Balancing both of these activities with COVID is going to be challenging,” Chopra says.

Hospitals will need to create capacity for COVID-19 patients, but can’t ignore patients who need care for other issues.

“A gentle ramp-down and agility in how we respond to COVID and non-COVID care is needed,” Chopra says.

What This Means For You

Hospitals may not be prepared to handle patients that come in because of COVID-19, or any other ailment. Depending where you go, there may not be a dedicated COVID-19 unit.

“They [hospitals] have had nearly a year to get their act together. We should not still be operating under crisis standards of care,” Castillo says.

Lessons Learned

Hospitals shouldn’t make the same mistakes they did earlier on during the pandemic, Chopra says.

Chopra says a national mask mandate should have been instituted, as well as a national response emphasizing widespread testing so doctors could have better traced, isolated, and treated patients with asymptomatic infection.

Jiban Khuntia, PhD, an associate professor at University of Colorado Denver, tells Verywell hospitals should be quicker to embrace innovation and infrastructure changes this time around, "such as drive-through tests, remote surveillance, and tents.”

Joseph Cavallo, MD, an assistant professor at Yale School of Medicine, tells Verywell that hospitals need to keep up with data on new infections during this surge. They should know what to expect based on historical data from the Northeast in the spring and the South during the summer, which can help them determine when to pause elective procedures or bring on more staff.

A Public Health Problem

“A poorly coordinated response and public health infrastructure, including the lack of widespread distribution of testing materials to ensure all healthcare workers could get timely tests, and of personal protective equipment, have all been documented failures of the current federal government's lack of leadership around responding to the pandemic,” Gary Weissman, MD, an assistant professor in pulmonary and critical care medicine at the University of Pennsylvania Perelman School of Medicine, tells Verywell.

Khuntia also thinks the rise in cases is due to a failure of public health mitigation strategies. He questioned whether information was given appropriately, explained clearly, and distributed through the right channels.

Khuntia's recent study assessed how citizens in the United States, Kuwait, and South Korea responded to pandemic guidance from their governments. Khuntia’s team concludes that citizens are dependent on how the government communicates with them. Understanding how people perceive the government’s role is important in how they will respond to suggestions and mandates.

“In the case of the United States and Kuwait, the citizens expect that the governments need to provide enough information and rationale to take away their individual and social freedom in the form of sheltering and distancing measures,” Khuntia says. “However, South Korea citizens are more willing to follow government guidelines during a national crisis.”

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Article Sources
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  1. Centers for Disease Control and Prevention. COVIDView. Updated November 20, 2020.

  2. National Nurses United. National nurse survey exposes hospitals’ knowing failure to prepare for a Covid-19 surge during flu season. Updated November 12, 2020.

  3. National Nurses United. National nurse survey exposes hospitals’ knowing failure to prepare for a Covid-19 surge during flu season. Updated November 12, 2020.

  4. Al-Hasan A, et al. Citizens’ adherence to COVID-19 mitigation recommendations by the government: a 3-country comparative evaluation using web-based cross-sectional survey data. Journal of Medical Internet Research. Nov. 8, 2020. doi:10.2196/20634

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