'We’re about to catch on fire': Inside a Texas hospital battling omicron & staffing shortages

"“We’re about to catch on fire”: Inside a Texas hospital battling omicron and staffing shortages" was first published by The Texas Tribune, a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.

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THE WOODLANDS, Texas – Earl Sprunger sits in his hospital bed, struggling to speak. He anxiously strokes his long, scraggly goatee every time he winces in pain. He’d hoped to shave it off before coming to the hospital, but there wasn’t time.

The 67-year-old originally showed up here, at Houston Methodist The Woodlands Hospital, when an existing stomach issue flared up so badly he couldn’t stand. He tested positive for COVID and was admitted.

“These other problems I already had, but I didn’t know it was that bad. [My surgeon] believes COVID brought them on, like that,” he said, snapping his fingers.

Sprunger has been here, in the hospital’s respiratory unit, for a week now, with only his nurses and a Christian YouTube channel for company. His daughter, a mail carrier, has been nervous to visit. Sprunger, a retired veteran, is working on getting his strength back, taking slow, supervised walks around the room with the help of a walker.

All 32 beds in this unit are full with COVID patients right now, and the hospital has reopened the overflow unit. Almost all of the patients, like Sprunger, are unvaccinated.

“I don't do vaccines too much really,” he said. “Years ago, they gave me the vaccine for flu or whatever it was. It gave me the flu bad, real bad…so it makes me leery about that stuff now.”

Sprunger says there haven’t been enough studies about the coronavirus vaccines and he’s worried about the side effects. His brother, who got vaccinated and boosted, is hospitalized in Michigan right now, he says, and Sprunger believes the vaccine made him worse, not better.

If unvaccinated people do get sick from this new, highly contagious COVID variant, Sprunger says they can just do what he did.

“If you get it, go to the hospital,” he said. “They'll get you through it.”

That’s hard for nurse and unit manager Kristen McLaury to hear, considering just how many of her patients haven’t gotten through it.

McLaury treated one of the hospital’s first COVID patients and hasn’t stopped since. She now runs the respiratory unit, where she and her nurses have watched otherwise healthy young people gasping for breath. They’ve put countless people on oxygen, or taken them off life-support. They’ve had to comfort grieving families, and facilitate video calls so no one had to die alone.

She’s risked her own life on the frontlines for nearly two years, and now, watching these hospital beds fill up again, she just feels defeated. In Montgomery County, a conservative, wealthy suburban county northwest of Houston, only 53 percent of its more than 600,000 residents are vaccinated, which is among the lowest rates for Texas counties with populations exceeding 500,000. Less than 16 percent of residents have received a booster shot.

“I work 60 hours a week and I don't see my child, I don't see my husband, so that I can come and care for you while you yell at me because you're upset that you have a disease that I told you how to prevent in the first place,” McLaury said.

As the unit manager, it’s McLaury’s job to keep morale up among the other nurses, a herculean task right now. Like every hospital across the country, they’re facing a nursing shortage, an increase in employee infections and a potentially terminal case of staff burnout.

As the omicron variant surges, Texas is on track to soon surpass its previous COVID hospitalization record, set in January 2021. Then, at least, there was the hope of vaccines on the horizon. Now, nurses like McLaury don’t see much hope at all.

From behind her Houston Astros mask and face shield, she begins to cry.

“It’s real, and maybe it might not be you [in the hospital], but it might be somebody else,” she said. “That compassion, I think, is just gone. The world has become so selfish.”

In the emergency room, a logjam

On a Friday afternoon in mid-January, the emergency room at Houston Methodist The Woodlands is starting to fill up. Plastic sheeting divides the waiting area to encourage social distancing. HGTV plays quietly in the background as a nurse hooks a patient onto an IV drip.

Around the corner, a hallway has been converted into a makeshift triage area for overflow patients. It’s empty now, but last week, administrators say, they were using every seat.

It’s been non-stop at the ER since omicron first emerged in the area. They’re seeing the usual emergency room needs — broken arms, heart attacks, flu symptoms — as well as lots of people presenting with this new, highly transmissible COVID strain.

So far, omicron seems to be leading to fewer and shorter hospitalizations than previous coronavirus variants, and vaccines seem to be providing significant protection against serious illness. Not as many of the hospital’s intensive care unit beds are being taken up by COVID patients at this point.

But with so many people testing positive, and such a low vaccination rate in the county, the emergency room is seeing an increase in COVID cases that require hospitalization.

All of this leaves the emergency room with a serious logjam. Patients are waiting a long time in the lobby because the emergency room beds are currently occupied by patients waiting to be admitted to the hospital — not just for COVID, but for surgeries and medical care.

Unfortunately, right now, all those longer-term beds are tied up, due in part to an influx of unvaccinated COVID patients.

“Patients stay in the lobby for my entire shift,” said Meredith Moore, an emergency room nurse. “12 hours. It’s frustrating. It's hard for them…and they get angry. It’s justified. But who receives that anger? Me.”

Moore has been a nurse for nine years and joined the emergency department here since soon after the hospital opened in 2017. She’s young and energetic, with expressive eyes that communicate exactly what she’s thinking — even behind a mask.

Before the pandemic, Moore loved the fast-paced environment and the feeling of helping people who really needed it. She was especially good at controlling her emotions, a requisite for this job.

“In the ER, you have a patient die on you and you have to go into your next room, and you have to act like nothing is wrong,” she said. “That has gotten more difficult as this has gone on.”

Last week, for the first time, she broke down and cried in the emergency room.

“I had five ambulances that had to have a bed…I had a patient that was circling the drain…I don’t have a nurse to take care of that patient,” she said. “That was the first time in two years I really felt helpless, because if one thing falls, if one person starts coding, it’s all over. It all goes up in flames.”

“I don't think that people [know] unless you're on this side,” she said. “I tell my family all the time. I'm glad you don't know. But that's a heavy burden to carry.”

There’s some relief coming for Houston Methodist The Woodlands — a long-planned hospital expansion is opening this week, with many of those beds expected to be filled by patients already awaiting care.

More beds will help. But nurses say they also need more staff. Of the 26,000 employees that work across the entire Houston Methodist system, 1,500 employees tested positive for omicron in one week, according to the hospital’s chief medical officer, Jason Knight. That’s burdening an already thinned-out staff to the breaking point.

"We’re coding"

Moore remembers the early days of the pandemic, when she and her fellow nurses were lauded as “health care heroes.” Back then, it felt like the whole community was standing in solidarity with the doctors, nurses and hospital staff who were risking their lives to treat this terrifying new virus.

When the first COVID patients arrived at the hospital, she swallowed her fear and suited up to treat them. She isolated herself from friends and family who were scared to interact with her and kept to that routine for months.

And she wasn’t alone: across the country, doctors and nurses put on masks, picked up extra shifts, figured out emergency childcare and lived in the agonizing fear of bringing infection home to their families. They reassured each other — this was terrible, but it was temporary.

But now, almost two years later, health care providers have yet to take off their masks. It’s untenable, doctors and nurses say, to continue at this pace, without a break, for much longer.

And no longer does it feel like the community is doing everything they can to stand with them. Only 57 percent of Texans have received both vaccine shots, and less than 20 percent have followed up with a booster. Several nurses described the pain of treating patients all day and then seeing people without masks at the grocery store or hearing about “COVID fatigue” from friends and family.

“I actually had a patient that was sick and tested positive, and I gave him the whole COVID lecture,” said Dr. Knight. “I saw that person in H-E-B the next day.”

After nearly two years on the frontlines, health care workers’ empathy is thinning.

“You’re so opposed to this vaccination, but then you want to come in here and you expect me to be your waitress and…take care of your every want and need,” said emergency room nurse Seanna Davignon.

Davingon has been a nurse for 12 years. Before joining the emergency room staff, she worked with cancer patients in oncology.

“It's very frustrating when I see patients who legitimately are fighting for their lives,” she said. “There are people who want to live … and are doing everything they can to not get COVID and still end up with COVID.”

As she spoke, an announcement came over the hospital PA system, reminding nurses to distribute lunch trays to their patients. Before COVID, there were dietary staff members who did that. But to minimize exposure, that’s just another task that now falls to the nurses.

Davignon is looking for opportunities outside of nursing. She has her MBA, and it’s always been her plan to try to move into health care operations. But COVID has hastened her departure.

She’d like to come home from work and hug her children immediately, without having to change out of potentially infected clothes first. She’d like to not be asked, every shift, if she can take on overtime. She’d like a job that doesn’t require her to drink to decompress.

Houston Methodist saw 21% staff turnover last year, double its typical rate, according to chief nursing officer Kerri Guerrro. She said nurses are leaving to stay home with their kids, retiring early, taking jobs outside of health care or taking higher-paying travel nursing jobs.

This hospital is better positioned than most to weather these departures. They had staffed up in anticipation of the new expansion, and have gotten some short-term “angel nurses,” as they call them, through a state-funded program.

But these shortages are affecting the entire health care system. The Texas Department of State Health Services reports that the state is downmore than 3000 hospital beds at a time when they are needed more than ever.

The federal government has deployed nurses to hard-hit areas, including sending thousands to Texas in response to the omicron wave. Harris County announced last week that it was allocating more than $40 million to help hospitals staff up amid shortages. Lawmakers in San Antonio have called for Gov. Greg Abbott to send more relief nurses to the area.

These short-term solutions have created a bit of a shell game, where, in some cases, nurses are lured away from hospital positions for these higher-paying travel gigs, leaving vacancies that then must be filled by state and federally funded travel nurses.

Meredith Moore recently decided to leave Houston Methodist The Woodlands for a travel nursing job. She says the hospital has been extremely supportive and a wonderful place to work, and she hopes to return one day. But right now, she just has to get out of the emergency room setting.

After she cried at work the other day, she said her supervisor asked her how they could help.

“I said, you can't give me anything that I need,” she said. “I need more ambulances. I need more nurses. I need this [new expansion] open immediately. I need all these things that you cannot give me.”

That was a bad day, Moore said. But what she wants people — needs people — to understand is that there are more bad days coming, for health care workers and the people they treat.

A good emergency room nurse, she said, can anticipate that someone is going to code before they do. That’s why, she says, she and her fellow ER nurses can tell what’s coming. And it’s not good.

“We’re coding,” she said. “We’re about to catch on fire…and what then?”

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This article originally appeared in The Texas Tribune at https://www.texastribune.org/2022/01/17/texas-hospital-omicron-staff-nurses/.

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