Gennine Yahya has lived five minutes down the road from University Hospital her entire life. Her mother, a nurse employee for the U.S. Army Nurse Corps, Yahya grew up around nurses.
So when it came time to go to college and choose a career more than a decade ago, nursing was Yahya’s obvious choice. Still living just five minutes down the road, Yahya chose University Hospital for her clinical rotations. She has since worked in the University Health System for nine years.
A year and a half ago, Yahya was made clinical nursing director at the University Health System – a role she said she was excited to take on, to help lead other nurses. Little did Yahya know she and her nurses were just months away from facing a whole new challenge – the coronavirus pandemic.
A change in pace
The word pivot has meant a lot to different people over the past year, Yahya said. For Yahya and her team, it meant going from treating neurology and oncology patients to facing a global infectious pandemic on the front lines.
“It’s been a bit shocking, right?” Yahya said. “All of a sudden, the patients are more sick. We’re changing [protocols] to make it safer for staff, we are creating more ICU rooms in places that would not typically be ICU rooms, we’re working a lot of extra time. We’re seeing all these travel nurses come in, and it’s high-stress.”
When the first major wave of COVID-19 hospitalizations swept through San Antonio in July, Patient Care Coordinator Marina Saucedo said nurses such as herself trained in other specialties received quick training in order to step up to meet the demands for staff.
“Everyone really stepped up to the challenge,” Saucedo said. “We were slammed with that initial wave [in the summer] and this latest one as well,” she said, referring to the increased COVID-19 hospitalizations and deaths in Bexar County in January. COVID-19 claimed the lives of 500 Bexar County residents in January, accounting for a quarter of all local deaths.
For oncology nurse Hema Chibawe, catching COVID-19 while away visiting family in Zambia last month has helped her understand the isolation and loneliness many of her patients are experiencing as they are isolated and quarantined during their hospital stay.
“Patients can’t have visitors, and the experience [of being alone in the hospital] can be really scary,” Chibawe said. While home in Zambia to mourn her brother’s death, Chibawe started experiencing symptoms and recalls the 10 days alone in self-isolation in her mother’s house as “boring.”
“The internet there is pretty spotty, so I could only use my phone every now and then,” she said. “It’s only my second [week] back to work now.”
The biggest change Chibawe said she’s noticed is the age of her patients. As an adult oncology nurse, Chibawe said she’s used to dealing with older people. Taking care of COVID-19 patients, she’s seen a lot more young patients, she said. “People in their 20s, 30s, 40s, 50s.”
Adapting to the environment
In order to keep up with the amount of incoming COVID-19 patients, University Hospital – like all local hospitals – was required to create “COVID-19 units,” areas COVID-19-positive patients were treated away from any COVID-19-negative patients.
University Hospital Administrator Michael Roussos said this meant using the medicine unit as it was intended, but it also meant changing beds in units around to make room for COVID-19 patients. Rehabilitation beds were transitioned to medical beds, to move out medical patients and expand space for COVID-19 patients, he said.
Also, part of the oncology/neurology unit was transitioned to a COVID-19 unit since this area of the hospital had ICU setups, he explained.
For both the July influx of hospital patients and this latest January influx, University Hospital prepared more than enough beds for COVID-19 patients, Roussos said.
“We’re following a very similar plan [for this surge] as we had for the first surge,” he said. “[For] the first surge, we had about 170 patients. This last, more current surge, we’ve had about 150 patients. So we put a plan in place for the first surge, and we’ve really been following that for this second surge.”
During both surges, University Hospital could have flexed to fit up to 200 COVID-19 patients, Roussos said. Luckily, numbers are on the decline again, with about 130 COVID-19 patients at University Hospital, he added.
Carlos De Hoyos was one such patient set up in a room that had formerly been used for oncology patients. Sitting up in his hospital bed, De Hoyos donned a San Antonio Water System cap as he watched the television. De Hoyos said he worked for SAWS and thinks he may have gotten COVID-19 from a co-worker.
“I’m feeling OK today,” De Hoyos said through the telephone at his bedside, as he waved to people on the opposite side of a window. “I’ve been here about four days, and I’m really feeling better.”
De Hoyos said he looks forward to being home again with his family and can’t wait to see his 13 grandchildren when he gets out of the hospital.
Keeping up with staffing needs has also been a puzzle, Roussos said. The way this need has been met is through a pool of “floating” nurses who go to other units that need nurses. These nurses typically have versatile backgrounds, specializing in ICU, and other specialties, Roussos said.
“We’re very lucky to have a large group of float pool nurses, many of them full-time nurses that go to units as needed,” he said. Nurses can volunteer to take on more hours as well, which has happened often throughout the pandemic, he added.
Staffing needs are also met through traveling nurses, many of which have been supplied by the Southwest Texas Regional Advisory Council (STRAC), Roussos said.
“We’ve had about 100 extra nurses to help us within our health system, to help staff us up for the surge,” he said. “That’s obviously been a big help to us.”
The vaccine: A double-edged sword
With COVID-19 vaccines out for distribution, most people – especially in the health care field – are hoping to return to “normal” soon, Yahya said. For nurses, that would look like regular shift hours in their regular nursing units and away from COVID-19 patients, she said.
While the vaccine can be seen as a light at the end of the tunnel, Bexar County is not out of the tunnel yet, Yahya said. She added University Hospital is proof of that; there are still multiple COVID-19 units, two of which are units not normally used for infectious diseases.
“I think there’s two sides [to this vaccine’s distribution]; there’s the side that this is going to be great for us, we’ve got a vaccine, it’s 90 to 95% effective, it’s going to help … alleviate this pandemic,” she said. “Then there’s the other side where people are getting the vaccine and thinking, ‘I don’t need to wear a mask. I can hang out with my family and friends.’ And that’s not the case.”
This attitude has contributed to the local infection rates over the past several weeks, Yahya said. With local residents now having a false sense of security, Yahya said she and many other health care workers are concerned about what the effects of spring break will be in upcoming weeks.
“Remain vigilant, keep up with hand washing, wear your mask,” she said. “It’s still here.”
Clarification: This article has been updated to better explain how University Hospital utilized space for COVID-19 patients.