Front-Line Reports From Austrian Hospitals

Doctors, nurses and caregivers describe the current situation on COVID-19 stations. Their reports are sobering and in some cases alarming.

Corinna Milborn, managing editor for news and moderator at Austrian TV channel Puls 24, collected voices from the healthcare sector. They report overcrowded intensive care units, overburdened nursing staff and patients who can no longer be treated.

The reports below are all in first-person, as received by Corinna Milborn, published originally in German by Puls 24 and translated by the Metropole team.

“Every hour, every day you work with us would give us some relief.”

I am writing this because I wish nothing more than that the people who are still happily going shopping and just don’t feel what is going on receive more information. I don’t blame anybody, I think that communication is much too abstract. The numbers don’t reach people anymore, the people are already numb. When I come out of the hospital and see the merry hustle and bustle outside, I don’t know whether it’s me who’s crazy or if it’s the others.

On the normal Covid wards, people are cared for by dermatologists, orthopedic surgeons, gynecologists and oral surgeons. There is a lung specialist they can call if they don’t know what to do next.

Only people under a certain age receive beds in intensive care units. (Note: Not confirmed)

The normal Covid wards are overcrowded with elderly people who have no one at home to look after them, although this would still be domestically possible in some cases.

Internally, e-mails with help-inquiries to nursing staff in all departments, are circulating, whose tone can only be described as pleading. (“Every hour, every day you work with us would give us some relief. Please think about whether you really need the next vacation.”)

“We have six Covid stations – in March, there were two”

We currently have six Covid stations. In March there were two. The catastrophe that we all expected in March and rightfully feared has now happened. But now, this seems to no longer touch people on the “outside.” No longer frightening them.

I am really not a friend of fear-mongering. But I didn’t find the sentence “Everyone will soon know someone who has died of Covid” as reprehensible as many others, back then. The phrase was etched in one’s memory and frightened people. This caused a change in their behavior.

Too bad it was fired too early. Because now it would have been justified.

“We hope that the total workload capacity limit will not be reached.”

I work as a nurse in an intensive care unit. We have both corona patients as well as others. We try (in accordance with the guidelines) to delay intubation as long as possible and getting the patients without such, “out of the woods”, due to heightened mortality with intubated patients. Of course, this regularly presents us and our doctors with great challenges. Not to miss the right moment for a possible intubation (too late is also bad) and on the other hand, making ethically correct decisions (topic: refusal of emergency ambulance admissions because a Covid patient is coming etc).

According to the circumstances, the atmosphere in the team is good, we do our best. Of course it is a learning process, the most efficient workflow has to be acquired first and the procedures are constantly changing. Perceiving however, treatment recommendations change daily. We all strongly hope that the total capacity limit will not be reached and that we will not have to rely on untrained personnel. Until then, we’re biting the bullet and are looking forward to when all this is over again sometime.

“Massive shortage of nursing staff”

The number of patients is increasing day by day. There is already a massive shortage of nursing staff, so that much of the nursing staff from other wards has to help out. The problem with this is that most nurses have a different education. But now they have to work in pulmology-, even in monitoring wards, and they have no qualification for this whatsoever. They are simply thrown in at the deep end, without enrollment. Only last Friday at about 14:00, a colleague was informed that she had to work night shifts in the evening. The colleague mentioned above has not worked at a normal hospital bed since her career training, as she was employed at a day clinic and transitional care area, now she had to hold night duty at an IMC (a preliminary stage to intensive care) with colleagues she doesn’t know and most of whom also come from other areas. Such a thing would have been unthinkable until now.

Employees warn of overburdened hospitals

“We are to care for patients without any experience”

Unfortunately the status registers in our hospital are not accessible for us employees, we do not get any information from the managers on how many Covid patients we’re looking after for here, how many wards are considered as Covid wards or other information regarding the daily situation in the hospital which would be important for our daily work though.

We often do not know whether the resuscitation area can be entered by the ambulance or not. The colleagues from surgery often do not know whether or what can be operated on the same day, in the morning at the time of service handover, as there is no information available as to whether there are free intensive care beds or at least surveillance beds.

The staff shortage in intensive care units has been so huge for weeks, that the nursing staff with intensive care training was withdrawn from the areas of anesthesia, recovery room and central emergency admission room to keep the intensive care units running. It does not seem to matter when these personnel last worked in an intensive care unit or if they’ve ever worked in one at all.

One could also say that we should care for and monitor patients without any experience. Without knowing how to operate the monitoring machines, how to operate the ventilators, how to position the patients or how to document. We have to prepare drugs for infusions or perfusors for patients without knowing what these drugs do, what effect and drug interaction they have, at what speed they’re allowed to be administered. 

This is more than just dangerous nursing. Although experts have warned about autumn and winter seasons, the time was not used in the rather calm summer season to train personnel in time.

“Eventually, there was just chaos”

I work in a corona intensive care ward. We had six beds before Corona. Now we have 10, and two more are being set up in the storage room.

An example of a service: We started with “only” 8 patients, all of whom of course need to be cared for, in full protective gear. It’s great that we have them, but you sweat yourself completely wet and that makes the whole thing even more exhausting. 3 patients need additional dialysis, 3 patients had to be turned over from a prone position back on their backs. Each time, you require 3 to 4 people for this.  One patient was dying and unfortunately came far too short. The others were also all ventilated and had to be cared for just as decently.

As soon as everyone was halfway tended to, the first admission arrived. Various necessary intravenous lines have been stung, he was intubated and ventilated and then also brought into the prone position. At about the same time, a second admission came, where the same thing had to be done. The procedure takes about 2 hours, there are 2 nurses and 1 doctor in the room. When the first admission was halfway through, another patient suddenly collapsed.

At some point there was only chaos, everybody helped somebody and we worked through the whole time without a break and without drinking – let alone eating anything. Of the total 12,5h duty I sat for about 30 min – but also only to shove my lunch down my throat and to keep record at the same time, I drank much too little and can hardly move anymore because I am so tired and exhausted. I am in my mid 20’s and actually fit. Tomorrow I must go back on duty because another colleague has dropped out and I have to fill in.

“I don’t know how it’s supposed to go on from here”

I work as an intensive care nurse in a sector with the capacity for 14 intensive care beds. Up to 10 beds can be provided for Covid. At the beginning there were three beds, in the middle of last week there was an expansion to 6 beds, which were also filled immediately. And now the last 4 beds have been made available additionally, which are already being tended to. Only 4 beds remain free for internal, neurological emergencies/ patients. Surgical emergencies are apparently to be attended to in the recovery room now. Two normal wards are full of Covid, a third one was extended. I do not know how it’s supposed to go on from here. Other hospitals are apparently already quite full also.

Some colleagues are currently in quarantine, but we do not have any staffing problems in the intensive care unit at the moment. However, this can change again very quickly. There have always been small outbreaks of infected staff. And if a high workload persists over a longer period time, more sick-leave will automatically occur again.

We daily strive for the care and treatment of the patients, which we can currently still provide to the usual standard. However, the increasing number of patients makes us worry how it will be in the near future, possibly not even being able to care for patients anymore. Also other people, without Covid, will fall ill and require nursing in the hospital.

“We must wear our mask for 12.5 hours”

I work in an intensive care unit. We have “enough” protective equipment at the moment, whereupon we have to wear our mask for 12.5 hours.

The condition is extremely critical as we have WAY to LITTLE TRAINED personnel. We have a lot of overtime and we are told that the law on working hours no longer applies – so we have to come to work and one does that, to not let his colleagues down and to give the patients some quality.

The number of sick leaves is increasing because we are burnt-out.

Not only that there is generally too little nursing staff, because we are left so abandoned by our employer and politics, hardly any employees want to stay in this profession until their retirement – due to the current situation I know many who simply want to quit or look for something new after the crisis.

Only now, one can notice the lack of trained personnel in intensive care units and NO, one cannot simply appoint personnel from the normal stations because:

  1. Special training for special sectors is not free of charge
  2. We work with highly sensitive drugs and equipment
  3. We are trained for emergency situations
  4. During duties which are already understaffed there is no time is to train staff as well
  5. Also normal wards requires staff 

The lack of personnel existed before Corona and now it is particularly noticeable and will continue being so after Corona, as many will look for another profession.

Covid-Intensive care unit in Upper Austria: “The situation has drastically worsened”

Since two weeks, the situation has drastically worsened, our Covid contingent is exhausted. In addition, our bunks have no airlocks (except for one bunk), which naturally increases the risk of viruses escaping from the bunk. Our staff, especially the nursing staff, is working at the absolute limit. Many colleagues are sick and/or Covid positive, which is probably also due to the adverse working conditions. Due to the many absences, the remaining staff has to take over duties continuously, the overtime for some employees amounts to several hundred hours – a reduction is of course not in sight. Luckily we have an enormously great team, which simply sticks together in these times “because it doesn’t help anyways.”

Intensive care- capacities in Upper Austria soon at the limit

“Responsible for so many patients that it cannot work out properly”

The department was only minimally affected during the spring. Now the whole ward is a corona- ward. When the media say that new bed capacities are being created, it means that even more beds are simply being pushed into the multi-bedrooms. With the same number of staff. Young doctors are responsible for so many patients that there is no way it could work out properly. Visiting the bathroom, eating or calling your own children before going to bed – it is not possible.

Allegedly free intensive care beds do not exist. What is reported in the media is simply “sugar coated”. It is about beds that are not occupied by Corona patients. The intensive care units cannot simply be filled with more beds in some places because, for example, the rooms are not large enough. Or there are not enough devices. What certainly is the case: there are not enough personnel. But the cohesion in the department is enormous.

“We have not been able to care for cardiological patients for a long time now”

I work in a hospital in an intensive care unit and it is a disaster. Since weeks we are overcrowded with patients who have corona. We have not been able to care for our cardiological patients for a long time now. We are chronically understaffed. Many of the nursing staff have quit or have reoriented themselves. In addition, we all have to do a lot of extra work – on our ward and also on other wards. It is even required that if you have had contact with a positive patient and were not sufficiently protected, you still have to go to into service. Everyone would have to be quarantined but nurses and doctors who are allowed to work with critically ill people would have to continue to work! Access to protective equipment is also more difficult. Only some receive Corona bonus. All in all very unfair. So, it is getting more and more acute.

“I was desperately looking for a free intensive care bed”

While our health minister was still talking about the numerous free intensive care beds, I was desperately looking for an intensive care bed for a non-Covid patient. In the whole of Burgenland as well as in all reasonably nearby hospitals in Lower Austria no bed was free. That was about two weeks ago, when the case numbers were much lower.

“In the end, the patients suffer from this”

Somehow everyone is already quite tired of these imaginary beds that should be available – the trained staff is also missing for this.

It is a pity that so much was missed over the summer – one could have offered training courses regarding respirators and the like. Instead, in many hospitals, personnel are being removed from the normal wards with minimal intensive care experience (e.g. an internship during training) and assigned to the emerging Covid (intensive care) wards.

On the normal wards, of course, this means that even fewer personnel are available.

In the end, the patients who are actually under our protection suffer. The excessive demands are caused by the fact that it is often difficult to prioritize in everyday ward life, which means that everyone wants to do their work as well as possible – even if it takes away all their strength and energy.

After all, it makes no difference whether two or four people are on duty: it’s all about people, the best possible is always attempted, even if it means reaching your own limits.

“Everything is based on the ‘learning by doing’ principle”

Before the pandemic, we had two recovery rooms in which patients were treated postoperatively after major and minor procedures and then transferred to the normal wards for further care. In the case of major interventions, minor blood pressure instability or abnormalities requiring closer postoperative monitoring, patients remained in the recovery room overnight and were transferred, on the next day, to the normal ward in a stable condition or, if the condition was not stable, to the intensive care unit.

Then came Corona ….

So in the recovery room, in which staff with standard fundamental training work, intermediate care was established within three days. What does this mean for us?

We get intensive care patients who need very sophisticated nursing devotion without ever having been trained for this, nor having the personnel requirements. Neither staff has been increased, nor has medical assistance been considered. These patients are cared for in addition to the non-reduced OP program. Thus, no 2 on 1 care is possible as it is usual in an intensive care unit. Furthermore, there is no privacy for these patients, as they are in the same room with up to 9 others. Everything is based on the “learning by doing” principle simultaneously with full liability for errors. In addition to intensive care patients and normal post-operative patients, we also care for corona-positive patients post-operatively. I don’t need to explain what this means in terms of additional effort by diverting people in and out. You just do your best and hope that nothing happens.

“We feel insecure and left alone”

We feel insecure and abandoned. Before Corona we were not allowed to take part in important trainings, because they cost too much money, during Corona, at the same time we are suddenly asked to play intensive care unit. Furthermore, staff for the intensive care units is still being withdrawn and overtime is being produced en masse. In case one is transferred to the intensive care units, he gets a 4-day crash training and then has to independently manage patients he’s never cared for before, with a documentary program he’s never seen before.

There are reasons for enrolment, special training and further education. I am aware that it is not possible to follow the normal procedure during this pandemic, but I expect to be involved in these processes as a basic employee. I don’t expect compulsory transferals when we all are already, psychologically at the limit of what is possible. I expect adequate protective equipment, which not only has FFP2 standing on it, but also being what it says on the outside. Instead, we get FFP2 masks, with “non-medical” written on their packaging and which are certainly leaky. With these, we care for corona positive patients. FFP3 masks are not available to us. These should only be used in case of strong aerosol-buildup. In addition to that, I have to say that we do aspirate, nebulize and in case of emergency, intubate and ventilate the patient. If in such an emergency situation I should go get a FFP3 mask, which isn’t available anyways, before I care for the patient, this is negligent for me and in no case for the patient’s well-being.

Rescue workers in Upper Austria: “We have to transport patients across the country”

Rohrbach, Freistadt, Braunau, Schärding – they are all full. On Tuesday, the circular letter arrived that Steyr is full. Therefore we have to transport patients across the country to Linz. The next free bed for a Corona case is there. The profoundly wrong idea is that we measure the hospital capacity by the intensive care beds. This is one of the last areas where it becomes critical. It’s the normal wards that are cracking. We have to bring many to the hospital because they are alone and are not cared for by the general practitioners if they are positive. There is only one doctor for the whole province of Upper Austria who cares for corona patients. She drives through the whole country, alone. She often simply doesn’t get there in time. Anyone who says that this was not predictable is lying. We have known this since mid-September. We’ve known that for two months.

“Staff shortage slowly no longer sustainable”

For a prolonged period of time I have been overcome by an oppressive feeling. A feeling of helplessness, a feeling of not being seen or heard and a feeling of having to give 120 percent without knowing how long my personal capacities will be sufficient for this. In addition, there are the daily reports in the media about the situation in the hospitals. Mainly reduced to bed capacities and their occupancy rate. Not unimportant in the current situation, of course. But essential problems are not mentioned.

I have been working for years as a qualified nurse in intensive care units. The shortage of personnel has always been noticeable and has been a part of our daily work routine. Much is well shrouded by permanent additional services through the nursing staff. The patients have to be cared for and this is our top priority. This means that before the Covid crisis we had already reached our limits many times. Now the situation has changed dramatically. Since March we have been going to work every day and do not know what new working conditions await us.

The lack of personnel is slowly becoming unsustainable. Especially due to the increased demand for intensive care beds for patients suffering from Covid, dramatic restructuring is now taking place in hospitals. Due to a lack of intensive care nurses, colleagues from normal wards are now being asked to work in the intensive care units. In addition it must be said that it is not without reason that special training for intensive care must be completed within 5 years of working in an intensive care unit.

Furthermore, new personnel are normally trained in an intensive care unit for three to six months. This clearly shows that colleagues from the normal wards are exposed to a total overload. In the intensive care unit, we work with highly sensitive medications, equipment, etc. However, our colleagues in the normal ward lack the necessary know-how. Although we are very grateful that they are willing to help us out, we still consider this to be very critical on many levels. To keep in mind that some of the normal wards are increasing the number of beds in order to be able to treat Covid patients. Therefore, there is also an urgent need for personnel. This allocation of staffing does not help anyone. The lack of nursing care is not remedied by this, but is actually increasing on the important wards.

“I’ve tested positive the day before yesterday and have to go back to work the day after tomorrow”

We have Covid patients and normal patients. The separation between the wards is a simple screen. Meanwhile six colleagues including me are positive. According to the hygiene instructions, we could have tended to the patients without protective clothing, only with FFP2 mask, if there were no more care-intensive activities to be done. This also included taking blood samples. But: many decision makers have forgotten what people are like. They cough at you and think nothing of it.

And bang! you are contaminated. I was tested positive the day before yesterday and have to go back to work the day after tomorrow – because the nursing staff on the ward are running out. Actually I am in quarantine with my family. I have to protect myself with some kind of attestation if there’s a control.

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