Gangtok: A viral audio of a nurse claiming shortage of staff and how COVID-19 patients are dying with minimal symptoms in Sikkim has been doing the rounds on social media. The nurse claims that there are only three nurses to cater to 52 patients admitted at level-9, which has been dedicated to COVID-19 patients, in STNM Hospital, Gangtok.
In her audio message to friends over Instagram, she claims that they have to administer up to seven medicines to a single patient. This has to be done by three nurses with PPE suits on, she said, adding goggles come in their way of not seeing things properly.
Later, the audio message reportedly became a subject of discussion among government officials. On May 17, a day after the audio message was circulated, chief minister Prem Singh Golay issued directives to depute health workers in a comfortable ratio of one nurse to look after and treat a maximum of 10 COVID-19 patients, so that their duty would not result in stress and burden.
To understand this arrangement, EastMojo spoke with health secretary and director general Dr Pempa Tshering Bhutia.
“There are around 25 health workers posted at one time. It cannot be true that only two nurses were present,” he claimed.
Currently, there is more than one nurse for every 10 patients in the wards, Bhutia said. “In the ICU, it is one nurse for every patient (1:1), in the OT it is 1:2, and in the wards it is 1:4. If you see in non-COVID ward, there is around eight to 10 nurses. You won’t need so many nurses, with an average of 24-25 patients,” he added.
With shifts, one in-charge looks over nine staffers, Bhutia said. “Some have just three to six patients. There are more than 200 nurses at STNM Hospital alone. We hired 261 nurses two years ago. We also have around 79 ANMs,” he added.
However, the ground reality in the COVID-19 section seemed to be different. EastMojo spoke with a few nurses and doctors at STNM Hospital to understand the prevailing situation.
Upon inquiry, this reporter learnt that the nurse whose audio message went viral, is currently deputed in the COVID-19 section of the hospital. Many of her colleagues claimed that the audio message is authentic and showcases the ground reality.
Currently, STNM Hospital has three levels — Level 7,8, and 9 — in the building as COVID-19 section. The four levels down below house an ICU, HDU and different wards for COVID-19 patients. There are 142 COVID-19 patients currently admitted at the hospital, of which 20 are in ICU and 122 in HDU and COVID-19 wards, as on May 18.
“The nurses work in three shifts — morning, evening and night. However, when we take the case of a ward, there are more patients but our numbers are the same — just one or two nurses to look after them,” said a nurse on condition of anonymity.
“Even in that audio clip, the nurse has mentioned that there are three of them in the ward. In each shift, there are a maximum of two to three nurses in the COVID-19 ward. It all depends on the number of patients admitted at the time as well as the severity of cases,” the nurse added.
Another nurse, who took evidence of duty roster at Level 9, shared, “At present, there are 12 nurses deployed in Level 9 where the audio clip mentions is facing shortage, the COVID team there started working from May 16 and will carry on till May 23. On May 17 evening shift, there were three nurses deployed. The same count of nurses follows in the morning shift, and then again 3 nurses for night shift. But in ICU there are 2 nurses deployed per shift. The 12 nurses will work in shifts of three, but one set of three nurses will be a back up as those nurses who take up the night shift will be given a day off on the next day”.
“In the COVID Hospital, which has four levels, currently there are two nurses each in level 1 and 2 (wards) and 3 (ICU). But sometimes, both level 1 and 2 are looked after by only two nurses, which makes it one nurse per ward. They have to run to different floors to administer medicines, but these wards mostly have stable patients,” said another nurse.
Earlier, there used to be three nurses in a particular shift to look after all the four floors, including the ICU and HDU, the nurse said.
“If a medicine was to be given to a patient in ICU, the nurse would have to run to a different level, find the medicine and come back and administer the same. The other nurse at this moment would be sitting beside the serious patient, so that he doesn’t collapse before the medicines come. But now, there are more nurses as the patients have increased. With this declaration by the CM, we are hopeful the situation would improve,” the nurse added.
But what is also concerning is in every shift, the ICU has only two nurses. To simplify the numbers, for a week, there are eight nurses for level 1 and 2 which are the wards. Each of these eight nurses work in pairs per shift, while two are kept in standby as well as to give them a day break after their night shift.
Meanwhile, a senior doctor at STNM Hospital also backed the claims made by the nurse in the audio clip. “It is the ground reality,” the doctor said.
He stressed on how more than the decision of the number of nurses or their ratio to COVID-19 patients, quality approach to treatment should be need of the hour.
“Along with the treatment of patients, the hospital administration should simultaneously run the orientation and management plan for COVID-19. You cannot take a bunch of doctors and nurses and put them in ICU. Not all the nurses are trained to work in the ICU, they may not know the basics,” he said.
As the situation with COVID-19 is changing every passing day, what was considered ideal and medically sound last year, the same cannot be given this year. “If there is orientation, it will save time and a situation of panic,” the doctor added.