When the pandemic took hold one year ago and the nation went into quarantine, most Backus Hospital nurses bravely faced their fears about catching COVID and persevered to care for their patients with compassion and commitment.

They contended with staffing shortages, periodic mandated double shifts, a shortage of personal protective equipment and sometimes going without breaks, said Registered Nurse Sherri Dayton, president of the Backus Federation of Nurses, AFT Connecticut, Local 5149.

“These are the nurses who are holding the tablets up,” for families to say goodbye as they extubate them, because loved ones are not allowed to be there in person for their own safety, Dayton said during a February telephone interview.

“A year ago, we did not know what it was going to be like and we’ve learned so much so quickly,” said Donna Handley, president of Hartford HealthCare’s Backus and Windham Hospitals, during a March telephone interview. “As we understood this virus and disease better, we continually changed policies and processes to keep our staff, our patients and the community safer.”

The number of COVID-positive people hospitalized fluctuated on any given day in March, April and May 2020 between 10 and 20, said Dr. Robert Sidman during a January 27 telephone interview. That number dropped to fewer than five during the summer, but spiked in October. Since mid-December, he said the hospital averaged 40 COVID-positive patients, but some days “approached 50.” About 25 percent of those individuals were admitted to the critical-care level.

As of March 8, Handley said Backus Hospital only had two COVID-positive patients and neither of them needed to be in the Critical Care Unit. On this day, staff was also waiting for test results on four other individuals who came into the emergency room overnight. Handley said they do a “surveillance COVID test” on every patient that gets admitted. “And until we have the results, they’re listed as a person under investigation.”

Now, because they’re optimistic and have “such good safe practices,” Handley said they’re allowing visitors in the hospital again.

Several times, the one-nurse-to-two-patient ratio in CCU has been bumped up to one nurse for three patients, Dayton said. Since the Progressive Care Unit (PCU), which usually has a one-to-three ratio, is now caring for CCU patients, Dayton said it too should have the one-nurse-to-two-patient ratio, but they sometimes have a three-to-one ratio.

“So it’s been very difficult for them (nurses) with these patients to do that,” she said.

Just like every other hospital in the country, Handley said they did everything they could with the resources and patients that they had. She and her staff continue to reevaluate staffing every four hours to determine how sick a patient is and do everything they can to adjust staffing accordingly.

Dayton said they have better PPE now than they had in the beginning and they have policies and procedures in place. “Everybody was scared we were going to run out so we were conserving.”

Early on, Dayton said nurses were told to use one mask per week unless it was compromised (torn or dirty). “I did not follow that order; lots of nurses did,” she said. “One was disciplined for not following it, but different floors got different amounts of push back.”

Ultimately, she said if nurses demanded a new mask, they received them. “The fear is some got sick because they followed policy. After the strike, nurses got to change their mask daily per policy.”

Handley said there was a PPE shortage, but just for several weeks, after which time they were able to stockpile enough PPE and N95 masks, so that nurses “always felt that they have what they needed to be safe.”

Progress is also being made on other fronts, according to Dayton. Between Dec. 13, 2020, and Jan. 11, Backus Hospital mandated nurses work 12-hour or 16-hour shifts 78 times. Between Jan. 13 and Feb. 10, the hospital mandated nurses work 12-and-16-hour shifts 12 times.

“So I think they’re starting to listen,” Dayton said.

Handley said she is grateful for the “courageous” nurses who worked extra shifts, because they were covering for their colleagues who were sick.

“There were days when every nurse on my team, whether they were in a leadership role (or) a non-direct patient care role, were in the emergency department or in critical care, helping support nurses taking care of patients,” Handley said. “I think we really pulled together as a team, so that we could support our nurses in bringing extra resources on those days when we were doing the most critical work that we needed to do.”

Backus Hospital has not mandated a nurse to stay an extra shift since Feb. 12, 2020, she added.

Handley said Hartford HealthCare also provides two-week pandemic sick pay for staff who become COVID-positive, so they don’t “have to use their hard-earned paid time off.”

Dayton said taking breaks to snack or use the bathroom is more challenging than ever for nurses. “Now we have a surgical mask and a face shield on the entire time we’re on the unit and we can’t just have a drink anytime we want or throw a Tootsie Roll in our mouth. You can’t take your mask or facial (shield) off at all unless you’re in a break room with two people in it.”

The pandemic has taken a toll on nurses, who are experiencing symptoms which range from exhaustion and depression to anxiety, Post-Traumatic Stress Disorder and alcohol addiction, Dayton said.

To address exhaustion and burnout, Backus Hospital has created Zen Dens, where nurses can go on breaks for respite and reflection, Handley said.

Beginning the week of March 8, nurses also started receiving chair massages. Additionally, the Colleague Support Center is available to staff 24 hours per day, seven days a week offering resources, which include emotional support, as well as financial support via the Hartford HealthCARES Colleague Assistance Fund for employees who have faced dire financial situations because of COVID.

Supported by charitable donations, this fund has given over $1 million to people whose loved ones lost jobs.

At the beginning of the pandemic, Handley said Hartford HealthCare also “made a clear decision, unlike other health systems, that we would not lay off staff, that everybody would keep their jobs. So many of our staff had spouses and family members who lost their jobs and children were home from school so they had personal stress and anxiety. They had the stress and anxiety of coming to work and dealing with a virus that was new to us,” Handley said.

“Hospitals and health systems face catastrophic financial challenges in light of the COVID-19 pandemic” caused by cancelling non-emergency procedures, Americans postponing care, increasing costs of PPE, “the effect of COVID-19 hospitalizations on hospital costs” and “the costs of the additional support some hospitals are providing to their workers,” according to an American Hospital Association’s May 2020 report.

Dayton said some nurses who contracted the COVID virus then gave it to their spouses, children or parents. “I’ve caught COVID myself,” she added, “and my biggest fear was giving it to my 76-year-old-father, and thank God I didn’t when I caught it.”

“Nurses have quit left and right,” Dayton said, adding that at least 11 nurses have left the emergency department in the last three-and-a-half months and about 10 left the CCU. “Some are taking jobs that are less COVID intensive” at Hartford Hospital, UMass Memorial Medical Center and Lawrence + Memorial Hospital, so they “don’t have to deal with COVID every second of every day.”

Some nurses have just taken other positions at Backus Hospital. For example, one emergency room nurse went to the IV Therapy Department, while a CCU nurse left to go to the Post-Anesthesia Care Unit.

“Natural transitions happen in nursing all the time,” said Handley, adding that some young nurses with small children “decided they wanted to leave critical acute care nursing out of concern for their families and the pandemic itself.”

Some nurses made the decision to “stay home with their families, take a break, or go to other areas really just to have a break,” she said.

Since the two-day October 2020 union strike, Dayton said “nurses have had their feelings hurt by management” at Backus Hospital and “there’s not a lot of trust between nurses and management at this point.”

The nurses’ new contract includes being part of a monthly staffing committee. “We are working with management to try to come up with recruiting and retainment policies, procedures and incentives,” she said. “They just instituted a $10,000 sign-up bonus for CCU, because they’re just desperate. They’ve lost like half their staff.”

Backus Hospital has also raised its sign-on bonuses for oncology nurses for the night shift, which Dayton said, “is really hurting right now,” as well as incentives for current nurses covering open shifts.

“A lot of the other hospitals in the state are doing way better incentives to have nurses pick up (shifts) because this isn’t a unique problem at Backus,” Dayton said.

The nursing shortage was an issue before the pandemic and got worse during it, Dayton said, because a lot of nurses who were 65 years of age decided it was time to retire.

She said Backus Hospital has hired some licensed practical nurses to work as per diem floats. “They can’t do CCU but they can help out on the floors, partnering with a nurse to help make things a little bit easier.”

Now that medical staff has been vaccinated, Dayton said nurses’ fear of bringing the virus home to their families is starting to subside and their comfort levels are improving. “We understand the virus a little bit better.”

“Last March, none of us could have anticipated how much the COVID-19 pandemic would change our lives,” Handley said in a statement. “Yet through it all, we’ve innovated and collaborated to find solutions and overcome a tremendous amount of adversity. I am deeply grateful for our team of providers, nurses and front-line workers who helped keep our community safe and well-cared for, even in the darkest days of the pandemic.

“Although tired, we are more united than ever before, working together to use the lessons we learned to not just return to normal, but emerge better than before.”

Dayton thanked the commmunity for its outpouring of support.

“It is definitely what keeps us going,” Dayton said. The hearts in windows and donated pizzas and other items have given nurses “a little boost” and “definitely helped us through some difficult times.”