For Brittany Goyette, home is wherever she can bring her chihuahua Charlie. The 10-year-old pup joins her on every work trip across California.
The two are Sacramento natives — well, she found Charlie in Chico — but they’ve spent the pandemic in San Diego. Goyette, a licensed ICU registered nurse, is part of a mobile workforce that travels around the country to hospitals hit by sudden patient surges, especially from COVID-19.
Since February, she has been holding the hands of San Diegans during their toughest and sometimes final moments.
“I don't ...ever feel like this isn't my community,” Goyette said as she sat outside her rental unit in Mission Beach. “Because in the end, this is another human, another soul, another life that I don't need to be part of your community to make sure I do my best job that I can.”
Hospitals often rely on travel nurses for increased patient needs, which can sometimes be anticipated because of seasonal illnesses like the flu. But the widespread and unpredictable impact of the SARS-CoV-2 virus has the mobile clinicians in even higher demand all over the U.S.
RELATED: San Diego County Monitors Hospital Capacity But Not Everyone Agrees How To Track It
Medical resources are under a spotlight during the pandemic; state and local governments track hospital beds, ventilators and personal protective equipment to monitor possible strain on health care systems. But Sharp Chula Vista Medical Center’s director of critical care services said hospitals are also focused on the crucial component of staff.
“Having a clear picture of availability of intensive care nurses is an important metric...in painting a much more clear picture of a specific institution's ability to safely care for their patients,” said Danisha Jenkins.
Click the image above to check out the KPBS Trigger Tracker, which uses data from San Diego County to monitor the spread of coronavirus in the region.
Goyette, who contracted with Sharp, is one of countless travel nurses in the region who have been holding the hands of San Diegans during their toughest and sometimes final moments. At least 880 people have died in the county, including one of Goyette’s earliest ICU patients — an elderly man sick with COVID.
“(He was) just one of those charismatic people that when you meet him, you’re like, ‘Oh, I really like this guy,’” Goyette said.
His wife, also sick with COVID, was just down the hall. They were both nearing their final treatment options, but he decided he didn’t want any further measures and asked for pain relief as he struggled to breathe.
Goyette administered morphine and as she waited for more medication from her team, she placed his hand in hers.
“I asked him if he’d like me to pray for him, and he said yes,” Goyette recalled in an interview with KPBS, briefly stopping to keep tears at bay. “So I said Our Father and had to pause like every three words.”
The patient’s sons made it in time to say goodbye, but the wife he had married in his teens was too unstable and couldn’t be moved from her room to join him.
“That was also really tough,” she said. “We ended up taking him to her afterwards so she could say goodbye per her request.”
Bringing in help
San Diego’s South Bay hospitals felt the region’s pandemic surge first.
Jenkins, lead of critical care services at Sharp Chula Vista, said she knew it was coming when the emergency department had a jump in people needing ventilators. Jenkins said in April, they had to intubate four suspected COVID patients nearly back-to-back.
The hospital modified its intensive care unit to better handle pandemic patients and pulled in ICU staff from its sister facilities. But she said they also looked to travel nurses to fill increased demand for the highly skilled workforce.
Jenkins said the state of California mandates one ICU nurse for every two ICU patients.
“If we are getting to the point where we're having to go beyond that, then that becomes a very challenging situation to manage,” Jenkins said, noting that hospital officials monitor nurse-to-patient ratios on an hourly basis.
She said the state allowed flexibility during the emergency. Jenkins said travel clinicians helped Sharp Chula Vista maintain its nursing levels during the pandemic.
Goyette said at times she is assigned to one coronavirus patient, but certain procedures require even more people. It can take five clinicians donned in full personal protective gear to “prone” or turn over a sedated COVID patient to help increase oxygen flow.
RELATED: County Still Evaluating Goal On COVID-19 Outbreaks (Which It Still Can’t Meet)
She said patients often remain in the position for hours, but on a recent day her patient needed to be turned back within only 30 minutes. Yet the gowned-up crew that helped her the first time around was already down the hall proning another patient who had just come in.
“I had to find a whole new group of people to flip my patient while another patient wasn’t doing well so needless to say it was a pretty busy day, a little hectic,” Goyette told KPBS in a video diary from her 12-hour shift.
Requests across America
San Diego-based Aya Healthcare places travel nurses all over the country to keep hectic days manageable during the pandemic.
April Hansen, Aya’s executive vice president of workforce solutions and clinical services, said there is usually a baseline level of staffing needs caused by personnel or seasonal changes — a clinician’s planned family leave or the higher rate of trauma patients that usually comes in summer, for example.
But the pandemic brought surges in requests from hospitals all over the country and meeting those needs has felt like a “giant game of whack-a-mole,” she said.
“So rather than (hospitals) saying, ‘I think in three or four weeks when we have someone go out on a maternity leave, we might need a clinician to come and cover them for a period of time,’ it has been, ‘We have way too many patients in our beds right now and we need somebody like yesterday,” Hansen said in a Zoom interview.
Hospitals contact the organization with specific skills it needs and the organization’s online app allows the company’s registered travel nurses to browse job opportunities that match their qualifications.
Hansen said the company can see coronavirus hotspots based on the locations of hospitals seeking staffers. Seattle was the first, followed by the East Coast and Midwest
“Places like New York, New Jersey, Chicago, Detroit had a high volume of demand in a short period of time,” she said.
Inquiries from San Diego hospitals jumped in March and April as well, then dipped and a big local surge came in July. That's around when the county’s rise in COVID cases triggered state-ordered business closures to reduce spread of the virus.
Since then, requests for staffing help have been relatively stable for the region as more hospitals are allowing routine procedures and Hansen said inquiries are closer to baseline measurements outside of COVID. The number of hospitalized ICU patients in San Diego has dropped from 182 in late June to 84 on Wednesday, according to county health department data.
RELATED: San Diego COVID-19 Data Funneled Through Patchwork Of Overlapping Reporting Networks
But Hansen, also a former travel nurse, said Aya is looking at scores of data points from anchor cities like San Diego to keep ahead of any increased demand.
“I think one of the biggest struggles in health care staffing is just really understanding where is the sweet spot on being prepared and being ready and being proactive,” Hansen said. “But then not overcompensating and sort of having too much bench strength lying around, which doesn't happen very often, but it certainly can.”
This past week, Hansen said Aya had 9,600 travel clinicians contracted at hospitals in the U.S.
Looking ahead
At Sharp Chula Vista, the lower ICU rates have brought the hospital a reprieve from its earlier surge of patients. Jenkins said high numbers of travel nurses can put more demand on the core staff who onboard and support them throughout their months-long contracts.
“They're having to orient people every single day to our area, our processes, how we're doing this,” Jenkins said during an August walkthrough of the ICU unit.
But she said the investment pays off — many travel nurses have recommended friends to the facility and they’re able to retain top clinicians. She said this helps keep familiar faces around for the hospital’s patients who often know staff by name.
The ability to retain nurses could become crucial as other states are seeing second waves of COVID and experts are worried flu season could collide with the pandemic.
Sharp also extended its contract with Goyette, keeping the Northern California native and her dog, Charlie, in San Diego for at least three more months. That’s more time for Goyette to see San Diegans overcome COVID — thousands in the region have recovered.
“To see anyone get extubated, honestly, and do well or get recovered to where they're moving out of the unit, you feel really proud and happy that you got them there,” she said.
She remembered feeling relief for one recovered COVID patient the day he was going home. But he was heartbroken to be leaving Sharp Chula Vista without his wife, another ICU COVID patient who also had dementia.
Goyette was eager to bring them together before he walked out the door.
“I was like, ‘Well, why not bring him up here? He already had COVID. She has COVID — he should see his wife,” Goyette said.
That time she was able to reunite a husband with his wife.
