Unprecedented patient loads during the COVID-19 pandemic forced many healthcare workers and materials managers to navigate prolonged supply shortages. Dannon Gorham, a frontline nurse who traveled to several cities highly impacted by COVID, discusses how both hospital inventory management and patient care felt the effects of the pandemic—and the creative solutions nurses devised to cope with dwindling inventory.
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Q: What led you to become a nurse, and then later to become a travel nurse?
A: I got married, had some kids, and then my wife took ill and passed. While I was her caretaker, she would often say, "You should have been a nurse, the way you're taking care of me." So, I went to nursing school to fulfill a promise to her. I became an LPN first, and then I became an RN. And then the pandemic happened, just like that.
I was working at Northlake Methodist [in Gary, Indiana] at the time, and there were alerts going out that they were looking for nurses to be deployed. The first city to really be hit was New York, and it was so bad. I had so many colleagues from NYC with horror stories.
I took a Chicago deployment, and they were retrofitting McCormick Place to be a 3,000-bed hospital because they were anticipating Chicago to be the next New York. From there, COVID-19 was everywhere, and so was I.
Q: COVID-positive patients were often put on ventilators. How did the hospitals you traveled to ensure each patient who needed a ventilator got one?
A: Ventilators were a problem early on; I think we all know that. No one had enough. But people who aren't healthcare professionals don't know that if there aren't ventilators, that means that aren't ventilator-related supplies. Imagine all of those things that attach to the ventilator that need to be switched out. I found myself in a lot of situations where I was down to my last hose or stuck using a water trap that hadn't been changed in a week. We just didn't have the supplies.
But people got creative. If there was a room with three or four patients on a ventilator, they would use a splitter for the oxygen and adjust it three or four ways.
Q: Were there other situations like this, where you had to take a clinical accessory and innovate with it?
A: Yes, so, we would take disposable items and make them "reusable" for COVID-positive patients. Meaning: Each COVID-pos patient would have their own disposable blood pressure cuff and stethoscope. But rather than dispose of them after use—like you're supposed to with disposable products, right?—they stayed in the room with the patient. Then, whenever you went in to take that patient's blood pressure, etc., you reused those items.
Doing this saved on supplies: as COVID-pos patients came in, it was just one cuff or one stethoscope per room for as long as they were there. Reusing disposable supplies like this is not advised, obviously. But if we used reusable cuffs that we carried around with us and just wiped down with disinfectant, there was no way of knowing we fully removed all contaminants. By leaving certain items with certain patients, we knew there would be limited opportunity for cross-contamination. Then, because it was a disposable item, we would throw it out when that patient left.
It also depends on the accessories. We saw how bad things could get if certain accessories were not changed out.
Let's say someone's nasal cannula has to be switched out. They could technically go weeks without a new one, but we learned that would affect their breathing, which also affects their pulse oximetry. So, we learned to not try to prolong the use of certain supplies, especially when it affects breathing. But we had to learn that the hard way because we had no other choice.
Q: Were there concerns about the quality of supplies sourced from nonmedical vendors?
A: Some hospitals I went to were ordering medical supplies from Amazon or buying things from local hardware stores. It varied. Nurses just had to hope for the best in terms of quality, but we were happy as long as it worked.
It's like if you're cooking for somebody; you want to use the best ingredients. If I'm taking care of somebody, I want to use the best supplies possible to give the patient the best chance. If you're handed a product that came from a nonmedical supplier, or you're forced to manipulate something, it does lessen the quality, but we had to do what we had to do.
Q: As a nurse, how much of a difference does a well-resourced facility make?
A: It makes the job easier. One hospital in Chicago had an excess of supplies when I was a frontline nurse, and it made patient care easier and more effective. And it makes you more confident as a nurse because you can concentrate on what you're doing and not, "Where am I going to find these supplies?"
You can never have enough supplies and nurses know what we need. So if there's a way for hospitals to get us the supplies we know we need, that really helps us provide the best care.
