Chronicles of an ICU nurse during Covid-19: The Shortage Issue
As an Intensive Care Unit nurse in a major state hospital in Seoul, I have been particularly confronted with problems of shortage: shortages of staff, of facilities and of adequate equipment.
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The Covid-19 pandemic gave rise to several problems within the South Korean healthcare system. As an Intensive Care Unit (ICU) nurse in a major state hospital in Seoul, I have been particularly confronted with problems of shortage: shortages of staff, of facilities and of adequate equipment.
In our hospital, the most acute problem has been the lack of medical staff as the number of patients requiring intensive care suddenly increased. Since last year, our hospital has tried to think of ways to solve this problem. It decided that instead of hiring new nurses, nurses from the General Ward (GW) would be transferred to our ward. This meant that my fellow ICU nurses and I would train the new transfers, so that they would be able to work at the ICU.
The ICU is quite different from other wards. Among other things, we work with ventilators and ECMO machines, and our patients require constant monitoring. Patients who are in the ICU ward face a much higher uncertainty than in other departments. These are big changes for nurses from the GW to learn to deal with and it was difficult for them to adjust. Senior ICU nurses like myself not only had to look after patients—including those who were completely reliant on life-supporting machines—but we were also given the additional responsibility to train the GW nurses. In conclusion, both sides dealt with tremendous amounts of stress, which raised complaints and made the working atmosphere deteriorate.
As far as the facilities and equipment problem is concerned, as Covid-19 hit Seoul—a big, crowded metropolis with close to 10 million inhabitants—the number of patients increased exponentially and it was not possible to accept all of them in the hospitals.
Senior ICU nurses like myself not only had to look after patients (...) but we were also given the additional responsibility to train the GW nurses.
Even in normal times, Seoul hospitals have a lot of patients and struggle to accommodate them all. Before Covid-19, when a hospital could not accept more patients, they would be transferred in an ambulance to a different hospital. But in the case of Covid-19 patients, when they have to be transferred, the hospital cannot use normal ambulances, because they lack adequate equipment such as ventilators and intubation tubes. Special ambulances for ICU patients are needed, but not a lot of these are available. In fact, there is only one ambulance car in all of Seoul that is fully equipped to carry ICU patients. Luckily, Seoul National Hospital has been implementing a new system since 2015 called SMICU which makes the situation a bit better for the capital. On the downside, these ambulances cannot go to other areas in Korea, where the virus has also been raging.
Additionally, hospitals have had to create new facilities to accommodate the incoming Covid-19 patients. However, not all hospitals are able to build separate facilities. For example, in my hospital, there are two main buildings: one building uses a vent system for the whole building, and the second building has a separate heating, ventilation and air conditioning system installed on each floor. Only the second building can be used to admit Covid-19 patients since the coronavirus is airborne and there is a danger that the ventilation system could make infected air circulate around the hospital.
In the news, we often hear that because of previous epidemics like SARS (in 2004) and MERS (in 2012), Korea was much more prepared for a new pandemic than other countries. In reality, we were not, and nothing could have prepared Korea for a pandemic of this scale.
 ExtraCorporeal Membrane Oxygenation: a method of life support used to oxygenate the blood in patients with lung failure, using a machine incorporating membranes that are impermeable to blood but permeable to oxygen and carbon dioxide.
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