One emergency department (ED) provider recently posted on Facebook about his frustration with the hundreds of people angry enough to protest outside his South Carolina hospital, shouting that hospitals should not mandate the vaccine or require N95s for unvaccinated staff.

“While this was happening, we were having the worst day I’ve seen in the [ED] in my career. Our hospital is full. All the hospitals are full. We are full with hundreds of nonvaccinated patients who didn’t listen to the experts, who gleefully discounted scientists and researchers and doctors, and who now have COVID-19, and are shocked — shocked — to find out that it is way worse than they were told it was going to be,” Zachary Kahler, MD, wrote in a viral post on Aug. 24.1

In September, Canadian ED physician Trevor Jain, MD, MSc, told a local paper that anti-mandate protestors at his hospital were “causing an extra layer of stress and anxiety to patients and healthcare workers that need our help … so we’re angry.”2

Case managers and other providers see patients who are frustrated by long waits and the numerous, sometimes-changing infection prevention rules. The anger comes from more than just the patients who are sick with COVID-19.

The pandemic has affected case management for all patients, not just those with COVID-19, says Jenny Quigley-Stickney, MSN, BSN, RN, CCM, ACM-RN, case manager with Cape Cod Hospital in Hyannis, MA.

“People are much sicker than they need to be because they all waited too long to see a healthcare provider,” she explains. “Everybody walks in the door as an inpatient, and everybody waits too long.”

Whether patients need breast surgery, treatment for heart disease, or diabetes treatment, they waited until they are very sick to seek care. “All would be an overnight stay and out the door, but people waited too long, and you’ll hear [that story] throughout the whole country,” Quigley-Stickney says.

Another change for case managers is dealing with many angry family members. “That’s what has really changed — people are angry now,” she says. “They just walk in angry, and that’s what’s strange. It could be a buildup of everything that’s happening in the community.”

Anger from patients and their caregivers is directed at hospital infection prevention rules that limit visitors or require masking. As hospitals try to adapt to shifting public health guidelines and priorities, they also have made multiple changes to rules governing visitors. “There’s a lot of adjusting, and I find the families are angry about it,” Quigley-Stickney notes.

For instance, in some states, hospitals have to verify whether patients and their caregivers are vaccinated, and with which vaccine. Some even ask to see vaccine cards. Patients might be matched according to which vaccine they took.

“The anger from family members is over how so much has changed, and it hasn’t stopped,” Quigley-Stickney says. “If I discharge someone, I have to know whether they were vaccinated and they want their vaccine card.” This places considerable pressure on case managers to ask patients’ family members to show their cards.

Another problem involves communication with patients. Before COVID-19, case managers could gain patients’ and their caregivers’ trust through in-person meetings. Since March 2020, communication takes place through videoconferences or in-person with masks. Using telemedicine and tablets have helped people maintain some connection during these difficult times.

Hospitals also use drive-thrus for patients to pick up medication or meet with a pharmacist. It helps, but is different from the way situations were managed pre-COVID-19, Quigley-Stickney says.

Other changes that can wear down healthcare workers’ emotional defenses include masks, gowns, and isolation rooms. Nurses, case managers, and others sometimes have to don and doff this personal protective equipment when they enter and leave a patient’s room.

“I’d help people put gowns on because it was their 10th time that day,” Quigley-Stickney says. “We got used to ‘Here’s a mask. Wear shield. Hold arms out. Put gown on. Tie it up.’”

Hospital staff learned these new protective steps quickly, but patients appeared to struggle with their providers wearing masks. “I have to wear a mask all day long. When I see people, they tell me, ‘I’m hard of hearing and how dare you wear that mask?’” Quigley-Stickney says. “I spend all day constantly apologizing, saying, ‘I’m so sorry. I have to do this. Could you please be patient with me?’”

This impedes the opportunity to build trust and puts the patient-case manager conversation in the wrong direction. “I have to start every conversation with an apology. If I start it any other way, people don’t have any patience left,” she explains. “I try to maintain my patience and do whatever I can to help myself: meditation, walking, even running over to my son’s house in another town and grabbing him for a walk.”

Quigley-Stickney acknowledges she has a low voice, so she is looking for a technological solution, such as adaptive ear devices she could offer patients.

“I could start by saying, ‘I have a really low voice. Can I offer you this so you can hear me better? You could put this in your ear and it elevates the volume in the room,’” she says.

When the pandemic began, a sense of camaraderie and team-building arose among hospital staff.

“But as it continued, people are starting to look at how they can cope differently,” Quigley-Stickney says. “Something I’m looking at is what I need to do to take care of myself.”

REFERENCES

  1. Kahler Z. “So, I hit my breaking point today…” Aug. 24, 2021.
  2. MacLean L. Protest held outside QEH hospital in Charlottetown draws criticism from emergency room doctor. Saltwire. Sept. 13, 2021.