Nurses Are Working as Bouncers Outside Emergency Room Doors

Shelby Young did not expect to feel like a bouncer at a club while working the night shift at an emergency room, but that’s the closest thing she could think of while describing her role at the doors of the ER during the pandemic.

Young, 30, is a nurse at an Edmonton hospital that, like most health care facilities, has overhauled its operations to address COVID-19. The ER has made significant changes to stop the spread of the novel coronavirus, including transforming a mental health section into a dedicated COVID-19 ward, and stationing nurses like Young outside to start the triage process before patients even enter the hospital.

Called pre-screening or greeting, nurses like Young are now tasked with sorting patients with COVID-19-like symptoms to a separate waiting room, and limiting visits to only the most critical life-threatening circumstances. It’s a job that didn’t exist before the pandemic, but has become essential in the fight to flatten the curve across Canada.

Each entrance at Young’s hospital is staffed by one or two nurses, who ask every approaching person a series of questions about their health issue, or their relationship to a sick person. For healthy people trying to visit a sick family member, Young is often the one who has to break the news that they won’t be allowed inside the hospital.

“We’re only allowing essential visitors,” she said, adding that most non-terminal patients aren’t allowed visitors at all. Only patients who are near death, or newborns in critical care, coded C1 or C2, get to have close family with them.

Young, who has worked in nightlife through her company Indigo Harm Reduction, joked she can’t help linking the task of standing outside with a clipboard from 11 p.m. to 7:30 a.m. with raves and parties.

“You’re right at the entrance, and you have this guest list, and all this criteria, and you're constantly stopping every single person who comes in and you're like, ‘Hi, how are you doing? How can I help you today? Why are you coming in here?’” Young said. “It's almost like, either show me your badge, or I need to know your business.”

Though the changes have been in place for many weeks now, most patients who arrive at the hospital aren’t familiar with the rules, and can be caught by surprise. Turning people away has become one of the hardest parts of her day. “That's really heartbreaking for me, because we have people who are sick and haven’t seen anybody,” she said. “They can’t be with a loved one to get a hug.”

Young said she’s had to deny couples from being together during some of the toughest stages of childbirth. “When their partner’s going into labour, they can’t be there,” she said. “They have to go sit in their car, and they have to get called up when the moment happens. And they have to leave after.”

Pre-screening is one of dozens of ways health care providers have sprung into action to stop the spread of the virus. Before Young starts her shift, she’s also screened for COVID-19 symptoms by her colleagues before suiting up with a scrub cap, mask, goggles, face shield, and shoes that she keeps at the hospital.

Alberta has the third-largest coronavirus total caseload in Canada, behind Quebec and Ontario. The province has confirmed 5,963 cases, and 112 deaths. As of Thursday Canada reported well over 60,000 cases and 4,000 deaths.

When asked how the ER has transformed in recent weeks, Young said there are fewer patients, but the pace and workload are more intense.

Just a few months ago, the waiting room was filled out with people hoping to see a doctor about fevers, cuts, and sprains. Now, if someone is coming into the hospital, they’re more likely to be in a critical condition. Hospitals across the country are reporting a 30 percent drop in emergency room visits between March 16 and April 12, worrying heart and stroke experts.

“They’re only coming in when they’re really, really sick,” Young said.

Young’s shifts are now filled with a hell of a lot more wiping down and sanitation. Even taking a sip from a water bottle can become a complicated task involving multiple rooms, Lysol wipes, and layers of personal protective equipment, she said.

When she’s not working the doors, Young spends more time with patients on what is likely the scariest day of their lives. “Now with no visitors, we are a huge part of that person’s emotional and mental wellbeing,” she said.

Night shifts, according to Young, can be particularly eventful, with families grappling with their worst coronavirus-related fears and last goodbyes. “I have to get to know somebody in five seconds, and make that connection and have that person trust me,” Young said. “Nurses are really good at stepping into the room and reading the energy of the patient.”

Young works two nights on, and two nights off, and sometimes she sees the same patients in critical care for days at a time. In one recent case she spent four days helping a family come to terms with the imminent death of a husband and father.

”I was actually the nurse there when he passed away,” she recalled. “To be there with them in that moment, and to give them a hug, I almost had to cry because I felt so hard for their family. They just lost somebody they absolutely loved.”

Thankfully, Young says patients have been understanding and appreciative, even in the face of intense restrictions and a lot of unfamiliar hazmat-looking gear.

“They know we’re taking on a lot right now,” she said. “We’re the last line of defence, and people are recognizing that.”

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