“It's a bit complicated at the moment, we can't see the end of it…
As soon as a patient leaves the intensive care unit or, unfortunately, dies, another takes his place.
It's a constant back and forth,
”sighs Alexandre *, a young nurse in intensive care in a hospital in the Paris region.
Read also: Is the saturation of intensive care services a usual phenomenon?
In office for a year and a half, he has seen almost nothing but the health crisis and the third wave that is currently falling on the Île-de-France.
Its service, which until now had twelve beds, must now accommodate more.
As of Monday, more than 1,400 people were in critical care in the region, a figure expected to climb to 1,500 in a few days.
As a result, the Regional Health Agency (ARS) has asked hospitals in Île-de-France to reach 2,200 intensive care beds
"in the short term, with a first level of 1,800 beds in the middle of next week" .
"
It's a monster effort
“Worries Professor Djillali Annane, head of the intensive medicine and intensive care unit at Raymond-Poincaré hospital in Garches, who points out the lack of intensive care personnel.
"
We are beyond our capabilities and we are already operating on a reserve that we did not have,
" he insists.
To try to compensate for this lack of arms, nursing staff from other poles of the hospital are mobilized to create ephemeral resuscitation services to support pre-existing ones, as was already done during the first wave.
This is the case of Justine *, 25 years old and nurse in intensive care of cardiac surgery in pediatrics in Paris.
Last March, its service had to close one of its three units in favor of a dedicated to Covid patients in intensive care.
“I was assigned there as a nurse but also as a nursing assistant because there was a lack of it,
” says the young woman who has had neither rest nor leave during this period.
But for Thierry Amouroux, spokesperson for the national union of nursing professionals (SNPI) mobilizing staff "
will be more complicated than a year ago
".
At the start of the crisis, tensions in intensive care were particularly concentrated in Île-de-France and Grand-Est, while the third wave affected more regions.
The situation makes it difficult to transfer doctors and caregivers from one region to another.
Thierry Amouroux is especially alarmed by the consequences of this staff movement.
Moving doctors and caregivers in intensive care involves deprogramming care in amputee wards.
Currently 40%, deprogramming could reach 80% with the objective of 2,200 beds set by the ARS.
A lack of trained staff
Another solution to compensate for the lack of personnel consists in calling on temporary workers to swell the ranks of the intensive care unit, but not all are trained.
To remedy this, the AP-HP urgently launched an accelerated training program for nurses and nursing students.
Three-day courses so that they can integrate the fundamentals of resuscitation.
"It cannot be learned overnight,"
recalls Thierry Amouroux of the SNPI for whom the rapid training offered by hospitals
"is not sufficient"
.
For his part, Professor Annane regrets that the government did not increase the number of intensive care boarding places last June.
“
Interns play a huge role in hospital care.
It deprives us of these competent young people who could have been an extremely important resource
”.
According to him, “
you need very specialized and specific skills that cannot be improvised.
During the first wave, it was a cause of suffering for many caregivers who were confronted with this exercise of resuscitation in a brutal way without preparation and for many it was a psychological shock
”.
Justine is one of them.
Last March, propelled into a covid intensive care unit, she was confronted with new machines that she had never handled before.
“It was a big stress, I felt helpless,”
says the one who now feels more confident.
"Every day people crack"
Professor Annane is worried about the consequences of such pressure on staff.
"
I see it every day, some crack
".
All of them devote themselves without counting their hours, even if it means neglecting their own health.
The manager sometimes had to force certain members of his team to stop to protect them.
He called in a psychologist and tried to "
organize breathing valves
".
"
We are trying to consolidate our team to detect weaknesses and support them very early on to avoid accidents,
" he says.
Read also: Covid-19: Have 800 resuscitation beds been removed in Île-de-France since the first wave?
Failing to crack, some simply give up.
According to a study carried out by the SNMRHP after the first wave with 115 intensive care units, 2% of doctors decided to quit this activity and 3% of nurses.
Alexandre also wonders.
He who has always wanted to work in intensive care is thinking of turning to the private sector or setting up on his own.
"
It's less interesting but at least I can decide my schedule
"
,
he explains hint.
"
They experienced this first wave with difficulty and are not ready to do it again
", agrees Professor Annane.
If Justine feels ready to mobilize again, this is not the case for many of her colleagues, still traumatized by the first wave.
A lack of recognition
Beyond the working conditions in intensive care, the medical and nursing staff denounce a lack of recognition.
The salary increase of 183 euros (in the public and 160 euros in the private sector) set by the agreements of the Ségur de la Santé last July, is considered insufficient.
"
This is a very slight advance but we remain below the average European salary
", points out Thierry Amouroux of the SNPI who also denounces the few cases of contamination with the coronavirus among caregivers recognized as an occupational disease.
At the end of February, only 437 people were concerned.
Despite everything, doctors, nurses and orderlies have already started to put themselves in battle order to cross this third wave.
"We are well versed in never giving up,
" confirms Professor Annane.
"
When we are faced with a critical situation, our only concern is to solve the problem
."
But faced with a public hospital
"on the edge of its limits"
, no one is bound to the impossible, he recalls.
* These first names have been changed