Moreso the Covid unit. Even the covid unit isn’t full of strictly covid patients either. Confused yet? Well, I promise you will be by the end of this post. Let me start by saying that the rules/protocols were changing everyday, and they are still changing now. So something I say now, could easily be different by next week. I say all this because obviously we are all still figuring shit out. Also, because some of these protocols make no sense, you’ll see. Back to the unit itself. The covid unit is more the admission unit of our facility. Now, before I lose your interest, yes we have had covid positive patients. I am the only PT on the unit and then there is a COTA representing the OT department. All new admissions come to that unit and stay at least 2 weeks before being transferred to the rest of the facility. We were requiring a negative test within 48 hours of admission. We now cannot require testing before they admit, hence why all new admissions are isolated for at least 2 weeks. They are tested upon admission and tested weekly. (Staff is tested twice a week. But not the test where your brain gets violated.. because I would quit.) Ready for the first non-sense rule? IF, the patient does not have a negative covid test within 48 hours of admission, only one discipline of OT/PT can evaluate at that time. Why? To limit risk for exposure…? “Whitney, why the question mark?” Because I literally help nursing and still go into these patients’ rooms and get exposed by the patients. Also, because no matter when the test was, speech therapy can come in and see all the new patients. So, the patient then gets tested at the facility, and once their test comes back negative (and it is communicated to the therapist.. Because communication could for sure be more stellar), then the other discipline may evaluate.

Now what happens if a patient ends up testing positive? No one but the nurse on the floor can go into this room anymore. No therapists nor CNAs can enter this room. Sometimes I think “well it’s like too late now, I have already been working with this patient and been exposed! Why stop now?!” But I do understand it is to limit continued exposure to other patients. PPE? I’m so glad you asked. We are “spoiled” in the covid unit and we get endless gowns. Each time we enter a room we gown and glove up (we are given a new N95 mask each day we wear all day along with a face shield). And when we exit we dispose of the gown and gloves. Now this seems like a basic procedure right? Well, because there have been PPE shortages, the other part of the facility has had to share gowns. They just keep approx. 3 gowns tied up in the patient’s room and take them off and hang them back up before they leave. 

Is all of this clear as mud yet? Cool. I have been on the unit for several weeks now and I feel like I’m just winging it (but that is my entire being from SPT to DPT, forever winging it). The first few weeks, we were very slow with not having admissions and low caseload. So, myself and the COTA were able to clock in under “nursing” and help CNAs with their duties. NOW, however, I am getting swamped. We have had several admissions of the past 2 weeks, which is great. But… we are slow on moving patients off the unit. So I’m having to do as many evals as I can in a day, while also seeing all my treatments in a day… while also trying to avoid overtime. Forever a balancing act. 

What gets very unclear is when we can move the patient off of the unit. At one point we had 2 positive cases, and they had been asymptomatic for almost 2 weeks. This means they can be moved off the unit. We also had negative patients that were hitting their 2 week mark which means switching units. THEN, we had another patient test positive. So then none of the other patients could move off the unit for another two weeks, EXCEPT the 2 positive asymptomatic patients. I’m getting stressed typing this hoping y’all can understand it because Lord knows I can’t. That, I think, is the biggest rut we have hit where it has been over 2 weeks of no new positives and patients being eligible to move off the floor but then there is no initiation. And for a while there the coivd unit was starting to feel like the psych ward because the whole floor was patients with some form of dementia. Not the cute “pleasantly confused” dementia; moreso the “grab you by your throat, rip your gown off your entire body, and throw things” dementia. Yes, all of those things happened to me, within the same week. 

I’ll conclude with the issues that have come up d/t some of these protocols:

• Communication between the other side of the facility to ours.
  • This has caused a lag in getting patients moved off the unit in a more timely manner
  • As well as a lag in communicating when a new patient’s test comes back negative as this dictates when the other therapy discipline may eval. Due to this, there have been several family members upset about a patient not yet receiving PT, even though they are still receiving therapy. (I have received SO many calls lately on that) 
• Caseload balance
  • Our therapy department has an extremely low caseload on the other side of the facility, while the COTA and I are starting to drown on our end. And with the weird rules, we cannot have other therapists come help us. (ONLY the PRN therapists).

All of this being said. The unit has definitely formed a bond with the staff. There has always been some friction between nursing/CNAs and the therapy department, and I think since being on the unit they realize we are here to do WORK. There is also a sense of camaraderie amongst us, which I have always cherished in groups. Everything is day by day back there, and it is absolutely nerve-wracking still finding out a patient you just treated for 1 hour in close quarters, (who was not always wearing their mask) tested positive for COVID. However, we are all in this together! So if I was exposed, so was the rest of this small staff. Who needs blood oaths when you have Covid oaths? I hope this gave you some insight into working the covid unit as a therapist! Stay safe out there y’all! (P.S. the title is inspired from the song “Let’s talk about sex” by Salt-N-Pepa so now that should get stuck in your head like it is mine).

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