Kristen Jordan Shamus and Darcie Moran, Detroit Free Press, and Robin Erb, Bridge Magazine

Nurses in the emergency room at DMC Sinai-Grace Hospital took a stand late Sunday night against what they said are dangerous working conditions that put them and their patients at risk.

Salah Hadwan, a registered nurse in the emergency department at Sinai-Grace, which is in the heart of Detroit, the city hardest hit by the coronavirus outbreak in Michigan, said the surge in extremely sick patients coupled with nurses who have quit or been sickened by the virus, has led to a crisis in staffing.

This story was co-published with Bridge Magazine.

The hospital's emergency room managers are requiring those who report to work to manage more than 100 critically ill patients, many of whom are on ventilators and need critical care, he said, adding that ideally, there would be 21 nurses on staff for every shift.

"Tonight, it was the breaking point for us because we cannot take care of your loved ones out here with just six or seven nurses and multiple vents (ventilators), multiple people on drips," said Hadwan, adding that the patient load has been building for three weeks.

"There would have been nurses that had to watch up to 20 patients at a time, which is not safe," he said.

The night nurses asked managers to call for extra help to handle the patient load. But when they saw no relief, they staged a protest late Sunday, said Hadwan, 30, who has worked at Sinai-Grace for three years and said he has never seen working conditions like this.

"We decided to sit in our break room until they could pull in more resources to help us out for the night," he said.

"After four hours, they basically told us there was not going to be any support coming in for the night. And they told us, 'What is your decision?' We told them we were taking a stand, so they basically told us, 'You can leave.' So that meant the day-shift workers had to work the whole night, for 24 hours."

Hadwan, who also is vice president of the Hamtramck Public Schools Board of Education, posted a Facebook Live video about midnight Monday, showing the group of nurses leaving Sinai-Grace. The nurses said they love their hospital and city, but they could not take those working conditions anymore.

Brian Taylor, a spokesman for the Detroit Medical Center, said high patient volume is driving an increased need for staffing, especially nurses.

"The DMC is using a variety of resources to help to supplement nursing staff including contracting with staffing agencies to secure more nurses and reaching out to colleges and universities to recruit nursing students who are close to graduation to assist in providing care to our patients, in accordance with state guidance," Taylor said.

“We know this is a very challenging time for caregivers. Our doctors and nurses continue to demonstrate their commitment and dedication to our patients.

"We are disappointed that last night a very small number of nurses at Sinai-Grace Hospital staged a work stoppage in the hospital refusing to care for patients. Despite this, our patients continued to receive the care they needed as other dedicated nurses stepped in to provide care.”

Nurses face long hours, dangerous conditions

Nurses throughout the state are working against increasing anxiety from a continued shortage of personal protective equipment, intimate care with the most contagious patients, and pressure to keep their loved ones safe at home, nurses have told the Free Press and Bridge in recent days.

“When there aren’t enough troops to fight this fight, what do you do? You retreat.” said Nina Bugbee, president of the Teamsters Local 332, which represents radiologists and respiratory therapists at McLaren Flint Hospital.

“These workers who appear to be walking away, aren’t really,” Bugbee said. “This is not something they want to do, but they are saying, ‘This is bigger than what we can handle. You have to give us the weapons to fight this, or we will lose this war.’ ”

Bugbee also represents tens of thousands of health care workers in her role in the International Brotherhood of Teamsters, where she serves as director of the health care division.

She said the tension, building for weeks, is near a snapping point at hospitals throughout Michigan and the country.

“In Week 1, we were in shock. In Week 2, we didn’t have (personal protective equipment). In Week 3, we realized the hazards and warnings, and now here in Week 4, the (staffing) ratios are not manageable and they are not safe.”

Nurses have "a tipping point" where "the best thing any RN can do for their patients, their families, and their coworkers is to speak out ... rather than remain silent," Jamie Brown, a critical care nurse at Borgess Hospital and the president of the Michigan Nurses Association, said in a prepared statement.

"Until hospitals start taking the concerns of nurses seriously, it’s only a matter of time before more actions like these (at Sinai Grace) occur," she said. "It is absolutely essential that hospitals start working with nurses and stop silencing our voices."

Hospitals, as well as nurses, are in impossible situations, said Jeff Morawski, a longtime nurse and president of the OPEIU Local 40, which represents nurses at McClaren Macomb Hospital in Mount Clemens.

Hospitals and patients need nurses. And for many nurses, caring for others is threaded through their DNA.

Still, Morawski said, among the ranks of nurses are parents of young children and caregivers to elderly loved ones and spouses to people with underlying conditions that make them more susceptible to the virus.

Those loved ones, too, count on the nurses.

"There is a point in your life and you have to decide that your own life is worth something, and whether it's worth working without protection and putting the people you care for — the patients — in danger and your families — in danger," Morawski said.

He said McLaren's nurses aren't pushed yet to the point reported by Sinai-Grace's night shift.

Detroit nurse fired after voicing concerns

Kenisa Barkai, 38, of Woodhaven said she was fired March 27 from her nursing job at Sinai-Grace after speaking out about staffing and poor conditions at the hospital.

She said she was in talks to form a union for the nurses before Michigan marked its first known coronavirus case, but the pandemic brought underlying problems that were simmering at the hospital to a full boil.

On March 16-17, the single mother said she was caring for seven patients, including two who had tested positive for COVID-19.

Then, she said, more patients were admitted, increasing her workload.

“I voiced my concern loud and clear that day, like this is ridiculous,” she said. “… I can't be 100 places at one time. I was already overwhelmed and overworked. You know, we don't get to take breaks. We don't get to go to the bathroom. And with COVID patients, it's not just like, you're able to go in and out of the room — you have to take a lot of steps to protect yourself, right?”

Barkai said she repeatedly raised concerns about conditions and indicated plans to contact authorities. She posted a Facebook video, showing her gown and mask, which was then featured by WDIV-TV (Channel 4). The local news station interviewed her about conditions at Sinai-Grace.

The following week, she lost her job. The hospital system cited a violation of its social media policy, according to a termination document provided to the Free Press and Bridge Magazine by Barkai.

Taylor, the spokesman for Sinai-Grace, said he could not discuss the personnel matter.

“This is the most important time for nurses, you know, to actually have a sense of maybe, finally, like how important we are in ... health care and how important we are with patient care and patient safety,” Barkai said. “… When you go to war, you know, you're working right alongside with your coworkers to fight this battle. I am being sidelined right now.”

Hadwan said the pressure for the night nurses just got to be too much on Sunday.

"The anxiety, the mental stress that it's put on everybody, it's rough," Hadwan said. "We love going to work there. We all love working with each other. We do everything to support each other, but we honestly get off work, and we can't go to sleep just thinking about having to go back and having to deal with the same conditions over and over again.

"We try our best, but honestly, it's impossible to give them the care they deserve with the amount of staff we have."

Hadwan described an emergency department with patients filling the hallways, and nurses who wear the same mask over multiple 12-hour shifts. "The patients deserve to be in a room. They deserve to be monitored correctly," he said.

"We've had a lot of great nurses resign. We've had a few people call in because they are mentally exhausted. ... It's gotten to the point where it's hard to keep the staff they want to be there, but it's unsafe."

Hadwan was scheduled to report to work again Monday night.

"They didn't take our badges," he said. "We all are scheduled to go back in tonight. We all plan to go in tonight, and see what happens from there. We don't quit. We don't quit, you know."

He hopes people who hear about the situation will understand that COVID-19 is not a hoax or a scam, and that it is killing people.

"People are dying in large amounts. Please stay home, please. If everybody stayed home for two weeks, you know we could be saving each other just by doing that. We have to take it seriously," Hadwan said.

"If only they could see what we see. There's no words to describe it."

Get involved: The Detroit Free Press and Bridge Magazine are teaming up to report on Michigan hospitals during the coronavirus pandemic. If you work in a Michigan hospital, we would love to hear from you. You can contact Kristen Jordan Shamus at kshamus@freepress.com or Robin Erb at rerb@bridgemi.com.