Life in the vaccine clinic (can I whine for just a moment?)

[klone, MSN, RN]

I am the nurse manager of a very large primary care practice, one of several of part of a large-ish HMO/hospital/primary care network (like Kaiser Permanente, but not as big). 

Last Spring we decided to expand our practice to provide a vaccine clinic as well. First, just Covid (Pfizer), and then starting in September, it's a combination Covid and Influenza.

The mRNA vaccines take special handling, and the Pfizer vaccine is particularly fussy. It has to sit at room temperature for a certain amount of time, but not TOO long or it expires. Then it has to be diluted with exactly 1.8ml of preservative-free NaCl, and flipped back and forth exactly 10 time (DO NOT SHAKE!). Then, the diluted vial needs to be drawn up into 6 syringes of exactly 0.3ml. These syringes are then good for exactly 6 hours after initial dilution. Of course, a typical clinic day is 8-10 hours, which means you can't just draw up enough at the beginning of the day to last you throughout the day. So you have to stagger your prep, and plan, and count exactly how many will be needed (do I need to pull 8 vials out of the freezer at 0700, or do I need 9??). And any waste has to be reported to the state health department on a daily basis.

Now, for a moment, imagine being the person who has to calculate each day how many vials need to come out of the freezer, and then be diluted, and then pulled into syringes, and syringes hand labeled. And this number is in the hundreds. Every day. Every single day. Since May. I'm tired, yo. 

Now also imagine the added complexity of now having a DIFFERENT formulation of the vaccine (the 5-11 vaccine), which get's 1.3 ml of diluent added instead of 1.8ml. And the syringes are 0.2 ml doses, instead of 0.3 ml doses. And the expiration time on them is different than than the 12+ doses also. (12 hours vs.  6 hours). 

And now I just heard that they are discussing approving boosters for all. And while this makes me happy as a nurse, it makes me silently weep inside from sheer exhaustion.

Also, I've timed myself, and I can dilute, pull up, and label 1 vial (six syringes) in 5.5 minutes. For the 5-11 vaccine (10 syringes) it's 6.25 minutes. Which means that I spend approximately 168 minutes out of my day, every day, just prepping Covid vaccine syringes. For the past 6 months. And there is no end in sight. ?

I have an appointment next week for one of our clinic's docs to give me cortisone injections into my thumb joints because I've developed repetitive motion injury.

#vaccinessavelives

[Rose_Queen, BSN, MSN, RN]

Wow. Our vaccine clinic has a dedicated pharmacy team on site responsible for diluting and drawing up the vaccines for the clinic staff to administer. 

[SmilingBluEyes]

Wow I am exhausted reading that!

[RuralMOSchoolRN, ADN, RN]

Hugs girl!  I'm part of a rural Health Dept mainly as a district wide School Nurse and helped in our vaccine clinic the other day.  Its crazy-and I can't imagine doing it every day like you are!  I agree with the complex prep--we carry all three vaccines (moderna, Pfizer, and J&J) and are now also giving second and third boosters, 5-12yo covid vaccinations, plus influenza (high dose and regular).  We also give all childhood vaccines (try and do it a different day but you know...)

I've worked at the actual health dept on my school days off just to give them a mental breather and even then they still have to wrangle all the covid tests, contact tracing, animal bites, childhood vaccinations, WIC clinic, etc.  So I just give them a vaccine breather.  

[BeenThere2012, ASN, RN]

I hear ya!

I work in a very busy pediatric practice…long days 10-12hrs 5 days a week, plus some 1/2 days on Saturdays.  We can never get all our charting done by the end of the day and there are always patients still being seen after closing time.

We try to designate a nurse to do vaccines only, but often we don’t have the staff to designate to that role, so we each have to do our own vaccines, or take turns doing the vaccine only visits as they come in.  Luckily, we only have Pfizer so at least we don’t have to juggle the different brands.  When assigned to the vaccine only role, we do draw up a certain amount ahead of time, but we always end up having to waste some.  We have 3 nursing stations, so when there is not a dedicated nurse, we have to run around to the other stations to see if anyone already reconstituted a vial before we can proceed.

We have been short-staffed in every role since Covid started.  Our Triage nurse, the front desk staff, the prior authorization/referrals person, and of course our supervisor and manager have ALL been overwhelmed with work.  The patients complain about the wait times, the difficulty getting through on the phone lines and lack of availability of appointments daily.  

In spite of all this, I am SO grateful I no longer work in-patient.  I can’t tel you enough how much I admire those that do who can tough this out.  
 

God bless you all!

Not that’s MY whining for the day.  We plug along.

[MelEpiRN]

Virtual hug!!

[CommunityRNBSN, BSN, RN]

AND can I just add--

as someone who does this in our clinic too--

Those Pfizer vials are so full of air!  When you add the diluent, you have to pull out practically a full syringe of air, or else it starts squirting out of the vial and shooting everywhere!  (Which then has to be reported as waste, and you can't tell how many doses were wasted when it's dripping off your hands.)

[klone, MSN, RN]

Yes,  when I inject 1.8 ml of NaCl, I generally pull out about 2.2 ml of air when I remove the needle,  or it squirts everywhere. 

It's nice to have other syringe preppers to commiserate with. ? 

This past Saturday we did a 5-11yo vaccine clinic at the local middle school. The clinic was from 8a-12p. I was at my clinic at 5am in order to prep 140 syringes before the 8am start time. The only silver lining there was since I was alone, I didn't have to wear a mask, and I was able to crank up my music really loud while I was working.

[nursej22, MSN, RN]

19 hours ago, klone said:

This past Saturday we did a 5-11yo vaccine clinic at the local middle school. The clinic was from 8a-12p. I was at my clinic at 5am in order to prep 140 syringes before the 8am start time. The only silver lining there was since I was alone, I didn't have to wear a mask, and I was able to crank up my music really loud while I was working.

Do you get protesters? We regularly have people show up with signs calling us "baby killers". At our 5-11 yo clinic, protesters approached the kids in line telling them they were going to die from the vaccine. Classy. 

And this is in a town that prides itself on its good Christian values. 

[klone, MSN, RN]

On 11/25/2021 at 1:20 AM, nursej22 said:

Do you get protesters? We regularly have people show up with signs calling us "baby killers". At our 5-11 yo clinic, protesters approached the kids in line telling them they were going to die from the vaccine. Classy. 

And this is in a town that prides itself on its good Christian values. 

Wow, no. It wasn't a widely publicized event (only the parents of that school district were told about it). I live in a fairly liberal community (Minneapolis) so I have yet to see any protesters. Before  this I lived in Montana and I'm still FB friends with some ex-coworkers, and there are definitely protests happening there, including some people I used to love and respect. One of them actually said that the vaccine was "the mark of the beast." I responded, you are the reason why I have a rule that I don't "friend" on FB people I currently work with.  Because there is no way I could have a civil working relationship with this person after knowing her whackadoo views.

[Squidpdx, CNA, LPN]

I am the sole vaccine nurse for my clinic's outreach vaccine clinics, and man, I can absolutely relate to your sentiments! It takes me forever, and unfortunately, I am not allowed to transport prefilled syringes, so I have to rush to prep a million different sge ranges of Pfizer doses as soon as I get to wherever the site is, while patients are already waiting (why do they always come early?). Flu shots too. It's nerve wracking! Thanks for acknowledging the frustrating air/squirting thing too! So nice to commiserate with y'all.