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NP's how are you these days?

NP   (1,767 Views | 39 Replies)

juan de la cruz has 27 years experience as a MSN, RN, NP and specializes in APRN, Adult Critical Care.

3 Followers; 8 Articles; 60,152 Profile Views; 3,998 Posts

Just checking in to see how everyone is doing in the NP world amidst this COVID19 pandemic.  We in Acute/Critical Care for sure are on high alert...mandated work hours if a surge happens.  We've had patients with the disease of course but not to the point of shortages of supplies, equipment or healthcare worker fatigue.  The daily emails and updates can be overwhelming though.  I'm sure those in primary care are inundated with requests for testing.

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TheSquire has 9 years experience as a DNP, EMT-B, APN, NP and specializes in Urgent Care NP, Emergency Nursing, Camp Nursing.

1,248 Posts; 14,344 Profile Views

Urgent Care FNP here - testing drought has meant that I've sent patients home for 14-day self-isolation without testing.  While I've not seen any yet, patients with the fever-cough-SOB trifecta are being sent to the ED for eval and probable admission.  Patient that was seen and discharged at the beginning of the month by another provider was admitted a few days ago for fever and pneumonia - waiting on testing results.

The staff has spent the past few weeks worried about people coming in who meet testing criteria, and there's a whole policy about how we're handling that - but I know the true danger is the person with a URI who's really a mild COVID-19 case flying under the RADAR giving it to half the staff.  We don't have enough surgical masks or other PPE to have the staff be masked and gowned to prevent that from happening.

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juan de la cruz has 27 years experience as a MSN, RN, NP and specializes in APRN, Adult Critical Care.

3 Followers; 8 Articles; 3,998 Posts; 60,152 Profile Views

Yeah, testing has been challenging even in acute care. It's getting better though and being ramped up at least. Our PUI cases fluctuate between 30-40 a day at first but is actually mellowing down a bit surprisingly.  I think the faster turn-around in getting results is responsible for that.  ICU cases are relatively low, I'll tell you that. It's affecting hiring though...interviews are being rescheduled, some NP students are getting cancelled in some of the clinical placements.

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GoodNP specializes in Cardiology, Research, Family Practice.

190 Posts; 6,503 Profile Views

Primary care: Lots of patients with cough, some shortness of breath here and there, but few with fever. Only one patient that I had a high level of suspicion due to domestic travel to an area with increasing prevalence reported. Since she's afebrile, stable, and low-risk, didn't send her for testing. 

My problem - 24 staff:5 N95 respirators AND a CMO belittling those of us wearing surgical masks. Actually had a staff meeting and told us that wearing a surgical mask increases inhaled virus. 🤔 

I'm wearing mine anyway.

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juan de la cruz has 27 years experience as a MSN, RN, NP and specializes in APRN, Adult Critical Care.

3 Followers; 8 Articles; 3,998 Posts; 60,152 Profile Views

We've actually changed our PPE guidelines. We use Contact + Droplet precaution (mask and eye protection, gown, gloves) with most patients except for those with a high risk of aerosolization of respiratory secretions (patients requiring intubation, high flow nasal cannula, BiPAP/CPAP, or with a trach). In the latter case, N95 or PAPR must be used.

Our city enforced a no visitor policy in all city hospitals except for women in labor in which case a spouse or partner is allowed to be present. That's helped a lot with the concern that a sick COVID19 patient or any other patient can arrive with a number of family members with mild symptoms who can be spreading it in the premises. I'm not sure how that is working in Peds as I don't work in that setting.

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LibraSunCNM has 10 years experience as a MSN and specializes in OB.

1,385 Posts; 25,759 Profile Views

I'm a CNM, not an NP, but I lurk here so I thought I'd chime in.  I'm in TN, where there are 98 reported cases so far.  No pregnant women have been infected that we know about, I believe a couple kids have been identified as positive but are doing OK.

Here in TN we've already been encouraged to pretty much lock down in place as much as possible, which seems to be better than some states with way more cases are doing (my parents are in FL, and like nothing is shut down! so crazy).  Our practice has moved to doing non-critical prenatal visits via telehealth with a platform called Doxy, and only having essential visits in person at our office/birth center.  We are a freestanding birth center but have privileges at the nearby academic medical center for transfers/complications.  In order to keep the birth center as pristine as possible, since it's ideal for moms to deliver there and NOT the hospital, we're asking people coming in for essential visits to come by themselves, and in labor come with only 1 support person, and not bring kids to visit after birth.  We're also trying to come up with a system for drive-through labs/fetal heart tone checks.  There are apps out there to listen to fetal heart tones with your phone, which are spotty at best, but it's something, as well as try to check their own weight and BP.  

It definitely makes you think about what is really essential and what's not.  I'm grateful for how my team has handled this crisis so far and as a pregnant woman myself right now, very hopeful that we will ride out this wave over the next 1-2 months and then be on the other side.

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37 Posts; 433 Profile Views

I work in LTC/TCU/AL settings.  We have moved to mostly tele-health visits via the previously mentioned Doxy app- but it has been slow so we are also using FaceTime.  Tele-health restrictions have gone out the window, so luckily I can work from home but still take care of my patients and screen those who are high risk.  The nursing homes have been great about assisting us with this.  Right now I am going through my 80+ resident building and screening everyone with quick visits, and updating POLSTs as we are already having shortage of ventilators where I live so we want to know who is a DNI for sure.

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juan de la cruz has 27 years experience as a MSN, RN, NP and specializes in APRN, Adult Critical Care.

3 Followers; 8 Articles; 3,998 Posts; 60,152 Profile Views

10 hours ago, ICU2NP said:

Right now I am going through my 80+ resident building and screening everyone with quick visits, and updating POLSTs as we are already having shortage of ventilators where I live so we want to know who is a DNI for sure.

I love that bolded part. What state are you in? 

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BCgradnurse has 11 years experience as a MSN, RN, NP and specializes in allergy and asthma, urgent care.

1 Follower; 1 Article; 1,661 Posts; 49,527 Profile Views

Allergy and Asthma NP- We have been doing 100% telemedicine for the last week and will do so again for the upcoming week.  Tomorrow providers and admin will video conference to come up with a plan going forward.  Allergies are acting up in my area (New England), and we're getting a lot of calls from the worried well.  Our asthma and COPD patients have been well stocked with their meds.  I have referred 2 patients for testing as they met the criteria, but Dept of Heath told them to monitor at home and isolate, as testing is not readily available.

We have very little in the way of PPE at our offices-surgical masks, gloves, maybe a few gowns. No N95 masks or face shields. We will not be able to do spirometry due to risk.  I have also been precepting a FNP student, and  have to tell her she cannot come back until things calm down.

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verene is a MSN and specializes in mental health / psychiatic nursing.

1,612 Posts; 10,122 Profile Views

PMHNP at a psych hospital. We're being proactive-- we did a lot of restructuring of units over the last couple of weeks so we can have isolation units for our high risk patients (e.g. elderly, immunocompromised) and a quarantine unit for patients suspected/confirmed to have COVID (recognizing our local medical hospitals will likely be overwhelmed.). I had no idea we could go from 2 negative pressure rooms and 6 medical beds hospital wide to 4 units (~ 100 beds) of negative pressure rooms in under a week but we've done it.  Visitors are banned (with very few exceptions), as are new admissions (though these will likely be starting again now that we have screening protocols).  All staff are screened on entry to the building.

More and more staff are working from home or remaining in offices away from the units to limit exposure and help us maintain the 6 ft recommended distance.  Lots of meetings being held by phone or by e-mail rather than in person.

We were having shortages of PPE before all of this due to a heavy flu season,  not really sure what we will do going forward.

For now I'm still meeting patients face-to-face on the unit, but there is talk of starting up telepysch options for routine assessments and limiting face-to-face for more critical assessments (e.g. seclusion/restraint).  In many regards my workload (at least for the moment) has decreased - which feels surreal and a bit like the calm before the storm. 

 

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juan de la cruz has 27 years experience as a MSN, RN, NP and specializes in APRN, Adult Critical Care.

3 Followers; 8 Articles; 3,998 Posts; 60,152 Profile Views

We're told we have a 2-week supply of PPE's as of a few days ago based on our usage. That's going to be challenging if replenishment doesn't come. Our census has gone down now that elective OR cases are on hold. The hospital is pretty quiet with no visitors entering the halls and only confined to a waiting area in the lobby where numbers of people are closely monitored. Our COVID 19 positive cases including ICU are low considering the number of cases that have turned out positive in the city we're in. We're enforcing limited patient contact in those cases - just essential care by a small number of staff and providers entering those rooms and logging in prior. We have employees who have tested positive but were deemed community-acquired. It seems eerie because it can be a calm before the storm for sure but still hoping we are successful in flattening the curve. 

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FullGlass has 2 years experience as a BSN, MSN, NP and specializes in Adult and Geriatric Primary Care.

8 Followers; 2 Articles; 1,063 Posts; 10,151 Profile Views

Primary care NP here.  I am waiting to start a new job.  My NP friends at previous position said the clinic is very quiet - patients are only coming in if absolutely necessary.

The clinic has a Saturday clinic that is urgent care only.  Shockingly, a week ago, the NP on duty literally said, "F*** this," and walked out.  Left waiting room full of patients.  No one knows what happened to him.  He was fired.  But very unprofessional behavior.

 

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