One Patient at a Time

My COVID patient just wanted to know what I, his nurse, would do. So I told him. And that's how nurses will stem the tide of COVID: delivering the best and most trustworthy care that they can to the patient right in front of them, one person at a time. Nurses COVID Article

“Can I ask you something?”

At this point in the pandemic, I already know this question is coming.  In my role as a telephone triage nurse I’ve had this conversation with so many patients today, I’ve lost count.  I’ve already rattled off the CDC guidelines for vaccination, the contagiousness of the Delta variant, the percentage of physicians who’ve received the vaccine, the fact that this patient is way more likely to get a blood clot from COVID than from the Johnson and Johnson vaccine.  I hope he is listening to the facts.  But judging from his question, I think he’s just listening to me.

“Sure,” I say.  It’s not typical that I talk about my own experiences on these symptom triage calls, but these are not typical circumstances.  The pandemic has changed so much about healthcare that we’re having to rethink much about how we reach patients.

“Have you gotten the vaccine?” he asks.

There it is.  This patient has read the news, heard the guidelines, most likely knows someone suffering from COVID, and is unconvinced.  Unconvinced, unvaccinated, and very much at risk to become seriously ill from a disease that has killed 1 in every 500 Americans. In the face of so much information (and sadly, misinformation) he wants to know what I, his nurse, have done to keep myself safe.

How is it that patients can be presented with the best, most current evidence and still be wary and want to know what a nurse would do?  Is it because they’re confused?  Scared?  Just looking for the most trustworthy person to point them in the right direction?  Ultimately, aren’t we all?

That the pandemic has been exceptionally hard on nurses has been no secret.  An already dire pre-pandemic nursing shortage has gotten to the point that the American Nurses Association has urged the US to declare it a national emergency.  Hospitals across the country report being overrun with COVID patients and understaffed to the point of turning truly sick people away.  The strain of caring for patients as COVID ravages the country is felt most acutely by nurses and those on the front line of patient care.  As the months of pandemic life drag on, the feelings of helplessness and fatigue in the face of such challenges have left many nurses simply burned out, wondering how they can face another shift.

So what are the roughly 4 million of us left in the profession to do in the face of seemingly insurmountable challenges?

We do what we’ve always done.  We focus on the patient right in front of us, right now, knowing that a nurse’s care is exactly what they need.

Because ultimately, that’s why we entered this profession.  Not to reach masses of people, but to help one person at a time.  It is for this reason that nurses are the most trusted and honest professionals, year after year: because we take the time to care for and value the individual, right where they are.  In the midst of a seemingly unending pandemic, the work feels daunting and the help does not seem to come.  If we thought about our current health crisis in these global terms, it would make an already hard shift feel almost impossible.

But nurses do not see crises in terms of statistics; they see them in terms of faces.  Names.  Voices of actual people affected by a terrible, and now largely preventable disease.  We’ve seen up close what COVID can do.  And now we’ve seen what a tremendous difference a vaccine can make.  So it is with these individual faces in mind that we show up and do what only a nurse can do, with as much hope as we can muster. One conversation at a time, one interaction at a time, one patient at a time.

“Absolutely, I got vaccinated,” I add. “And I really hope you do the same.”

At the end of our encounter, I don’t know whether or not he will get the vaccine.  That’s one of the hardest parts of nursing, the not-knowing.  We do our best to care for the patient and often never know what happens after they leave the hospital or, in my case, hang up the phone.  

So I just did what nurses do: I listened, I cared, I gained his trust, and I was honest with him about the best next steps to take for his health.  Because at the end of the day, he just needed a nurse’s care.

Specializes in NICU, PICU, Transport, L&D, Hospice.
2 hours ago, turtlesRcool said:

At this point, patients just assume we're all vaccinated.

I think it's wrong that some nurses are very willing to abuse that assumption and trust that nurses are more altruistic than they are narcissistic.  

18 hours ago, toomuchbaloney said:

I think it's wrong that some nurses are very willing to abuse that assumption and trust that nurses are more altruistic than they are narcissistic.  

Okay, but in my health system everyone is either vaccinated or had a medical exemption (which were apparently extremely hard to come by). In some places this might not be the case, but at my hospital it's a reasonable assumption.

Specializes in NICU, PICU, Transport, L&D, Hospice.
1 hour ago, turtlesRcool said:

Okay, but in my health system everyone is either vaccinated or had a medical exemption (which were apparently extremely hard to come by). In some places this might not be the case, but at my hospital it's a reasonable assumption.

I didn't comment upon whether it was a reasonable assumption for a patient to make. I commented upon nurses abusing those assumptions. 

On 11/4/2021 at 7:41 AM, T-Bird78 said:

At what point is our right to privacy more important than pt’s wanting to know?  I am fully vaccinated, was one of the first ones in my office to get it, but how comfortable are others to have strangers ask about our own health decisions?  Where is that line?  Will they ask about HIV or Hep B status?  At the same time, I have had a pt walk out of our office because she overheard a front desk associate, non-clinical, say she hadn’t gotten her vaccination yet and pt was furious that my coworker 1) was not vaccinated and 2) was so vocal about it. Our employer has mandated the vaccine so we all have it now, but there’s a fine line between nurses being expected to provide comfort and assurance to pts over the vaccine and some right to our own healthcare status. 

While I agree with your general premise, I don't think it applies universally.  A patient doesn't have the right to peruse my medical record.  "Where is that line?  Will they ask about HIV or Hep B status?"  Probably not.  I have never heard of this happening.  But- if there was a massive disinformation campaign about hep-b causing millions to mistakenly believe my hep-b status put them at risk, I expect they might ask.  Or, if they were struggling to make a decision because of their exposure to bad information, they might ask what I do because I have gained their trust.

It's an unprecedented situation.  

I don't think a patient has a right to know whether I have had a vasectomy.  My vasectomy status has no possible bearing on their outcomes.  My lack of a vasectomy is not going to accidentally impregnate a patient, and potentially pass that asymptomatic pregnancy to her fragile grandmother.

I think you would be hard pressed to find a physician or scientist who truly understands viruses and vaccinations who would be OK with an unvaccinated nurse caring for a vulnerable patient/family member.