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  1. KellyM RN

    Short Staffed: An Epidemic

    Talk to any nurse and they will have something to say about the staffing at their hospital or facility. More often than not, that something will be an unflattering depiction best summed up with three words: stretched too thin. Additionally, the COVID 19 pandemic, like a flare up of a chronic disease, has only exacerbated the issue. While the problems addressed here can be frustrating, the goal is to rationally examine the causes of under-staffed hospital units in order to then identify potential solutions. The Problem: Defining Short Staffing What is short staffing? That depends primarily on the defined nurse-to-patient ratios in each hospital and on each unit. Ask any hospital administrator and any nurse at the same hospital to describe the safe, ideal nurse-to-patient ratio on a given unit and they will be give completely different answers. Why is this? One likely reason is the perspective and roles of each side varies greatly. An administrator considers a completely different set of criteria than a nurse would for the same problem. The Fix If nurse-to-patient ratios are the foundation for safe, effective patient care then coming to an agreement on what those ratios should be is paramount. This requires open, honest communication between clinicians and administrators alike. Clearly defined and agreed upon criteria for what adequate staffing on each unit looks like gives everyone a solid foundation with which to start. Nurses are critical to helping define these standards in order to ensure that expectations are realistic. The Problem: Accounting for Census Changes There is no question that patient censuses can fluctuate dramatically in short periods of time. We’ve all left a shift with adequate staffing only to come back 12 hours later to twice the patients and half the staff. These variabilities are difficult to predict, although not impossible to prepare for. While floating nurses to other units is a commonly used solution, it is a temporary fix and not always seen favorably with floor nurses. Why is floating such a dreaded event? There are many perspectives and reasons although most of these boil down to one common element- the unknown. On any given shift, there is a lot a nurse can know ahead of time and a lot they cannot. We can know our units- where the supply room or code cart is or the policy for various unit specific procedures and processes, on the other hand we can’t know our patients, their conditions, or what may happen over the course of a shift until we are there. Floating to new units takes away the piece of the shift we can know. The Fix One option is to give nurses to chance to choose two separate units to work on and then provide full orientations to both units. Allowing nurses the choice of an extra unit gives them some element of control, additionally the orientation gives them the chance to be more comfortable and therefore safe on the unit. Furthermore, this would have the added benefit of reducing potential burn out from being in are place too long. Another option is to hire nurses specifically as float/pool nurses. Setting the expectation at the time of hire for their role and work expectations will allow the hospital and nurse alike to find and fill roles that fit both parties. The Problem: Nursing Burn Out and Turn Over It’s a true “chicken or the egg” type question: does short staffing cause nurse burn out or does nurse burn out cause short staffing? There are good arguments for either side, however ultimately addressing both issues is crucial. The Fix Hospital administrators have many parameters they use to measure their hospital’s success. There are internal considerations such as patient satisfaction surveys and even employee surveys as well as external influences such as various accreditations that can elevate a hospital’s standing. Including safe nurse-to-patient staffing ratios as a unit of measurement for success and then getting “dinged” every time a unit operates without appropriate staffing aligns nursing priorities with administration priorities. This alignment of goals puts everyone on the same page. Which, in turn, helps nurses feel protected by their hospitals leading to a reduction in nurse turn over. All in all, it is mutually beneficial to ensure safe nurse-to-patient ratios. The Best Chance for Change? While short nurse staffing can be difficult problem to address, it is not impossible manage. Ultimately, the best chance for change has everyone working towards the same goals: safe, effective, compassionate care for our patients. What are some of the issues you’ve found that contribute to under-staffing at your hospital? What are some possible solutions?
  2. nikkulele77

    Texting with Flo

    Texting with Florence Nightingale Yo, Flo! Can u talk right now? (I like saying yo flo) 😊 Talk? Do you mean text? Yeah, I do mean text. Yes. But why do you say talk instead of text? IDK. I know we aren’t literally talking, but ….our fingers do the talking. 👋🏽 Yes, I see. I’m still learning this new technology. What can I help you with? Well….I still can’t believe I’m somehow talking to u. So crazy. 🤪 Anyway, I had a horrible shift the other night and I just wanted to talk it out a bit. If u don’t mind. Oh. OK…. No offense, but I think that may be a little outdated, Flo. It’s 2021. We talk. I think there’s, like, studies and stuff that say debriefing is really important. It helps people process and decompress. And it can lead to action. Changes. Studies, you say? I think so. Ummm, OK. So ... Apologies. You were saying? Yeah. My shift the other night was rough. We were understaffed, like usual, so I had to triple while being charge. Ridiculous! IDK how they expect us to work like that! Patient safety, anyone? Right? It’s just so frustrating when we tell admin over and over and nothing happens. I guess u dealt with that. Getting the men in the military to see that the medical facilities were unhealthy was very difficult. I can only imagine. Anyway, I’m still pretty new at being charge. Any words of wisdom? Ooo, I like that. I’m gonna take it to our unit director. Did you work in the Covid unit? Yep. So so sick of this pandemic. 😷 ??? 😶 I am proud of you for working through such an ordeal. How were your patients? Had a sweet little old lady who always said TY. Seemed lonely, so I gave her an extra long bath last night and talked to her. That was one good thing…. Says the Queen of Hygiene! 👑 Where would we be without u, Flo? I shudder to think…. Haha! True. And some people still suck at hand-washing. This poor lady is getting confused though. Maybe a touch of ICU delirium That interests me. Agreed. My other patient goes berserk whenever we try to wean his sedation. Nearly ripped his tube out. I had just got him settled when the docs came in and just HAD to get their neuro exam. I was like, EM? Let this dude rest! 😡 IDK what sine qua non is, but after they left it took a good half hour for my guy to settle back down. Even the monitor alarms got to him. Remember how I told u about all our monitor and vent alarms? Oh, yes. I must say that bothers me. Sing it, sister. I wish u could come teach us a thing or 2. Most of us could use your wisdom. So you are saying all my CE and classes aren’t a waste of my time? 😉 Flo, did u ever get scared about how nursing would go after u left it and your nursing school? I would be lying if I said I never feared. But I learned that ... I try. I don’t have to tell u how tiring it is. Feels like all I do is work, eat, and try to sleep. I know nursing was like a calling for u, but how did u find any time for urself? Netflix and chill, am I right? 👊🏽 Yes! See, u get it! They can scream self-care at us all day, but until we feel like we are being listened to ... I guess I don’t have to tell u. I don’t mean to complain. Keep that in mind if you want to ignite change. Who was your 3rd patient? Oh, right. I had a 42 yo woman who probably won’t make it. So sad. Married and has 2 kids. She’s been here so long they are starting to talk about what the goals are with her. Like, should we extubate. IDK. Usually I’m pretty on board with it, but this time . . . she’s so young and I don’t think her husband is ready. I know u didn’t deal with this exact thing, but u had some moral dilemmas, right? Oh my ... 👍“The world does nothing but sketch.” I’ve talked to her kids on the phone. So nice. But that just makes it harder knowing she probably won’t make it. Curse Covid! Flo, u dealt with a ton of death. What do u think? It’s never easy. I’m sorry. Remember though ... Hmm. Can I share that with the family if I need to? Of course. 💜 Thx. Hope I don’t have to. I have a few days off and I’m going out for the first time in a long time. TBH, I feel a little guilty. TBH? Guilty? To be honest. Yeah. I guess bc there are all these people and their families who are suffering and here I am going to a movie and eating popcorn. So trivial. Dear, with this pandemic the war you are fighting is different than the one I engaged in. But my response is the same ... Beautiful. TY. Makes me feel better. References Florence Nightingale Quotes from BrainyQuote
  3. Each day I wake up for another day the same as yesterdayI make my coffee and turn on my computer, browsing my emails before anything else. For the last several weeks, there are constantly new updates surrounding Covid-19. New training guidelines, new questions to discuss with patients, changes from the CDC and updates regarding medication dispensing. Help for the fightThere are also constant requests from state governors, healthcare agencies and boards of nursing requesting additional healthcare personnel to help fight this virus. Requesting nurses to come out of retirement. Waiving reinstatement fees and extending licensure renewals. They are almost begging. My heart races and my stomach drops – I feel guiltyMy social media feeds are flooded with pictures and videos of nurses crying, quitting their jobs due to fear, risking their lives working without proper PPE, or simply braving the virus and taking a risk because of their oath of caring for others cannot be shaken. Should I be out there?I stepped away from the bedside in 2018. I was fortunate to find a position as a Case Manager with the added benefit of working from home. I am young and do not have a family I am supporting or worried about spreading the virus to. I should be out there. In fact, I did reach out to my employer about the possibility of taking leave to help on the frontlines, but this was not granted. I would be lying if part of me wasn’t a tiny bit relieved. I believe that most nurses, healthcare professionals in general, have a sense of needing to help. If you ask a nurse why they chose their profession, that is likely the answer you will receive. We seem to naturally possess traits of compassion, selflessness, and empathy. We are also (usually) stellar at teamwork and critical thinking. Unfortunately, the traits of a nurse can be detrimental. To ourselves. We tend to put the oxygen mask on someone else before ourselves, metaphorically speaking. We do not often make ourselves a priority. I partly blame our healthcare environments for this. They have conditioned us to accept more responsibility with less support. To be a “team player.” To pick up extra shifts when we are exhausted. To work when we are unwell ourselves. And now, nurses are being exposed to a deadly virus and are not being provided basic PPE, yet they are expected to accept these conditions without complaint. There is not a soul that does not support our frontline nurses during this time. Truthfully, I do not feel there is enough being done to support them (free donuts and shoes is barely a band-aid) but that is an article in itself… I am grateful and I am necessaryAt the end of the day I am grateful I do not have to make the decisions our frontline nurses do. I must remind myself that the work I do is also helpful and necessary. That I am still supporting my patients in a different manner by educating them, ensuring they have necessary supplies and medications and that they are staying home, in turn hopefully making a small dent in lessening the burden of hospitals and our brave nurses. I hope that nurses are feeling confident enough in their WORTH to make the decisions that are right for them and their families. To know that their fear is valid and if they are scared or feeling unsupported that they need to use their voices. Remember that nursing is so vast with so many opportunities, and if your employer does not value you in a crisis, they do not deserve you. LastlyI want our frontline nurses to know that we stand with them in solidarity. We are crying and praying along with them. We admire their sacrifice and will never judge whatever tough decisions they may make during this time.
  4. tnbutterfly - Mary

    Travel Nursing

    The concept of travel nursing began as a solution to provide additional nurses to areas/hospitals experiencing a nursing shortage. Over the years this has become a very popular option for those wanting to change locations and assignments regularly and have the benefit of vacationing where they work. Travel nurses are Registered Nurses (RN) who travel to other parts of the country where there are not enough trained nurses to handle the workload. They work temporary assignments in one location lasting 8 to 26 weeks, although 13 weeks is the typical length of assignment. Travel nurses have experience in various fields and specialties. COVID-19 Pandemic Currently (November 2020), due to the COVID-19 Pandemic, hospitals are in dire need of nurses in many U.S. states that have been declared a state of emergency. Due to this overwhelming need, some U.S. states are waiving requirements involving RN licensure as well as requesting that retired RNs return to the workforce. Duties and Responsibilities The duties and responsibilities of a travel nurse vary depending on the nurse's specialty and the assignment location. The travel nurse will generally perform the same duties as the permanent staff nurses with whom she/he works. Work Environment Travel nurses work at hospitals across the country with the permanent staff RNs, under the same supervisors and charge nurses, and often with other travel nurses. They frequently make friends with other travel nurses with whom they may work other assignments. Depending on the hospital's needs, travel nurses may work part-time or full-time, and may work various shifts. They can also earn extra income by working per diem shifts at their assigned hospital or at other hospitals in the area. Education / Work Requirements Graduate from an accredited RN nursing program Degree: Diploma, ADN, BSN, or higher Successfully pass NCLEX-RN Current, unencumbered RN license in U.S. state of employment Minimum of 18 months of clinical experience with 1 year preferred in one's specialty Other requirements as determined by each individual facility Recommended Skills and Qualities Flexible and able to work in various locations and work settings Excellent communication skills Detail oriented Strong support system Rapidly adapt to change Enjoys a challenge Rapid assessment skills If involved in international travel, should be able to speak or have a knowledge of the local language Salary (2020) The salary for travel nurses is one of the things that makes travel nursing such a popular option as salaries for travel nurses are generally higher than those of permanent hospital nurses. Since travel nurses are often hired for critical needs, they often earn significantly more than the average salary. According to indeed, the average weekly salary for a U.S. travel nurse is $1,725 with $13,750 overtime per year. In some areas, however, nurses have the potential to earn $3,000/week. Currently (October 2020), due to the COVID-10 Pandemic, nurses are often seeing salary packages of over $10,000 per week or $100,000 for 13-week assignments. Factors Which Can Affect Salary (not all-inclusive) Assignment location Vacation locations more appealing and competitive applicants are willing to work for less Less desirable locations pay significantly more because of smaller, less permanent workforce pay significantly more because of the need to remain competitive Demand for the position Local cost of living Type of nursing specialty being sought Level of experience Recruiting Agency In addition to regular base pay, many agencies offer various types of bonuses in order to remain competitive. Such bonuses may include loyalty bonuses and referral bonuses. Other Benefits (not all-inclusive) Free housing Medical coverage Dental coverage Meal subsidies Travel reimbursement Non-taxed stipends Retirement plans Travel Nurse Pay and Salary told by an EX- Travel Nurse Recruiter Resources PanTravelers (PAN) - The Professional Association of Nurse Travelers is a non-profit national organization representing nurse travelers in the United States. Travel Nurse Toolbox
  5. Wyckoff Hospital is in Brooklyn, New York, and Amy has had a busy week after being named as one of the 100 Influential People in 2020 by Time Magazine. Her image graces the cover, representing the heroism of nurses and other frontline workers. Time chose her as an individual who seized the moment to save lives. The list reflects the pulse of society and life in these extraordinary times. Amy was interviewed by Dr. Esther Joseph Pottoore, DNP, RN, a New York nurse working in the South Bronx in a Primary Care clinic. An Interview with Amy Esther: Thank you Amy for calling me on your break and consenting to this interview! Let me know when you have to go back to work! Amy: You are welcome! I will let you know when my break is over. Esther: How long have you been a nurse? Amy: Since 1992 (28 years) and 19 years in the Emergency Room at Wyckoff Heights Medical Center. Esther: Where did you study Nursing? Amy: In New York at BMCC - Borough of Manhattan Community College in the downtown area of Manhattan. Esther: What degree did you get? Amy: I have an Associates Degree in Nursing! Esther: Where were you before you came to New York? Amy: I was born in San Jose, California. My family moved all of us to Baton Rouge, Louisiana where we grew up after my dad retired from the Navy. I came to New York after high school. Why did you become a nurse? Esther: Did you always want to be a nurse? What sparked your interest? Amy: I remember vividly when my dad was in the hospital he was very sick and dying and how the nurses took care of him. I was in awe of them, watching them - which now I realize are IV drips, ventilators and how they maneuvered to manage them was amazing. That's when I knew In my heart, that's what I wanted to do in life. Esther: Tell me something the world doesn’t know about you! Amy: Well pretty much everyone I know knows the family's passion; my passion is the water. We have to be close to water at all times. We have a pool in the back yard; we love to swim. I am an avid surfer. I love to surf! I have been surfing since my twenties and am self-taught. At least twice a year we would drive to the Gulf of Mexico to the Florida Panhandle to surf - one of my favorite beaches. And when we're in New York, we try to get to Long Beach Island (LBI) which is in New Jersey at least once a week to surf with the whole family, my partner Tiffany and the three kids, Summer who is five, Kali who is 11, and Ocean who is 13. Esther: That’s impressive! I am afraid of swimming! Amy: Really? I love the water! Even in the cold months, I want to be in the water and the kids do too - just sitting on the beach during the cold weather makes us happy. First Encounter with COVID-19 Esther: Let's talk about the pre-COVID days in New York. Did your hospital or ED make any special preparations or educational sessions to get ready? Amy: I think like most everyone we were unsure of what was coming our way or what to expect. We talked about it, but on the day of a very large group huddle in the emergency room, we were talking about the Coronavirus and the precautions that we needed to take. At that point, we weren't sure that the first COVID patient in Brooklyn was in our ER in an isolation room. That was the day that I took care of the first suspected COVID case. Esther: Tell me more about that case. What do you remember? Amy: What I remember most is she was super sweet, and I sat in her room and talked to her for the longest time. She told me she had traveled to the Philippines in late January and returned in late February. She wasn't feeling great during the last two weeks of February. It was the beginning of March when she arrived in our ER, feeling tired and weak, with no fever. She was in the main ED for over 8 hours. Esther: At what point did you suspect COVID? Amy: Actually one of the ER attendings suspected it as the chest x-ray confirmed an abnormal pneumonia - a pattern of pneumonia that is rarely seen up until now, which we now know is COVID pneumonia. She died 10 days later. She was the first COVID death reported in New York State. Amy's Personal Battle with COVID Esther: I heard that you then got sick. What happened? Amy: I remember the day our first COVID patient entered the ER there were talks of possible quarantines for any staff members who came in contact, even though we were all asymptomatic at that point. The following day myself along with a doctor and six or seven other nurses were asked to quarantine themselves, which we did. There was a lot of anxiety with all of us with the unknown and fears that went along with this. I remember each one of us talking every day about how we were feeling and about any symptoms that we may have had. That was a great support system that we all shared with each other. As far as myself, I think I was just feeling tired and fatigued. About three days later, I noticed I was feeling winded. I was searching for a place close to home to just be tested. It was very difficult to find that test, but at that point, I started to feel short of breath, so I called the administrator on duty at Wyckoff, and she told me, "We will have a room ready for you. Please come! We will take care of you." So, I hopped in my jeep drove to the hospital, and found myself in an isolation room, where on a daily basis I saw and took care of patients before. It was very odd to be on the other side. Thereafter, it was becoming more difficult for me to breathe. I remember one of the ER residents coming into the room, gowned up with his PPE's. He placed me on a BiPAP as my fellow coworkers sat outside the room watching and crying with worry. I was taken up to ICU pretty quickly where the ER attending told me that I had Pneumonia, which shocked me to hear that news. I was intubated soon thereafter. I was then transferred to another hospital in Long Island where I was in ICU for a few more days until I was extubated 4 days later, and soon I was discharged home to recover. Esther: Were you out a long time? Amy: I remember the first week was the worst week of my life. I felt horrible; there's no comparison to anything I've ever felt before. The second week was a little better. The third week was even better and then soon after that, I return to work. Esther: The pandemic was kicking in at that time. That must have been tough! Amy: I don't know if tough is a good word it was just something in all of us that made us want to go to work and help. I remember my partner, Tiffany, calling me before I returned to work telling me that they were COVID patients and that it was busy. Each day more and more patients would arrive at the emergency room with COVID-related symptoms. At that point, when I returned to work, 98% of the patients who entered the emergency room were COVID patients. As I and the staff members watched, the emergency room started to overextend itself. We actually made the pediatric emergency room a makeshift ICU unit where there were intubated patients. Every floor was an ICU with COVID patients. At that point, they built a makeshift patient treatment area in the lobby of the hospital where we could take care of at least 20 other patients who were stable when they entered the hospital but had COVID-related symptoms. Esther: How did you cope in the ED? Amy: What I found is that we've all become closer and more trusting of each other. We worked as a group helping each other out as much as we could. We just did what we had to. Everyone helped! Security guards were gowned-up in their PPE's, helping us in every way they could, even making beds. The clerks and technicians were out on the floor helping us do whatever they could do. Administrators who normally wear suits and skirts and the CEO put their scrubs on, geared up, and helped us in the emergency room every single day during this crisis. Esther: Did other staff get sick with COVID? Amy: I don't know the exact number, but there were many nurses, doctors, technicians, and clerks who became sick but also returned to work soon after their recovery. Esther: Did you lose any of your coworkers? Amy: There were five staff members in the hospital who did not work in the emergency room who unfortunately passed from COVID-related issues. Coping with the After-Effects of COVID Esther: So sorry to hear that. I know this has stressed us all out. What has been the effect on you post COVID? Amy: You know, at first I found myself with insomnia, feeling restless; I wasn't able to focus and feeling very antsy. I thought it was because I wasn't able to go to the gym because the gyms had been closed during the pandemic. Before the pandemic, I would go to the gym during my lunch break for one hour and return to work. While I wasn't sure what I was experiencing, I thought I was just tired. But I soon realized one day I was having a panic attack while I was working which I've never had in my life. After I came back out on the floor, I was talking to the pharmacist about how I felt and he told me he also has had panic attacks and feels very anxious post-COVID. Then I started asking questions to the other nurses about how they were feeling, and they all agreed that they have anxiety now which they all say they've never had before up until now. Then I reached out to a therapist who specializes in PTSD. Now I am going to therapy, which has been my savior. My partner, Tiffany, also started going to therapy. During all this, we have had each other to talk to about what we went through each day. This has been a wonderful support for each one of us because no one on the outside understood what we were feeling or seeing outside of the hospital setting. Esther: I see that in some of my coworkers who tested positive too! How are you normally? Amy: Yeah, testing during the crisis was frustrating for most of us. We were unsure of the results and it was hard for us to find somewhere to be tested. I am normally funny, outgoing, silly. I love to joke around with the patients to try to make their visit to the emergency room not so serious and fearful for them. Esther: What are you doing to cope? Amy: It was a slow recovery. I didn't feel really like doing much just laying around, which is something I never do. I slowly started meditating and doing some yoga at home. The gyms have reopened so going to the gym during my lunch break. A big part of this recovery is therapy Esther: I would say having no traffic while going to and fro work was great! I have to confess I was way over the speed limit and I reached work in 15 minutes! No traffic in New York was really good! The one positive of COVID times! (Both laugh). Amy: Yes, traffic in New York was horrible. One of the good things about this pandemic was there was no one on the road but frontline workers which was great. Travel was less stressful, less tiring, and less time-consuming. However, what I've noticed now is that people are returning to work, and I see a lot of aggression on the roads and people in a hurry to get somewhere. Esther: During the height of the pandemic what did you see that was concerning to you? Amy: What concerned me most was being safe. We're in our PPE's, but how are we going to keep our family at home safe? So we changed our entire homecoming to taking our clothes off in the garage, putting them in a separate bin. Shoes are outside in a separate area. We would walk up through the garage, which we've never done before. No one was allowed to talk to us, no one was allowed to touch us, not even the dogs, and we can go right to the shower. We were sure to wipe down the insides of our jeeps, our phones, and our IDs from work. Dealing with Lack of PPEs Esther: How about PPEs? Amy: PPE's were given to us, however, the hospital could not keep up with the demand in the outpouring of patients that entered our emergency room on a daily basis. And then our savior, Melanie. We were lucky because Melanie from an organization called International Medical Response started an ongoing Emergency Supply Cabinet Project, initially funded by a GoFundMe page. They were angels and got us supplies throughout the pandemic! They hand-delivered them to us outside the emergency room throughout the Pandemic. The surge was from March 2020 to June 2020. Home and Family Esther: How did your family take all this? Amy: Well, thankfully, Tiffany is a nurse in the same emergency room where I work, so we were able to figure this out as a couple. However, our entire routine changed with the 3 kids, 3 dogs and 3 cats. They were used to us coming home and sitting at the table and talking about our day with then and how their day was. We would play with the dogs and the cats, but now it's come to going right to the shower and going right to bed. That's now the new normal for us. Esther: I think you are missing fish and birds! Amy: Well we did have a fish tank, but it was a lot of work along with three kids, three dogs, and three cats. We thought about birds, but we were afraid the kitties would bother the birds. One of Time Magazine's 100 Most Influential People 2020 Esther: This has been a rough year for both of you! Despite all this, you were chosen by Time Magazine! How did that happen? Amy: That was by chance! I happened to go on my day off to protest alongside my colleagues in front of the hospital about the scarcity of PPEs. There was a lot of media and I was talking to them. The CEO of the hospital who is a very nice man came with a reporter from Time and recommended that he talk to me. Since I was still at work, we talked later when he called me and I was off work. The hospital later allowed cameras in the ED and they saw the team in action in and out of work. They even followed us home! That’s going to be a documentary that will come out at some point. Later on, I found out that I was nominated and then later named as one of the 100! They came for a photoshoot! Esther: What was your first reaction? Amy: I said, “You gotta be ****ing kidding me!” I curse a lot! Esther: How did it make you feel? Amy: Happy. This is for the entire team and not just me! There are staff that have been to hell and back. Their stories have not been told, mine was. Ever since this was announced on ABC Network, the phones have not stopped ringing! I got interviewed by major networks and I heard that Ellen DeGeneres might be calling! Esther: That’s definitely exciting! What’s happening in the ED now? Amy: We are beginning to see patients with pneumonia, cough, positive D-Dimers, and a negative chest x-ray. We are isolating them and getting them COVID tested. The numbers are increasing. We are also seeing a lot of stress-related issues like PTSD, aggression, overdose, suicides, and stabbings. Advice for Nurses Esther: What is your advice for healthcare workers especially nurses? Amy: Wear your PPEs. Do not take off your N95 mask. Do not rub your eyes or bite your nails. Maintain social distancing at work and at home. I am homeschooling my kids till this is over. Esther: Did you think about family, death, spirituality, or faith during these times? Amy: I do not have a particular faith. I believe in Karma. Good Karma begets good actions and auras. I did and still worry about the kids. What if anything happens to us? We have no family here in NY. I try not to think too much about it. I also was worried about getting targeted for wearing scrubs. I always wore and still wear my mask when I am out in public. Life is so fragile. You have to live every moment because soon it may be gone! Esther: Do you have any final words for new nurses? Amy: Just be honest and be yourself! Congratulations and Thank You Esther: Thank you for being the Face of Nursing 2020. Congratulations on making it in the list of the 100 most influential people in the world. It’s an honor for all nurses in the International Year of the Nurse! Have a wonderful and safe day and thank you for all you do! Amy: Thank you and be safe! As we wrapped up part 2 of her interview, she was driving home in her baby blue jeep with the top down! I could hear shouted congratulations from regular people who recognized her on the street! Amy’s response was a typical New Yorker’s response. “Yo! Thanks, man!” Let the Diamond Within Shine To all my nursing colleagues! Let's take a page from the Harley motorcycle riding, avid surfer RN Amy O’Sullivan, and ride the next wave of life with confidence! Like her, let's treat each other and our patients with kindness. Let us be the light that shines brightly in the dark and the source of comfort in a time of need for others. Like Amy, let the diamond within shine! Dr. Esther Joseph Pottoore, DNP, RN
  6. allnurses

    We Did Not Sign Up For This

    This article was written by someone who wishes to remain anonymous. Due to the topic and emotionally charged nature of the article, the member wanted the topic out in the open so nurses could discuss it. Because she is afraid of retribution if any of her hospital administrative staff should read this article and link it back to her, we offered to publish it for her anonymously. Please add your comments regarding this issue negatively impacting nurses and the healthcare system. COVID-19 is here and it is terrifying. People are scared. People are panicking. I have seen posts that criticize nurses who choose not to work right now because they are afraid. “This is what YOU signed up for!” people say. That is not true. This is NOT what we signed up for. NOBODY has signed up for this. Unlike what you might have seen on TV, there are many different types of nurses and we all have different skills. We specialize in our own fields. The Renal nurse knows how to educate patients who are in renal failure about fluid and dietary restrictions, so they do no overload their systems. She understands shunts and dialysis equipment. For the patient in renal failure, she is an expert. The Cardiac nurse knows how to take care of patients who have just had open-heart surgery. She can read an EKG expertly. She may not know how to connect a patient to a dialysis machine, but for cardiac patients, she is an expert. The Labor and Delivery nurse can check your cervix to tell when it’s time to push. She can read fetal monitoring strips to make sure your baby is not in distress during labor. She may not be an expert at reading EKGs, but for a laboring mom, she is an expert. The ICU nurse takes care of the most fragile patients. She understands ventilator settings, arterial pressure readings, blood gas readings. Drugs that most wards will never see – like Levophed are used here. She cannot check your cervix, but for a critical patient, she is a lifesaver. Each of these nurses (and oh so many more different types of nurses!) are experts in their fields. They “signed up” to care for those patients. They have trained and educated themselves to care for their specific patients. That is why if you are in labor, you want a labor nurse, not a renal nurse, at your bedside. Right now, ALL NURSES, regardless of specialty, are being called to care for COVID patients. Please bear in mind that not ALL nurses have been trained to deal with highly infectious patients who have the potential to go into acute respiratory distress quickly. We are NOT being offered additional training. This is part of the reason nurses are terrified. This is why some nurses are leaving nursing right now. This is definitely NOT what they “signed up for.” For the most part, nurses take care of people who are ill or injured with non-communicable illnesses or injuries like cancer, heart disease, strokes, car accidents, etc. This means we can help without the risk of catching our patient’s illness or injury. We do take care of patients with infectious illnesses as well – the flu, pneumonia, etc. Because these patients do not take up a large part of our hospital normally, we have the appropriate respirators, reverse-air flow rooms, and PPE we need to take care of these patients. These patients are usually on appropriate wards with nurses who have been trained to care for them. Although there is a risk when we take care of these patients, there are also vaccines and known treatments to help us fight if we get infected. COVID-19 IS DIFFERENT. IT IS A HIGHLY INFECTIOUS, POTENTIALLY FATAL VIRUS WITH NO KNOWN CURE OR TREATMENT. Because it is a PANDEMIC, many people are sick at the same time. Hospitals are overwhelmed. Patients are being sent to wards where nurses do not have the correct expertise to care for them. Hospitals do not have the appropriate equipment to help keep their nurses SAFE while we are caring for patients. There are not enough masks. Nurses are being asked to wear bandanas or sew their own masks at home! Would YOU walk into a potentially infected person’s room and care for them with a bandana? So please. STOP. STOP saying “Nurses signed up for this.” We did not. We did not sign up to sacrifice ourselves because hospitals won’t provide us with the proper equipment and training we need. We did not sign up to die of an infectious disease just because “it’s your job!” Do you want a labor nurse trying her best to ‘figure out’ how to operate a ventilator for your child? Do you want a cardiac nurse delivering your daughter’s baby? Do you want a wound care nurse to try and figure out your dialysis settings? No. I promise - you don’t. We understand you need us, but our families need us too. If we are scared right now, it’s because we have every damned reason to be terrified. If some nurses choose to stay home and protect their families, that is their priority. They have a right to protect their own life. No JOB is worth anyone’s life
  7. spotangel

    Saving Frank!

    This article was written and initially submitted in December 2017 and at that time I asked for it not to be published yet. With what just happened in the last few weeks, I feel now is the time. Ironically enough my initial title was, “I can’t breathe!” I had changed the title as I did not want to evoke or trigger emotions. Now that same title is a hashtag! It is out there now. Trevor Noah called it and gave us all a perspective of how the shoe feels on the other foot. Frank In the last two weeks, we have seen blatant discrimination captured on camera in NYC and Minneapolis. As a human being, it was extremely hard to watch George Floyd die. As a professional, my mind was screaming to let up on the knee pressure, start CPR on the field and right a wrong. I imagined the other end of it as the ER staff now received a patient who was clearly dead and desperately tried to save him. It took me back to 2008 when my ED team and I were in a similar situation. Frank was brought into my ED when a Group Home staff's good intentions backfired. Here is what happened. Saving Frank in Today’s World “Not again lord!” my brain screamed as my hand reached for the red phone calling with an emergency. This was our 5th code in the space of 2 hours that EMS was bringing in on a Saturday. A 25-year-old black male without a pulse and CPR in progress. ETA (Estimated Time of Arrival) 5 minutes. I marshalled my weary troops again and set up for the code. We had plenty of time as they took around 20 minutes to arrive. We took over once they rolled in. Behind the ambulance around 6 squad cars pulled up. As I went in and out of the resuscitation room, my eyes lingered around 20 police officers by the entrance of the ED. “Something is cooking!” I thought to myself. The Story of What Happened The patient, Frank, was DOA (Dead on Arrival) and had been coded in the field for over 40 minutes. We worked on him for over an hour without a rhythm. He was finally pronounced. The EMS gave us the story. Frank was a schizophrenic and lived in a group home. He had no family. He was agitated and pacing and so one of the staff got worried. They asked him to go to the ER and he refused. They called 911 after consulting their manager and EMS arrived as so did the cops. When Frank refused again, the cops called for reinforcements and struggled to contain him. He struggled violently. They then put him in an Emotionally Disturbed Person (EDP) body bag also known as a "burrito". Every time he raised his head up and screamed, they held him down. Soon he stopped struggling. The EMS team got him on the stretcher to put him in the ambulance. One of the EMS workers noticed that he was not breathing and had no pulse. They called for reinforcement and started CPR. The ALS team arrived to help and intubated him on the scene, continued CPR, and brought him to our ER. I saw the ED Tech take his belongings and clothes after the code, label the bag with his name, date of birth, Medical Record number and the date, then put it in our utility room. The weary staff moved on to the next emergency disheartened that we could not save him. Police Arrive I saw two more unmarked police black SUVs park at the ambulance bay and a few suits come in. They wanted to speak to the ED attending that ran the code. I pointed him out to them and they thanked me. They were from the police IID (Internal Investigation Division) as a call had gone out to them. They were also directed to Medical Records as they wanted copies of the ED course and copy of the medical chart as part of their investigation. Medical Records would direct them on our hospital protocol to obtain records. Frank's Group Home Contacted A phone call was made to the group home and the phone number obtained for the manager. She was not informed of his death but asked to come to the ED. She came with the assistant manager and the doctor and I took them to our family room. Sitting around a small table we informed them gently of his death. Rose, the manager, began shaking and crying. “I should not have asked them to send him to the ER. I should have come in and calmed him down. He would have been alive!” Sara, the assistant manager, raised a trembling hand and put it on Rose’s shoulder to comfort her. “I can’t believe it! Poor Frank. Dear God! What did we do! We only wanted to help him.” Both women sat crying. The doctor walked out after hearing an overhead page for him leaving me with both of them. Swallowing my tears, I asked them if they wanted to view Frank’s body. Hesitantly, still in shock, they agreed. I walked them into the resuscitation room and pulled 2 chairs for them to sit by Frank. They sat silently, tears rolling down and dripping, shoulders shaking, Sara covering her face while Rose stared at Frank’s face, her eyes anguished. I silently offered them a box of tissues and murmured that I would be back in a few minutes. Frank's Belongings I walked into the utility room and put on gloves and took out the bag of Frank’s belongings and the belongings list clipped to it. Silently, I opened the bag and checked all the items against the list. A watch with a cracked dial, shoes and socks, a tee-shirt still wet with his sweat and sweat pants and underwear soaked in urine, a wallet with a $2 Lotto ticket, and a train monthly pass. Eyes smarting, I put all the belongings back imagining his last struggle at life as with every ounce of his strength he struggled to live. I Wish ... I wish he had got a second chance in life. I wish he had been with staff that knew how to handle his pacing and increased agitation. I wish it had been a weekday with full access to a psychologist and other trained personal that could have handled his issue in a safe manner. I wished that the EMS and cops that had come in contact with him had dealt with him differently given a second chance. None of the wishing would change the outcome. Wiping my tears away, sick to my stomach, I walked slowly back into the room and gave them his belongings. They left and Frank was sent to the morgue as he had no family. The police group and the IID also left. De-escalation I went home feeling drained, wondering what we as nurses can do to educate others in handling psych patients. Many times as situations can quickly change, chances of violence and harm are high, triggering the choice to use force to subdue a patient. De-escalation is a learned art. How much training and mock practices on de-escalation are our first responders getting? What kind of training should health teams get to help patients, keeping ourselves safe at the same time? What is the aftermath of the ones left behind and the ones that worsened the situation while meaning to help? Which professional schools teach these techniques in mainstream classes as anyone at any time can be affected as one goes about their daily life? I have seen videos of how to deal with an active shooter scenario but very few on psych outbursts and de-escalation techniques. How Can We Help Save the Franks of the World? For starters, the focus should be on primary care. Many times, these situations escalate during off-hours and weekends when there is minimum help available. Primary care health providers including Nurses, Home Health Aides, Med Techs, Community Health Workers, and all who touch the patient in clinic or at home (family members) should be taught mental health awareness, de-escalation techniques and how to recognize early signs of agitation and mental health changes. The training should include: Scenarios Role-playing Drills on a yearly basis Safety for both staff members and patients is critical. Always be near a door Be fully aware of your escape route Have a backup plan in your head Watch for nonverbal cues of increased agitation from the patient Always listen to your instincts as they will guide you to be safe This could be done as a public health funded program where training is offered in a primary care setting. The next group that could potentially touch the patient are EMS, police, and firefighters. There should be yearly mandatory training. The response team should preferably include those who excel at de-escalation especially when responding to an Emotionally Disturbed Person (EDP). Once they arrive, they should collaborate with someone who works well with the patient as much as possible. NYC police (NYPD) presently have a dozen crisis de-escalation teams that collaborate with Health professionals and are on call for street calls. The Receiving Emergency Department The ER that the patient is brought to should preferably be a psych ER. Since this is not always feasible, the ER should follow the protocol for EDP to keep both staff and patient safe. It is amazing is to see how certain doctors and nurses excel in dealing with these patients, so they would be your first resource when available for a smooth transition. I was heartened to read a recent article about a collaboration of a healthcare system with emergency services to provide ongoing training for first responders in New Mexico. The University of New Mexico’s Department of Psychiatry and Behavioral Sciences has an ongoing collaboration with Albuquerque Police Department to improve patient outcomes, including 24/7 contact with officers and continued education for both police officers and physicians. This would be a model of care of collaboration within a community and would be more proactive than reactive in nature and help save lives. Yet another article talked about mentoring youth that are touched by violence (Youth Alive, a California based nonprofit organization that work with hospitals to instill leadership traits in adolescents and prevent further violence). Increased Mental Health Issues During the Pandemic The reality of our lives is that these cases are becoming more the norm than the exception. The COVID-19 pandemic has increased mental health issues among Frontline Workers along with the general public! It is important for us nurses as frontline staff to be aware of how to deal with volatile situations and have a few plans in place both as individuals and as teams. Staff at a supervisory level should have safety as a top agenda and mandate trainings and drills. In primary care, people coming in for doctor’s appointments should get screening questionnaires that trigger referrals to appropriate services that support their mental health and teach caretakers how to deal with exacerbations or flare ups of a patient’s mental state. Another collaboration would be a group home supervisor reaching out to the local police precinct and building a relationship with their clients and the cops so that there is a connection when the call comes in. Our call to action as nurses is to get in touch with our local government and be their resource and expert when needed. This requires time and commitment but think of the lives you can save with your actions! The ripple effect can go far and wide! I have worked in a group home setting in the past and learned to build a trust base with all clients. What I learned to foster de-escalation was to use activities that calmed the patient at the beginning stages of agitation and not to ignore the behavior. For one, it was walking to the store and getting a cup of coffee (fresh air therapy as I call it). For another, it was putting on his favorite show or music in a quiet space. For yet another, it was tearing down white paper methodically and piling them up (sorry trees). Each of these activities helped the individual get to a safe space within themselves and made the situation more manageable. An approach that worked with Frank might have kept him alive instead of being in a body bag at the Medical Examiner’s office. It is easier for us to point and blame than recognize the underlying problem and come up with ways to fix it and thus save the Franks of the world. This Year, Let Us Mark Mental Health As One of Our Priorities Let us not forget our mental health and the mental health of others entrusted in our care. Be kind to one another! Use your professional expertise to advocate for others that cannot advocate for themselves! I do not know if Frank ever got justice and what was the outcome of the investigation. In the case of George Floyd there was no known mental issue but a suggestion of “awfully drunk” on the initial 911 call that needs to be verified by toxicology report. It still does not justify in any shape or form the overuse of restraint techniques used by the policemen. I hope and pray for swift justice for George Floyd, his family, an end to innocent people being harmed and for us to heal as a community. Every life is precious and every day is a chance to be a better person! As we cry out against injustice, let us persist for justice to prevail and be there for one another. In this time of unrest, I pray that let there be peace on earth and let it begin with me!
  8. I used facebook to reach out to nurses working in hospitals in many places in the U.S. I’ve rounded all numbers to protect the identity of the nurses who agreed to be interviewed. I offered to pay all the nurses I interviewed for their time, but they all refused, so I’m making a donation to the American Nurses Foundation Coronavirus Response Fund in their honor. The fund focuses on: Providing direct financial assistance to nurses Supporting the mental health of nurses – today and in the future Ensuring nurses everywhere have access to the latest science-based information to protect themselves, prevent infection, and care for those in need Driving the national advocacy focused on nurses and patients Ann works in a state that implemented a stay at home order in late March. It appears to be flattening the curve to the extent that many hospitals are almost empty. The state has only had approximately 10,000 confirmed cases with 300 deaths. In her county, there have been 150 cases with 12 deaths (total population of the county is 120,000). She used to work in a large, urban hospital but after four years started to feel burned out. Now she’s at a small hospital in the suburbs and is much happier, though there were some staffing issues at first. “I started in ICU 1.5 years ago and I wore many hats. At first, we were understaffed with a 1:4 ratio of ICU/stepdown patients (mixed) and no help. Now we have CNAs, and the ratios are now at a max of 3 (if you have 4, they are all stepdown).” Ann’s partner is also a nurse – she’s at a nearby hospital, but she is planning to give notice in a week to do travel nursing and relief work in areas that have been harder hit. I’m planning on interviewing her partner as soon as she gets settled. According to nurse.org travel nurses are earning over $10,000 per week to work in New York City right now. Changes? I asked Ann how her life as a nurse has changed since Covid-19 emerged. “I’m being flexed a lot – almost every shift. I went 2 weeks without work. Before Covid-19, I switched from full time to PRN, but I always had shifts 1-2 days each week.” Ann says the hospital is still paying a percentage of her pay. “For the last 3-4 weeks I’ve been getting paid to stay home.” There is currently a very low patient census with only 1 or 2 patients in the entire ICU. Ann continued, “COVID came in and all the other sick people disappeared -- no stroke, heart failure, COPD, pneumonia. People are afraid to come in and are staying at home.” Ann’s hospital has gotten creative with staffing. Healthcare workers who have reduced hours have been asked to be screeners in ER or to work as triage nurses at the phone for suspected Covid-19 patients, but they get paid their nursing pay. “The triage nurses take the calls and tell them to come in or not come in.” Testing Ann said they are only testing people who are admitted to the hospital. CDC guidelines recommend that state health departments modify guidelines to suit their state’s situation. The CDC says clinicians should, “use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Most patients with confirmed COVID-19 have developed fever1 and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing).”1 Priority Testing Priority 1 testing is reserved for hospitalized patients and symptomatic healthcare workers. Priority 2 testing is to ensure that those who are at highest risk of complication of infection are rapidly identified and appropriately triaged: Patients in long-term care facilities with symptoms Patients 65 years of age and older with symptoms Patients with underlying conditions with symptoms First responders with symptoms Priority 3: As resources allow, test individuals in the surrounding community of rapidly increasing hospital cases to decrease community spread, and ensure the health of essential workers Critical infrastructure workers with symptoms Individuals who do not meet any of the above categories with symptoms Health care workers and first responders Individuals with mild symptoms in communities experiencing high COVID-19 hospitalizations ER screening questions In the last 14 days have you: Traveled to China, Iran, South Korea, Italy or Japan Come into contact with a confirmed Covid-19 patient Had symptoms Fever greater than 100 Difficulty breathing Cough Are you currently experiencing fever over 100, difficulty breathing or cough? Triage protocol can be found at Triage of patients with suspected COVID-19 infection For areas with widespread community transmission, If there is fever or history of fever and at least 1 sign or symptom of respiratory disease, place a mask on the patient and then separate them from other patients in a single-person room with closed door. Droplet precautions should be instituted. At Ann’s hospital, if the patient is not sick enough to be hospitalized, they are told to go home and quarantine– right now her hospital is not testing them. She said, “Even if they are hospitalized, if they don’t present as a classic Covid-19 case, then they are not being tested. We are being told it is due to the lack of tests.” When I asked her if she knew how many testing kits were on hand and why they were in limited use, she said she didn’t know. I called labs and hospitals and had no success finding out the availability of testing kits in the area. Testing is ramping up in some states. On April 27th, 2020, I googled “Where is covid testing on the rise” and saw Minnesota, Indiana, Virginia, and Illinois are increasing testing due to a sharp rise in the number of cases. The same will likely occur in Ann’s state if Covid-19 gains a foothold there. How about training? “We’ve had training on how to take care of the prone intubated patient - how to put them on their bellies for safe care. I’ve gone online and read articles and we’ve done education on what it looks like and how it increases oxygenation.” “We also had a refresher course on PPE donning and doffing - how to do it and what is expected.” PPE? When I asked if there was enough PPE, Ann replied emphatically, “NO” “We get one new surgical mask daily. Prior to this they were one-time use. It says right on the box that they are to be worn a max of 40 minutes, but we are wearing them all day.” “It just feels so weird that we are rationing supplies when the hospital is so empty.” “We get an N95 that we have to wear for the entire week. We are wiping them down with sani wipes and placing them in paper bags when they aren’t in use, but the material will eventually break down.” “We turn them in and they are collected and are kept in case they need to be recycled or reused. As of right now we are not actively redistributing used masks. I think they are holding back because they are afraid we will run out.” “Gloves are not an issue. Gowns we are not reusing. We have those stupid paper gowns, the yellow ones, and we toss them. There’s an assigned nurse to guard the PPE – it’s locked up and you have to request PPE and sign a form.” I asked Ann how many times each day she had to visit the PPE distribution station? “In a 12-hour shift with 1 Covid patient I made about 7 visits and each visit took 2-3 minutes. You know, you’re a nurse, what impact that has on your day, on the care you can give.” Census I asked Ann if there had been many Covid-19 patients at her hospital. She said, “We are seeing patients trickle in. There are just a few between med surg and ICU, but there’s a larger hospital nearby that is supposedly full of Covid patients – we think they are coming here, but aren’t quite sick enough to be admitted, being turned away, waiting it out, getting sicker and then going to [the larger hospital].” “We tend to have one in the ICU at any given time and 2-3 on med surg floor. We are being told it’s coming and to brace for it. The entire third floor, which is a 40-bed med surg unit – is dedicated to covid with an additional 12 ICU beds. When asked how many Covid-19 patients she has cared for she said, “I have taken care of 2 – No deaths, all recovered, none required intubation, both middle aged, only one with comorbidities.” I wondered about the statistics about people going on ventilators – how do the Covid-19 patients compare with other patients who are ventilated? “In a year and a half in this ICU, I’ve only had 3 people not make it off the vent. Most are getting well compared to the covid patients.” Presentation “A lot of these patients present with low O2 sats, but are asymptomatic, they feel okay in terms of breathing. The O2 levels are really low because the virus is attaching where O2 would attach – it’s filling the receptors and blocking the O2 binding sites. It’s like Carbon monoxide poisoning. It’s affecting other organs in bodies. A positive is that patients with blood transfusions see a turnaround in 2-3 days and are not dying. That fresh healthy blood is making a difference.” According to Dr. Marc Moss, the division head of Pulmonary Sciences and Critical Care Medicine at the University of Colorado Anschutz Medical Campus, “There are other conditions in which patients are extremely low on oxygen but don't feel any sense of suffocation or lack of air. For example, some congenital heart defects cause circulation to bypass the lungs, meaning the blood is poorly oxygenated.” “A lot of coronavirus patients show up at the hospital with oxygen saturations in the low 80s but look fairly comfortable and alert”, according to Dr. Astha Chichra, a critical care physician at Yale School of Medicine. “They might be slightly short of breath, but not in proportion to the lack of oxygen they're receiving.” Chichra said it's becoming clear that patients who aren't struggling for breath often recover without being intubated. They may do well with oxygen delivered via nasal tube or a non-rebreather mask, which fits over the face to deliver high concentrations of oxygen. Hypoxic patients who are breathing quickly and laboriously, with elevated heart rates, tend to be the ones who need mechanical ventilation or non-invasive positive-pressure ventilation, Chichra said.2 What do you do when you get home? "I don’t wear scrubs home. My partner's facility keeps and launders her scrubs to sanitize them – so we both change at work, but I bring my scrubs home and wash them. I go straight to the shower, no hugs. I brush my teeth and gargle with antiseptic solution since the virus can live in your throat for 3 days. I bleach the bottoms of my shoes and leave them in the car, and I keep hand sanitizer in the car. “ “Since I have to change at work it poses this whole issue of changing in the ICU bathroom and then walking through the hospital without a mask. I wonder what is getting on my clothing. We have to leave our masks at work so I’m walking out to my car without a mask. I think I’m going to start bringing my own mask from home to do that.” When I asked about the rumors that some hospitals had told workers they couldn’t wear masks because it might frighten visitors, Ann said, “We are allowed to wear out masks at any time here.” Before we ended our phone call, Ann had a request for an article: “I think Covid-19 is showing where our hospitals are failing. Hospitals are having problems with payments, they’ve lost funding because we are cancelling all elective procedures – hospitals are taking a huge $ hit. It’s an interesting dynamic and I wonder where will things go with healthcare? Will folks realize that for-profit hospitals are a huge failure?” Well, Ann, I’ll look into that for you, but for now, stay strong and stay safe! What’s happening in your state? Do you have any stories to share? How many testing kits are available at your hospital? Thanks in advance for your comments. References 1 - Overview of Testing for SARS-CoV-2 2 'Silent hypoxia' may be killing COVID-19 patients. But there's hope.
  9. I’ve changed many details to protect the identity of the nurse I interviewed. I offered to pay her for her time, but she refused, so I made a donation to the American Nurses Foundation Coronavirus Response Fund in her honor. The Coronavirus Response Fund for Nurses focuses on: Providing direct financial assistance to nurses Supporting the mental health of nurses – today and in the future Ensuring nurses everywhere have access to the latest science-based information to protect themselves, prevent infection, and care for those in need Driving the national advocacy focused on nurses and patients Mental Health RN I interviewed Frannie, a mental health nurse who specializes in addiction medicine. She is a Registered Nurse who works at an outpatient opioid treatment center. I was surprised when she told me that some people wouldn’t describe patients on methadone as being in “recovery” because methadone is still an opioid. Frannie said, “If their story is that they are recovered, then they are.” I have no experience with this type of nursing, so I was fascinated to learn that about 30% of the patients at the clinic will likely be on methadone for life. “These are stable patients with jobs, families, work. They are highly functional.” I asked about access – do you have to get referred? Frannie said, “Anyone can walk in off the street. We have an NP there every day and a doctor 2x week.” For those struggling with addiction to opioids, methadone is prescribed at a low dose. Many start out at 30 mg daily, but some are now at the daily maximum dose. Their tolerance level is extremely high. If they have been doing fentanyl, they need a lot more. You have to not judge a 90 lb. woman who needs 200 mg to function.” Frannie told me many of her patients have been coming to the clinic for 5 years or more. Many of them are at 80 – 120 mg daily. I asked how a maintenance dose could max out. I wondered about tolerance. Frannie said, “A lot of it is psychological. If they miss a dose they feel like they have the flu. Most of them come in once a month or every 2 weeks for their supply. They take it the way they are supposed to and then come back for more.” What about the other 70% of your patients? “At the bottom of the ladder are the people who are unstable with comorbidities. People with higher levels of care do come in and we are trying to keep them off the street. These are the borderline stability folks. 15-20% of them are never going to get to take home doses. They have to come in every day. They are often also still using methamphetamines, cocaine. We test them once a month randomly, but even if they test positive, we still treat them. We keep an eye on their dose. Urine tests get sent to a lab. Sometimes we can’t dose them because there are too many other drugs on board. There’s a small percentage of patients who are freaking out, like they are coming in wearing three masks, but most of them seem to be hanging in there. They’ve already been through some rough S%$#. Even though they are addicts they have some resiliency.” Unique challenges to those with addiction According to the National Institute on Drug Abuse, the pandemic presents some unique challenges for people with substance use disorders and those who are in recovery. I read an interview with Dr. Nora Volkow, the director of the NIDA that focused on the collision of the Covid-19 pandemic and another very real public health crisis – substance use disorder. It really hit home when Dr. Volkow said, “We had not yet been able to contain the epidemic of opioid fatalities, and then we were hit by this tsunami of COVID.” Issues that are exacerbated by Covid-19 The healthcare system is not prepared to care for those with addiction Social distancing makes these folks even more vulnerable by interfering with the support systems that help them to recover The drugs themselves negatively impact human physiology, making those with addiction at higher risk for getting Covid-19. According to Volkow, it’s harder for patients to get access to treatment. Some clinics are decreasing the number of patients, the healthcare system is less able to initiate people on buprenorphine. If you are socially isolated and you overdose, it is much less likely that you will be rescued with naloxone. There are no statistics yet on how Covid-19 is influencing fatalities from drug overdoses. Research into the NIH’s $900 million Helping to End Addiction Long-term (HEAL) initiative came to a halt. Research into bringing medication-assisted treatments to prison inmates has stopped. Some IRBs are closing, making recruitment for research impossible. Dr. Volkow spoke of the need to be creative with virtual technologies to advance the goals of NIDA and the NIH. How have things changed at Frannie’s clinic since Covid-19? “For the patient it’s unsettling. They come here every day and it’s different. They are more stressed. They are constantly asking – are you going to close? They are so worried the clinic will close. It’s their life-line. We’re behind glass. Before we always had half the window open, now we keep it closed. There’s no paperwork due to pen sharing. We are doing it all on the computer. They used to get their own water from a pitcher, now we pour the water for them.” What about infection prevention? “People who in the past didn’t get take home doses are now getting them." I thought that would be a bonus for folks to not have to come in as often, but Frannie said, “People like coming into the clinic, though it’s hard to be responsible for all the medications. If they don’t live in a home, 14 bottles is hard to keep track of. You can’t get more take out if you can’t be responsible for your medicine. I’ve been surprised though that most of the ones who have gotten the extra doses to take home have been bringing back all their empty bottles, which is required if they want more doses. Another change is that we have to call them every other day on the phone to assess how they’re doing. I’m pleasantly surprised. It’s been interesting to call my patients every day. I thought maybe they wouldn’t answer their phones, but they are sober and kind and happy for the check-in. It’s increased my trust in my patients. I have to wear a mask and gloves all day and the patients also have to wear them. We keep their masks in plastic bag with name. It’s now the security officer’s job to let in ten people in at a time. He hands out the masks.” Frannie said previously there were between 20-30 people in the room, “being social and seeing each other, they miss the interaction." I wondered if the patient masks dry out in those baggies. Frannie said, “I have no idea. That’s the policy – it’s what we have to do. I am getting some skin breakdown from the mask. I switch between my homemade and my surgical mask. There are four of us nurses in the pharmacy and our desks are not 6 feet apart. No one is changing their masks. Despite that, I think we’re doing a pretty good job. I think we don’t give them enough credit. We talk about how vulnerable they are, but they are doing okay. They have surprised the crap out of me.” Future interviews I’ve written up interviews with two other nurses, so if you enjoyed this one, check them out: At the Bedside with Covid-19 - Stories from the Frontlines At the Bedside with Covid-19 Part 2: John I hope to continue to interview nurses in various roles. Please let me know if you would like to be interviewed, or if you have any requests! Next up is an interview with an ER nurse.
  10. On April 27th, the CEO of Denver Health Medical Center (DHMC) issued an apology to employees for the timing of executive and management incentive bonuses. The 2019 bonuses, paid out on April 10th, came a week after front-line staff were asked to voluntarily take leave without pay or reduce their hours. The hospital is facing the same financial challenges as many other facilities in the wake COVID-19. Employees Asked to Sacrifice On April 3rd, CEO Robin Wittenstein sent an email to employees how the pandemic will cause the hospital financial stress. Wittenstein’s email detailed measures that would be taken to ease the facility’s financial strain. These included: A hiring freeze Ask employees to voluntarily take leave without pay Use personal time off, or Reduce hours in work week Wittenstein warned more extreme options, such as mandated use of paid time off and mandatory leave without pay, may be needed. However, the goal was to avoid these measures if possible. Big Bonus Payouts The dollar amount of bonuses is determined by the organization’s board of directors. Many of the bonuses paid out on April 10th were between 17% to 19% of executives’ salaries and were between $50,000 and $100,000. Wittenstein received a $230,275 bonus, totaling 23.8% of her $967,155 annual salary. According to CBS4, about 150 hospital executives and managers received bonuses for their work during the payout. Hospital administrators have defended the bonuses saying the money puts DHMC executives and administrators at about the 50th percentile of what other administrators across the nation are paid. Employee Reactions Hospital workers expressed anger and frustration over the payments. An online petition, posted on Change.org, called for executives to return the bonus money. The petition was signed by 3,449 individuals and included many DHMC employees. Chris Hinds, a Denver City Councilman, also asked the bonuses be returned and used to benefit front-line workers. During a facebook live session, Hinds stated Late Apology On Monday, April 27th, Wittenstein sent an email apology to hospital staff. The apology came 4 days after a local news channel first reported the executive bonuses. Wittenstein apologized for the timing and acknowledged the payments have “caused you hurt and anger”. According to CBS4, she also apologized for the lack of transparency writing Wittenstein also informed staff she too was sacrificing by using her paid time off in place of her regular salary. She also waived accrual of her paid time off for the next 3 months. In an April 14th email, Wittenstein asked her executive team to also give back. As a result, the executive staff reduced hours and pay by 12%, contributed over $550,000 in salary back to the hospital and donated $386,000 to the Denver Health Foundation for an employee relief fund. According to Wittenstein, a 100% of the executive team agreed to give back in some way. Board Response The Board Chair for the Denver Health and Hospital Authority also sent an email apology, writing **DHMC has 7,000 employees and treats about 930,000 patients a year. QUESTION: What do you think about incentive payments to hospital administrators? References Denver Councilman Calls Hospital Bonuses Disgraceful Denver Health CEO Apologizes For Timing of Executive Bonuses Denver Health Executives Get Bonus 1 Week After Workers Asked To Take Cuts
  11. J.Adderton

    If Truth Be Told...

    I have been moved by the awesome outpouring of gratitude from the public during the coronavirus pandemic. My spirits are lifted each day as I pass the homemade “Thank You” signs and banners that line the road leading to my workplace. I have especially enjoyed reading the cards and letters sent by the youth to encourage the nursing staff. It gives me hope that the younger generation will carry a deep respect and appreciation for healthcare workers. Gut Reaction Concerns But, there are some expressions of gratitude that have been gnawing at me. When certain people cheer on front-line workers, I immediately have a major internal “eye-rolling” moment. Since I’m not a cynical person by nature, this gut reaction has bothered me. When I am struggling with something internally, it always helps to write it down. I So, I did just that…. fleshed it out for insight. I write under a pseudonym, which gives me the freedom to openly share my experience and thoughts when I write. Insincerity? Now that I have a better understanding of my angst, I suspect I am not the only lonely tree in this parking lot. The “people” whose apology I often perceive as insincere are executive administrators, politicians and lawmakers. Recently, healthcare administrators sent messages praising how we’ve “all come together”, “stepped up to provide competent and compassionate care” and “supported the organization’s mission during trying times”. But, thoughts like these below keep me from truly accepting their gratitude. Because I'm a Nurse I am a nurse, and like other nurses, this is just what we do. Yes, it is unprecedented and scary times. But because I am a nurse… I care for COVID patients with the same high level of commitment that I have for all patients throughout my career. Feeling Under-Valued I don’t feel valued by executive leadership and this is a common occurrence throughout my nursing career. There are many reasons for this, but the majority seem to be “universal” regardless of the employer. The "Executive Silo" I have had exceptional supervisors, managers and directors over the course of my career. Unfortunately, there have been times the voices of nurse leaders are not heard. Decisions made by executive teams are often made in a silo. This “executive silo” too often consists of non-medical individuals or individuals who are long removed from day to day realities. Disregarding OUR Safety My safety, as well as my co-worker’s safety, has been undermined by decisions driven by profit. Safety concerns run the gamut, from available PPE to violence against healthcare workers. I have worked the past few years with less than a $1.00 raise despite stellar evaluations. However, I have never lowered my patient care standards based on pay gaps and poor incentives. FACT: I suspect that Senator Walsh’s “card playing” remarks are shared in political circles. At minimal, her public comments certainly did not help build a rapport of trust. Recognizing and Addressing Personal Biases I’ve given much thought to what it is that I can do to address my biases. Ultimately, I need to use my voice and get involved. I plan to communicate to upper management that I appreciate the recognition for the quality of care I and other nurses have always provided. I also need to network with other nurses and educate myself on the barriers that keep nursing from being perceived as a profession. But most of all, I need to advocate for the profession I love. Final Note I wrote this article about my experience during the COVID-19 crisis. I acknowledge that my thoughts are limited to my own personal experiences and circumstances, which may be hugely different from your own. Even though my facility had a large number of COVID patients, we have not reached a point of an overwhelmed system. I invite you to tell us about your experience.
  12. SafetyNurse1968

    At the Bedside with Covid-19 -Part 2: John

    I used facebook to reach out to nurses working in hospitals in many places in the U.S. I’ve rounded all numbers to protect the identity of the nurses who agreed to be interviewed. I offered to pay all the nurses I interviewed for their time, but they all refused, so I’m making a donation to the American Nurses Foundation Coronavirus Response Fund in their honor. The fund focuses on1: Providing direct financial assistance to nurses (RNS SEE ELIGIBILITY HERE) Supporting the mental health of nurses – today and in the future Ensuring nurses everywhere have access to the latest science-based information to protect themselves, prevent infection, and care for those in need Driving the national advocacy focused on nurses and patients John works in an ICU in a large, urban hospital with 50 confirmed cases and only 4 deaths in a county of more than 300,000 people. In John’s state, there are 12,000 confirmed Covid-19 cases with 450 deaths. Their stay at home order occurred on March 30 and has been extended to June 10, 2020. PPE situation I asked John if he feels safe at work. His response was disturbing. “No, because they aren’t following protocols. I’ve worked in the ICU for almost 20 years. I love my job, and I’m passionate about educating staff on best practice, but I just got written up for trying to get my fellow coworkers to follow isolation protocols.” “To take a Covid-19 patient off of isolation, you have to have 2 negative tests greater than 24 hours a part – and even then, if the patient is still febrile and symptomatic respiratory wise –they are to remain on isolation as if they have Covid unless the physician discontinues the isolation. But nurses are opening the door and taking away the isolation cart – they are deciding the patient is fine. My question is, who am I supposed to go to when I see a break in policy with covid and the supervisor has no idea what’s going on and it’s putting me and my patients at risk? Another issue is how we deal with aerosolizing procedures. Any time you break into the vent line --Respiratory Therapists have to do that to change the filters in the vent --every time you open that circuit, the CDC says for 3 hours afterwards, anyone going into the room needs and N95 mask, but my hospital is doing 2 hours. I mean, technically, covid patients should be in negative isolation since it’s droplet, but limited rooms make that difficult. For patients who are not vented, you used to need an N95 for any Bipap, cpap or vapotherm that was over 6 liters, but they just changed it to >20 liters. And it’s all about PPE.” John says the hospital is assuring them that there is plenty of PPE. “They won’t give us numbers and they are asking us to recycle surgical masks, eye wear, N95, into a bag – But we don’t know the method. When will it happen? No information is being given.” “I was one of those people wearing a mask prior to it being mandatory. People looked at me like I was nuts. Now it’s mandatory.” To protect employees, John says they’ve closed down almost all entrances to the hospital, and no visitors are allowed. “The staff come through one entrance and there are screeners who take our temp with an infrared sensor, hand you a mask, and you sanitize your hands. John describes three levels of masks. “The one you get at the door is the cheapest – for housekeepers – it’s a level 1 – much thinner. Level 2 is a true surgical mask. Here’s the problem, people are walking from the parking area, getting on an elevator unmasked, not maintaining a 6 foot distance. These people are filling the elevators to get the mask, without wearing a mask! It’s insane. The N95 are under lock up with a guard. The only way to get one is if you have a covid suspicious patient, and they count everything. There are five locations in the hospital where N95s can be obtained, all of them guarded by nurses or security guards. If you have a patient on isolation, they bring you a PPE cart. If you run low on the cart, they bring you what you need.” Reuse of N95s “You have to reuse the N95s – they keep changing it. Right now I think it’s 1 per shift. There’s an egg crate container for your mask and it goes in a paper bag, but my concern is that the next time you have to reach in the bag you are contaminated. The bag must be thrown away after holding the mask. I’m using a Tupperware method to let mask dry out without contaminating myself.” According to the CDC, extended use is preferred over reuse.2 “A key consideration for safe extended use is that the respirator must maintain its fit and function. Workers in other industries routinely use N95 respirators for several hours uninterrupted. Experience in these settings indicates that respirators can function within their design specifications for 8 hours of continuous or intermittent use. There is no way of determining the maximum possible number of safe reuses for an N95 respirator. Hang used respirators in a designated storage area or keep them in a clean, breathable container such as a paper bag between uses.” Testing kits When asked how many test kits are available, John replied, “No one knows. There is rumor that our hospital isn’t testing anyone because they want to keep the perceived numbers down, make us look like a nice place to visit.” Census “Our hospital has only had 5 truly positive Covid tests, we’ve had 10 or so presumed positive, and a ton of PUIs (patients under investigation). We are waiting for test results for more than 100 people. But all of them are coming back negative. So we shut down the covid unit and sent most of the nurses home on pandemic pay. There is no one to test, no one is coming in. Patients are coming in for open heart surgery, which is incredibly stressful to the body, and then are becoming covid symptomatic. The tests we are doing can’t be accurate. If they don’t have covid then what do they have? I saw a patient with classic symptoms. She had thrown microemboli, she had bruises in her toes, but both tests were negative. When they did a bronch – the bronch was positive. The nasal swabs aren’t getting it. My question is, before doing a nasal swab, the patient is supposed to blow their nose, but you can’t do that on a vented patient. So maybe it’s not deep enough. We are seeing many patients with symptoms of covid who are testing negative. We have two other patients who we are pretty sure are covid positive, but they are not sending the bronch washes for testing.” (A “bronch” is a bronchoscopy – a thin tube is passed through the nose or mouth into the throat and lungs. Common reasons for a bronch are to get a sample to send related to symptoms or something unusual seen on a chest X-ray, or to remove foreign bodies or other blockages from the airway.) John went on to say, “A heart patient came in with a PO2 of 45 and after getting open heart surgery, covid symptoms appeared. He had two negative nasal swab tests. He was bronched but the sample wasn’t sent for covid testing. You’re supposed to send all samples for covid testing. Another patient was tested multiple times with the nasal swab and came up negative. Finally she was bronched and it was positive.” Here’s a Youtube video3 from Mt. Sinai on how to do a proper Covid-19 test: Proning I asked John about proning patients. “Proning patients has been around for a long time – we used to do a lot of proning. Our staff are all young and none of them have proned, so last week we had two classes on how to prone.” According to a review of literature conducted on April 11, 2020, Covid-19 can cause pulmonary edema, multi-organ failure, and acute respiratory distress syndrome (ARDS). The prevalence of ARDS among COVID-19 patients has been reported to be up to 17%. The prone position can be used as therapy for improving ventilation in these patients. “The main mechanisms of prone position in improvement of ARDS patients’ condition are affecting recruitment in dorsal lung regions, increasing end-expiratory lung volume, increasing chest wall elastane, decreasing alveolar shunt, and improving tidal volume. Patients remaining in lengthy prone position sessions leads to decrease in mortality of patients. However, correct selection of patients and applying the proper treatment protocol for prone positioning are key to its effectiveness.”4 I had never seen this, so I asked John to describe it to me. Read this step-by-step article describing how to do it and what it looks like.5 “It’s like sleeping on your stomach. With your left leg on a pillow, your head is turned the same direction as the left leg and the right arm is behind the patient with the patient’s right shoulder touching the bed and the hand is palm up. We also turn them the other direction. You aren’t completely flat. They do have proning tables, but they are so expensive. The biggest problem with proning is keeping the face and ears from breaking down from the weight.” ECMO Another therapy that John is excited about is extracorporeal membranous oxygenation (ECMO) “We started doing this 4 years ago as a last resort. You insert a massive canula into the jugular, or the femoral artery, you can even stick the canula into the heart. It pulls the blood to the machine, filters it to remove carbon dioxide, oxygenates it and returns it.” John went to Emory to learn how to do it. “What I love about ECMO is that it is nurse driven. Most hospitals have perfusionists doing it, but here, we run them. It’s intense. You need 2 nurses to 1 patient. It totally works – saves lives.” ECMO essentially replaces the function of the heart and lungs. It can be used for months to support patients until lung and/or heart function can be restored. For more information on ECMO, read this.6 All of these nurses are experiencing skin breakdown behind the ears, so if you know of where I can get them a behind the head ear loop holder, please comment!
  13. vmbennett

    We are Stronger Than Fear

    March 25th - Dear Diary: Stronger than Fear Over the weekend, my husband and I interacted with our church regarding the COVID 19, by online streaming the sermon in our pajamas. We also called and texted our family to check on them and wished friends happy birthday over the phone and celebrated with face time. As far as work goes, it is an eerie kind of calm right now. The intensive care unit (ICU) is not full yet. We have 38 general ICU beds, 12 Neuro ICU beds, 20 Cardiac ICU beds, 12 transplant ICU beds, and post-anesthesia care unit (PACU) beds available as a total. Not even half of these are full due to the cancellation of elective procedures and surgeries. The interaction between co-workers is quiet and focused. We occasionally talk about the special report on the television being overheard from the patient's room, but no one elaborates on the subject. My co-workers and I follow the guidance of our physicians to the point that if they do not show panic, neither do we. We are trained not to alarm other patients and visitors by our reactions and anxiety while in the hospital, so I have incorporated this mannerism at home also. I try not to increase my 72-year-old mother's fear by exemplifying calm and control when listening to her concerns. By no means do I downplay any concerns she has, but I explain the guidelines and instructions she should be following in a way not to alarm her. I adopted this habit a few years ago as my parents aged. I realized that increasing their stress and concern for their children did not benefit their health. April 24th - Dear Diary: Still Stronger than Fear Anxiety about resuming business and so much anger about continued regulations is being exemplified by today's society. People are feeling the need to catapult to one side or the other, then fight the opposition. Social distancing was never meant to stop the viral spread, but to slow it down while medical infrastructure was put into place. Protective measures have been put into place, and testing procedures have improved. The personal protective equipment supply chains have increased production, and the community has joined together in furnishing the needed equipment such as homemade masks, gowns, face shields, headbands, ear protectors, and touchless thermometers. This area has increased the testing sites by nine folds in the last few weeks and is working hard to overcome this crisis. A vaccine is still not in sight and probably will not happen until 2021. The Governors and city mayors are talking about systematic exposure with herd immunity, which will increase the cases after reopening the economy. Ideally, that exposure is controlled and calculated, in phases, to allow our medical community to respond adequately, and reduce the number of severe or fatal cases. Social distancing was never a solution for this virus and never going to eradicate this virus. Individuals will now need to proceed as their health, wallet, and conscience allow. The immunocompromised and medically vulnerable should not take part in what is about to happen. Stay at home if you can. Financially vulnerable individuals that must rejoin the workforce, please proceed with caution. Protect yourself, protect the elderly, and medically vulnerable around you. Fighting the opposition is not the answer. Financially struggling families do care about human lives, and those at high risk of dying from this virus are not cowering in fear. Not everyone is in the same boat. Judgment, harsh words, and disrespect do not change opinions. It just makes you a bully. We do not have to choose sides and fight. We can make different choices and still be a supportive community. We can learn and evolve in our understanding of these issues. StrongerThanFearCovid19.docx
  14. Hospitals and Nurses Are OverwhelmedThroughout the US many hospitals are overwhelmed with the ongoing pandemic of the COVID-19 virus. They are short-staffed on nurses forcing them to work long overtime hours. Many are so overwhelmed that they are hiring travel nurses to make up for the shortage. I am currently an RN at a hospital in Minneapolis MN and am experiencing the complete opposite of this. Social-Distancing?I work on a floor consisting mainly of elective, emergent as well as non- emergent surgeries. A little over two weeks ago all elective surgeries were postponed and absolutely no patient visitors are allowed in the hospital. Initially they told us this decision was made to promote people to stay home (social distancing) and to conserve hospital beds, ventilators, monitors and other critical supplies that will be needed for this pandemic. This has left the hospital quiet and very empty compared to the normal chaos of the typical daily pace. Patients are anxious and feeling alone not being able to have family members with them for support. Family members are confused and scared, constantly calling to get updates on their loved ones’ condition. As nurses we are taking on a lot of stress relaying messages between doctors and families, consoling people that are sad or upset, and trying to be positive to help shed some light on this situation. Hospitals are UnpreparedIt seems as though the hospital did not know how to prepare for this type of crisis. After the first influx of patients being tested it took weeks to figure out where they would put these patients and how we would get proper protective equipment. They now have elected one of our medical floors to take all of the COVID rule-out and positive tested patients. In addition, some ICU beds have been dedicated to caring for the critically ill patients needing ventilators. You can see and hear the frustration with this decision because now all the responsibility to care for these patients is only on a select few units. They are putting themselves as well as their families at risk to be exposed to this virus. While these nurses are hard at work and in a high-stress environment, other floors have completely shut down or decreased their patient populations immensely. This includes the OR, care suites, surgical specialties, orthopedic and observation units. This last week many nurses have been called off to stay home or put on low need due to the decreased census of patients throughout the hospital. Nurses are being floated every day to sit at door entrances for hours, screening visitors trying to enter the hospital. Other nurses are teaching classes about how to put on and take off PPE equipment. Some are walking around going to every unit basically begging to find any place they can help. I have done so myself and can speak for most of the nurses that we all feel a little useless not being able to care for patients. Financial Struggle Equals Threat of Lay-OffThis week we received notice that the hospital is struggling financially due to this pandemic. No surgeries and a major decrease in admissions mean no money coming into the system. In the next month they will be cutting back nurses’ hours, laying people off, or paying them a minimum of 50% of their FTE. The rationale for this is to conserve the hospital revenue as much as they can; all to prepare and utilize it to stock up on PPE equipment for the upcoming months when COVID numbers are expected to skyrocket. Calm Before the Storm?It is uneasy and hard to tell if this is truly the calm before the storm or if many nurses will have to apply for unemployment alongside a large number of other Americans. People see the news and expect all US nurses to be the ones on the front line helping patients and communities through this crisis. It is truly heartbreaking to feel that you may have to look for a new job at the end of this or could be thrown back into a completely unorganized surge of ill patients, without proper training or equipment. Nurses are full of anxiety and on edge not knowing what the future holds for us in our career. This pandemic is truly affecting everyone in a different way, causing lots of uncertainty and stress. I just hope that some clarity can be shed soon so we can properly prepare for this and try to prevent the spread of this virus to our population and healthcare workers.
  15. Linda Mellace Rice

    Birth Doesn't Wait

    For better or worseBirth doesn’t wait. Not for traffic, birthdays, baby showers. Not for other deliveries. And certainly not for good times. In 21 years as a midwife, I’ve witnessed pregnancy proceed through desertion by spouses, death of loved ones, job losses, homelessness, and yes through pandemics. Its never-ending persistence is both tragedy and hope. Obstetrics is kind of a weird specialtyWe tend to be in a bubble from the rest of the hospital, yet everything passes through. Disease, accidents, grief, abuse and all of life and medicine don’t pause for pregnancy. And, midwifery is somewhere between medicine and art. It’s the only job in the hospital where most of the time I have a duty to actively do nothing. To honor the wisdom of the body, and protect the ancient process from outside influence while also minimizing risk. It’s normally a tightrope that hospital-based midwives walk gingerly. Since Corona, I feel the tightrope snapping. Birth is above else a letting goThe less safe a woman feels, the less her body is able to toil through the work of labor. Worry is always part of the price of parenthood. When women tell me they’re worried about being a good mom, or worried that something will go wrong, after listening to their concerns and making sure they don’t have real anxiety, I reassure them that worrying is how I know they will make good mothers. It is our mother bear instinct that made me, a woman who handles babies for a living, worry about dropping my newborn son as I carried him up the stairs. The normal worry of motherhood is work enoughMy first rule for my patients is not what they eat or how much they lift, it’s “no googling”. I started as a labor and delivery nurse in 1989, and too much information, especially bad information, always caused more angst than it was worth. Back in the early nineties, the culprits of this excess of data was your mom, your co-workers, or your aunt Linda. As I’ve told my patients, in 21 years of midwifery, not one woman, according to her coworkers, has ever been the correct size. Most are “huge”, some are too small, but I’ve never had a woman tell me, “you know everyone tells me I look perfect for my gestational age”. However, the more modern barrage of internet experts and social media opinions makes for plenty of crazy. It's all about CovidNow we’re faced with many women home, on devices or TV, and it’s all Covid, all the time. And after 21 years of saying, no, the media, or web MD, or aunt Karen is blowing the risk way out of proportion, I now have to say, this time it’s real. If a pregnant woman becomes infected, she knows what the worst case scenario is. The thing about this epidemic is, even the best case scenario is somewhat dismal. Much of it has to do with the environment of birth which has suddenly shifted under our feet. For the first time, women may have limited or no support persons with them in labor. Family that was supposed to come help with other children are now quarantined in other locations. Women that were just visiting are now stranded here away from home, family, and their own healthcare providers. Women who test positive are told they must be separated from their newborns. I know many of us are postponing life events. As heartbreaking as it is to postpone a wedding, graduation, or vacation, birth doesn’t wait. For most of us, the most significant event in our life can no longer be shared by fathers, wives, or grandmothers. The missed, precious first few days of our children’s life can never be recaptured. Difficult decisionsBoth pregnant women and health care providers are left with agonizing decisions. Should we cut down on prenatal care? If she has abdominal pain, which 99% of the time is normal and 1% is perilous, does she come to the hospital? And then there are the women who have the virus. Everyone else who has mild symptoms is being told to stay home, but birth won’t wait. As the rest of the hospital is organizing around the epidemic, separating into “corona” wards, labor and delivery continues to pulse through the rhythms of labor, birth, complications, and cesarean sections, whether we have an isolation room or not. Like the rest of healthcare, like the rest of the world, we grapple with questions which have yet to be answered. What happens when our first patient goes on a ventilator? Who takes care of the baby after? The mothers who test positive are being separated from their infants, but by definition, aren’t their other family members at risk for being carriers? I sat with a patient to take her history, and for the first time in my career, instead of shaking her hand or giving her a reassuring pat on the shoulder, I sat on the other side of the room. We weren’t wearing masks yet for symptom-free women, because we didn’t have enough. She was alone, had the trepidation of any first-time mom, and instead of getting a midwife, a word that literally means “with woman”, she got a bank teller. This is not our first pandemic ...... and won’t be our last. Birth doesn’t wait. Not until we have enough masks, not until we have enough nurses, and not until we feel safe to take our infants home. It won’t wait until your husband can share it with you, or until your mother can help you at home. It has persisted through war, slavery, and poverty and disease. Birth is humanity persevering from our ancestors to our grandchildren. Birth is hope when we feel hopeless.
  16. spark plug

    My Dream That Finally Came True

    I had a job that I had been at for 22yrsI was scared to leave, to start my DREAM. Not knowing how I would pay my bills, how was I to pay for school, where and when was I going to find one. Plus being a single mother. This list of questions has been weighing on my shoulders and my HEART for 17yrs. Let me tell you my story. My dream started when I got to take care of my boss’s motherShanta was her name. She was a sweet lady. Always wanting to learn new English words and there meaning. She always asked me to hem, pin, sew and iron her beautiful Saudi’s among other tasks that she would ask. As the years passed by, Shanta started to have health issues. Her diabetes was under a watchful eye. That’s where I began to be her caregiver. Then her arthritis started to get so painful that she had to start, Embrel. I then started to give her daily injections. Sometime later, she became very ill. My mother and I stayed with her one night. She kept talking in her language, she was asking her god to take her, she was done and tired. Morning came when the day nurse got there my mom and I left. Later that day she sadly past on. I will always cherish the times we had together. She is DEARLY MISSED! A friend of the familyMr. Bob Massey was a very gentle, kind, helpful, caring, funny man. He had a heart of gold. Bob became ill, they found a tumor in his brain. The day he surgery to remove the tumor took over half the day. When the doctor finally came out, he said, it was bigger than he had thought. Bob had to undergo many Kemo and Radiation treatments. Bob was just getting weaker and weaker. One day I went to pick him up for a doctor's appointment, he was taking a long time to get ready. I went down the hallway and said, Bob, are you dressed he answered yes. I went in his room to find him NOT ready at all. What I saw was my son and Bob coloring away. Bob said, he wanted to color and so I did I’m not getting any better I’m not hurrying. This little guy wanted to color and I did, I don’t think I’ll ever have the chance to color again. As I watched them two color, I was to see Bob spend time with my son and color for his last time. We finally got to the doctor, only for them to admit him to the hospital. As I was leaving his room he said, Tronna your feet are getting wet. It meant that was where I needed to be a NURSE. After two months of fighting, Bob went to be with the lord. NaNaAfter Bob passed away, I started taking care of my NaNa. She couldn’t walk and was in a wheelchair. I became her leg from then on. I would go over in the morning after work transfer her the bedside toilet, let her wash her face, pick her clothes out for the day, get her dressed. Then we were off to the living room to drink coffee and chit chat with PaPa. I made breakfast or went and got it, whatever they wanted to do. We would sit down for breakfast having many conversations, and PaPa always trying to educate me. I remember staying the night with them and waking up to the smell of bacon. NaNa was up at the crack of dawn to get it made, for my PaPa he liked to eat early. After breakfast I would get them settled for the day and go home. At 8pm at night I was right back over there to get NaNa ready for bed. After she was all tucked in, I would sit down and talk with PaPa before I went to work. Saturday was bathing day for NaNa, doing grocery shopping and do their laundry. One day my Nana got sick, we went to the hospital and they said, she has gallstones that she needed surgery. Surgery day came and the family was there. Finally after it seemed like forever the doctor came out and said the surgery went well and that my Nana was fine. She was doing fine for about a week, then we got a call that she was going to ICU. Her body was weak and she stayed there on machines for weeks and was not getting any better. The day came that we all dreaded, It was time to take her off the machines. I sat and prayed with her before everyone got there. Nana knew what was going on, it wasn’t her brain that was gone, her body couldn’t fight anymore. When everyone was there we gathered around her bed, Papa on one side of the bed holding her hand and my brother holding her hand on the other side. My two nieces, mom and I stood at the foot of the bed. Then the nurse came in with syringes the nurse took one of the syringes and put it in my Nana’s IV, then respiratory took out the oxygen tube. Her eyes open I was thinking just breathe just breath. Her eyes began to close. That’s when she went on to be with the lord. August 3, 2009. PaPaAfter NaNa passed I continued to keep the house up to par and do things for Papa. He was alone after 54yrs. Even tho we both missed Nana, I knew he was missing her most of all. I felt bad for him. When it came time to work on “guy things” he would teach how to do it hands on I didn’t mind getting my hands greasy. He would still make sure the grocery list was made out and every Saturday drive me to the store then wait on me outside. The same routine was followed as if Nana was there. PaPa would make himself dinner, if he was tired of microwave dinners or throw on a pot of beans in the morning for dinner. One morning when I got to Papa’s I noticed the front door was not opened like it always was. This made my stomach dropped. When I got in the house, Papa had a stroke in the bathroom. The paramedics got there and Papa refused treatment so they left. I put him in Nana’s wheelchair and he wanted me to make breakfast. I did as I was told. Later that day I was able to get him to the hospital. He was there about 3 weeks before he went to be with Nana at the Lord's house. I finally left my job of 22yrsI got into school to become a CERTIFIED NURSING ASSISTANT, GOT MY BLS, and then HHA. I graduate at the end of the month. I HAVE MY DREAM AT THE TIPS OF MY FINGERS. I will soon hold this Dream in the palm of my hand close my fingers make a fist and NEVER NEVER LET IT GO. I’m ready to enjoy life.
  17. Interview With a Psychiatric NurseThis interview with Morgan L., an inpatient psychiatric unit nurse, started before the onset of the novel coronavirus. During the time of the interviews for this article, she volunteered to work with any patients infected with the virus. At this writing, the patients suspected of having COVID-19 are being sent to a nearby hospital for observation. She remains on standby to work in that capacity if needed. 1. I understand that you volunteered to work with COVID psych patients. Why?I volunteered to work with COVID psych patients because our administration said that if they didn’t have any volunteers, they would pick staff members from each unit, but certain staff members would be excluded if they had young children or were caring for someone elderly/immunocompromised. I knew I would be picked if I didn’t volunteer, and I didn’t want my administration to essentially say that my life is less valuable because I’m not actively caring for a child or elderly family member. Right now we don’t have a COVID unit, we are screening patients and watching for symptoms. If they have symptoms, we isolate them, send them for testing, and they usually get admitted to the hospital if they’re positive to be monitored for decompensation. We will only open a COVID unit if we see a significant surge in psychiatric patients with the diagnosis. 2. How has it been so far?COVID has been stressful on our unit - we’ve seen a lot more admissions for suicide attempts, anxiety, and drug relapses because patients can’t handle the stress of being out in the world right now. We’ve restricted a lot of our previous activities to limit patients’ exposure, so we no longer go to the cafeteria, have visitation, or go to activities groups. This causes the patients to be on the unit a lot more, cooped up with one another, and we’ve had a lot more disagreements and codes because of it. Needless to say, we’re all ready for this to be over. 3. Where are you from? What interested you in nursing?I was born and raised in Maryville, Tennessee. I initially became interested in healthcare when I was diagnosed with aortic valve regurgitation at the age of 12 after frequently experiencing shortness of breath and fainting spells. The nurses who cared for me throughout the numerous tests did everything they could to make me feel comfortable, even when they were going out of their way. I realized then that I wanted to do something with my life in which I could help people feel safe and loved when they’re scared. 4. Where did you go to school?I went to the University of Tennessee, Knoxville, for undergrad. I was delayed in school for a year and took three years to finish nursing school due to an arm injury that left me unable to move my arm. My current credentials are BSN, RN. 5. Where have you worked in the past?Throughout my undergrad I worked as a pharmacy technician at a chain pharmacy. The job was very stressful but I learned a lot, especially with medications. I also was a healthcare coordinator at a Summer camp in Occidental, California, for two summers, where I ran the first aid center and managed nurses and camp staff. I did my practicum during my senior year at Peninsula Behavioral Health and continued to work there as a behavioral health technician until I graduated and until I started work as an RN. 6. What interested you about psych nursing?Originally, I was interested in pediatric nursing due to my previous positive experiences. In a leadership program in college, I was paired with a child psychiatrist and spent many hours shadowing her as she worked in both inpatient and outpatient settings. I came to realize that while I love kids, I do not love the nursing aspect of caring for kids (LOL). I was very interested in the psychiatric side of things, and loved my clinicals in psyche nursing that followed. 7. What do you like about psych nursing?I love being a psychiatric nurse because I feel as if I can care for people who are not only suffering mentally, but are also fighting against the stigma of mental illness that exists in the world. I feel like patients who have mental illness are not only fighting their depression/bipolar/schizophrenia, etc, but are also fighting to inform others that their illness is real. A lot of patients have never had anyone listen to them before, so it is good to be this person for them. 8. What do you dislike about psych nursing?The hardest part about psychiatric nursing is balancing both mental illness and behavioral problems. A lot of patients have never had anyone listen to them before, so they have learned to make their presence known by acting inappropriately. Behavioral modification is necessary for these patients, and it can be exhausting. 9. Can you think of a particular case that stayed with you? That impacted your practice in a positive way?The case that comes to my mind is a patient from about four months ago who tried to commit suicide by driving her car off a cliff. She was severely injured and came to us after spending 2 weeks in the ICU She had a broken leg, a broken wrist, and over 50 stitches in her face. She was in a wheelchair because of a femoral cast, leaving her unable to walk. When I came on as her nurse the first day, I noted that her hair was matted. She told me she hadn’t had a shower since before her suicide attempt - 2 weeks in the ICU and no one had bathed her! (Except for a sponge bath in bed). Later that day, a tech and I took her to the walk-in shower and helped her shower, and I spent over an hour combing the glass, dirt, sticks, and blood out of her matted hair. She told me all about her family and how she had three children at home. She was a single mom, and two of her kids had disabilities, and her husband died unexpectedly the month before. She had become overwhelmed. It became very apparent to me how quickly certain life circumstances can change someone who previously had never been depressed and how mental illness truly does affect all of us. She became a new person after that shower, and had a more positive outlook solely because someone took the time to listen to her. This is why I love psych! 10. What advice would you give other nurses that might want to pursue psych nursing?I think if a nurse wants to pursue psych nursing, they need to make sure that they can aim to be non-judgmental with patients. A lot of our patients are judged in every other area of life, and they need a place to be where they won’t be looked down upon because of their choices. Also, have boundaries! Patients (especially those with addiction disorders) can be manipulative and will try to push you. It’s important to have boundaries with patients and stick to them.
  18. Sorry and thank you in advance for the long read. My Story - At Home with CoronavirusI have been out sick from work for several weeks due to the coronavirus. I am in my mid 20's, extremely healthy, no comorbidities. My symptoms progressed slowly but were severe for a time. There were nights I would wake up multiple times soaked in sweat, alternating between uncontrollable shivering and feeling freezing and like I was melting. Temps in the 103's and some time loss/hallucination. All of these experiences have been coming back to me as if I were blackout drunk for two weeks and the details are just slowly filling themselves in. Now that I am capable of once again thinking logically, I know I should have gone to the ER, but I didn't and I got lucky. While all of my other symptoms are gone my exhaustion, cough, chest tightness, and shortness of breath remain. I know that there is likely damage to my lungs that needs to heal, and I know that I won't be able to make it through a shift in my current state, let alone breathing through a mask the entire time. However, I am now expected to return to work. Return to Work?The ever loosening restrictions coming from the upper echelons on returning to work have been drastically dwindled down to only being free of fever for 3 days and all other symptoms are "improving". I sought out advice from my PCP, who works for my healthcare system, and the response was the same. I burned through my paid vacation time early on in my absence and it is currently only costing my employer their part of my insurance copays while I am out. I work in a large and currently very hard-hit city, and my hospital is almost entirely Covid-19 patients. We were not expecting it to ever get this bad here. I live with my elderly parents who are high risk. By the grace of God and my extreme self-isolation precautions, I did not spread it to them. I am worried about returning to work and bringing it home to them. They are retired and taking isolation very seriously, making me their biggest risk factor. I am (supposedly) immune now, but I know they would not survive if their symptoms were as bad as my own were, and IF I were to be reinfected somehow I'm not sure I would make it through again, especially with my lungs still healing. ScaredFor professional context, I am 13 months into my nursing career. I have been nominated for and received awards, received constant praise from my coworkers, and "exceeding expectations" performance reviews from my bosses. I am a darn good nurse, and burnout might be playing a part given I'm only a year into the job, but I'm not sure I can return to work. I'm scared to return to work, and given that no other options are available through my employer, I am thinking about quitting. *** THE QUESTION***To those of you in management or who were once in management. If I were to resign now would you even consider my resume let alone hire me after seeing that I left my job during this crisis? Would you bring me in for an interview, hear me out, and consider my circumstances? I've given up so much, spent time and money I didn't have to get where I am. I don't want to become some unhireable pariah and have it all go to waste. Most of all I don't want to have to start over from scratch in a different profession or be forced to put my license at risk in some bottom of the barrel nursing home where my morals and ethics will be put at odds with my employment. Which is unfortunately extremely similar to where I currently stand, my family's health vs my career and future. Thank you again for your time and consideration towards my dilemma. Gratefully yours, ScrubberDucky
  19. MsJenn_The_RN

    To be a coward, or to be a fool?

    My Dream Job as a New ICU NurseI have always known that I was meant to be an ICU nurse. Call it intuition, divine planning, or blind ambition. Since I was a child, my dream was to heal the sick, to protect those too weak to protect themselves, and to nurture those in their most vulnerable states. From the moment I enrolled in nursing school, I knew that the ICU was the place I would call my home. No other fields ever interested me; I wanted to care for the "sickest of the sick." Every decision I made in school and during my first year as a nurse, came from an unshakeable need to land a position in the ICU. After pushing myself to the brink of insanity to keep the highest GPA in my graduating class, accepting a new-graduate position on a medical stepdown-ICU, and putting in countless hours of overtime and continuing critical care education, every sacrifice I had made up to that point paid off. I landed my dream job: a position as a Medical-ICU nurse. I had never in my life felt the sense of purpose, belonging, or fulfillment that I felt as I navigated my way through the first few weeks and fell into a rhythm on my new floor. Unprepared and UnprotectedIt's surreal to me, that this was only a few months ago, in November of 2019, when I felt so elated. In a month that has felt like a decade, my life as an ICU nurse has come to include only 2 realities: walking unprepared and unprotected into a warzone of death and isolation, and hiding in my home, for fear of infecting those I love the most with the very disease I'm fighting so hard against (COVID-19). Where I once felt excitement and purpose, I now feel hopelessness and defeat. I spend my waking hours trying to decide if it's better to be the coward who deserts her comrades on the battlefield, or the hard-headed, idealistic fool who goes down with a sinking ship in the name of duty. As the US assumes the title of "new COVID-19 Epicenter," I can't see a third, "preferable" choice for myself. By now, the internet is flooded with nurses' testimonials, showing photos and videos of the unbelievable lack of resources and protection we have as we care for an escalating number of COVID patients. In one week, my hospital went from having 2 COVID quarantine units, to 6, with even more projected to be converted. My floor itself is not a designated unit, but each of us is sent to the critical COVID unit, at least once a week. This upcoming week will be my third week in a row using the same N95 mask; I was lucky enough to get a new face shield last week, as mine was so beat-up that it finally broke. Last week, my mask didn't even fit to my face, because the elastic straps are so thinly stretched. I have been praying that it lasts me through another shift, because we're just about out. Someone stole almost all the boxes of masks. Skepticism and MistrustIn the blink of an eye, my naivety has been replaced by skepticism and outright mistrust; I cannot believe for a second that the measures we as nurses are being forced to take while we care for infected patients, are remotely safe. We aren't protected; we know we aren't protected; we're offended and resentful over being told that we are protected. ICU nurses are quick thinkers. We know that what we're being told about our protective equipment is a desperate quality control measure, designed to prevent a panic. Unexpected and Unprotected ExposureI had to get tested last week, as well. Our whole floor got exposed, unknowingly, for a solid 6-8 hours. ICU is all about priorities, right? A patient comes in for a cardiac arrest, we're working on keeping him/her alive, and dealing with extraneous issues later. When a patient is crashing, we're also all in the room, helping each other out, working as a single well-oiled machine. Unfortunately for us, after an admission was sent up from the ED without being tested, we learned that this particular patient was from a "hot spot" county, and had been presenting with all the cardinal COVID symptoms for the past week. I can't explain how it felt to hear my child sob when I told him that I couldn't pick him up for a few more days, because I might have the virus that was making everyone so sick, and I couldn't get close to him until I found out for sure. I felt unspeakable shame, like the most selfish human on the planet, for being so devoted to my "dream job." I sat all alone at my house for 4 days, crying and hating myself for becoming a nurse, until the test came back negative. Fear and GuiltEven after my negative test, I still feel the same nauseating fear and guilt, every waking moment. I can't sleep, and the few hours of sleep I have gotten, have been plagued by pandemic nightmares. The fear follows me everywhere I go, sometimes nagging in the back of my mind, sometimes churning in my gut. It's the same questions, every time: "How long before I'm infected? How do I tell my kid that I won't be coming home for a while, and he can't see me, because I'm so sick that it isn't safe? What if I pass it to my dad, who has been the only person I've allowed to keep my kid since this whole thing started? What if he, the man who devoted his whole life to raising, supporting, and protecting me, spends the last days of his life on a ventilator, alone, with no one to hold his hand and pray with him...because of me?" At these times, it seems impossible to set foot back in my hospital. Then, I think about my patients. These patients are living my worst fears. They're unable to be at home with their loved ones, for weeks. If they're sick enough, they can't even talk to their families, because they won't last without a mask...or a tube. They're fighting for their lives, while we have to update their grief-stricken families over the phone, and tell them that they can't visit and be with them at their most critical hour. For these patients, we nurses are the only human contact they get. For the ones who inevitably will not survive, our voices are the last that they hear. Our hands are the last that touch them. Our prayers may be the last said for them, and our tears may be the last shed for them before they leave this world. When I think about the horror these patients and their families are facing, I can't imagine not showing up for my next shift. No Answers - No Happy EndingAs much as I'd like to believe the hopeful messages that this pandemic will soon pass and our society will again be safe and free, I don't see it. With everything in me, I don't see it. Never in a lifetime would I have guessed when I became a nurse, that it would mean putting my own life and the lives of those who I love the most at risk, to save the lives of others. I have asked seasoned nurses for an answer, and the answer I've come to is that there's no answer. There's no happy ending. Those of us who have chosen to walk away, have done their best; those of us who have stayed, are doing our best. Unfortunately, right now, the best we can do is nowhere close to enough to protect ourselves and those around us. For the time being, I will keep fighting the outward battle at the hospital against the pandemic for my patients. All the while, I'll keep silently fighting my own internal battle, until I figure out if it's better for me to be a coward and leave, or to be a fool and stay.
  20. Just a few weeks ago, I was helping with a list of classmates from my nursing school class of 1970. Yes, it was so we could plan our 50th class reunion. I was looking at the young fresh faces on my class photo, including my own. I have worked as a patient safety advocate for the past 10 years, as a volunteer. I have not worked clinically for 20 years. It is surreal for me to be out of school for 50 years. All of those anniversary festivities have been canceled. As those party planning emails came, the news on TV was getting more urgent about this new virus. COVID 19 had floated around for a few months. We heard stories about it when a bunch of people got sick on cruises. There were decisions being made about whether or not those people should be allowed back into the US. There were some pretty frightening images of the Chinese who were all wearing masks on the streets and many were dying. Some of the dying were doctors. This article is featured in the Spring 2020 issue of our allnurses Magazine... Download allnurses MagazineThe news got more and more scaryThe few nursing home patients in Washington State became the beginnings of an epicenter for this disease. Then New York City, then parts of California. Just a few weeks later, here we are. Every State is affected including Maine with our very small, but older population. The news is dire, every single day. Every day citizens are stocking up on face masks and hand sanitizers and clearing shelves of other necessities like toilet paper and food staples. There isn’t enough PPE for nurses, doctors and other frontline workers. There aren’t enough testing materials so that every single person who is exposed to COVID 19, or who has a risk factor or who may even have some symptoms, can be tested. We are all being trusted to socially distance ourselves, or to self-quarantine if we have a risk factor or symptoms. All of us are being asked to stay away from others and stay at home as much as possible. Basically we must consider every person around us to be infected…it helps us to socially distance. Businesses and borders are closedStill, irresponsible Spring breakers gathered in FL and other warm places, and COVID spread. Some large churches held big gatherings and services in spite of all of the warnings, and COVID spread. A few of our Senators and Representatives got it. Tom Hanks and his wife got it. This virus doesn’t care how famous, religious, rich or powerful you are….it will invade your body. It is a great opportunist. My son is out of work as of Friday. My husband and I have been spending most of our days at home, but we drive somewhere daily. Our little dog has been the star of our isolation show, and we take him everywhere with us. One day we enjoyed a short trip to the coast of Maine, and I am so luck to be so close to such beauty. And, this old nurse is going back to workI knew there was something I could do. I communicated with other healthcare workers and with my patient safety colleagues. The effort to keep patients away from crowded clinics and ERs meant that someone was going to have to keep telling them that it was the safest thing for them, unless they had life threatening symptoms. I called my local hospital. I asked if they had considered using retired nurses for some sort of telephone triage line. They hadn’t but they were very excited about my idea. Some of their staff was working on a phone tree and an algorithm. I offered to work from home, taking calls. I also offered to recruit other retired nurses to do the same. So, I have recruited 5 other nurses. 4 of us have had our physicals and background checks done already. We hope to be working within the week. We all can help ...We all can help, even those of us who are “older’, retired and at a higher risk of disease. Find a way. And for those nurses who are working with COVID 19 patients on the front lines, my hat off to you. Your courage and dedication just blows me away. I do hope that most of you will not face a shortage of needed PPE, and yes, I do know that some of you already have. We are all in this together. Doing what the experts are telling us is our social responsibility, but nurses young and old can do so much more. We all need to stand together albeit remotely.
  21. TreeJ

    Covid-19 Among The Navajo Tribe

    An enemy on the reservationOn the tribal reservation I live on there are probably greater than 488 cases of Covid-19 and 22 deaths. Enrolled members number roughly 352,000, with around 173,000 of that number on the reservation area. As you arrive here, I liken it to stepping back in time. People live in family clusters, 1 home, lack of running water, electricity in some parts. There are many elders who speak the native language only. No communication devices as a simple phone and some don’t have knowledge of the Internet. To say we’ve recovered from decades of great decline would not be accurate. Now, this enemy in the form of a virus here, targeting us. Unable to be reasoned with, debated with, but rather a realization that only with Global collaboration we will at least survive. I am worriedAs a Native RN, I feel part of a few with some knowledge, where I can be of assistance. I remember wanting to be in human service, and to help the people all I can. Where lack of PPE might only be the minor issue, it is concerning that general living conditions, health issues, language barriers the major battle here. How Covid-19 affects me just might erase so much of what I identify with by blood. I’m worried for the people so few in this Nation. The villain virusResearching past events as this is, disease is reported as causing more reduction of population of the North American Indigenous than human conflict. Having little exposure to diseases of other continents, the population is said to have been reduced immensely. Now, here in the year 2020, we are once again facing a villain virus, which is not only new to us but the World. When asked by new visitors, the disease processes present here. Without hesitation, I always relay that Diabetes & Hypertension I see so commonly. Care planning for this population always felt difficult, as you must consider can they buy the right food, do they live in the right conditions, will they even have transportation to their Provider’s next appointment. Recently, I remember an elderly non-English speaking woman hitchhiking to the clinic, and having to assist her in a way home. Working among this growing storm, I wanted to assist. So, chose to stay in this area, which seems to have the greatest numbers. It changes so drastically each day, higher and higher. I’m so busy to follow minute to minute, but know my locale is readying as best they can. Teams are in place, the staff has been divided to accommodate the surge they are sure is coming. I keep hearing the words, “I can't believe what is happening.” The older Nurses comfort the younger, and the younger appear ready to battle here. In the end ...I wonder how it will be and not as they predict. Though, of all tribal Nations in the United States, the cases here are highest, there are more tribes than whose numbers are less than 10,000 members. I pray each day for them, as well as all the World. All these years, believing that we can only have progression, then hearing statistics, we as a people could decline once again. The thought is disheartening. I am but one personJust like the rest of this country Nurses are few. My hope is being among them that I won't deter by becoming ill and can help that next Nurse with some relief. As I hear, we are all in this together. So, remember us, the smallest of people, also. Here there are no great metropolitans, but such rural communities and health care so basic it might depopulate us as a mini Nation. I’m one person, but indeed we all are. Believe you will make a difference, be it city, state, town, village.
  22. spotangel

    I Am Not Ready to Die!

    With my minimal PPEs, I was nervous entering the room on my first day on an unfamiliar unit in the hospital. All clinic nurses had been deployed to the hospital. No training, just show up and plugged in where the need was. I told the charge RN that I would assist them in any possible way. I saw Noel when I first went in to do his vital signs. He looked pale and sick and was short on breath even though he had a non-rebreather mask on. He was spiking a temperature of 102F. I informed his primary nurse who went in with the Tylenol. When I went back to retake his temperature an hour later, he was surrounded by a team of doctors telling him that his condition was worsening and that he may not be a good candidate for CPR as he was a do not intubate (DNI) and had multiple other conditions. "Do you understand what we are saying? If your heart stops, it's better not to do anything as your heart will stop again even if we revive you". I stood there holding his hand, a giant lump in my throat, my eyes looking straight at his black eyes clouded with tears. He was shaking with sobs once they left. I squeezed his hands gently and softly spoke to him. I told him to continue to fight, never give up, no matter who said what. His temperature had come down and I got him to get two sips of water in. I then gently removed his colostomy bag from which the feces had overrun his sheets, cleaned and put a new bag on. With the help of the Nursing attendant, we cleaned him thoroughly and put clean sheets on his bed and a fresh gown. He was sleeping like a baby when we left. It bothered me that the patient was not given a choice. Instead, the doctors called his nephew and explained the "situation". In my mind, unless a patient had a DNR, DNI everyone is a full code but now they pick and chose based on viability. Many units are told not to code futile cases even if they are full codes as the risk of spreading COVID-19 during chest compressions is greater to the health team and the chances of getting most of these patients back especially if they had Acute Respiratory Distress Syndrome, minimal. The isolation these patients face is not just worrisome to them but creates a kind of hopelessness in them. I would walk into rooms and some patients would be sitting with glazed looks, extremely short of breath. Their tray from the previous meal left untouched, as they are too sick to attempt to eat. There are two nursing attendants for 46 patients. Who would they feed? So I would talk to them, cajole them to eat and drink even if it was two sips of soup and exhort them to get better so they could go home. A patient who was on the mend showed me her four year old on face time trying to hug her. I promised him that I would make sure mummy came home safe. She left the next day crying as she thanked me and promised to pray for all nurses and other healthcare workers who put themselves at risk to take care of the patients. I quote her: My heart goes out to the nurses and the nursing attendants. Donning and doffing the PPES, medications, dressing, vents, suctioning, narcotics, vitals, blood sugar checks, feeding, changing, emptying garbage, moving patients on /off stretchers, calling pharmacy, calling families, calling team members for help, paging providers-----the list goes on and on. The fear of infecting themselves and their families, the isolation away from them, the guilt of ignoring call-bells, the futility of care in some cases, the call outs and worry, anger and grief about sick or dead colleagues, the emotional and physical toll especially when support is not perceived from management. So, I am girl Friday helping wherever I can and self-appointed call bell queen! One of the patients who had a stroke, is positive for COVID 19 and is actively dying, asked me a very pertinent question I intuitively knew she was talking about death. I asked her if she believed in God. When she said she did I told her to call on Jesus and that He would keep her safe. She shared with me that she had seen a green angel a few years ago! "Well I hope Ms. Smith that the angel keeps you company always so you won't feel lonely!" "You are nice!" she announced. Meanwhile, her roommate was getting ready to go home. I told her nurse that I would take a last set of vitals and remove the hep-lock for her. When I went in and saw how short of breath she was, I immediately checked her oxygen saturation which was 90% on 4 liters of oxygen. Her pulse was 130 per minute and her breathing labored. I immediately upped the oxygen, sat her in high fowlers and informed her primary nurse. Her discharge was held. She looked much better the next day and thanked me for speaking up for her. Her quote: In this time, when we are hit very hard, we have two choices in life. To follow our calling safely or to refuse. My personal opinion is that most nurses will put up with hardship and take good care of their patients once they know that they have adequate PPEs and management that cares and checks in to see how they can assist their nurses. We are today in a unique position of being the literal frontline staff and have an ability to laugh and cry with our patients, help them during their health crisis and sometimes being the last person they see as they leave this world. While continuing to speak up, fight for our PPEs, ability to protect our patient rights, our rights, and our family's rights; let us not forget to be the light that dispels the darkness and show the world that the other name for intelligence, advocacy, compassion, caring and hope is NURSING! To all my fellow nurses ...Thank you for each day that you put your life on the line to serve others! Your bravery may not merit speeches or awards in this world but somewhere in the world will be a grateful patient, a proud spouse/child, a coworker that is thankful for your life! We are the most trusted profession for a reason! Stay safe. Stay calm. We are nurses, we got this! God is in control of every storm!
  23. Lovethenurse2b25

    Is it wrong to turn down a shift?

    For the past few weeks my shift at work have been canceled due to the recent pandemic. A few days ago I was asked to work but unfortunately turned it down because we have a entire unit of Covid-19 patients. Heres the thing I have a toddler with asthma. Who is currently experiencing difficulties with her asthma due to the weather changes. In the past she has been hospitalized for 4 times for rsv causing low 02 levels resulting in more than a weeks stay. While I would love to be on the frontline saving live I afraid to compromise my child. I dont have anywhere else to send her. Her pulmonologist told me to stay away from anyone suspected of having it. My job feels as though I'm being selfish because they say its what I signed up for. I honestly would work if I had support. What are your thoughts? p.s. several workers have tested positive. The facility is using contact/droplet precautions.
  24. Julie J

    Dear Nurses: You Are In A War

    In an effort to save my sanity, I took a long walk around the base every day. One day a stack of shiny caskets appeared, the glare from their metal surface blinding in the hot sun. Their appearance was a stark reminder of the reality of the situation I was in, kind of like the refrigerated trucks that appeared at a Queens, New York hospital a couple of weeks ago, both designed to hold the bodies of the dead. It was a month before the official start of the war, December 1990. I was in Al Ain, United Arab Emirates, deployed in the first Gulf war. I was a flight nurse in aeromedical evacuation in the Air National Guard. I had left my job as an ER nurse 4 months ago. Since then we had all been waiting for the war to start, kind of like the thousands of nurses across the country waiting for the influx of coronavirus patients. My tentmate (we lived in tent cities) woke me up in the middle of the night the day the war started. We all went outside, gathering in nervous groups in the pitch darkness. The base had instituted blackout conditions at night a couple of months prior. That FeelingI will never forget the feeling I had when the war started, a sense of helplessness and powerlessness, kind of like what healthcare workers are feeling right now. My life was now out of my control. So is theirs. When the war started, we had to bring our chemical masks with us everywhere we went, ready for a chemical attack. Can you imagine the military telling soldiers: sorry, we don't have enough, but you can fashion your own, good luck. That is how nurses feel now. I Was On A Flight The Next Day After The War StartedI carried my gun for the first time. We were told to sit on our flack jackets in case the plane was shot at from below, kind of the nurses in protective gear all day every day at work even if they are receiving few coronavirus patients right now. The patients could come at any time. Some places they are already in the midst of it. We Weren't Ready To Do What We Were Tasked WithWe had never flown live patients. We had practiced on each other, simulating real conditions, kind of like the disaster preparedness exercises hospitals hold. We realized early on, we didn't have the supplies we needed, kind of like the lack of PPE in hospitals right now, the concern about the number of ventilators. We quickly figured out that we would need 3 things when the war started: IV bags, dressings and pain medicine. We scrambled to get them, kind of like the scramble for PPE, ventilators, right now. We Did Our JobsWe didn't have a choice, just like the healthcare workers right now. We flew up near the combat zone to pick up soldiers and around all the countries in the region. We adjusted to our new reality, just like healthcare workers are doing and will do, putting themselves in danger to do their jobs. Ready for anything. Our War Was ShortWe were blessed. This war won't be short. It may go on for months. Unlike healthcare workers now, we had help. More and more aerovac units were deployed. The military had pre-positioned supplies, already in place before we even went. They had a well-organized supply system ready to go. Unfortunately, we know that isn't the case right now. The War EndedWe came back changed people, feeling like aliens in a foreign land, just like healthcare workers will feel when this ends. Readjustment will be difficult, to say the least. Most will be okay, storing away memories in a vault in their minds. Some will struggle terribly. Believe it or not, as years go on, the memories will be easier. They will be grateful to have lived because many did not. They did their jobs. They had no choice.
  25. 2 Weeks AgoAbout 2 weeks ago (the second week of March), a friend asked me how work was with all the COVID stuff going on. I said, “Imagine having someone scream ‘COVIDDDDD’ at the top of their lungs until it’s hard to even think and you start gritting your teeth trying not to scream back... for about 13 hours”. That was two weeks ago, before I’d had to take care of a positive case. At this point we were just in prep-mode and finding our footing dealing with all the rule out cases. I’m a travel nurse working in an ICU at a regional hospital on the east coast. Two weeks ago, we were sorting out our protocols and PPE. We were seeing our new “Droplet Plus” isolation labels in EMRs and taping up our newly laminated “Droplet Plus” signs on doors. We were playing musical rooms to make sure the rule-outs were far away from our cardiothoracic post-op patients. We only had 2 true negative pressure rooms with antechambers so, given the recommended precautions, we were struggling with options there as well...but again, that was 2 weeks ago. My First Covid-19 PatientWe had a presumptive positive patient come in this week, who was confirmed positive 24 hours later. That call came in for that (my) patient about an hour or two into our night. Nothing had changed physically - the patient was already on a ventilator in a negative pressure room with us utilizing droplet-airborne precautions. I’d been in and out a couple times already in a PAPR/gown PPE combo...but at the same time, everything changed on the unit. We had already designated the pod of 8 rooms I was in as the COVID pod. The majority of the rooms had already been converted to “negative pressure” (which involves knocking out windows, plyboard, tape, caulking and rigging up an air-cycling system)...but for everyone there, the air on the unit instantly changed after that phone call. No longer was there this “screaming in your ear” feeling. It changed to a grave, deafening silence. Suddenly it was like someone was standing next to you holding their breath for 13 hours and you had to breathe the air in the COVID room. I knew I was getting in my head about it. I mean, I’d worked with our novel disease team before I was a traveler. I’d actually helped take care of an Ebola rule out patient years ago. COVID-19 isn’t technically airborne precautions and this patient was already on a vent - effectively keeping the transmission into the environment even lower than pre-intubation. We knew now, though. This is Not a DrillThe doffing protocol and cleaning of my PAPR became particularly intense. We’d initiated CRRT (continuous dialysis) on the patient due kidney failure, so over three nights I’d sit in my anteroom at least once an hour wiping down my respirator and hood. Try not to miss any spot. Get every surface. ***, did it just tap the used PPE bin? Wipe it again just to make sure. It became compulsory to make sure every inch of material was glistening in disinfectant. I feel like I truly understand how Lady Macbeth felt when she says, “Out damned spot! Out, I say!” in Macbeth. Holding My BreathMy nose and eyes started stinging because of the intensity of the fumes. I found myself holding breaths for as long as I could while cleaning because of the smell, and more than once I found myself a bit lightheaded after doffing (likely because of holding my breath, I didn’t see any warning about fume toxicity on the wipe’s container). The stress was most intense on the first two nights. By the third night I’d become very neutral on my current lot in life. I’d equate it to that feeling right before you do something crazy dangerous (like skydiving) or difficult (that exam that you’ve been dreading)...it was basically a shift from hyper alert stress response to an eerie calm - I’m here and this is happening, nothing’s going to change it. The ventilator tubing popped off the patient’s endotracheal tube and blasted COVID air onto my gown (at chest level) on that third night. I only had a mild Welp, I’m ***ed now, sense wash over me for about fifteen minutes then scrubbed the *** outta all my gear, hands and arms as usual. BurnoutWhat doesn’t change though is the strain outside of my own nurse-patient world. On night two, a patient coded who was a rule out and I suddenly have people banging on my window telling me to get out and wipe down the respirator part of my PPE so they get more people into the code to help. There is the gut-wrenching feeling of talking with my patient’s spouse on the phone, who is thanking me for calling and updating them on the patient’s condition because they are under quarantine themselves. The frustratingly difficult process of assisting each other in patient care because of the need to don/doff/disinfect for even the simplest things (getting a patient on a bedpan). There is already burnout I can see and personally experience that is hard to describe. I feel like I have on lead boots now. I can’t get things done at a pace I’m used to. Being pissed “at” a patient because of all the extra steps you now have to take in order to actually go into the room, and then beating yourself up about feeling like that because it’s a lot of *** that the patient has no control over. After three shifts with a COVID patient, my attitude had changed. I don’t think it’s any secret we compartmentalize well in the medical field and I guess I’ve made some shelf space for this pandemic. I still had this giddy energy to strip my scrubs off as soon as possible, throw them in the washer, and get in the shower. I literally hold my breath as I strip off my scrubs. I consciously made sure my beard had hot water running through it for several minutes in the shower. I’d drink a cup of hot water before I got into bed. Feelings of GuiltI secretly have this thought too...a bitter thought. I feel *** for even thinking it but I’m going to share it because maybe other people in healthcare are feeling the same and that might quell the feelings of guilt: I’m already frustrated that, by the end of this - months of this - there will be celebrations, parties, socials, and festivals celebrating the end of the pandemic and I’m going to be at work. There is no future reprieve because people can’t put off getting sick so we can have a break, nor will they postpone any sort of elective procedure that has already gotten pushed because of the pandemic. We’re here for the duration and beyond, and there is no “relief unit” or “change of guard” that will be sent in so we can all take some time off, rest, digest, decompress and recover. We’ll be here when everyone comes back because we have to be. We will take breaks in shifts and as availability permits, but more than likely there will be a surge of patients when this all calms down...not any sort of respite. It’s a thought I keep trying to kill and bury six feet under... So I’ll see y'all on the other end....ready or not.