The New Normal: A Stronger Savvy Nurse!

The Covid pandemic has changed nurses professional and private lives. How have we become stronger from the lessons learned? Nurses Announcements Archive

Published Aug 28, 2020

Chronic Care Coordinator

spotangel, DNP, RN, NP

24 Articles; 518 Posts

Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

So many things have changed in a blink of an eye. The Covid pandemic took and shook lives left, right, and center. Along with most others, my life changed.

Family

My children were in an uproar.

My 14-year daughter, Angela, was crying and shouting, “You don’t trust me!”

We were discussing the new school options due to Covid restrictions.

I was in favor of the hybrid program 2 days a week in class and three online days. The kids wanted an online program only. Some of their arguments were:

Mom, her classmates are not going to be socially distant!
How do they know if the class is clean?
What if they have to move from one class to the other? The hallways are going to be crowded and the next classroom may not be clean?
She has asthma. If she gets it she could die or bring it home!

My side of the argument went like this:

You are up all night and sleep all day! There is no one to wake you up in the morning!
What if you miss class and get a zero in your grade! These marks are looked at as you are a high school kid.
If your dad, who worked all night, has to stay awake after work to wake you up, he could get sleep deprived, have an accident, die or kill someone accidentally.
Just look at yesterday, it was time for mass and you were still sleeping. How can I trust you as you sleep through every alarm and refuse to get up even when someone comes to wake you! “

To date, I am not sure if I will send her for an in-person or online class but here is my wish list for in-person school.

Do a daily questionnaire online/on the phone for Covid symptoms exposure. Green for good. Have a plan for red-if symptomatic/exposed to Covid pts.
Temperature checks in school and designated markings while entering school and in hallways. This needs to be monitored.
Mandatory masking and hand sanitization at the entrance. Masks offered at the entrance if you have forgotten to bring one.
Keeps kids in the same class. Let the teacher come into the class, instead of the students moving from class to class.
Keep masks, tissues, and hand sanitizer at the teacher’s desk.
Have a Covid hotline number for students, staff, and parents to call during working hours preferably manned by a nurse.
Involve the PTA for a parent Covid resource team for parents with questions.
Have flexibility and a backup plan for classes if any issues.
Monitor the flow of entry and exit. Designate one class at a time to avoid overcrowding.
Shower as soon as one comes home.

My older two kids are in college. Alex is doing online classes but struggling to find sites for an internship. Annie will have online classes but on-site labs. I would recommend the same rules as schools but would also emphasize “no parties and social hours”. That seems to be a surefire way of getting into Covid exposure.

As a parent, I worry, but here is the silver lining:

Infection control will be on everyone’s mind and so will public health and safety!
It may teach my kids to become more independent, self-sufficient, minimalistic, and improve their time management skills. All these will help prepare "the child for the road and not the road for the child” which is what many Helicopter parents do.
People are looking at world trends and making decisions based on other’s experiences instead of in a vacuum.
Many kids have become inventive and have made/patented Velcro lining masks that fold and stick to your clothes while not in use and shields from 3D material and hairbands!
I appreciate my family and am thankful for each day, good health, a home to stay, food to eat, and a job that can help support my family and others in need.
I have had frank conversations with the kids, just in case something happens to my husband and I since we both work in healthcare and with Covid Positive patients!

Work

My husband works as a social worker in a trauma 1 ED at night. He has had many one-on-one conversations with patients who have Covid and are trying to arrange the home front or dealing with other issues. It does involve a lot of near contact. I work in a clinic but was deployed to my main hospital to work with Covid positive patients. I don’t want to go into the daily horrors of watching patients die in large numbers daily in New York, the feeling of helplessness when we did not code dying patients due to the risk of spreading the virus during chest compression and intubation, holding a dying patient’s hand, getting their family on Facetime on my personal phone as they didn’t have any other ways available in the hospital, worrying if I would infect my family, the exhaustion physically and mentally, feeling the heat of the PPEs as I sweated profusely, trying not to use the restroom as I would have to disrobe while conserving my PPEs----sufficient to say was a nightmare. I had anxious nights when I could not sleep and dreaded going to work the next day, painful calluses from being on my feet for 12.5 hours, wheezing from the N95 that smelled funny, skin breaks especially behind my ears, and unexpected bouts of crying and anger. Was it PTSD? So what did I learn for the future and how would I prepare for the next wave of the pandemic whenever it came?

Here are some of my strategies:

Always be prepared. Do not compromise on PPEs. Insist on N95 for close patient contact.
Speak up for what is right; for yourself or even a coworker.
Follow infection control guidelines on handwashing, cleaning equipment used, and PPEs cleaning especially goggles and face shields. Wipe down rooms used for patients before and after.
Avoid sitting in breakrooms unless you are alone. Bring your own food to avoid lines. Use your car in the parking lot if you need to during lunch hours.
Space everyone out during shift report and speak up if teams are not following protocols such as an MD walking into the Nurse’s station wearing a used mask or face shield without removing it wiping down and hand hygiene.
Insist on getting fit tested, so that you have the proper fit. Put it in writing to your manager.
Be there for each other and check in with your coworkers. We are all in this together. Many have lost family and friends or are struggling to make ends meet.
Follow a strict protocol to wipe down IDs & pens, discard hair covers, shoe covers, masks, change clothes and launder, and shower off before greeting your family. This was what kept us Covid free during the height of the pandemic.
Acknowledge when you are emotionally down and then get help. Most workplaces offer phone counseling or, talk to a trusted friend or family member freely. I felt like I was at war as all I saw was death!
Find positives at work and laugh a lot by sharing funny videos, jokes, etc. During huddles check in with your team to make sure everyone is starting the day OK. Be there for each other.
Make sure you have enough supplies ahead of time and conserve PPEs when you can.
Keep up-to-date with the latest protocols and inform each other and patients.

Community

Your community may be reeling from the effects of this pandemic. Keep your eyes open and see where you can help. Share what you can.

Money, food, a cooked meal, a phone conversation.
Volunteer to help in the church to sanitize it after mass.
Help cook meals or buy groceries for someone who is at risk and does not want to go out to the supermarket.
Check in via phone, face time, zoom meetings.
Keep abreast of local politics and decisions especially for schools, hospitals, and neighborhood stores.
Be mindful of social distancing and using a mask when outside. Walk early or late during the day mask-less if the street is empty but always keep a mask handy. Avoid using an N95 unless you are in a clinical setting.
Be a resource as a nurse to your local community and neighborhood. You are to dispel myths, ally fears, and bring science-backed solutions so that people can make informed decisions.

Nursing Students

I recently taught an online Zoom class on leadership for Nurse Practitioner students this Summer. I made sure I got a sense of where they were starting from. This class was to be an in-person class and so there was a lot of disappointment. The class was also changed from a 15-week class to a 7-week class, so there was a lot of material to cover. They also had another class before mine and so I was mindful to make the time meaningful and useful to them. I divided them into teams and had their assignments as team projects. They were given an opportunity to present as a team and that helped their confidence level. I also got real-life leaders to come in as Zoom guest speakers to discuss their daily routines, challenges during the pandemic and solutions they came up with. Being creative to keep the class relevant helped the students tremendously and they stated that they really learned from this class.

Another thing I did was to check in with them during the Zoom meetings and also in between through group emails to provide them with gentle reminders on upcoming deadlines. I kept in mind that many were working under tremendous stress in Covid units and providing care for elderly parents and young children, along with being a student, wage earner, and parent. They were very appreciative of the caring and responded by studying and excelling in my class! I was able to help them discover their own leadership skills and areas of improvement that they could work on! The importance of advocacy was stressed.

I believe that college is going to be more online except when you need a one-on-one class like a skillset lab during this pandemic.

Political Landscape

It is important to keep an eye and ear out for all the new legislation that is put out from each state and find out what your local politician’s stand is on issues that are important to you. This should help you when you cast your vote. Legislation on worker safety, PPEs, Infection control measures, etc., should be looked at carefully.

Know your union rights if you have a nurse’s union and know the safety policies of your workplace.

Volunteer to be on committees at the workplace and know your union representatives by name. Exercise your right to vote. You can help make history and protect your patients and your own rights when you are an informed and savvy voter.

Memory Lane

Never forget colleagues that lost their lives working on the frontlines. Some of their stories are heartbreaking. A nurse that I mentored, came down with Covid symptoms in the ED, begged to be tested, was refused, and sent home on antibiotics. Two days later, she was admitted to a neighboring hospital where she ended up going into respiratory arrest, was intubated, and died the next day. The rage and anger are real for her coworkers. The knowledge that the very hospital she worked for failed to provide her with safe care. In her memory and others who died in the line of duty, let us strive to speak up, advocate and garner support from the community we serve to stay protected, and to protect our patients by providing safe and equitable care.

Mental Health

Anyone who worked the frontline would tell you that the pandemic challenged them mentally and physically. When everything fell on the nurse including being put in an unfamiliar environment with inadequate skillsets in place to take care of critically ill patients with minimal to no supplies and inadequate PPEs, it took a toll daily. Two months at the frontlines gave me PTSD and I still cannot talk about those days without breaking down and crying. Even though I was down, I tried to help the brand new nurses that were breaking down daily and tried to encourage them even though I was broken on the inside. I kept telling myself that I would cry when I got home. When I reached home, I would try and be cheery in front of my worried family. At 3 am, I would awaken and cry into my pillow. By 6 am I was up and out the door for my 7 am shift. After coming back to the clinic “post-deployment”, I had an opportunity to speak to a psychologist on the phone twice but could not say much without crying. I still found those sessions helpful.

Many hospital systems have put in help lines for staff to call but to me, it’s still fresh in my mind and I find it hard to share my experiences. One of the things I found helpful was to quietly help others who are struggling. It gives me the feeling of hopefulness, unlike the helplessness I felt before. Be aware of your coworkers and administrators. Many are struggling at this point and may need a helping hand. Meanwhile, the patients who struggle the most already have underlying anxiety issues. I tend to ask them how Covid affected them and sometimes it's like a dam broke!

My New Normal

PPEs: I do not leave the house without a mask and have extra masks in my car. I always use an N95 and a surgical mask over it when I see patients. Goggles, shields, and gowns, I use if needed. I do not let my guard down and am careful during interactions with patients and staff.
Before I leave home for work, I do my Covid Safe work survey on my phone and get my “green pass” on my phone. Once I show my pass, the PCT takes my temperature, gives me a surgical mask and I go upstairs to my clinic. Every Monday, I get my N95 (one per week). I conserve my N95.
I speak to most of my patients on the phone. I see only 30% of my patients in person. The clinic has converted to 60% video visits, 30% phone visit, and 10% in-person visits.
I make time for my team and check on them frequently.
At home, I spend time with my family and savor the fact that we are all alive by the Grace of God!
Constant reminders to the kids to take their masks!
I speak to my doctor on the phone. My daughter recently had her physical via a video call!
I am on my church volunteer group to sanitize the church after mass.
I am still debating online versus in-person schooling for my youngest!

At the end of the day going through this pandemic has made me stronger and more appreciative of life!

God keep you safe in these tough times! We are nurses! We are here to stay and save, Covid or no Covid!

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