Guest writer: Carleigh Richmond, Virginia
I take care of sick people for a living. I have held hands of those that were dying. I have celebrated with those receiving another chance at life. I have seen people on their worst days and their best. But this, this I have never seen before.
I am scared. I am scared for my patients, my family, my friends, myself.
Hospitals everywhere are going through a lot of change and we are trying to be smarter than this virus. We are striving to stay one step ahead. The healthcare industry is always going through changes, adaptations, and advancements. It is my role as a nurse to embrace these changes and do what is best for my patients.
There is a constant sense of panic, uncertainty, and anxiety that does not seem to go away. And things are just different. I come into work not knowing what the day will hold.
It’s a weird time. I go to work (three 12 hour shifts a week) and don’t know whether or not I will be floated to the COVID unit or will stay on my home unit. I don’t know if I will be a nurse that day, a member of the “clean team”, or a door monitor.
On a normal day, I work on a floor with patients that had heart and lung surgeries. I take care of 3-4 patients at a time.
If I get floated to the COVID unit, there are an entirely different set of protocols we follow. You can take care of only one rule-out patient (meaning we are waiting for the test to confirm positive or negative) or you can take care of up to 3 positive patients. The purpose of having only one rule-out patient is to prevent cross-contamination due to the fact we do not know if they are positive or negative for COVID.
It is also difficult to help other nurses that need it. For example, if a positive patient needs to be turned, the only other nurse that can go into the room and help is someone taking care of another positive patient. Nurses taking care of positive patients cannot go into any other patient rooms for any reason.
It is strongly encouraged to “cluster care” with these patients. Meaning, that if you have to go into the patient’s room for any reason, do as much as you can during that time. Get your assessments done, pass your medications, do the wound care, draw labs, etc. And then try to avoid going into the room until your next assessment or medication time (sometimes 2-4 hours; obviously based on judgment and stability of the patient). Clustering care not only limits exposure to the nurse but also conserves PPE. This was a hard adjustment for me. Yes, I cluster care on a regular basis, but I enjoy going into my patient’s rooms frequently. I like to make sure they have everything they need at all times. I mean I’m there for them, to take care of them. However, I still take care of these patients to the absolute best of my ability.
Another big adjustment is that there are no visitors allowed in the hospital, with the exception of limited visitors for pediatrics, OB, and end of life care. This is devastating for patients, and in my opinion, it compromises their healing.
Patients need their support system, but right now the risk of contracting COVID is too high. I can see how difficult this is for the patients, not only on my floor, but the COVID floor as well. I do my best to call family members at the end of my shift (with permission from the patient) to update their loved ones and bring peace of mind to those that need it.
Healthcare is constantly changing and as a nurse, it is my role to be flexible and adapt. Emails are sent out daily regarding new policies, updates, and protocols for COVID patients. There are zoom meetings three times a week with hospital leadership that keeps the staff updated on all the ongoing changes.
The hospital has also created a “command center”. The command center consists of hospital employees that have been educated on anything and everything in regard to COVID and COVID patients. This has been so helpful for nurses. If we have a question about a policy or an algorithm we are supposed to be using, we call the command center and they guide us through whatever we need.
The command center also has a “clean team” which nurses or care partners can be floated to. The “clean team” goes around the hospital cleaning elevator buttons, doorknobs, railings, etc. for their shift. The command center can also assign nurses or care partners to be “door monitors”. A door monitor’s job is to sit outside a COVID patient’s room and watch the nurse or doctor put on and take off the personal protective equipment (PPE) to monitor for cross contamination, again for their entire shift. The hospital has built such a strong support system for the staff while we work on the front lines to care for our patients.
The hospital leadership is also taking necessarily action to ensure the entire hospital has appropriate PPE. The hospital has come up with “zones” to better help staff know when it is/isn’t appropriate to wear certain PPE. “Cold”/green zones are low risk zones, “warm”/yellow zones, and “hot”/red zones.
In green zones, it is recommended to wear a basic cloth mask. The hospital was able to get locally manufactured cloth masks for employees to wear in “cold” zones. In yellow zones, which are high traffic areas, it is recommended to use the cloth mask and required to use goggles, gloves, etc. when caring for isolation patients. Red zones or higher risk zones contains mainly COVID patients. In these zones, it is required to wear appropriate droplet or airborne (N95) along with appropriate PPE while caring for the patient.
There are very specific steps nurses and other personnel have to take in order to don and doff PPE. When doffing PPE, you wash your hands at a minimum of 3 times before exiting the patient’s room. For example, take off your gloves and gown at the same time, wash hands. Then remove googles, hand them to door monitor to be cleaned, then wash hands. Step out of the room, remove mask, and then wash hands. This is every time you leave a COVID patient’s room.
It is essential to follow these steps in order to prevent any cross contamination. The hospital has also given all nurses and doctors the option of changing into hospital issued scrubs while taking care of COVID patients or prior to leaving for home.
During this crazy time, it has truly been “all hands on deck”. There are various different types of nurses and specialties (operating room nurses, pediatric nurses, OB nurses, etc.). Because a majority of COVID patients are adults, it would not be appropriate for a pediatric nurse to care for an adult COVID patient. Similarly, operating room nurses are not at the bedside, they are in the OR room assisting on procedures/surgeries.
However, all elective surgeries have been canceled, so the need for nurses in the OR has greatly decreased. In order to utilize all nursing staff, the hospital has created a “RN assist” role for specialty nurses. The specialty nurses are assigned to a certain floor to help bedside nurses. Which has been an AMAZING help.
For example, the RN assists on my floor are primarily OR nurses. They help insert Foley catheters, draw labs, take vital signs, etc. The idea behind having RN assists is that when the “peak” of COVID happens, we will have an extra set of hands to help with our patients.
Typically, I take care of 3-4 patients at a time. With the uncertainty of COVID and how it could affect census, there is a chance bedside nurses could be taking 6-7 patients at a time. This is where the RN assist would come in and help wherever needed.
COVID does not discriminate. We have seen patients of all ages and all health statuses at the hospital. Yes, co-morbidities like diabetes, hypertension, asthma, etc. put patients at greater risk of contracting the virus. However, some patients have been otherwise healthy and still end up in the hospital. What scares me the most is how quickly the patients are decompensating. I’ve seen patients requiring 6 liters of oxygen at the beginning of the shift, need high flow oxygen, and then emergent intubation hours later. CPR is now “hands only” meaning we are only to do chest compression and no bag ventilations. This is to decrease the risk of spreading by droplets.
Overall, hospitals across the nation are doing the best they can with what they have to care for these patients. It is a huge learning process and every day that passes we figure out a better way to fight it. I truly love working as a nurse and my love for nursing has only grown during this time. I feel blessed to have such amazing support from the hospital, community, and my family and friends.
As a nurse, self-care is one of the most important aspects of the job. You cannot fully care for someone else unless you take care of your own body, mind, and spirit. This virus is taking a toll on everyone, especially those in the health care industry. We are tired, frustrated. But we are strong, resilient. Self-care for me is staying hydrated, getting fresh air, taking longer showers than usual, and eating a lot of chocolate.
This outbreak has affected everyone in various ways. For me, what hurts the most is not being able to hug my parents goodbye after Sunday night dinner, or not being able to celebrate my sister’s 25th birthday. I have to wear a mask when I’m around my family and friends. People don’t want to sit too close to me because I’m a nurse and could be contagious.
I’m required to check my temperature twice daily and “self-monitor” for symptoms. I drink emergen-C with almost every meal. I wash my hair and body twice in the shower, just for good measures. I leave my work shoes in my car so I don’t track any hospital germs into the house. I try and stay in my room as much as I can to limit exposure to my roommates. I put my scrubs in a separate laundry basket and wash them with laundry sanitizer. I Lysol the counters multiple times a day as well as the door handles in the house. I do all the precautionary measures to keep the ones around me safe. Because that is my job, to keep everyone safe.
Right now, the world needs more understanding and patience. As a society, it is our responsibility to put an end to this virus. We need to educate ourselves on the facts and not rely so much on what the media is saying. We need to actually practice true social distancing and quarantine ourselves. We need to wash our hands and eat healthy. We need to focus on getting through this pandemic together.