"When you get those rare moments of clarity, those flashes when the universe makes sense, you try desperately to hold on to them. They are the life boats for the darker times, when the vastness of it all, the incomprehensible nature of life is completely illusive. So the question becomes, or should have been all a long... What would you do if you knew you only had one day, or one week, or one month to live. What life boat would you grab on to? What secret would you tell? What band would you see? What person would you declare your love to? What wish would you fulfill? What exotic locale would you fly to for coffee? What book would you write?"

Tuesday, May 19, 2020

The Coronavirus Chronicles: Nurses on the Frontlines

This post has been a long time coming, and has been one of the hardest to write. A month or so ago, I had the idea to interview local nurses that I know about their experiences with COVID. We all hear about hero or tragic stories on the news but I wanted to be able to hear how local, real, close to home nurses were experiencing the same battle. I interviewed 6 different nurses, all from different backgrounds and roles to give you unique perspectives. I will also throw in my 2 cents where I see fit, coming from a nursing informatics background.

These 6 nurses are all from North-East Pennsylvania and Western New Jersey. I have chosen to keep their identity and the organization they work for anonymous, because I wanted them to feel as if they could truly be honest with me and my audience. I have changed their names to something not their own, and any details that make you think you know this person are purely coincidental.

All of these magnificent nurses are ones that I know personally. Some have trained me in my practice. Some I have worked side by side with. Some I have trained. Some have been my mentor. All bring a different perspective to the table here.

Miranda is a Medical Surgical Nurse in Allentown, PA with over 6 years bedside experience.
Chris has a Doctorate of Nursing Practice and practices in a PA ICU with over 20 years experience.
Reagan is a newer Emergency Department Nurse in Stroudsburg, PA with under 5 years experience.
Nicolette is a Medical Surgical Nurse in Hackensack, NJ with over 10 years of bedside experience.
Kayla is a nurse in the ICU in Easton, PA with over 6 years bedside experience.
Tyler is a nurse manager in charge of 20-30 nurses on an inpatient Medical Surgical Unit in Pennsylvania, and has over 10 years of bedside experience.

Okay well that was the easy part. Introducing them. The hardest part is going to be what comes next. Taking their honest, heartbreaking, gut wrenching words and doing them justice. Presenting them in a way that will never be forgotten. Not tomorrow. Not next year. Not in ten years. Not when this goes away. Never. So here goes.

This virus has come in like a tidal wave no one saw coming. All agreed that when training to be a nurse or before they decided to be a nurse, no one saw this coming in our future. No one. No one predicted we would have a world-wide pandemic and shutdown. No one saw coming how hospitals would be right up there with the rest of the world, losing millions and millions of dollars and cutting staff left and right during a health crisis. No one saw a three month quarantine coming away from their loved ones, their own children. No one saw the stable ground being ripped up from under them but still showed up to work every day, ready to fight. THAT is what has inspired me the most about this group. All agreed that if they knew this global pandemic was coming back when they decided to become a nurse, would they still do it? They ALL agreed YES. They would still become a nurse. Miranda stated, "We are making history right now. This has made me honored to become a nurse." Kayla from the ICU shared, "I would still become a nurse because even feeling fearful, frustrated at times, and dispensable, I know I am saving lives that no one else could. If I wasn't watching over their loved ones as they struggle to breath, these patients would not have made it out of the unit. I am making a difference and that is empowering."

But despite always choosing nursing no matter what, this time certainly has been anything but easy. It has taken a toll on some of their emotional health, physical health and their families. When I asked what is their biggest fear right now, every single one of them said something regarding "fear of a loved one getting the virus", whether that was their child, spouse, or a parent. They didn't even mention fear of themselves getting it, only their loved ones. I too, can agree that is my biggest fear. In order to protect their own loved ones, they've each had to go through intense measures. Reagan shared, "I have a little girl at home and my husband and I are both ER nurses. It's tough for us because we can't just stay at home to keep ourselves and little one safe."  So, appreciate that you can out there.  Kayla shared that she hasn't seen her family, including mother, stepchildren and Nana since the beginning of the quarantine as she has been self isolating in between shifts. She shared that no matter the wait, when she gets to hug her family again for the first time, she will never let go.   Nicolette actually acquired the virus herself which took a significant toll on her, her young son and husband, "My husband is an engineer that works for a company that makes ventilators. We were both much needed at work and at home with no alternative child support. Things only got worse once I got sick with COVID and had to isolate from my family. My husband became the only caregiver to our son, in addition to intensely working."

This has changed each and every one of them as a nurse and in how they approach their view of nursing, in some good ways and in some negative ways. Miranda shared, "Every day is uncertain and because of that I am anxious. I have been heartbroken many times when I see patients uncomfortable and fighting for their life...alone." As a nightshift nurse, Miranda shared that she was never personally a fan of family members lingering at the bedside but now sees the vital role and importance of family members being able to be present at their loved ones side- having that critical support system is key to recovery. She stated that is something in her nursing career she will never take for granted again.  Reagan agreed from the Emergency Department sharing, "I have seen more people die in the past few months than I have in the past year. I've watched as someone cried at their diagnosis knowing they were likely never going to see family and grandkids ever again. We deal with tricky diagnoses every day, but this is just so heartbreaking."  Christopher from the ICU shared that this pandemic has made nursing the dominant bedside force. Others felt differently in how they experienced this pandemic, sharing "This pandemic has strained my love for bedside nursing. Its not the sick patients or numerous deaths, its the political and poor administration support that we have at the bedside that I have never felt so dispensable", shared Kayla from the ICU. Nicolette agreed, stating "I lost trust in organizations and felt abandoned to drown more times than I can count". On the shift before she got sick herself, she had all 8 COVID patients, all in need of frequent and intense care. Tyler as a nurse manager shared how positive it has been seeing all of the love and the support (donations, food, cards, letters) outpouring from the local community. But as a nurse manager in a leadership position, he states "Its a difficult time to manage staff. They are scared and there is a lot of unknown. I feel like information is always evolving and changing and it's difficult to maintain trust amongst staff."

A common theme from the group was a newfound sense of anxiety but also calm and a mixture of both, for some. Everyone thinks nurses are immune, that they've seen it all so they can't be affected. But they certainly can. They too are so human and take in everything that is happening directly to their soul.  Miranda shared that "this pandemic has brought out the cranky part of me. I've been on edge at work. We are all working so hard and stressed out. It's very exhausting at times. I've recognized this flaw and am working on channeling my inner peace."  Reagan shared that "I am typically a very calm person but I struggled with a lot of anxiety in the beginning because there is so much unknown with the virus." But they all shared something positive that is keeping them sane during this tough time. Christopher goes out running between shifts. Reagan has picked up a new hobby to stay busy and tries to get outside with her family during the nice weather. Nicolette is looking into counseling services. Tyler disconnects from work when he goes home and plays games with his children and works on house projects. Kayla is working on her degree as a nurse practitioner. Kayla writes, "If I could give any advice, always keep your body and mind busy and the stress is easier to handle." I challenged them all to share a positive thing this crisis has brought them, and they shared many. Extubations and discharges home, seeing a newfound kindness and humanity in strangers, seeing themselves grow with new skills and hobbies, seeing a decline in COVID cases (thank you social distancing!) and seeing their own loved ones get better. Miranda shares from her organization "Every time a COVID patient is discharged from the hospital they play a song for the patient and we all line up at the door to cheer them on as they exit the building. The patients love it and we get to celebrate with them. This proves that there is hope out there. We can always turn negatives into positives." That was beautifully said by Miranda and I can attest with my own experience, after strenuous bedside work- having those positive moments where you can cheer a patient on together as one big community is something she will likely remember forever from her nursing practice.

American Healthcare will change, we have no way around changing at this point. We have already changed drastically and will continue to do so. Things we didn't think were possible "yet" or were on the backburner, now suddenly are the top priorities. As an informatics nurse, I've seen first hand a huge shift in the way patients are seeing their doctors. What once was a "once in awhile thing" that was originally advertised as an option a patient could do if they had the flu and just wanted to connect with a doctor via Facetime, is now a common occurrence. Most of our well visits and sick visits have been converted to "telehealth" visits. Doctors and nurses are also using I-pads to be able to round with their patients electronically from outside the room without having to enter into a COVID room multiple times. This prepares nurses to assemble themselves and get what they truly need to be able to "bundle their care" and handle multiple tasks for the patient at once. Patients are using I-pads to communicate with family members and to connect with specialist providers that may be home, in the office or another hospital.  These are all things we were "slowly working on" that launched into all-hands on deck to make happen in a matter of weeks. But it truly all has made a difference and will permanently shift how we provide American healthcare. Miranda experienced that exact shift in technology, sharing "I have adapted to using more technology and allowing patients and family to see each other on Facetime on Ipads."

There are other shifts happening in healthcare, non-technology related also.  Nurses are seeing a new sense of community, within and outside the hospital. "A lot of flaws in the system were exposed and with every tragic event we learn from that experience. I have seen great teamwork, also. What once used to be a battle of the departments has become a unity of the hospital. We are all in this together." Shared Miranda from the Medical Surgical floor.  The Emergency department is also seeing a shift in care, Reagan states "the ER has been filled with true emergencies and less non emergency cases"- like the ER was always meant to be. This has shifted peoples train of thought to, "do I really need to go to the ER for this sore throat or can it wait until Monday when my doctor is open?" It has opened up more avenues for urgent cares and other forms of healthcare delivery with a primary care provider. The ER was always meant to be there only for true emergencies, as if you must be close to dying in order to come in (heart attacks, strokes, loss of some sort of function, a broken limb, a missing limb, trauma, etc.), but has evolved over the years into being that level of trauma but also bogged down with the "my leg has been sore for 2 years" and "i have a runny nose" cases. I too hope that the ER can see a permanent shift in care delivery mindset. The ultimate goal is to keep people out of the hospital that don't need to be there, and shifting as much care as possible to be in peoples homes.

These six nurses are some of the strongest people I know. They are exhausted. They are suffering. But they are showing up every day. For you. So YOU can stay home. They are working beyond their normal job roles to make sure you stay safe. Their hearts break a thousand times over each shift they endure. They are crying for and WITH your family members that they care for. They are scared. They need a little bit of extra love right now. So if you know a nurse in your life, give them some extra (non-physical) love right now. Kayla from the ICU asks of everyone in the community, "Don't call me a hero. Just say thank you, practice social distancing, and follow the recommendations of the department of health. Remember, practicing social distancing and wearing a mask is not about you, it is about the people you come in contact with. The world is smaller than you think. Don't think your actions do not have consequences, they can kill someone.  It's also not just nursing that needs extra love and kindness right now, remember food services, grocery store workers, truck drivers, warehouse workers, police, firemen, and others in public service. Without them, we would be in true chaos." I couldn't have said it better myself, Kayla!

Thank you to my audience for reading and for listening to these six nurses stories. I am so thankful they all agreed to participate in my idea and to share their feelings, emotions, honest thoughts and stories. This is no where near over but we are adapting, we are getting stronger, we are learning. Healthcare is changing. We will come out stronger from this. Our nurses will come out stronger than they ever were before when this is over.

Thank you for reading. Thank a nurse.

Below is a picture that I saw from another local nurse. This is not one of the nurses that wrote in, but when I saw the picture, it composed every single emotion and honesty that every nurse out there understands, so with her permission I wanted to share.

Photo credit: Miguel Farias
A Writer in  Nurse's Body