Gut Check | Thursday, April 30, 2020
Preparing for COVID-19: Frontline Report From Coastal Virginia
Disclaimer: The opinions expressed in this article belongs to the author. They do not represent those of people, institution or organizations that the author may or may not be associated with in professional or personal capacity.
In the 1870s, Florence Nightingale wrote in her personal diary that it would take 100 to 150 years for the world to see the nursing she envisioned. Who would have thought that this first modern pandemic is what she had in mind?
Nursing has radically evolved since the Crimean War, when Nightingale and her nurses took care of the wounded soldiers without personal protective equipment (PPE), proper training or sufficient medical resources, and it continues to evolve in response to this pandemic. PPE has become the battlefield uniform 150 years later, as modern nurses and essential healthcare providers are the frontline soldiers fighting this unyielding coronavirus foe.
We are charging forward to provide excellent care in every way to all our patients. It is who we are at the core. We are focused on what we can do and how we can be a part of the solution. While we may be experiencing critical shortage of PPE, we are fortunate to have modern-day technology to determine the COVID-19 positives. We have negative pressure rooms to quarantine them. We have ventilators. We have medications. We have cleaning supplies.
COVID-19 has truly upended everyone’s norms in unimaginable ways. We must reconcile our new reality of living with this enemy. As we race to find a cure globally, our respective health system bubbles have been strategically preparing for worst-case scenarios while hoping for the best. Contingency tactics include staff redeployment, identification of alternate spaces, equipment planning, conservation and reprocessing of PPE.
Here in Coastal Virginia, we have not seen the surge predicted by hospital impact models for COVID-19. Peak projections have changed so many times. Effective social distancing intervention strategies have tempered the curve. However, we cannot be complacent. Public health and the safety of frontline health are providers must remain our top priorities.
Virginia’s statewide ban on elective surgeries and procedures will be in effect until May 1 and faced with drastically reduced patient volumes since early March, our endoscopy department stepped in to support our inpatient nursing units, environmental services, guest services and central sterile services. We worked as ambassadors who monitored hospital entrances and screen members of the team. We were part of the housekeeping crew tasked with cleaning public spaces. We were innovators, cutting and sewing masks from OR drapes. All as we maintained a skeleton crew in Endo who took care of our urgent/emergent outpatient and inpatient cases.
For the past three weeks, our hospital division has undergone anticipatory staff planning, providing pandemic education and redeployment training to nearly 200 ancillary personnel, including endoscopy. The pandemic curriculum consisted of a virtual component and a less-than-10-person group orientation/onboarding process. Each staff member was provided a coronavirus orientation packet based on their specific job description. The structured computer-based training consisted of one-link learning on topics including inpatient nursing documentation and infection prevention.
Just in time supplementary training videos, ranging from one to nine minutes, were also developed on topics such as patient sensitivity indicators, respiratory care and equipment usage. Skills check-off stations included phlebotomy, IV pumps, beds and ventilator 101 training. Bedside orientation included scavenger hunts to learn the specific layout and nuances of individual inpatient units. Our personnel were tasked with completing their abbreviated pandemic competency, valid only during this COVID-19 crisis, while shadowing in the units.
With training completed, we have changed gears to the redeployment phase, in which supporting departments — such as endo, OR and PACU — are required to provide constant “all hands-on deck” smooth and standard coverage to our inpatient units during this pandemic state. Our inpatient care delivery model has changed from the traditional modified primary (RN/nursing care partner) to RN-led, team-based care approach in which an experienced RN from his or her home inpatient unit is responsible for a group of patients and assigns tasks based on scope and skill level of the redeployed licensed and unlicensed assistive members of the team.
We must keep up with rapidly changing protocols. We are assuming new responsibilities and working outside the box. Our routine changed in an instant. As healthcare providers, we have higher than average risk of contracting COVID-19. We experience the constant fear of unknowingly infecting our loved ones and patients. In addition, we also have our worries at home — financial implication of a partner losing work hours, kids with no childcare and the care of elderly parents, among others.
Staying positive is difficult in this unprecedented time, but resilience is essential. We are in this together. We never leave our wingman behind. The glue holding our endo team is stronger than ever. We take care of each other. We are crucial to each other’s healing process, having experienced this emotional stress together. Our group therapy includes inviting our hospital chaplain to bless our hands during one of our daily huddles and participating in our upcoming hospital nurse’s week TikTok challenge. We have access to mental wellbeing resources like our employee assistance program. We are lifted by the unending love and moral support from our family and friends; our hospital system proactively keeping our patients and caregivers safe; and by the tremendous outpouring of kindness, encouragement and generosity from our community.
For information on clinical guidance, peer insight and information sharing, helpful resources, and more during these difficult times, visit the SGNA COVID-19 Resources page.
If you are an SGNA member and would like to share your experience working in the time of COVID-19, please reach out to SGNA at firstname.lastname@example.org.