Issue link: https://digital.copcomm.com/i/1259738
Working Nurse l WorkingNurse.com 11 June 15–July 27, 2020 through a filter. We also use N95 masks with face shields, gowns and gloves when- ever necessary. Our hospital was very aggressive about obtaining PPE from the beginning. The normal channels were exhausted early on, so we found alternative channels and chose to pay double or even triple the price so that our staff could count on being pro- tected no matter what. What about keeping staff members' families safe when they go home from work? Since all elective surgeries have been can- celed and those units closed, all surgical scrubs have been redirected to staff treat- ing patients with actual or suspected COVID-19. Scrubs are all washed in-house and everyone wears work shoes that can be easily wiped down and disinfected. All staff change in and out of their scrubs at work, so they go home wearing clean street clothes and a pair of clean shoes. RCPs, housekeeping, and other staff are also issued scrubs. Our housekeepers and other ancillary support staff are the unsung heroes of this entire situation. Nurses get a lot of credit, but those other departments are just as crucial. After all, where would we be without clean rooms, meals and a smoothly operating physical plant? How are your nurses doing these days? At first, there was a sense of heightened anxiety, but our nurses and other staff have handled it with grace as we've moved into our "new normal." As mentioned above, we're put a great deal of energy into their safety, which assuages some of their very understandable anxiety. The nurses have had to be very adapt- able. Policies and procedures had to change multiple times per day as we got up to speed. It was a hectic time for everyone, and we have remained ready to pivot as new data emerges. Tell us more about this "new nor- mal" as we face the rest of 2020. Our census fluctuates and will likely contin- ue to do so. In our unit, staffing is the biggest challenge; having a sufficient num- ber of clinicians on board will continue to be a priority. Some staff worked crazy shifts at the beginning, but, with more travelers available, things are now much better and have settled down into a sort of rhythm. We've had to relearn the practice of nursing in this novel context. For instance, when someone is experiencing a cardiac or respiratory arrest, you want to run in and save them, but COVID-19 demands a change in mindset. You have to stop at the red line at the door of the patient's room and make sure your PPE is sorted out. This takes pre- cious time, but everyone has to be protect- ed, even when you're trying to save a life. We also have to think about how to care for other patients in the ICU. People are still having non-COVID-19 related medical crises, and they also need our protection and care. We simply won't allow anyone to fall through the cracks for any reason. How do you prepare for what may emerge in the months to come? We've designated the pediatric ICU as our first overflow unit; it has 10 beds and our ICU has 20, giving us a 30-bed overall capacity. We also have a second surge plan in place for increased census. We have to take it day by day and week by week. We're currently holding our breath in terms of the current stay-at-home order. With more people out and about in the city, we can expect things to change. What are your thoughts on the Year of the Nurse (as declared by the World Health Organization) in light of nurses' role in this pan- demic response? The Year of the Nurse and Midwife calls attention to the ways in which nurses con- stantly innovate. COVID-19 has forced us to reinvent many aspects of our approach to patient care. For example, when a patient presents with myocardial infarction symptoms and shortness of breath, we also need to swab them for COVID-19. Some of these changes may seem small, but they have a big impact on our practice. We're learning to cluster care even more efficiently and adding more tools to our nursing toolbox. The pandemic also calls on us to find new ways to empower and inform patients' families, even when the patient is intubat- ed and the family can't physically visit. We now call patients' families at least once per shift to check in and ask if they have any questions or concerns, just as if they were actually in the room. There are so many lit- tle things we've reinvented. The challenge has made it an interesting time to be a nurse: You get to use your crit- ical thinking to its utmost and learn so much from the evidence-based practices that are coming to light. This being the Year of the Nurse and Midwife is appropri- ate on many levels. What would you say to a novice nurse with interest in the ICU? It's a hard to place to start out as a new grad. Some people just know it's for them and are successful. Others don't do so well. The most important thing is to have a total passion for learning and for deeply understanding how body systems interact. You must be willing to use your experi- ence, build on your background, look deeply at what's in front of you and keep learning and growing day after day. You have to be a passionate, open-minded crit- ical thinker who's willing to accept that there will be many times when you just don't know what to do. You simply can't let your pride get in the way of asking ques- tions. ____________________________________________ Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com. WN COVID-19 has forced us to reinvent our approach to patient care. We're learning to cluster care even more efficiently and adding more tools to our nursing toolbox.