Nurse Musings on Covid 19 Preparation

I am an RN, so I haven’t been on Facebook for a while and I certainly am not sheltering at home. I thought you might be interested in what I’ve been doing for the past two weeks. I am not a bedside nurse, I’m a nurse administrator so I’ve been helping prepare for a large influx of patients. Because the USA has done a really poor job at testing we don’t have a good idea of how many people in the community have Covid-19 so we can’t make an accurate estimation of how many people will need hospitalization. Are we expecting 50 patients or 5? I just don’t know. The hospital where I work usually has 65-80 in-patients. We are working to add 50 beds. Thanks to you who are doing your part and sheltering at home so we can avoid big spikes in the number of patients. We can take care of all of you, just not all of you at once.

Last week we identified places that we could re-purpose as in-patient wards. We stopped doing elective procedures and moved research studies out of the hospital. The support side of the house has been working hard to get hospital beds, medication dispensing machines, linen, supplies, all the things that you need to take care of patients. The nursing service has been figuring out how to staff the new beds. We are going to use nurses who were working in procedural areas since we are doing fewer procedures. We identified the staff, and then here is the part that kept me and my peers up at night: we told people who currently work eight hour days five days a week that they would be working six 12 hour shifts and one 8 hour shift every two weeks, to include weekends. And what’s more, the people with the least seniority would be working nights. While we have some staff that are less than pleased (I don’t blame them!) the majority of the staff have said ‘whatever we need to do to take care of patients, we are happy to do it.’ I am so proud of my staff and my profession. Just gearing up like this took so much work that I worked 12 days straight. I have this weekend off, but I’m not sure when I will have another day off, but my peers and I are working out how to cover for each other so we can all rest.

So what is next? Well, next week the procedural nurses are paired with in-patient nurses to get the flow of care and nurse educators will be meeting them in the units to make sure they know how to use the equipment, document, and refresh on any skills they haven’t done in a while. Then a mix of experienced in-patient nurses and procedural nurses will open new units and be prepared to take patients. If we get too many patients then the nurse administration team will be bedside too. I expect that I will care for patients at least part of the time, if not out of urgent necessity, as a stand of solidarity with my staff. I am in scrubs every day and I have been assisting with the extra cleaning and screening patients at the door.

That all sounds pretty straight forward, now add in the context of a huge amount of fear by both the public and professionals. We have huge numbers of staff call outs because we still have the flu and other illnesses. Schools are out and nurses are scrambling to find childcare, especially since we aren’t supposed to leave children with their grandparents because of the danger of transmission. We are staffing the screening stations at the doors, handling large numbers of worried patients, and still taking care of those with cancer, strokes, heart attacks and any number of other illnesses as well as providing increased mental health care. It is challenging and stressful.

In addition to all that is the fear mongering. This week someone from my hospital posted on Face Book that we don’t have enough masks and that staff are being asked to bring in their own cloth masks. This is not true. Our facility has enough surgical masks, we just don’t have enough masks for staff to throw them out after every time they go into a patient room which is the standard. Under direction from our infectious disease team each staff member will now be issued a surgical mask at the beginning of every shift. They are expected to put their name on the mask and utilize it for the entire shift. Staff will also be given goggles that they will clean and reuse every day. Since coronavirus is spread with droplets these are appropriate masks. If we do procedures that cause the virus to become an airborne risk instead of a droplet risk (there is a list from the Center for Disease Control about what procedures these are) then staff will either use an N95 or a hood with their own purified air supply. Most staff already have the hoods, and we have plenty of N95 masks for staff who do not.

I am a little concerned about bringing the virus home with me. I don’t wear any jewelry since microbes can gather under rings. I’ts odd for me since I’ve worn my wedding band consistently for 35 years. I practice precautions at work. I wash my hands before I leave work, I take off my shoes before I get out of my car at home and sanitize my hands. None of my family members are allowed in my car. I put my clothes in the laundry and get in the shower as soon as I get home. I wash my hands frequently and at least once a day I clean high touch surfaces, including my phone, and then wipe them down with bleach wipes or spray them with bleach and water. We also try to not be too close to each other, and have an illness plan of how to isolate anyone sick in the household. It isn’t a guarantee, but life is always uncertain.

I choose to be a nurse, and I am aware that it comes with risks. I have cared for people with AIDS, hepatitis, flu, flesh eating strep, all sorts of infectious and deadly diseases. I don’t want to be infected with any of these diseases and I take precautions, but I am willing to take the risk because caring for people is what nurses do. I’m not a saint, I’m just someone doing my best to do my part to make a difference in the world, just like nurses around the world do every day.