Home Health in the Time of COVID-19

Home Health in the Time of COVID-19

The office is closed. The door is locked. If you need supplies, you make a request by email 24 hours in advance. Text when you get there and the supplies will be placed outside the door. Maybe by elves.

I’m in my car. The air conditioner is blowing. I’ve been waiting for 20 minutes for my bag of hand sanitizer, chucks, gloves, masks, gowns, booties, and various dressings and accouterments of wound care. My next case is across town and I’m not getting paid to sit around.

Across the parking lot is Regional Medical Center’s Emergency Room. They’ve closed the waiting room and put up tents in the parking lot with chairs placed well away from each other. I watch as people drive up to be tested for COVID-19 or to unload someone needing emergency care. A tech in full PPE walks out and waives a thermometer across the forehead…OK, next station. Such is medicine in the age of COVID-19.

My first “official” case of COVID-19 is a man in his early 60s. He shuffles to the door with a walker. His skin is hanging off of him in folds. He looks like one of those dogs with droopy flaps around his face. He got sick in February, a construction worker with a cold before we really got the news of a brewing pandemic. Three months he lived on a ventilator.  He points proudly to his tracheostomy scar. “It couldn’t kill me,” he says.

I say “official” because you never really know who may be contagious since so many people show no symptoms. I’m standing outside the door of his house at 2 pm on a hot California day wearing a yellow gown, a mask, face shield, blue gloves, and blue knee high paper boots that are making my feet itch like crazy. Sweat is dripping down my forehead onto my glasses and I can barely see a thing. Sweat is also dripping down my back and arms. I think my gloves are full of sweat. I should have drank more water.

He lets me into the house. There is no air conditioning. The windows are all open. The living room and dining room have been stripped bare for remodeling. There are boards piled up, things in boxes, a new floor. It’s going to be nice. He’s staying with his daughter while he recovers and he’s anxious to get back home but still too debilitated to take more than a few steps.

The home health start of care evaluation is 29 pages long—29 sweaty, hot pages. We are sitting on those cheap folding camp chairs. The only other furniture is a small fish tank on the mantle that needs water.  The pump is sucking air and making a sound like a jet engine. I rock the fish tank gently back and forth and get enough water to the pump that it starts working quietly again. He looks at me. The fish look at me. I sweat. I hope he’s not noticing the growing splatter marks on his new hardwood floors.

What should take 40 minutes takes 90 minutes. Each step of the way I’m double checking what the patient has touched. Did I give him this pen or that pen? I clean the BP cuff twice. Next time I’ll just leave it there. He’s not even shedding virus any more. He’s recovered. Not exactly spry, but he definitely has the air of a man who escaped the tiger’s den. He doesn’t even need oxygen. He’s a lucky dude. I tell him to buy a lottery ticket. One for me too. He laughs.

I ask him who is in the house and I document each person I come in contact with and what PPE I was wearing. It’s a new policy at our company. We document every person and what we were wearing. Let’s face it, sooner or later, one of us is going to come up positive and it will be the unpleasant job of someone in the office to call all of our recent contacts. I can hardly imagine how that conversation goes.

“You know the nurse that came to visit you? We are calling all of the people that she visited because she has COVID-19 and we want to ask you to get tested yourself and self isolate for 14 days.  Also everyone in the household and everyone they’ve come in contact with. Have a nice day.” I pray to God I’m not that one.

So I check everything twice, three times. My next patient is even sicker…and older. I can’t be the dark angel of death. I sanitize my hands again. I stagger out the front door and take off all the gear. Sweat is literally pouring off of me and off the inside of the slick yellow gown. My shoes are soaked. I take a moment to red-bag my PPE and wipe down the outside of my ditty-bag. I have an hour of paperwork to do on this guy. I have to call his doctor and get a verbal order for start of care. I have to drink a lot of water…I mean right now because my vision is getting grey around the edges. The blessed blessed AC is blowing cold in the car. Thank God for small favors.

This is the new normal. Everyone has to make changes. I don’t understand the resistance to wearing a mask that some people have. For some reason, someone in the highest office has decided that wearing a mask makes you liberal. The virus makes no such distinction. I don’t understand how wearing a mask to protect the people around you has any political significance at all. But there you have it—the new normal. Stay safe out there.

A Career of Choices: Where Will You Live?

A Career of Choices: Where Will You Live?

It’s a great time to be a nurse. Especially with the COVID-19 pandemic and as the global population continues to swell, improving public health is paramount. Health care professionals, especially nurses, are essential to helping people establish and maintain healthy lives. Thus, nursing professionals are in high demand. Job growth within the industry is expected at least through 2028, reports the Bureau of Labor Statistics (BLS), at a rate that’s much higher than average.

At its core, nursing is a fulfilling job where you can truly make a difference. But the perks of a nursing career don’t end with humanitarianism. Nursing opportunities essentially span the globe, giving you free rein to comfortably live wherever you want, from dynamic cities to suburban enclaves or rural communities where the pace of life is slower.

So where will you live? It’s in your best interest to find somewhere that you enjoy, and where you can envision building a life over the long-term. In fact, your health may count on it.

Cultivating Happiness at Home and on the Job

Every place we have ever lived has left some kind of an impression on us. Many of those places spark joy and fuel happy memories, aptly illustrating the connection between mood, emotions and place. As a healthcare professional, you may be aware of the ways in which where you live affects your happiness. And where your personal happiness is concerned, it all comes down to well-being: According to NPR, well-being is associated with “longer life expectancy and better health outcomes.” The place we call home has the power to diminish or boost our well-being

Most of us have heard the old cliché, “home is where the heart is.” Or how about “there’s no place like home?” Your hometown and its traditions are the building blocks of your personal identity, influencing everything from your choice of sports team to favorite recreational activities. What’s more, cultivating a sense of place helps us build our identity as we grow older, and make decisions that impact our career.

No matter how much you love the place you call home, however, changes in your work or life situations can lead to a geographical change as well. Sometimes, we outgrow a place, a company, or a once-beloved position and want to start afresh. And figuring out where shouldn’t be done lightly. Start by asking yourself what you want in a city while also looking for employment opportunities that reflect your values. Conducting research into the top states and cities for career growth, including Seattle and Austin, may help you narrow down your choices.

And with a nursing degree, you can broaden your search well beyond jobs in the U.S. Across the world, 6 million more nurses are needed to help fill demand and meet global health targets. The nursing shortage is more prevalent in low- and middle-income countries, the World Economic Forum reports.

Taking the International Leap

Nursing provides plenty of opportunities for adventurous spirits to satiate their wanderlust, in the U.S. and beyond. For many, the international nursing experience is life-changing, broadening your worldview as you build essential skills. Further, nurses with a job history that spans continents may have a leg up when it’s time for a career change.

Employers in the health care industry appreciate a diverse background in their candidates, as well as the ability to quickly adapt to changing environments. Alongside the U.S. and its territories, some of the best countries for nursing include Italy, Canada, and Luxembourg.

International nursing is a great choice for those who are passionate about the humanitarian side of health care. Some international workers may care for refugees or marginalized populations, for example, such as those aboard Africa Mercy, a hospital ship. It’s important to note that international nursing jobs aren’t always paid positions, but volunteer experience in the health care trenches can be an invaluable tool in furthering your education and career.

Reflecting on Your Career Choices

Just as there are different types of nurses, there exists a seemingly endless array of places in which you can practice your craft. Your chosen career field is a guide towards the place that you can call home — For instance, Nurse Practitioners (NPs) may end up working with marginalized populations in a primary care provider (PCP) capacity. Registered Nurses (RNs), on the other hand, primarily work in hospital settings, so city life may be in the cards.

Your nursing career provides boundless gifts. For starters, you can truly make a difference in the world, helping improve quality of life at both the individual and community levels. But nurses also enjoy the freedom to choose where to live, and that gift shouldn’t be taken lightly.

Whether you’re kicking off your nursing career or entering a new field of nursing, it may be the perfect time to upgrade your location as well. You may find that a change of scenery does wonders for your personal well-being, allowing you to thrive like never before.

Nursing Assistants Provide Care and Comfort

Nursing Assistants Provide Care and Comfort

Nursing assistants (NA) have been essential members on healthcare teams throughout the COVID-19 crisis. And while the pandemic continues to spread around the world, National Nursing Assistants Day on June 18 is timed to thank nursing assistants for the care they provide.

For 43 years, the National Network of Career Nursing Assistants has sponsored an entire week to celebrate those who choose this career. This year, that week runs from June 18 to 25 and is being marked as “Celebrate in Place” as many events have moved away from in-person formats.

According to Genevieve Gipson, RN, Med, RNC, and director of the National Network of Career Nursing Assistants, the theme for the week is kindness. NAs are encouraged to focus on a different aspect of kindness throughout the week and focus on events and projects that can continue to have an impact over the course of the year.

The National Association of Health Care Assistants seeks to elevate and promote the professional NA career . Working on teams and with other healthcare providers delivers more consistent and better patient care and nursing assistants are part of the team.

Nursing assistants and certified nursing assistants perform the routine patient care that often allows opportunities to talk with patients and learn more about them. Whether a patient is in a long-term care facility and sees a nursing assistant almost daily or in a short-term hospital stay and only has brief interactions, NAs and CNAs can make an enormous impact on the patient’s general care. By getting to know a patient and listening to them, nursing assistants can pick up on subtle physical or emotional changes or on preferences that could help fine tune such necessities as a preferred meal plan or understand family relationships.

NAs work under the supervision of registered professional nurses and perform duties that can range from basic patient care including bathing, feeding, toileting, grooming, dressing, and answering patient calls for help. They are generally responsible for things that help keep patients comfortable such as changing linens or checking bandages.

NAs can increase their training and competency with certification. Each state determines its own certification requirements, so plan to look into this additional step in whichever state you plan to practice. The extra certification can take a couple of months to complete, but offers additional skills that will be used every day.

The impact of NA-provided patient care can’t be understated. Because of their close interaction, they often help patients who are lonely and can comfort those who may need companionship. During the COVID-19 crisis, many facilities restricted visitors and so healthcare teams were the only people many patients could see for months. Having a friendly person to talk with calms nerves, staves off loneliness, and provides a much-needed human connection.

Celebrate National Nursing Assistants Day and National Nursing Assistants Week and be proud of the much appreciated care you provide.

The Economic Impact of COVID-19 On Nursing Staff

The Economic Impact of COVID-19 On Nursing Staff

In the last two months, the world has begun to recognize and acknowledge what anyone in the health care field has always known: that nurses are society’s real superheroes. And yet for all the praise and adulation being heaped on our health care providers, for thousands of nurses, it all feels like lip service.

The fact that nurses are risking their lives every day in the fight against coronavirus isn’t news. But what few people know is that nurses aren’t just being asked to sacrifice their physical and mental health in the face of the pandemic. They’re also being asked or required to sacrifice financially as well.

This article discusses the profound economic impact of the COVID-19 pandemic on nurses, especially nurses of color. It also provides strategies for minority nurses to protect themselves financially as well as physically during the pandemic and beyond.

Becoming “Expendable”

Nurses worldwide and particularly in the US are being asked to risk their lives and health to care for infected patients without even the most basic of protective equipment. At the same time, they’re facing job cuts on a level second only to those of the restaurant industry.

And even as nurses not called to the frontlines are facing furloughs and job losses, minority nurses find themselves contending with skyrocketing rates of infection in their own communities. This means minority nurses who may have been exposed on the job or at home now face the prospect of illness and the massive expenses of treatment on a reduced income and possibly without health insurance.

A Heightened Risk

It’s not only the loss of income and insurance that nurses are facing today. The coronavirus pandemic has also fundamentally changed the way health care is delivered, and that has increased both the physical and the financial risks that nurses must face.

For example, as the virus began to spread and lockdowns became more prolific across the country, health care providers turned increasingly to telehealth to care for their patients. This was a great benefit in ensuring continuity of care while protecting against the spread of the virus. Telehealth, however, is an entirely new beast for many nurses, and that’s exposing them to greater liability than they might ever have faced in the clinic. As effective as telehealth technologies may be, they can’t duplicate the conditions of a face-to-face patient exam. There are things that can be missed when you can’t touch the patient, see how she walks into the room, or listen to her breathing.

The question isn’t whether mistakes will be made or symptoms unrecognized. The question is how many of those mistakes will be judged to be malpractice and who will be held financially as well as legally responsible. This is a particular concern for nurses caring for patients with substance abuse disorder. The national lockdown has pretty much necessitated that patients in recovery transition to telehealth.

And yet substance abuse disorder is notoriously susceptible to relapse and the signs of relapse often incredibly difficult to detect, especially through remote care. Should a patient overdose while under the auspices of telehealth care, it is not unimaginable that a treating nurse could be held financially responsible

Planning Ahead

No matter how deep a toll the pandemic has taken on your physical, emotional, and financial well-being, there is a tomorrow to come. If you have been furloughed because of the pandemic or if you simply cannot tolerate the conditions you have been asked to endure, you might find that a career change is your best option.

That doesn’t mean that you have to leave the field of nursing entirely. If it’s still your heart, then you might take the hard lessons learned during the outbreak and use them for good. You might find your purpose in a new career spent solving the problems that threatened to break you.

For instance, you might decide to pursue a Master’s degree in Health Policy and spend the rest of your working life developing programs to protect those on the frontlines and the patients they care for. You could build a career ensuring that tragedies like those nurses are encountering every day of the pandemic never happen again.

You might decide, however, that you need an entirely new start and venture into an entirely new industry. You might reinvent yourself. If that’s the case, then you need to be strategic and start thinking like a recruiter. Now, more than ever, hiring managers are using behavioral interviewing to find the ideal candidate. Understanding what that is and how it works can give you a decided advantage, especially when breaking into a new industry. At its core, behavioral interviewing gives you the opportunity to demonstrate exactly why you are the ideal person for the job. You simply have to “read” what the interviewer is looking for in the questions she asks.

The Takeaway

Nurses are finally being recognized as the superheroes they are, but they are far from getting the treatment they deserve. Instead, they are facing massive job losses, potentially lethal working conditions, and significant financial liabilities. Because of this, some nurses are choosing to leave the field altogether, while others are looking to transform it from within.

How to Keep Your Patients Calm During the Pandemic

How to Keep Your Patients Calm During the Pandemic

With visitors being banned at most hospitals and health care facilities because of the spread of the coronavirus, nurses are often now one of the only contacts that patients have. So how can you help keep your patients calm during this scary time?

Dr. Judi Kuric, academic coordinator for Walden University’s MSN Gerontology Acute Care NP program, and a nurse practitioner board-certified in adult-gerontology, family, and emergency care. She took the time to answer our questions about keeping your patients as calm as possible.

What are the easiest things that nurses can do to help keep patients calm?

Nurses should keep patients informed about their status and treatment plan. There are a lot of scary stories circulating that can increase a patient’s fears about their own condition. Clear, simple, and individualized information will help allay a patient’s fears.

Set expectations and next steps for the patient each day. Identify one or two daily goals to help the patient understand their priorities for the day. Goals could include exercising their lungs by expanding them hourly or walking around the room three times daily.

Provide meaningful distractions such as favorite television shows, movies, or music to entertain and engage the patient and decrease anxiety.

What are some tips that nurses can use to keep patients calm on a daily basis?

Hospital routines and activities like repeatedly checking a patient’s vital signs can increase their stress. Counteract this by providing reassurance on their physical status. Give feedback when their status is stable or better. If a patient’s physical status is worse, help them understand the plan for improvement. Provide ways patients can help themselves and involve them in developing goals. These can be as simple as taking 10 full, slow, and deep breaths every 30 minutes.

Many facilities are playing uplifting songs or classical music throughout the hospital or unit several times a day.

Encourage contact with family and friends using social media.

What can nurses say to patients?

Open, honest, and calm communication is always best. A patient’s imagination can add to their fears about complications or outcomes that may not apply to them. Engage patients in discussions about their fears and try to address each one. Build continuing and meaningful dialogue with the patient by asking them about a family member, a favorite vacation, or their hobbies. This helps you learn more about the patient and also engages them in positive memories.

How should nurses act around them to keep them calm? Confident? Use calming voices?

The stress nurses are feeling has increased in the pandemic. The pandemic means nurses are providing higher levels of care that require additional equipment, procedures, and safety measures. Restrictions on visitors mean nurses must strive to fill the void for conversation, compassion, and smaller tasks that comfort patients.

Avoid passing on your own stress and anxiety. Try to refocus as you enter each patient’s room; use a calm voice, and make sure your activities seem unhurried. Don’t talk with patients about your stresses.

Nurses need to take care of themselves. If your stress level is lower, you’ll be less likely to pass on your worries to patients.

What can nurses encourage family and friends to do to help the patients stay calm and more relaxed? Write letters? Use social media? Facetime?

Now is the perfect time to use social media. Have set times for family members to video chat with the patient, and ask loved ones to send emails or post on social media. If hospital policy allows it, provide the patient with pictures and letters.

It’s important to encourage families to be calm and use their interaction time with the patient to be positive and supportive. This isn’t the time to detail all the anxiety they are feeling or the stressful things happening at home.

Critical Care Nurses Are Essential

Critical Care Nurses Are Essential

Critical care nurses, those who work on critically ill patients in intensive care units, emergency departments, and other units, have likely had some of the most intense moths of their careers this spring.  As the last week of National Critical Care Awareness Month is celebrated, this designation brings attention to the specialty work performed by these nurses across the nation.

Because of the unpredictable and often hectic cases they work with, nurses in this specialty need to have an innate ability to work in a calm and steady manner no matter what the conditions. As their patients face serious and life-threatening situations, critical care nurses are there to assess the patient, monitor for changes, treat injuries or problems, and provide thorough and immediate hand-off instructions.

Critical care nurses can work in various locations, but the care they provide is especially important for patients whose conditions are not stable. As these nurses have seen and relayed many times over, the COVID-19 crisis has shown why this kind of nursing is so essential. Patients with COVID-19 are often improving, says nurses, or showing signs of only minor distress before their conditions abruptly worsen. As a critical care nurse, watching that patient closely and continuously monitoring for any changes in vital signs, comfort level, breathing and talking, or overall general behavior can help give the patient the right care. Critical care nurses all over the world have been alert to these kinds of changes in condition and have been able to implement life-saving measures for many. As a nurse in this specialty, many nurses have also faced the opposite situation and have had many patients die despite being given the best treatment and care.

Becoming a critical care nurse requires a commitment to getting at least your BSN or most likely your MSN, continuing with certification and additional professional development, and recognizing the personal and very real impacts of this role. The American Association of Critical Care Nurses and the Society of Critical Care Medicine offer excellent resources, tips, and guidance for those considering this career path and for those who are already experienced critical care nurses. Critical care nurses face the highest highs and the lowest lows, often within one day, and sometimes from gut-wrenching situations. As a nurse in this field, it’s essential to understand how you’ll process so much emotionally. Managing job stress is a top priority. Of course, nurses enter the field because they do well under pressure and can keep calm and focused for the sake of their patients, their teams, and themselves. But sustained and traumatic caseloads, as have happened with COVID-19, or even a case that can strike an emotional chord for some reason, can take a toll on nurses. If you’re considering this field, honestly understanding if this is something you’d be suited for is critical.

There is high demand for critical care nurses in the job market, so your skills are needed across the country. If you think this is a good career path for you or if you’ve already chosen this path, the rewards of being a critical care nurse are significant. You are the voice of your patient and you’re able to make choices and be the best advocate for your patient. Being able to do that and knowing you have provided the best care possible while ensuring your patient’s best interests is gratifying.