While the worst of the COVID-19 pandemic seems to be behind us, the spread of the Delta variant indicates that it’s not completely over yet. During the height of the pandemic, nurses worked on the frontlines all over the country, and some are just now sharing their experiences working in the ER during the height of COVID-19.
Rastisha Smikle, RN, works in an ER at a hospital in central Florida. Having worked as a nurse for more than 10 years, she answered our questions about what it was like in the ER during COVID-19.
As a nurse in the ER in Florida, what has it been like working there during COVID-19? How has it changed over the last year or so?
It was very challenging to work during the pandemic. In the ER, we are a patient’s first point of contact, and because of that, our staff is considered at a higher risk of being exposed to the virus. Although safety and infection control elements have always taken priority in our roles, the unknown factors of the virus’ transmission, ever-changing symptomatology, and treatment contributed to our challenges because of all the unknowns.
Patients were more fearful than ever; they often came in anxiety-ridden wanting testing because of recent exposures, which added additional challenges because the critical emergencies also relied on our care.
In some ways, things have gotten better. As we have learned more about the virus and therapeutic treatments, patients are being cared for more efficiently so that they can recover at home. Unfortunately, hospitals nationwide are busier than ever right now. The volume that we are seeing is higher now than we saw during the pandemic. It’s tough to say what that is.
Did your duties change during COVID-19?
My duties didn’t change per se, but the way we cared for patients did.
Before the pandemic, PPE like N-95 masks were not permanently a part of my uniform. Now, I wear an N-95 and face shield with every patient encounter. Because of the wide range of symptoms, we have to be extra diligent in caring for patients just in case they have the virus and aren’t aware of it yet. In addition, minimizing my exposure time with known Covid-19 patients is also an element that I have had to implement in my care. For the safety of myself and the other patients, swift patient care must be implemented with these patients when appropriate.
Employing the use of hospital phones has been a way that I try to fill in the gap. Throughout this time, I have learned how fearful patients are after they get the diagnosis. With these talks, I can extend some reassurance, listen to their concerns, and figure out thoughtful and effective ways to help them with the emotional challenges that often accompany the diagnosis and isolation.
Was it scary to work there in the beginning of the pandemic? Why?
There was a level of fear when it came to the unknowns. I had worries about getting the virus. But primarily because of my level of exposure in the ER, I was mainly concerned about others being around me. I isolated myself from family and friends, and my life was work and home.
There were times when we would care for patients with no known symptoms and later, we’d find out that they were positive for Covid-19. I would have mounting thoughts of whether I wore the correct PPE or if I was exposed in those moments.
We also had staff members contract the virus, which was scary. Thankfully, most of them recovered well, but seeing how careful other staff members were and finding out that they still contracted the virus was nerve-wracking. Every minor allergy symptom or cough would cause concern and anxiety about whether I was next. To combat those fears, I had to reshape my focus. Instead of being hyper-focused on getting sick, I began to fix my focus on doing my job well and providing the optimal patient care that I was used to. With this newfound focus, my anxieties slowly began to dissipate.
How do you keep yourself from bringing the stress of the job home? What do you do to relieve your stress?
Sometimes it can be challenging, especially after losing a patient. My go-to stress reliever is prayer. I have a solid spiritual foundation, and thankfully the organization I work for also provides spiritual support, if needed. As nurses, we are fortunate enough to work three shifts per week. I try not to take my days off for granted; I use that time to refuel. Therapy, exercise, and self-care activities have been essential to my mental well-being.
What are the biggest challenges of your job—especially during COVID-19?
One of the biggest challenges of my job is knowing that I have to be on my A-game at all times because the safety of myself and others depends on it. The unknowns that came along with COVID-19 made it challenging to do and be our best. For example, we didn’t always know the best course of action when treating some patients because everyone would respond so differently, which posed one of the biggest challenges. Thankfully, as time went on, we learned more about the virus, the treatment options that worked for others, and we eventually adapted very well.
What have been your greatest rewards during this time?
My greatest rewards have been seeing how the nursing and healthcare community banded together during the most challenging times. The support from our community members was also very inspiring. We often came into work with goodies from companies that wanted to encourage and thank us for our continued work.
Changes have occurred since the Civil Rights Movement of the 1960s to improve the treatment of Black people; however, the underpinnings of systemic and structural racism are alive and well in the United States. Through the inequitable outcomes of the COVID-19 Pandemic, 2020 bestowed upon us an undeniable reality check on the national impact of systemic and structural racism in our healthcare delivery system. As of March 17, 2021, the Centers for Disease Control (CDC) (2021) reported 533,057 COVID deaths in the U.S., 289,119 of which were reported by race. Of those 289,119 deaths in which the race was known, 14% of the victims were identified as Black, non-Hispanic. Although underrepresented in the U.S., Black people disproportionately led the death toll rates as they suffer from existing socioeconomic hardships in addition to the adversities brought on by the pandemic.
The COVID-19 Pandemic has shone a light on the health disparities and inequalities that people of color suffer from daily. The lack of trust for the COVID-19 vaccine embodied within the Black community due to historical and current medical negligence and bias provided by a vastly white population of healthcare professionals compounds this problem. In November 2020, a survey conducted by the National Association for the Advancement of Colored People (NAACP) revealed that only 14 percent of Black respondents trusted the vaccine and only 18 percent indicated that they would definitely get vaccinated.
Health care disparities extend beyond the pandemic, however. For example, according to 2017 data from the CDC, Black women are three to four times more likely to die of pregnancy complications than white women. Contributing factors to these disparities are financial, bureaucratic, transportation, language barriers, and care that is not consistently culturally appropriate or respectful.
To abate these tragic, disproportionate outcomes and build trust within the U.S. health care delivery system, the healthcare workforce must become more diverse. Our nation’s population is continuously changing and becoming more diverse. The healthcare workforce must change to match. The United States Census Bureau predicts that by 2045, over half of the U.S. population will consist of minority populations. The American Association of Colleges of Nursing (AACN) stated, “with projections pointing to minority populations becoming the majority, professional nurses must demonstrate a sensitivity to and understanding of a variety of cultures to provide high-quality care across settings.”
Culturally congruent health care providers representing racial, ethnic minority populations improve trust in the health care delivery system, quality of care, and outcomes of minority populations. A 2017 report by the National Institutes of Health determined that cultural respect was an essential factor in reducing healthcare disparities and improving access to quality health care for diverse patients. According to data from the National League of Nursing and the U.S. Census Bureau, approximately 80% of registered nurses, nurse practitioners, and nurse-midwives are white. Schools of nursing must also develop strategies for increasing diversity within the nursing workforce.
An example of this shift can be found at Frontier Nursing University, which, over the past decade, has placed an emphasis on diversity, equity, and inclusion (DEI), with a particular focus on increasing the enrollment and graduation rates of students of color. FNU included DEI in its strategic plan to address issues surrounding access to health care, health outcomes, health disparities, health inequities, and to increase diversity in nursing. These efforts will play a significant role in ameliorating health disparities and inequities. FNU’s SOC enrollment has grown from 9% in 2010 to over 25% in 2020. FNU is continuing on the trajectory of integrating DEI and antiracism throughout the university to support racial, ethnic underrepresented students. Resilience during the COVID-19 Pandemic permitted FNU to graduate 841 students, including 208 students of color, yielding an increased workforce diversity to care for diverse, rural, underserved populations. Additionally, FNU’s current retention rate for SOC is 84%, exceeding the university’s goal of 80%, and the number of faculty of color is on the rise, currently standing at 14%.
FNU is an example of the intentional focus required to begin building a more diverse, culturally competent health care system. We have known and understood for a while now that the lack of diversity among primary health care providers was a contributing factor to the glaring disparities in health care outcomes among diverse populations. The past year only acted to exacerbate the problem and heighten our awareness of the need for immediate change and action. If we have learned anything from the pandemic, it is that diversity, equity, and inclusion are the keys to the future success of our nation’s health care delivery system.
2020 brought to light the INTRANSIGENT nurse. This year was ushered by the unforeseen- the unexpected, unpredicted, unanticipated eruption of COVID-19, which brought a seismic wave of panic, fear the world over, and brought every nation’s economy to a grinding halt. While it looks like the virus can run a government aground, due to incompetence and ineptness, rising to the occasion to save a nation are the unsung heroes in scrubs. YES – the nurses, along with other health care providers, are at the forefront of this war. Geared up to a bare minimum of PPEs, giving them a modicum of confidence in keeping themselves safe, they bravely trudge over the fear and the virus with sheer tenacity, determination, and dedication to the call of duty. Their assiduity to the crisis has left a profound and moving picture of the BEST of humanity – a picture that will be etched in our memory of memories forever.
COVID-19 is a new strain of coronavirus which left health organizations around the globe scrambling for a cure. It is a war with the unknown and yet, unknown it may be, the nurses are in the battle armed with strength of character, sharp awareness of their ethical responsibility and a dogged resistance to give up in the face of great uncertainty of one’s own safety.
Nurses are …
Noble. Nurses are not blue-blooded by birth but has patrician ideals and aspirations – that is, to serve. Nurses are hell-bent, driven, purposeful and intentional – to do the right thing.
Undeterred. Nurses remain steadfast in the face of setbacks. They remain to be the voice of reason amidst the noise of the government who make emphatic declarations that are seemingly plausible but wrong – statements simply aired to give their actions a specious appearance of novelty and a tinge of humanity because there is none.
Regal. Geared up not in a ritzy way yet, they conduct their duty in an exalted, august manner.
Spartan. Nurses are people of great courage. They give up their security to save humanity.
Energetic campaigner for the vulnerable and the defenseless. They go on the offensive to defend the helpless. Creative, Ingenious. Resourceful.
As unforeseen as this crisis may have been, COVID-19 has not predicted 2020-2021 to be the year of the nurse either. The COVID-19 virus may seem relentless but it is no match to the unshakable spirit and intelligent mind of the INTRANSIGENT nurse. Nurses have the Midas touch… nurses act to complete humanity. To all my fellow NURSES on the frontline, I wave the flag of victory! You deserve the highest of honors! To you, my HATS OFF!
As the coronavirus pandemic reaches new heights across the country and hospitalizations rise, nurses are facing extreme and unprecedented demands. A recent study from the Journal of Occupational Health found that the coronavirus pandemic has significantly impacted the mental health of health care workers, especially frontline staff.
The heightened risk of exposure, coupled with inexperienced nurses providing care in fields where they have limited experience and veteran nurses feeling severe burnout, has caused many nurses to quit and move to outpatient clinics or home care.
As a result, hospital systems are turning to short-term travel nurses to fill the gaps in care as they continue to rely heavily on their nursing staff to manage the increase in hospitalizations due to COVID-19. These temporary nurses often struggle to feel connected to the resident nurses which can result in miscommunication and lapses in effective patient care.
These rapidly changing circumstances have put hospital systems in a tough place. Many are focusing all their energy on dealing with the crisis at hand, rather than addressing the deteriorating mental and emotional health of their nursing staff.
To protect one of their most valuable resources–their nursing staff–it’s crucial for hospital systems to think proactively about building resilience among their nursing teams and leaders. In my work with Innovative Connections, we we’ve been able to help nursing leaders at Baptist Health in Montgomery, Alabama, do just that.
In May 2020, it was clear to Gretchen Estill, MSN, RN, CNML, Chief Nursing Officer at Baptist Medical Center East (BMCE), that her nursing leadership team was emotionally exhausted from the nonstop care needed to handle COVID-19 hospitalizations.
“We had a multifaceted challenge,” Estill said. “This strong group of leaders were beginning to run on empty as we realized that this was not a transient pandemic. We are a very relational group, and we were missing the ability to get together in person and debrief.”
Meanwhile, at Prattville Baptist Hospital (PBH), chief nursing officer Meg Spires, RN, MSN, recognized a similar pattern of fatigue and frustration among her team of clinical leaders. Her close-knit leadership team still felt a strong commitment to their mission of putting patients first, providing passionate care, and pursuing perfection. However, the challenges from the pandemic made this mission seem impossible to carry out.
Although investing time in team development and resilience work during a pandemic may have seemed counterintuitive, these nursing executives at Baptist Health understood their teams needed emotional and psychological support to make it through the ongoing challenges of COVID-19.
Nursing teams participated in weekly team coaching sessions facilitated by Innovative Connections, a management firm in Fort Collins, Colorado, via videoconference. Nurses were able to discuss mindfulness, dealing with grief, changing their perspectives and building resiliency.
At the end of each training we give them a mindfulness practice to help ground them during their work. We had nurses dedicate the 20 seconds they wash their hands multiple times each day to practice mindfulness. Instead of adding one more thing to their non-stop schedules, we were able to incorporate this self-care practice into something they already have to do throughout the day.
“This resilience training is a necessary investment before and especially during a crisis,” Laurie Cure, CEO of Innovative Connections said. “If a team has been working to build trust, they are better positioned to show up and do their job when a crisis hits.”
Initial feedback found that the nursing team was grateful to have an opportunity to connect as a group in a designated place to debrief about how they were doing mentally and emotionally with their teammates. Many enjoyed the chance to unplug and understand how others on their team were coping to focus on their collective contributions and strengths during such a stressful time.
“I’ve heard repeatedly from my leaders that they’re extremely appreciative that we, as an organization, cared enough about them and their emotional health to invest in them,” Spires said.
Dedicating the time for resilience and team building during the demands of the COVID-19 pandemic may have seemed counterintuitive at first. However, the awareness that these key team members gained from having protected time to rejuvenate and support one another was invaluable. Pursuing this intervention has contributed to increased efficiency and connectivity for these nursing teams.
“The team had to acknowledge that we have to take care of ourselves before we can take care of others,” Spires said. “We focus on our physical health, but we don’t pay as much attention to our emotional or mental health. We can’t do justice to our patients or our team members if we’re not emotionally healthy.”
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.
