Nurses’ Concerns with COVID19: Update April 1, 2020


Ongoing Issues: By now, most of us know the obvious: nurses and other healthcare professionals do not have the PPE that they need to practice safely. Nurses are testing positive for COVID19. The Defense Production Act has not been activated to produce more PPE and ventilators, and nurses and other providers are even fired for speaking out about it or organizing ways to access more PPE (Doctors and Nurses Fired for Speaking Out ).

Nurses’ Skill Level: Nurses are worried about being asked to do work they aren’t prepared to do. A former student of mine, who has been in more of an administrative role, is extremely concerned with being asked to go back into a hands-on medical surgical or even ICU in a supportive role. Practicing beyond one’s skill level or expertise is just one area of concern that is likely to grow as more nurses become ill, or refuse to work, or are otherwise unable to work. 

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Volunteer calls: From California to NYC to Maine, nurses are being asked to submit their names to volunteer to work. Most of these nurses will be paid, and it is an effort to organize our resources.

Nurses on the Front Line: The stories I am hearing from nurses are war-time hell-like, maybe even worse then you have heard of if you don’t have direct contact with nurses on the front line.

An example is a story a friend of mine posted from his friend in NYC: in the ER, there may be 7-10 COVID+ vented patients waiting for ICU placement. Some patients are lying on the floor in the ER because there are no beds. People are being taken to rooms on the floors and passing away before they even get seen by a nurse on that floor. Medications like propofol, ketamine, versed, and fentanyl are being run without pumps because there are no more pumps. Supplies are running out. Med Surg nurses are being forced to run drips and vents that they have not been trained on.

Pay Issues: In Utah, nurses and doctors are being asked to take pay cuts, and there is concern that this will create a great deficit of providers in this state when professionals go elsewhere to work (Utah’s largest medical provider announces pay cuts). Meanwhile, note this lovely NYC serene skyline shot, with pay that must recognize the obvious inherent hazard pay for these positions.

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(nurses recruitment add, contact information removed)

Populations and Outcomes:

Much preventative and maintenance care for those with chronic and even acute illnesses is now taking a back seat. A positive note is that telemedicine and telehealth are being used much more widely, and this may have a favorable effect on how we care for populations in the future.

Dr. Chinn forwarded a first-hand account to me of a nurse who is working in Brooklyn. She is concerned about how this illness is impacting Latinx populations, as they are often members of “essential worker” populations, and they also live in large households. This nurse states that these patients are at higher risk for death, and often experience death with less dignity. She also sees all staff getting sick, from direct care providers to janitors, and patient care technicians.

Anecdotally, in one social media group, I heard the nurses estimating that survival rate once a patient is ventilated is only around 14-20%. This is devastating to be surrounded around so much futile care and facilitating so much end of life care without perhaps the time and space it requires to do this well. (Edited: national statistics show a recovery rate of about 50% post ventilator initiation).

Heartbreak:  I am hearing heartbreaking stories of nurses sending off their children to grandparents or ex-spouses, so they won’t be exposed in the household should the nurse become sick themselves or accidentally contaminate the household. Nurses who can’t hug or hold their loved ones are aching inside every day. Nurses dying. Nurses looking around at their colleagues and they might wonder, who will be the next to not be at work, which one of us might end up in the ICU? Nurses may know that much of the care they are providing is futile or palliative, which creates moral distress. I am very concerned when I hear of nurses working multiple shifts, with one nurse posting that she had worked 13 shifts in a row, another posting about minimal sleep, and losing 10 pounds already. They don’t have time to eat and when they go shopping, the stores are lacking in supplies. There is no question in my mind that nurses are being put at greater risk not only due to exposure, but also due to physical, mental, emotional, and spiritual stressors.

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Post-Traumatic Stress: We could say nurses are stressed, or maybe we should just be truthful and say that nurses are being traumatized. I have great fears of nurses leaving the profession after this, and I also have great fears about the health of the population in general. I am fearful for those on the front lines without access to proper PPE. This sort of chaos we are experiencing may lead to positive change eventually, but for now, it’s extremely uncomfortable, painful, confusing, infuriating, and even disorienting.

We need to take good care of ourselves and take good care of one another.

I am reaching out with loving-kindness to all nurses:

May all nurses be safe

May all nurses be at ease

May all nurses be loved

May all nurses know personal healing

Namaste

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4 thoughts on “Nurses’ Concerns with COVID19: Update April 1, 2020

  1. I’m going to make this short because I will probably be banned once again so I don’t want to waste a lot of my time writing something that may never see the light of day as was the case with my last post.

    There is nobody coming to rescue nurses. There are no regulatory agencies that are going to enforce safety standards. The ANA and other nursing organizations are going to fail in this environment. The answer isn’t in writing to politicians. They don’t know what to do and a lot of them don’t even want to do anything – they have been waiting for decades for a thinning of the human herd. Hospitals are hard hit, but the dangers in nursing homes, assisted living facilities, and home health are astronomical because everyone is focused on the resource needs of hospitals.

    Nurses aren’t going to get trained to care for patients they have never dealt with before. In a few weeks, people dragged in off the street will be caring for acutely ill patients in the hardest hit areas because the many of the nurses will have died or become so sick they cannot keep working.

    Nurses need to be creative to protect themselves. It may seem ridiculous to wear a trash bag, but a trash bag is damn close to a hazmat suit. The biggest problem I see with the picture of nurses wearing trash bags is that they don’t have their heads covered with a clear plastic trash bag. The biggest risk is airborne transmission – A clear plastic trash bag over the head would be way more effective than an N95 mask, though adding an N95 mask, which would stay much cleaner under a plastic trash bag, would help. But keeping a virus off the face, out of your hair, and being physically impeded from touching your face, eyes, mouth offers protection far greater than an N95 mask.

    Yes, sanitizing N95 masks is a disgusting idea – when you have ample supplies of clean N95 masks, but it beats the hell out of no N95 masks when that is the alternative.

    Nurses need to get out of their usual passivity and start being creative at protecting themselves, their colleagues, and patients. This requires thinking not just out of the box, but far, far out of the box.

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    • Tom — we have NOT banned or censored any of your posts at all!! Want to be sure that people reading this know that we welcome all perspectives and comments – and especially when the comments make us all think!! We do have a “guideline” that appears in the sidebar of all pages: “Please identify yourself. *Refrain from harmful flaming or name-calling. Negative feelings and thoughts are welcome as long as they are expressed without harming others. We place a person’s comments in moderation after one harmful post, and ban the person after a second instance.
      *If you have a criticism (which is welcomed here!) focus on also sharing alternative possibilities to consider.”

      Your comments have always been respectful and when you raise critical points you provide detailed explanations and alternatives. Thank you!

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      • We have not put any comments in moderation – the only comments we moderate at all are from comments coming from first-time emails. We have nothing that we have deleted, and our spam only contains comments that are trying to sell products! Could this have been on another website? If you ever experience this again, please email me or Carey right away – or use our contact form on the site. And if you can send us a screen shot of what you see that would be helpful as well!

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