Nurses’ Concerns with COVID19: Update April 1, 2020

April 1, 2020April 2, 2020 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 4 Comments

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.

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.

(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.

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

Nurses’ Concerns COVID19: Update March 29, 2020

March 29, 2020 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN

There is so much going on that it’s really hard to summarize all of the issues. I welcome dialog and discussion of your concerns and what you are seeing and hearing about.

Nurses’ Shifting Thinking About Duty To Provide Services

I am seeing a shift in thinking with more nurses being willing to leave their jobs as they are not adequately protected: working without adequate PPE creates harm to self, others, and community. An emergency room doctor was fired for speaking out about his hospital’s response (US NEWS report). So these actions are not without their cost.

We are also seeing more and more healthcare workers testing positive for COVID19. What stands out to me is the over 160 healthcare workers in Boston have tested positive for COVID19 in these early days. (Boston Hospital Workers test positive) and 12 nurses in Chicago have tested positive for COVID19 Chicago nurses test positive for COVID19.

Nurses who are staying in the direct care workforce are often very frightened: they are staying because if they quit, they won’t’ get unemployment, they are fearful that they won’t find another job because they left their current job abruptly, they are the sole or majority breadwinners in their families, and they are afraid of losing their healthcare benefits. Some nurses may still feel the deep roots of historically being linked to self-sacrificing, or with links to nursing’s history of religious or military duty (I do anecdotally feel like I am seeing less of this as the pandemic crisis grows).

New Grad Nurses as a Resource: Dr. Chinn pointed out to me that one area that is not getting enough attention is the idea of new grad nurses being allowed to or recruited into practice early, perhaps even before sitting for NCLEX or even finishing their final exams. An example: A CNO in a large New Jersey medical facility is begging a Nursing Program Director to send her senior nursing students to the clinical site, the NLN is okay with this, but how can she, in good conscience, allow her students to be there without proper PPE? Her students who work as techs at this facility also convey the dire conditions in the facility. Also, her faculty, like most nursing faculty, is older (in this case, age 59 on average) with underlying health conditions, which creates a greater risk for them as well.

My ethical perspective answer to this is that unless adequate supervision and proper PPE can be assured, the students should not be allowed into theses settings, as they will ensure harm to self and others, and we must abide by our ethical responsibility to practice beneficence and nonmaleficence. In my own setting as a director of an RN-BSN nursing program, we decided to remove all of our students from all clinical settings, even though we had students who wanted to stay in these community settings, the risks do not outweigh the benefits.

I also think of the challenges of being a new grad nurse: there is so much to learn and process and in a crisis situation will this even be possible? Will we ultimately end up losing a large number of these new grad nurses to post-traumatic stress and illness? This seems to me to really be lacking an ethic of care toward a very vulnerable population, our new grad nurses.

Is Nursing Political?

I was reminded this week that nursing is of course political. I found an interesting posting about how very political Florence Nightingale was. Cynthia Sim Walter (March 22, 2020, facebook) stated that during the Crimean War, Florence was first known as the Lady with a Hammer; she fought for her nurses to have what they needed to provide proper care, and she beat down military storerooms with a hammer. I loved this quote: “Military leaders loathed her and feared her. She drank brandy with the soldiers, did statistics for fun, and had no respect for the politics of men,” (I did not fact check this).

Florence took physical action when nobody else would and her actions were a political act of rebellion to save lives in dire times.

Let’s Reuse Our Masks? Here’s some data

This is heartbreaking when our leading facilities are looking for ways to somehow sterilize single-use masks. Here is something floating around on social media, put out by Stanford.

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The full report can be read here. It sums up two important things, that autoclave may be effective (the mask will not have the same integrity, particularly over time; please see stats above). Also with the plastic face shields over other masks, we have no efficacy data around their effectiveness (Stanford Report).

We still need PPE to be well stocked so we can be more assured that we are well protected. We still need to be demanding that.

New Resources and Webinars:

To share more current information, the American Journal of Nursing has joined with Johns Hopkins and others to share ideas around keeping nurses safe. Here’s the link with all the info. https://nurses.wikiwisdomforum.com/

The Schwartz Center for Compassionate Healthcare is offering a webinar on Tuesday, April 7, 1-2 pm EDT, entitled: Leading with Compassion: Supporting Healthcare Workers in Crisis. Register Schwartz Compassion Center Webinar

Be well.

Expressing Gratitude For Our Global and Local Nursing Leaders

June 29, 2016June 29, 2016 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 1 Comment

I have been fortunate to have been supported and influenced by many of nurses’ contemporary leaders: I studied with Dr. Jean Watson prior to completing my dissertation by taking 6 units of doctoral level electives with her at UCHS. I had contacted Dr. Watson during my Masters studies, and I was amazed at how approachable she was via email. Watson’s Theory of Human Caring has influenced and directed my work in a way that is immeasurable on many levels; being with her and spending a week in sacred center, studying emerging sacred-caring science concepts brought me to a new vision of how nursing education can and should be practiced.

I also stumbled upon the work of Dr. Peggy Chinn and the nurse manifest project during my early doctoral studies, and soon found myself embraced by the NurseManifest community. I was blessed to have been part of the first Nurse Manifest research project team, and the experience of presenting our findings together was monumental in my life as an emerging nursing scholar.

While Dr. Watson and Dr. Chinn epitomize the amazing academic and scholarly accomplishments of Nurses’ Living Legends, they both also remain approachable, kind, caring, and generous. They reflect back to us a deep love for nursing, coupled with calls toward caring and a level of social justice activism that is highly needed in our process of supporting both local and global healing. There are many other nurses whom I might call “global nursing leaders” who share in this attitude, commitment, and consciousness toward change.

I am also frequently touched by the leadership capacity of my nursing students; the willingness to change their lives, spread their wings, and find ways to bring caring, holism, and healing to the “local” bedside in environments where these concepts often remain fringe in the face of allopathic approaches. The many global nursing leaders inspire nursing students, and the continuum to me is clear; students and nurses need these leaders to raise our consciousness, build our confidence, and lead us into our own leadership capacity at the local level. We need global leaders to shine a light on our professional paths and support our deepening understanding of both self as nurse and our profession’s capacity to create nursing qua nursing as the norm.

I am honored to be working with my RN-BSN students this fall in their leadership coursework. We will look at Chinn’s Peace and power work and also explore leadership through holistic concepts. We will examine burnout and how we can recover or support others in their recovery through self-care. In analyzing our workplaces, we will explore Sharon Salzberg’s (a registered nurse and globally known meditation teacher) Real happiness at work: Meditations for accomplishment, achievement, and peace as a supportive tool for self-exploration around workplace issues.

Many nursing students struggle to perceive themselves as “local nurse leaders”, and I strive to support them to tap into their own leadership capacities, to create the types of healthcare workplaces where they can thrive and support the healing of their patients through integrative modalities and caring consciousness. I do believe one way to provide this platform for students’ emerging leadership is to create a caring environment for students, to support their own healing processes, and to role model shared leadership processes and self-care-healing for, and with, students. In this way, I humbly express my deepest gratitude for those global nursing leaders who have shone their light on my own professional and healing path when it was often far from clear where I was headed.

The Power of Nursing

April 27, 2016April 20, 2016 / marlainesmith / 2 Comments

On January 24^th in the early morning hours my husband Brian woke me up because he said his left arm was hurting and he was nauseated. After I gave him two aspirin we rushed to the ED of our regional hospital….He had a myocardial infarction in process. The cardiac cath team was called, and an amazing interventional cardiologist performed a balloon angioplasty to open up the blocked artery. After Brian was stabilized in the CVICU he was transferred to the CV Step Down unit to wait for surgery. On January 29^th the cardiothoracic surgeon performed a CABG x 4 and Brian was discharged on February 3^rd. It was quite an ordeal. There are always lessons we learn when we are the recipients of health care.

As you can imagine this has been a life-altering event for both of us. During this critical time every person that we encountered and every circumstance that occurred, big and small, mattered to us. I can honestly say that Brian and I experienced the most excellent care that I could ever imagine, and this made a significant difference in his healing and my experience as a family member.

The nursing staff at this hospital were wonderful. We know that nurses are the heart and soul of any hospital. Every single nurse that we encountered was knowledgeable, skilled, attentive and compassionate. They were truly person and family-centered. Every one of them asked how she/he could be helpful to us. Watching the nurse caring for Brian immediately after surgery in the CVICU was amazing to me. It was like watching the conductor of a symphony. Her technological competence was incredible…she monitored everything moment by moment, while continuing to focus on Brian as a person experiencing this critical event, and on me as a wife fearful of what was happening. When I was waiting for news of Brian’s condition during surgery, several of the staff stopped in to encourage me and to give me updates if they could. This was so meaningful to me. When Brian was recovering, the CVICU staff pushed and encouraged him and did anything they could to make me comfortable. All the staff on the step-down unit exquisitely cared for Brian, supported us and made us feel “at home”. I’m so grateful to the nursing staff for creating the healing environment where this level of care happens.

We often hear about the horrors of poor nursing care, so I wanted to share this story of hope and encouragement with everyone. I am so proud to be a nurse because of the profound difference we make in the lives of people in the most vulnerable moments of their lives. Yes, our cardiologist and surgeon saved Brian’s life, but the nurses were equally biogenic (life-giving) to both of us. They preserved our dignity, prevented complications, prepared us for discharge, facilitated a smooth transition, allayed our anxieties, relieved our pain, provided comfort, lifted our spirits with laughter, gave us critical information, challenged him to do more than he thought possible, instilled hope for the future, involved us in choices, and took the time to listen to our fears and rants.

P.S. Brian is in cardiac rehab now and is recovering.

Never ever ever underestimate the power of nursing. We transform lives by healing through caring.

Celebrating recovery with Brian!

Nurses as Healers: Good Work Environments

January 25, 2016December 23, 2017 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 2 Comments

I remember when I became a new nurse 21 years ago, and a friend asked me what I did at the hospital when I worked those long 12 hour night shifts. His thoughts were that the patients were asleep, so it was probably a job where you hung out and drank coffee, occasionally checking in on a patient. I remember walking him through what I usually did on a 12 hour 7pm- 7 am night shift, including most of the tasks and requirements of the job from receiving report at the start of the shift to giving report at the end of the shift. I made sure to include that if- when I got a break, it was usually around 2am or 3am when I was finally “caught up enough” to take some 20-30 minutes to nourish and hydrate myself.

As I thought of this telling of what nurses do some 20 years later, I wondered if I included what nurses are really charged with doing, which is supporting the healing of those we care for. Did I focus on all of the tasks and duties I would complete during that 12 hour shift, or did I also include the time spent rubbing backs, holding hands, saying prayers, educating, and supporting patients and their loved ones? Did I include the story about the time I had to call a deaf woman and tell her husband had passed after she left for the evening? Or the time when the family asked me to increase the morphine drip rate because “the doctor said she would be dead before the morning and we are ready for her to be gone”? What about the man with ALS being kept alive on a ventilator and feeding tube who lay lonely in his bed, unable to verbally communicate, and went for weeks at a time without a single visitor?

I believe that as nurses we need to educate the public not just on all of the technical skills we do each day to support patients’ receiving good medical care, but also on the healing aspects of our unique work as nurses: on how we were likely “called” to be a nurse because we want to make a difference, the skills we have developed that support us in creating caring-healing environments for patients, and the rewards of being able to support others through their healing process. I think we should be making it clear to the public as well that we are committed to our own health and healing, knowing that we can’t support others through health challenges if we are not also dealing with these challenges ourselves. And as nurses, we need to support one another in our own healing process, role-modeling what self-care and stress management look like in action.

A recent study research from www.mountainmiraclesmidwifery.com/, showed that supporting nursing and creating “good nursing environments”, with adequate nurse staffing, leads to better long term patient outcomes, with fewer deaths one-month post surgery (http://mobile.reuters.com/article/idUSKCN0UZ2XL). It pays for hospitals to invest in having enough nurses, in treating those nurses well, and supporting nurses in what we have been called to do: create healing environments that support patients toward their greatest health potential. Healthcare facilities need to be moved to support nurses in managing their stress and enacting self-care in order to potentiate the healing of the patients these facilities serve. Good staffing is just the beginning of creating “good nursing environments”: nurses should be empowered to begin dialog with their employers regarding what a healthy and good work environment for nurses looks like in consideration of the healing work that nurses do.