Message to Young Nurses Working With COVID-19 Patients

I saw the news of young nurses (those who graduated well after 2000)  impacted by the storm of COVID-19 patients. They never knew what it was like not to have Universal Precautions as part of daily ‘norms’ at work.  They’re scared and angry, and that is so very understandable.  In normal times, all of this would be absolutely unthinkable.  But these are not normal times.  This is a global situation that was not fully appreciated until it hit US. Many warnings had been issued over the last several decades.   Mistakes were made.   In the US, we tend to think that we’re immune to things that happen in other parts of the world.  While 9/11 erased a bit of that, it has never hit us in a medical battle like this, for the vast majority of people alive now.  Viruses don’t care about what country they’re in.  Every country on the planet is trying to get equipment, from PPE (gloves, gowns, masks, face shields, etc) to ventilators.  EVERY. COUNTRY.  There is little in the way of  inventory to purchase.  Add that the US government is outbidding states’ governors, and it’s a total cluster.  I’ve been an RN for 35 years, though have been disabled for many years now. I have the ‘luxury’ of watching this, but wish so much that I could be there helping. It goes against everything in me to not be of use during this time. So, I write. It’s all I have to offer.  My mom’s grandma died in the Spanish Flu of 1918. Pandemics influenced my family in how my mom’s mom did NOT cope with the death of her mom. Her father died a year later.  She stayed broken.  She raised kids as a broken mom. None of this is “just” the current situation… there will be collateral damage.  But we have to protect the caretakers AS BEST WE CAN with what PPE is available. Now. 

Time speeds up as you get older, so this may sound like ages ago, but it’s really not.  In the mid-80s, AIDS was still relatively new, not well understood, and another cause of fear and much discrimination. It was different, as there were higher risk groups. COVID-19 just needs a breathing body.  We didn’t have Universal Precautions until 1987. There was typically one box of gloves at the nurses’ station, and those were only for “Code Browns” (a poop situation beyond the ability of one person to deal with) or massive bleeding- and that was at the discretion of the nurse.  This is when I started nursing.  It’s just how things were.  We did have isolation carts for AIDS patients, with gowns and gloves.  Masks were only used for suctioning, and face shields weren’t even imagined. I don’t remember ever having protective eyewear.   We gave IM and IV meds with syringes that had needles. Not everybody had an IV pump… and Dial-a-Flows were rationed.   We were expected to be careful.  We also had up to 14 patients on an acute neurological/neurosurgical floor on the night shift PER NURSE.   It wasn’t until 1996 that Universal Precautions became “standard precautions”, and were considered part of basic care.  I taught infection control at a nursing home in the mid-90s.  Back then menstrual blood wasn’t considered a risk, and the guidelines were “if it has not saturated the pad to the point of dripping, it can be disposed of in regular trash cans”, which stunned me back then. Now, I can’t imagine putting any sort of blood in the regular trash.  Things change.

Governors are doing all they can to get enough PPE, but when it will arrive isn’t set in stone, especially with the “eBay” manner in which they are having to purchase supplies.  The feds aren’t  looking out for anybody on the frontlines. So it’s time for ingenuity and remembering that these are not normal situations.  Normal rules are out the window in a crisis.  This is more like M*A*S*H than 2020 hospitals.  Mentality has to adjust. Some conservation now may mean even more critical availability later.

It troubles me a lot that so many people who are dealing with this crisis are going to develop (if they haven’t already)  PTSD.  The repeated stress and life-altering/life-threatening situations does something to a person.  Please reach out to someone when (not if) you are overwhelmed.  Remember that this will not last forever.  The overall percentage  of people in the US who have this now is still statistically insignificant (a bit over 331,000 positive cases right now… with a population of 330M in the US, that is %0.001).  The folks who have this are not in any way insignificant, nor is their suffering or the loss felt by the family, friends, and coworkers of those who die from COVID-19… but from a pure numbers standpoint many, many more people are OK.  With that same 331,000, 9441 have died- that’s %0.03 of those who are positive. That’s 33 times less than %1.  Just of those who are positive.  The death rate is %0.0000000003 of the total population. I know you’re still swamped and getting slammed. But feeling like ‘everybody’ is sick can be another stressor.  For those in hotspots right now, I realize that how it feels is what is hard, because it seems so non-stop.  It will get better. Not today and not this week, or maybe not even this month… but it will get better.  We will know a time when this isn’t all over the news anymore.  And hopefully, we’re better for it.  This can’t happen in vain.

So, nurses who haven’t known a time without standard precautions, hang in there.  Bring your ideas to your managers about how to conserve PPE.  When all of the patients are positive for COVID-19, how many times do you need to change gowns?  I know reusing some things sounds absolutely counter-intuitive. I’ve seen some creative things on the news from the nurses in the thick of things.  You can change how this goes with your ideas.  Hoping for more PPE is fine- just don’t expect it on a timetable that is “normal”.  Nothing about this is normal.  Including what you have to do as a nurse or other caretaker.

Would I want to work with less PPE?  Absolutely not. But there IS no bounty of  PPE now- it’s all rationed, when it’s available.  And it’s because every corner of the country is going to see this virus hit close to home.  The hotspots need things now.  Until it gets there, what else can you use? How can you change the policies for a catastrophic influx of patients?  How do you stay safe?

Dementia Wins By A Landslide !

I worked in various nursing homes during the years I worked as an RN, starting in 1985.  I worked as a ‘floor’ nurse, charge nurse, supervisor, and administrative (desk) nurse.  Nursing homes really are quite delightful places to work, and while nursing home nurses are often looked down upon by hospital nurses (I’ve done that kind of nursing too), the skill set required is extensive.  They have to have a bit of knowledge about all medical specialties (except obstetrics, though one gentleman did scream that he was giving birth to a calf in an emergent situation…my guess is that most people in a 3-4 block area knew of his distress; his doc felt that Haldol was a good ‘post-partum’ drug… I don’t like Haldol for the elderly; it was designed for schizophrenics- but it did quiet him down).  There are the medical issues that put people in nursing homes to begin with, and then there are those folks with dementia who can be so totally heartbreaking to watch…or a source of some humor. If we didn’t chuckle, we’d weep.  The following are from some decades ago… some of the rules were a bit ‘different’ back then, though nobody ever did anything to make the situation worse.

One woman I remember was very distinguished in her outward appearance. She was always ‘put together’ in how she dressed and in her appropriate greetings of people she met in the halls, but had no clue about hygiene or changing her clothes regularly.  Usually the certified nursing assistants (CNAs) could get almost every resident into the shower without too much hassle, but this lady was persistent in her refusal.  Nursing home residents have the right to be sloppy…when they are coherent enough to know the risk/benefit of their decisions.  When a green cloud follows them, and people fall like dominoes in their wake, something has to be done.  That’s when the administrative nurses have to jump in and figure something out.

The first thing to do was notify the family and get their permission to bathe Mrs. Cloud, even if she refused. They were the legal guardians since she couldn’t make decisions, so that wasn’t hard- they were thankful we were looking out for her (they were also out of town, so couldn’t be ‘hands-on’). The next thing to do was to figure out a plan.  The assistant director of nurses (ADON) and I were the ones who somehow got blessed with this task assignment, and thought we had a pretty good idea of how to get the job done. We got Mrs. Cloud into her private room, and carried on some generic, though tangential conversations as we got her overcoat off, and then talked about getting her clothes washed (that was usually less threatening than actually talking about showers up front).  OY.  We got the coat. We were doing pretty well with the dress, but getting down to her slip, and undies, we noticed that she had about 4 pairs of caked-on pantyhose. Each of those pantyhose required getting Mrs. Cloud back on her bed, ‘scootching’ the hose down, and then removing them…. x 4. Between each ‘scootch’, she’d bolt up and try to run off, so we’d have to get her seated again, then lying back on the bed so we could continue ‘scootching’.   The ADON and I were sweating by the time that was over.  The slip, bra, and undies were a piece of cake after the pantyhose circus.

So, we get Mrs. Cloud into her shower- after all, if we’re going to clean her clothes, why not get a nice warm shower (sounded like a good line)… she wasn’t happy, but went for it. We had the towels and washcloths ready. But…. oops. I forgot the body wash.  The  poor ADON was left wrangling Mrs. Cloud in the shower as I sped out of the room to find body wash.  I found what we needed, and we finished the shower from hell with no casualties.  A few minutes later, I saw Mrs. Cloud in the hallway, all fresh and sans cloud-o-funk, and she greeted me as if she’d never seen me before- very polite with a superficial smile. She remembered nothing. Crickets.

I also worked ‘the floor’ at night for a while.  One night, another confused little lady was wandering in a sort of frenzy, and was visibly tired. She had a sleeping pill ordered, so I offered her one. She wouldn’t take it.  I opened up the capsule, and mixed it with a tablespoon of orange juice in a one ounce plastic ‘shot glass’ medicine cup. I offered her a little nightcap, and she was so happy to take it.  I had poured some plain orange juice to get rid of any funky taste in her mouth, and she looked at me- dead serious- and said “Oh, Honey- I can only have one”.  She traipsed off to bed and finally got some sleep.

Another night, I was doing my routine work on the 11-7 shift, and one of the CNAs comes flying up the hallway off  one of the ‘pods’ (a grouping of rooms), calling my name as if she’d just witnessed Jack the Ripper field dressing a dozen deer in the back room.   I immediately went racing down to meet her, and follow her to the room in ‘distress’.  I stopped cold when I saw the elderly gentleman (also confused as all get out) sitting completely naked, bolt upright in his bed, grinning from ear to ear with his sheets and blankets all over the place. He was ‘splashing’ the gel from his gel mattress (as much as someone can splash something with the consistency of applesauce).  He had managed to puncture the mattress (used to protect skin), and had that gunk all over the place. It was hysterical.  I didn’t want to laugh at him, but it was hard to maintain anybody’s dignity at that moment. He was having a ball !  We got him cleaned up, and my only comment to the CNA was the need to differentiate between something that is life-threatening and something that is an inconvenience, but essentially harmless.  We didn’t need blood curdling screams in the middle of the night for a little  gunk on the floor (well, OK, it was a lot of gunk).

We also had a  hoarder.  The facility towels and washcloths, junk- didn’t matter. And she was possessive.  Anybody who went to clear out the stuff for laundry to rewash had to have someone else ‘stand lookout’, or the poor ‘lone’ retriever would be yelled at for a good 3-5 mintues, until the hoarder forgot why she was mad. One afternoon, one of the activity aides found a family of mice (mama and babies….LOTS of babies) living in a leftover popcorn bag (from movie and popcorn day), and a cake in a plastic bakery container that was so old that nobody could figure out the original flavor and/or color.

One of my favorite little ladies was superficially appropriate, but 2-3 minutes into a conversation there was no doubt that some bulbs were dimming. She was generally cheerful, and had a buddy she hung out with. She also was not fond of showers or combing her hair (think Einstein plugged in to a household outlet), but would let me check her skin weekly (per required protocols everyone got weekly skin checks- head to toe). The CNAs and I got into a routine of doing the skin checks in the shower room, and since I needed to see ALL of her skin, she’d agree for the CNAs to ‘hold’ her clothing…funny how the shower would get turned on, and she’d get nice and clean- she was always very agreeable once she felt the warm water. One day before getting showered, she walked past one of the mirrors, and saw herself. She literally gasped loudly and stepped back from her own reflection… she looked at me and asked about a hairbrush.  At least she still knew it was her own reflection- some lost that.

Nursing homes get bad reputations, but there are so many nice ones. I had the chance to work at two that I really liked, each for about 2.5 years.  The residents become like extended family, and some of their families also became part of the daily routine.  I’ve worked with CNAs who have been at the same facility for over 30 years…when offered promotions, they refused, not wanting to leave ‘their’ people. ❤  I’m incredibly thankful for the coworkers and residents I met when I was working at those facilities. 🙂