We Go Above and Beyond

During the course of my nursing career and my life, I have always focused on being consistent. Consistency for me includes doing basic nursing skills well and constantly educating myself on upcoming changes in practice and innovation in the healthcare community. Reflecting on the COVID 19 pandemic over the last 18 months leaves me grateful that my underlying belief in practicing consistency has served me well. Consistently looking at the changing science of the COVID pandemic has at times proved challenging at best. Early in the pandemic we really did not have many answers or treatments available to the sickest of the sick. In March of 2020, I was practicing as a critical care transport nurse and as a Family Nurse Practitioner at a local urgent care center. Over the last 18 months, the diagnosis and treatment of COVID have changed exponentially with the onset of rapid COVID testing. Rapid testing has many inconsistencies related to false positives, false negatives, presence of symptoms, and time of exposure. Advising patients becomes challenging. Sometimes patients hear what they want. Consistently using the CDC terminology and recommendations even when patients do not want to hear has proved effective.

Fear is the one emotion that has been apparent to me as a healthcare provider during the pandemic. Nurses and healthcare providers are the gatekeeper of the patient experience and assist to ease fear and confusion.

Last week an 84-year-old gentleman diagnosed the day before with COVID on day 4 of symptoms arrived in the lobby of the urgent care clinic requesting assistance. He received an information handout from the CDC for a monoclonal antibody infusion clinic at our urgent care the day before. The handout gives a number to call for regional clinics administering monoclonal antibodies. It was apparent that the patient had called the information center because phone numbers were penciled in on the side of the handout. The patient was angry that he had followed the steps outlined and had not yet been scheduled for the infusion. I have to admit it was a busy morning in the urgent care and there was already about 20 patient signed in. My inside voice said, “Yikes, I don’t have time for this! “ The gentleman was being very aggressive verbally in his request for assistance and acting out his frustration (trying to snatch papers from my hands). I asked the patient to sit down in the lobby of course in a sequestered area so that I could do some fact-finding with centralized scheduling at the regional healthcare facility. The local infusion center only completes monoclonal antibody infusions in the evenings on Monday, Wednesday, and Friday in the cancer infusion center after 5:00 PM closing. The patient called his primary care provider the day before to have an order sent for the infusion without a response. After several phone calls, a consult with my medical director, and submitting orders for the patient to receive the infusion, I received a phone call from the patient apologizing for his behavior during our initial encounter and expressing gratitude that I had ordered his medication. There are many parts to this story and it took a few hours to accomplish, but I want to focus on the fact that there was an 84-year-old adult having difficulty navigating the healthcare system after receiving a very scary diagnosis- COVID 19. As nurses, we go above and beyond any given day for our patients. Remember the story of the person throwing starfish back into the sea and he was asked “why” when there was a whole beach full of starfish. The person replied, “Because it makes a difference to this one!”

Be persistent, be consistent, have faith in yourself and your skills, be hopeful because you do make a difference even if it is to just one person!!!

- Cheryl Riwitis, DNP, RN, FNP-BC, CEN, CFRN, TCRN, EMT-B, FAEN

Roller Coaster of COVID

As a nurse manager, the roller coaster of COVID has been a nail-biter. From low to high volumes, the perpetual high acuity, the increase in terminal weans, and daily deaths, the impact on the team has been unpredictable and unrelenting. The daily unknown of the ED has elevated to a level never seen before in my 13 years working in the ED. While the team has transitioned with grace, the long-term impact remains to be unknown and stress levels are at an all-time high. Some patients are grateful and others are hateful.

Complaints about not being able to visit a family member occur daily. Patients are increasingly frustrated by increased wait times due to the demands on healthcare everywhere. Hospital diversions are daily and at record levels. Supply issues continue and impact normal operations. Still, I believe the light at the end of the tunnel continues to shine, even sometimes when it feels like the light is buried under Mount Everest. The team continues to push on, working together with purpose and excellence.

-Jennifer Davis, DNP, RN, CEN, TCRN, NE-BC

Has My Outlook Changed?

There are so many stories I could tell from the past 18 months about COVID that it would take days to type. Personally, I have been a nurse for 21 years and have seen many outbreaks but nothing as bad as this.

I have one story that has affected my outlook on this pandemic more than anything. I had been gone from the bedside for a few months due to illness and chose to come back at the beginning of this pandemic. My first patient came from triage with positive exposure and respiratory distress. This is what I had been reading about and have been preparing myself, or so I thought. He was a little older than me, on his 5th day of COVID, and severely short of breath. With PPE donned and respiratory by my side, we attempted to get his O2 saturation above 68%. We tried everything but intubation, but soon it became apparent that nothing we were trying was working. As a team, we decided to intubate, and my team began handing me an RSI kit, meds, and a crash cart through the door. It then dawned on me… where was this man’s family?? I asked staff and we learned that the wife had to stay at work and was unable to leave.

My heart broke, knowing that this was the first moment I would have to hold that proverbial phone everyone talked about. The next thing I knew, a phone was handed to me with a young woman waiting to tell her husband goodbye. I held it, listening to her tell him of her love for him, how brave and strong he was, that she would be by his side as soon as possible. I then stood there listening to him very quietly squeak out he loved her so much. I introduced myself, explained I would do my best to take care of him and make him feel comfortable, praying she didn’t see my tears. Once I hung up and I had to stand with my back to him to compose myself. The last thing I wanted him to see was his nurse crying as he was sedated. We continued our job, transferred him to CCU and I was on to the next patient.

I have held phones since, but I guess you don’t forget your first. He made a lasting impression on me and still over a year later I can see his face.

Starting in the ED 13 years ago, you are always told “Be strong, don’t show too much emotion, carry on with what you have to do, it makes you weak…” So many excuses not to cry. I think 2020 has broken that mold and I for one am glad. We have had many tears, frustrations, and anger over the last 18 months. Traits that Emergency Department nurses have, we are independent, stubborn, and hardheaded and we refuse to lose. I think one day, we hope to never have to hold a phone again, but I promise that we won’t forget the ones we did hold the phone for.

-Kelly Smith, RN

My First COVID Positive Patient

Towards the beginning of the pandemic when we felt the calm before the storm and the nation was still learning about what this disease could do, when healthcare workers were rationing PPE and separating from our families to answer the call of duty yet keep our loved ones safe, is when I had my first COVID positive patient. While this patient struggled to breathe and their face showed fear, they were able to laugh and joke with me as I got to know them. I heard about a family from out of town, their business, and their hobbies. As they continued to get worse in front of my eyes, I did my best to comfort and reassure them even though I had no idea what they were up against. I took them to their ICU bed and went about my shift. When I left that evening, I saw their business van in the ED parking lot.

I saw that van for the next 2+ weeks as I came and went to and from work. It put so much fear and sadness into me seeing it day after day not knowing what they were going through or if they were even still alive. One day, it was gone. It made me wonder, "did they get better?", "did they have family come get it?", and worst of all, "did they die?". Jump forward to a year and a half later, I saw them in our ED again, in a much better condition. I could tell they had a huge smile on their face, despite the mask, as they met my eyes. I told them how much it meant to me to see them again and to know they recovered! We don't always get that resolve as ED nurses but, after this fight, I was reminded why I am there.

-Samantha Priest, BSN, RN, CEN

Vaccination Matters

As a vaccinated RN providing bedside care, I encounter patients who are unvaccinated and still trying to work through whether they should be vaccinated. One patient, in particular, had recently lost her spouse, not to COVID, and her son had just gone away to his sophomore year of college. They both came down with COVID, he was fine, she was not. She told me 'I'm healthy, I exercise frequently, I don't drink or do drugs, I'm educated, I thought I would be okay. Apparently, I wasn't." When she finally came into the ED her sats were in the 70's and she could barely breathe. She told me "The doctor said I might need to be intubated." At this point, she was alone and afraid. By the time I took care of her, she was SOB with any activity but able to keep her sats in the 90's with 2 liters of oxygen. Her son told her he was going to drop out of school for the year so he could take care of her. She was able to talk him out of it and was starting to feel better.

We talked for quite some time, how she felt initially, how scared she was that she was going to die and leave her son, and her regrets for not having been vaccinated. She told me she is going to tell everyone she knows to get vaccinated, it isn't worth it, I don't know why I didn't just do it. Not all patients that become ill after getting COVID decide to get vaccinated and not all of them encourage it. But when they do, it makes it all worth it. She survived and will live to tell everyone she knows to get vaccinated. Most importantly, she will be around to see her son again!

Brandy Summers, BSN, RN, SANE-A, CEN, TCRN

Excited to Start My Nursing Career

I graduated from nursing school in December of 2019 and was excited to start my nursing career. I started my love of patient care 20 years ago as an EMT and have held my paramedic certification for 18 of those. I wanted to pursue my nursing degree to further my knowledge and skill to care for patients. After school, I had attempted to get a nursing job PRN. I am currently the Chief of Police for a small town and I still enjoy this as my full-time role, but I wanted to get into an ED as a nurse. I had difficulty finding anyone that would take me on as a new grad in a PRN role. So, for a year I sat on my nursing license. During this year, I witnessed the COVID pandemic take hold and my fellow classmates keep in touch. They expressed their fatigue, sadness, frustrations, etc. But, most often while talking to them; they spoke of their willingness and their determination. They told me stories of being with patients that could not have their loved ones there. They told me stories of true bedside nursing that were back to the basics of helping their patients fight for recovery. I couldn’t help but be inspired by my friends who once sat through nursing school with me. I also watched my mother, who is a nurse, fight with all she had to help those affected during this time. I have seen a lot in my EMS career, but I had never seen anything like this. I knew I had to get in the fight.

In January 2021, I got a call from a nurse manager of an ED. She and I worked together as Emergency Department Techs back in the early 2000s. She advised that she had some PRN openings and wanted to know if I would like the opportunity. I was thrilled and jumped at the opportunity. Now was my opportunity to make a difference in this pandemic. I started my ED nursing job in late January. It seemed that we had some patients coming in who tested positive for COVID, but it seemed that the virus had slowed. I worked several months and had taken care of few COVID-positive patients. But, more recently, I started to see the numbers climb.

One night in August 2021, I had picked up a twelve-hour shift. This particular night, I was assigned, four patients. All of my patients were COVID positive and all of my patients were critical. I had one particular patient that was in their 20s and was on a Vapotherm. I had no experience using this equipment and looked for another nurse to assist me with it when my patient started to run into trouble. I quickly realized that every other nurse in our unit was tied up with their critical patients. I was able to find our NP who quickly swooped in and showed me how to use the equipment. She aided me in understanding exactly how I needed to use it. That night I also had a patient on BiPap due to complications from COVID, I learned that the doctor wanted to intubate this patient but our hospital was out of ventilators. I did not sit down the whole night shift, as I was going room to room to check on my patients and follow up on their ever-changing orders. It was a night I will never forget.

After finishing my shift, I was complimented by one of my co-workers for the job I had done. I thanked her but felt as though I had not done enough. I went home and reflected on the shift. I thought about the intensity of it and how I had not stopped because I was determined to give my patients the best care. I thought about the NP that helped me and how she told me that she knew how to use the equipment from her ICU days. I thought about the seasoned nurses I work with and how invaluable their experience and knowledge are to us. I thought about how these nurses are tired and leaving their ED positions because of the strain put on our system. And, how a new nurse like me longs for their guide ance and know-how. I thought about the years they have dedicated and the grit they have had to possess. They teach you in school the basics of what you need to know, but I feel the most valuable learning is done working with our seasoned nurses. I called my mom the next day, she has been a critical care nurse for 38 years. I told her of my shift and how it was hard to learn right now because we are so taxed. She explained that she understood and encouraged me to stay focused. She encouraged me to believe in myself and my abilities. She explained that nursing is not for the faint of heart and it’s not easy, but with true grit we can get through this pandemic. I am thankful for this pep talk and for all the nurses who have taught me and helped me along the way. COVID is strong, but we are stronger!

Mandy Riwitis, RN, NREMT-P

An ED Hoosier Nurse Story

Throughout the last year and a half, emergency departments throughout the state have had to change how we care for all patients. One of the patients that really sticks out to me was a middle-aged man that came into the hospital for severe shortness of breath. After multiple different attempts to bring the patient oxygen level up and decrease his work of breathing, it was finally decided to intubate the patient. While preparing everything for the intubation, we brought the patient wife to the bedside so they could have a few minutes together. During that time, you could see the fear in the patient eyes about having to be intubated. After all the supplies were gathered, the team went into the room for the intubation.

The patient wife and the patient stated to each other "I love you" both knowing it might be the last time they will be able to talk to each other. As we had the patient wife step outside of the room, she stated to the staff to take great care of her husband. After successful intubation, we brought the patient wife back to the room, where she never let go of his hand. When it was time to transport the patient to the critical care unit, the patient wife thanked all the staff for their hard work. It is moments like these that remind all nurses of the reason we got into the nursing field and especially Emergency Nursing.

- Hoosier Nurse

An ED Hoosier Nurse Story

My story was a very brief interaction but hit close to home and hopefully made a small impact on my patent and her mother.

It was a welcome week at the nearby University. Move-in week. For most, it is their first time away from home. A scary, stressful but exciting process for incoming students and their families. Adding a pandemic in the mixture just enhances those feelings.

A young freshman student arrived at the ED. She just didn't feel well. She said she had been drinking, but not too much. She had been at a concert with a few friends she had just met and decided she felt bad enough to seek medical attention. Her friends drove her to the emergency department, but due to COVID restrictions, were unable to stay with her. She received a complete workup including a COVID test. She waited for results in a closed room, isolation precautions in place, so not the normal traffic of staff checking on her. Her results were positive.

My first interaction with this patient was when I was out rounding in the department. She had pressed her call light and was needing help because her phone had died. I offered to charge her phone at the nurse’s station which she was grateful for the help. I felt the need to continue checking on her and reassured her that she was doing great and that we were taking great care of her. As I was talking with her, she reminded me of two of my sons. One is a senior in college and the other a freshman in college. My senior tested positive for COVID and thankfully he was able to drive the hour home to quarantine.

I answered the phone at the charge nurse desk and found a very worried mother on the other end. She was in Virginia and was trying to get an update on her daughter who had checked in earlier in the evening. When she gave her daughter’s name, I knew I had been at the right place at the right time. I was able to reassure her that her daughter was doing good and that I personally had had contact with her and was checking on her frequently. She began to cry, apologize, and then cry more. I assured her she had nothing to apologize for. I could understand how she was feeling.

Throughout the rest of this ED visit, I continued to check in on this young lady. I was able to have Case Management assist with arrangements for her quarantine and transportation back to the University upon discharge. I spoke to her mother one last time to give an update on where her daughter would be staying and contact information through the University. She was grateful for the time I spent with her daughter and the many updates she received.

My single goal was to help decrease this patient and her mother’s fear and stress during this time. I couldn’t help but think “what if this was my son” and I was too far away to jump in the car and be able to get to him within an hour. Such a helpless feeling that maybe I made just a little better.

- Hoosier Nurse