The day-to-day challenges of an RN during the COVID-19 crisis

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4/7/2020

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Editor’s note: This episode of the MGMA Insights podcast continues a series focused on COVID-19 and its effects on healthcare professionals and their patients. Keep up with the latest updates by visiting the MGMA COVID-19 Federal Assistance and Advocacy Center.

The day-to-day challenges of a registered nurse have changed in significant ways since the COVID-19 pandemic and its effects on medical practices. Kat Olson, RN, BSN, Lutheran Medical Center, Wheat Ridge, Colo, works on the ortho-surgical floor at night and occasionally is a relief charge nurse at night, having worked night shifts for more than 20 years.

The response to COVID-19 has changed some longstanding procedures for Olson and her teammates, such as coming in a little earlier to ensure there’s time for having her temperature checked before working.

Managing PPE shortages

Changes that Olson has seen include how to handle mask usage and handling the shortage of personal protective equipment (PPE) that medical professionals nationwide have encountered. “At first, they wanted everybody to wear a mask when you were in the hospital inpatient settings,” but later shifted to providing sewn masks that some designated nurses were creating for all the units — “they’re sewing 400 masks a day.”

“So everybody gets a sewn mask now that we wear when we're in the inpatient settings, because to save on the surgical masks, and we try and use those until they get become soiled or wet,” Olson said.

Olson noted that Lutheran is taking steps to safely recycle materials, such as using a UV light to sanitize masks so that N95 respirator masks can be used for days instead of just one use. That same UV light can be used to sanitize rooms to ensure no new coronavirus will be on surfaces throughout the room before switching to a new patient.

Olson said the community response to try and sew masks for local hospitals are encouraging but added that the need for isolation gowns is now growing and that those gowns would be an ideal project for anyone looking to help their healthcare professionals if they have the means to make them.

Team nursing

For nurses is units with decreased patient volume, nurses now shift to be helping hands in the intensive care unit (ICU) to assist with patients’ daily living activities, such as assisting with teeth brushing, face washing, baths and similar activities.

As the census of patients went down by one-third, staff were cross-trained into other areas, such as telemetry, progressive care and sometimes the ICU. “We're trying to do what we call team nursing, where the ICU nurse would do a good amount of the care, and then the floor nurse would be like a helper — we would hang antibiotics and other medications that we have knowledge about, [and] the ICU nurse would take care of more of the vents and pressor drips.”

Reducing fear, boosting communication

For nurses handling the handoff of patients from the ER up to an isolation room, “the biggest thing [for patients] is they’re scared,” Olson said. While the nurses still do rounds to check on patients, the isolation room doors remain closed and can lead to patients feeling cut off from others. “Sometimes they just want to talk to somebody,” Olson said.

Increased communication is also pronounced when it comes to phone calls — and not just incoming calls. “I'm trying to remind [other nurses] that they really need to call the family to ease their fears, to give them updates,” Olson said, since family members are still encouraged to stay at home to avoid potential exposure in public.

“It's really hard for the family members, not being able to be there with their loved ones in the hospital,” Olson added, which is why she stresses keeping them in the loop as best as the nurses can. “It really puts the families at ease when you talk to them.”

That step is appreciated, Olson noted, and it helps keeps the nurses’ morale up, too, to know they’re making a difference. She also said they’ve gotten lots of flower deliveries and food deliveries to units across the hospital as people show their appreciation for their work. “It's been really nice to see that,” Olson said.

Supporting peers

And for the times when things get rough, Olson noted that the medical center leadership set up a peer-support phone line where nurses could share how they’re feeling and get things off their chest in a private manner. “We all have the same fears of bringing this virus home to our families,” Olson said.

The leadership also made sure employees understood the availability of the employee assistance program (EAP) and ways to get in touch with therapists specifically trained to help healthcare workers.

An EAP is especially useful for anyone feeling stressed and under pressure. That’s natural for some nurses and others as they are cross-trained into new areas, where the challenge of using equipment and medications they haven’t used since nursing school feels daunting or scary.

“We're all getting pushed out of our comfort zone,” Olson said, adding that she spends time studying to be as prepared as she can. “Know as much as you can but do what you feel comfortable doing.”

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MGMA Insights is presented by Decklan McGee, Rob Ketcham and Daniel Williams.

Thanks to Midmark for sponsoring this episode.