Virginia Nurses Today - August 2020

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Page 6 | August, September, October 2020 President’s Message continued from page 3 team nursing. Rapid onboarding processes were also established for education and competency demonstrations. Communication to assist in navigating the pandemic on an ongoing basis was key to success. Communication was dispersed through multiple platforms. Many held town halls to provide information on proposed actions and to obtain staff input as leadership wanted to gain insights from their team members and make them part of the decision-making process. Other organizations dispersed electronic communications daily to provide updates on established changes. Team boards were established where staff could post questions and obtain a response while purposeful rounding on team members was performed daily by the administrative staff to understand the issues and concerns of their teams. The number of PUI and positive cases were tracked and communicated daily as well as the number of deaths associated with the virus while individuals being discharged were celebrated in conversations as well as in person. Many nursing groups took it upon themselves to meet and propose ideas to leadership regarding changes to nursing practice to improve on efficiencies. Many expressed the desire to engage in research related to the pandemic while others such as wound care nurses, recognized the need to address skin breakdown related to the use of PPE by identifying a product that could be utilized to heal as well as prevent skin integrity disruption. Ongoing two-way communication was and remains essential. Existing department silos were also removed as communication around the pandemic impacted nearly every department, forcing teams to work more closely than they ever had before. A huge focal area for each of the leaders was the safety of the patient and the physical and mental well-being of their teams. Ongoing PPE supply availability and conservation of these supplies through specific strategic initiatives was key in the current and ongoing protection of nurses and other personnel. Education about team-based care models was provided so nurses would understand how to most effectively deploy these models for their organizations. Intubation boxes were also put into place. The segregation of patient care areas and waiting rooms was established within emergency departments and other areas of the facilities. Decisions were made to place all PUI and positive cases in negative pressure rooms, even though the evidence did not require this. Provisions for housing were made for patient families so they could be near their loved ones. Correspondingly, housing arrangements were made for nursing personnel caring for PUI / positive patients as a means to protect their family members. The list goes on as other multiple means were implemented to provide high quality care while protecting nursing staff. In addition to physical safety, the mental health and well-being of nurses and other care providers served to be, and still remains, challenging. The care of PUI and positive COVID-19 populations is highly demanding. The care is then further complicated by the fact that nurses have, and continue to, stand in for visitors and keep families and patients connected. Furthermore, nurses are often the individuals who are with patients as they pass, using technology in an attempt to provide closure to family members at the time of death. Making resources readily available to nurses such as Employee Assistance Programs (EAPs), availability of psychological services, counselors, and pastoral services Virginia Nurses Today | www.VirginiaNurses.com through private sector partnerships and associations was identified as a need early on by each leader. Other support systems provided programs such as “Healing Gardens,” a phone line nurses can call to express their feelings and concerns to support teams. All leaders focused on the resilience of nurses as well as the stigma associated with seeking help and the need to destigmatize such actions as a means to promote sound mental health. According to the nursing leaders, other challenges varied among organizations, although PPE availability was number one for each facility. In the Richmond area, the greatest challenge was identified among the Hispanic population, which may defer from seeking care due to immigration status. In northern Virginia, turnover in nursing personnel related to refusal to care for PUI or positive patients was identified as highly problematic. Specific equipment needs were also identified throughout the process with plans to rectify these needs in the near future. In southwest Virginia, challenges included lack of nursing resources pre-COVID that are now compounded as well as ventilator needs. Collectively, the recognition of the publics’ fatigue related to social distancing, compliance with face mask use, and hand hygiene diligence continues to place the medical community, as well as our local communities, at risk. Correspondingly, northern Virginia identified specific success relative to their implementation of rapid testing for all admitted patients as multiple asymptomatic patients were identified through this process and the appropriate care of these patients was then instituted to protect the staff as well as other patients. Southwest Virginia recognized successes in partnering with local companies to produce facial shields and masks as well as partnering with other community groups targeted at minimizing community spread. VCU’s greatest success was cited as community collaborations. Collectively, all the nurse leaders echoed the outpouring of appreciation to their nursing teams for their diligence, hard work, and ongoing pursuit of patient care. From the tears shed at the time of death of a patient to the shouts of jubilation at the discharge of a COVID positive patient, to the long hours and tireless shifts, to the nurses who stepped up to the plate and out of the box, and to the other healthcare workers who supported the efforts of the team, a huge, humble “thank you” is owed as they transitioned plans into successful actions. As we now enter a second wave, the success encountered in phase 1 and the lessons learned along the way lend confidence as we move into subsequent phases. There is a need to make data based decisions relative to human resources, PPE, and other supply resources while also recognizing the ongoing need to keep nurses prepared and confident. This is not the first pandemic nor will it be our last. Building upon lessons learned and planning for the future are key as we all move forward. NURSES MONTH SPOTLIGHT ADVANCE. LEAD. SERVE. }} RN-BSN (online) }} MSN (hybrid) oo oo oo Family Nurse Practitioner Leadership/Education Psychiatric Mental Health Nurse Practitioner Post-graduate certificates also available in the above listed specializations. bluefield.edu/school-of-nursing Under investigation by the Virginia Board of Nursing? Eileen is a nurse and an attorney and is here to help you with licensing issues, investigations, and disciplinary matters before the Virginia Board of Nursing. ETalamante@goodmanallen.com (804) 565-3526 goodmanallen.com DEDICATED TO SERVING THE LEGAL NEEDS OF VIRGINIA NURSES.
www.VirginiaNurses.com | Virginia Nurses Today August, September, October 2020 | Page 7 Virginia Frontline Nurses Share COVID-19 Experiences continued from page 1 “This virus is indiscriminate and invades without warning,” Williams said. “My hope is that this will be taken seriously to avoid further unnecessary deaths. Unless you are on the frontline to witness this battle and its path of destruction, it is incomprehensible and hopefully only once in a lifetime. Without a doubt, the most difficult aspect has to be the vulnerability we all face every day, that we show up for our shifts. Could it be the day for exposure, leaving me or a family member to become another tally mark or statistic?” Williams shared that earlier in the year, she endured a mandatory quarantine for 14 days due to in-hospital COVID-19 exposure. Fortunately, she and her coworkers were able to return to work and care for the patients in their ICU. On her return to work, there were several COVID-19 positive patients. Three of these patients became critically ill at the same time, and all were intubated within twelve hours of each other. Because Riverside is a smaller facility, two of the patients needed to be transferred to a higher level of care, leaving the third in Williams’ unit. This patient had endured the typical COVID-19 course: admission due to shortness of breath complicated by worsening respiratory failure and increased oxygen requirements. He stayed in the ICU for more than three weeks, suffering multiple acute episodes, including a few near death incidents. “Caring for a patient like that is made more complicated when the family is unable to be present due to visitation limitations,” Williams explained. “It is then that the nurse not only cares for the patient, but becomes the liaison/lifeline to the family, communicating over the phone several times per shift.” During those weeks, nearly the entire ICU staff became close to the patient’s wife and, in turn, became emotionally invested in his care and recovery. Eventually, he was weaned off of the ventilator but remained critically ill. Being unaware of his surroundings for many days was frustrating for the family and created questions of whether a full recovery would occur. This patient finally emerged to a conscious state and was able to communicate his needs, but also remained dependent on rigid physical therapy. Staff went the extra mile to make connections to his family happen, such as wheeling him to the window so they could see him or connecting via FaceTime so they could see and hear each other, as well as taking him outside to meet at a social distance. “What a grand celebration it was for our ICU team, as well as most of our hospital team members, to give loving recognition when this patient was being discharged to a rehabilitation facility. This moment of survival will forever remain in my memories and in my heart, defining what it means to be a nurse,” Williams recalled. When asked how she mentally navigates these kinds of experiences, Williams explained that moral resilience is a trait that must be learned and is important in overcoming challenging times. Many critical care nurses face distress at some point in their career, but with the support of administration, coworkers, family and community, this resilience is achievable. “Having worked with the acutely ill population for more than 20 years, I have faced numerous moral and ethical dilemmas, making COVID-19 simply another challenge, albeit a tremendous one,” Williams said. Williams emphasized that nurses should realize that self-care is of utmost importance, as they cannot care for others if they do not care for themselves. Whether this is through online or workplace support, families, friends, or coworkers, nurses need to reach out to any outlet available. “Personally, utilizing these outlets and believing that I have done my best to provide care despite the outcome gets me through these tough times, along with a little humor! I know that keeping myself educated on this new disease and its course as it unfolds and sharing this knowledge and experiences with others can only prove useful,” Williams explained. She ensures her mind stays healthy through hobbies such as painting, gardening and crafting, all of which have played an integral part to her own self-care. However, the most important lesson she has learned has been to focus on what is truly important: “Being somewhat forced to stay at home when not working has helped me to do a “reset” and connect with my immediate family on a new level, and for that, I am grateful.” The pandemic has certainly underscored how vital nurses are in healthcare and is bound to change the nursing profession in multiple ways. “To show up and ‘to care for others as we would care for those we love’ (Riverside Health System’s mission) during these times takes dedication, compassion and courage, prompting the media to portray the nursing profession as frontline heroes,” Williams noted. “On the flip side, the same media has exposed and exaggerated the ugly truth by focusing on the PPE and staffing shortages in the United States.” Williams explained that she is uncertain about what to think of nursing in the future. Is the nursing shortage going to grow exponentially due the truthful tales and stories of nurses who have paid the ultimate sacrifice by unselfishly taking a risk to care for others? Or, will prospective nursing students see the Virginia Frontline Nurses Share COVID-19 Experiences continued on page 8 NURSES MONTH SPOTLIGHT
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