DiversityNursing Blog

Nurses are a critical part of healthcare and make up the largest section of the health profession. According to The American Nurses Association (ANA), more Registered Nurse jobs will be available through 2022 than any other profession in the United States.

As predicted by health officials, the United States is seeing surges of Coronavirus cases from the holiday season. As health systems and hospitals deal with the surges, they are worried about finding enough medical workers to meet the demand.

“What we see now is just the beginning of the post-Thanksgiving peak,” said Eric Toner, senior scholar with the Johns Hopkins Center for Health Security. “It’s going to be huge, and it’s going to be awful.”

The problem is especially dire in intensive care units which are overcrowded with a record number of critically ill patients.

An article from the New Yorker stated, at least half of all states are now facing staff shortages, and more than a third of hospitals in states such as Arkansas, Missouri, New Mexico, and Wisconsin are simply running out of staff. Usually, an ICU Nurse might care for two critically ill patients at a time. Now, some are caring for as many as eight patients at once.

In some situations, patients have been transported hundreds of miles for an open bed. Some patients have been moved from Texas to Arizona as well as central Missouri to Iowa.

According to ABC News, hospitals in some states are enlisting retired Nurses and Nursing students. In Alabama, more than 120 students and faculty members from the University of Alabama at Birmingham’s Nursing school began helping with care last week at UAB Hospital.

In some states, health officers have amended orders that allow health care workers who tested positive for COVID-19, but are asymptomatic to continue working.

To free up healthcare workers, hospitals are asking medical and Nursing students, firefighters, and EMTs to administer Coronavirus vaccines.

According to Reuters, nearly 10 million doses have been delivered across the country, but only about 1 million administered due to staffing shortages at hospitals and the special requirements for preparing the shots.

Nancy Foster, the American Hospital Association’s vice president of quality and patient safety, said she’s heard from two dozen hospital leaders over the past two weeks, warning her of staffing shortages.

Travel Nurses are usually a good option to help fill open positions, but the pool of available travel Nurses is drying up as demand for them jumped 44% over the last month.

Dr. Mark Ghaly, California’s Health and Human Services secretary, said the state is “lucky to get two-thirds” of its requests for travel Nurses fulfilled right now.

The main hope here is for cases to decrease by people following COVID-19 guidelines such as quarantining and wearing masks.

School Nurses have become the main point of contact for any and all things COVID-19 related. They are a key component in making sure schools stay open.

The American Academy of Pediatrics (AAP) recommends that every school have a Nurse on site.

But, according to the National Association of School Nurses, before the pandemic, a quarter of American schools did not have a Nurse.

Now states are scrambling to hire School Nurses as students go back to school.

“Most school Nurses are the only health care experts in their school community able to understand infection control and do disease surveillance,” said Linda Mendonca, president-elect of the National Association of School Nurses (NASN). “But not every school has a Nurse who’s going to look after the children and staff. You need that expertise as a resource to safely reopen schools.”

COVID has made the role of a school Nurse even more complex, adding many challenges and new responsibilities for keeping children and staff safe.

They're responsible for complying with applicable federal, state, and local laws, regulations, ordinances, executive orders, policies, and any other applicable sources of authority, including any applicable standards of practice.

Nurses will also have to create plans for how high-risk students will return to school. They'll also help with screening protocols, creating safe classroom setups, hand washing and sanitation stations, and PPE distribution.

The school Nurse should collect and share school data in compliance with state and federal confidentiality regulations.

Once a coronavirus case is identified, school Nurses and local public health officials will work together to determine which students or staff might have been exposed to the infected person.

Face masks will be one of the main ways of limiting the spread of the virus in schools this fall. However, with younger students there's a risk of children trading masks or not keeping them on.

Social distancing is another key factor in keeping everyone safe, NASN guidelines suggest, staggered start times, small group and outdoor activities, no sharing of musical instruments, and meals in classrooms.

Liz Pray, MSN-Ed, RN, NCSN, School Nurse for the Moses Lake School District in Washington State and President of the School Nurse Organization of Washington said, "If I could offer any words for nurses feeling overwhelmed, I would encourage them to allow themselves and others a little grace. Everyone is struggling. Tempers are short, people are on edge and it’s been very difficult for students, parents and team members to adjust to these changes. Remember to take a step back, take a deep breath and take care of yourself."

Many Nurses and Doctors said in interviews with TIME, that fighting COVID-19 is making them feel more dedicated to their chosen career, and determined to persevere and help their patients. But, many also said they were struggling with negative feelings.

Healthcare workers are afraid of spreading the virus to their families, frustrated about the lack of PPE, and feel they can’t do enough for their patients. First responders are tired from long shifts, and are extremely sad for their dying patients, of which many are passing away alone. This is heartbreaking.

Dr. Jay Kaplan, an emergency room Physician and wellness specialist at LCMC Health system in New Orleans, lets his staff know they aren't alone. He listens as Nurses and Doctors share their fears and problems.

Kaplan tells them it’s okay to get sad or angry over the coronavirus. He reads them his poems. He shares that one day he came home and cried to his wife because he was  overwhelmed by the rate of dying patients.

“We need to break the culture of silence and let people know it’s okay not to have it all together all the time,” he said.

Kaplan’s “wellness visits” are a key strategy in preventing healthcare workers from spiraling into depression and post-traumatic stress disorder during the pandemic. Many hospitals across the U.S. are launching similar initiatives.

Mount Sinai hospitals in New York City ramped up initiatives, such as a 24/7 mental health crisis line and one-on-one counseling. It also launched a wellness and resilience center that will track staffers' mental health long term.

Dr. Deborah B. Marin, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai and Director of the new center said,  “This multi-disciplinary center will consider the physical, emotional, mental and spiritual needs of our entire health care community, including those on the frontline and in supporting roles. Working closely with every department across the health system, our aim is to not only address  but to also prevent the development of mental health issues before they occur by intervening early, offering resilience training and treatment for every health care working in need. It’s important that we launch now as this crisis continues to evolve and take a toll on our community.”

Several healthcare workers in the TIME interviews said, among all the uncertainty and fear, they have found some relief in support from their families, communities, and one another.

We’re offering this article during Nurses Week as a reminder to all to be as patient, kind and loving to our Nurses, Healthcare workers, first responders, grocery store employees and all the people out there working to keep us safe. Thank you!

Nurses, Doctors, EMTs, and other healthcare workers are on the front lines of the COVID-19 battle. Even though they are going through the toughest time right now, they still manage to keep a good sense of humor. 

Take a look at how these healthcare workers are spreading positivity.

Thank you for staying so positive!

What Nurses Need to Know about COVID-19

All Nurses and the health care team must receive the highest level of protection to provide care for the individuals and communities in which they serve. It is essential to develop and educate ALL staff on preparedness plans that provide infection control procedures and protocols used within the health care facility for the early identification, containment, and care of patients with symptoms associated with Coronavirus Disease (COVID-19) to prevent spread within the facility. Here are some tips:

• Develop inpatient, ambulatory, and home care policies and procedures that are in line with current CDC guidelines for COVID-19.
• Provide training to all personnel on screening and isolation procedures.
• Provide updated training and guidelines on the use of Personal Protective Equipment (PPE), including the use of N-95 respirators, gloves, gowns, masks, eye protection, and face shields.
• Display clear signage with instructions for access and use of PPE.
• Ensure consistent use of proper hand hygiene, standard precautions, contact precautions, and airborne precautions, along with the proper use of a National Institute for Occupational Safety and Health (NIOSH)-Approved N-95 respirator or higher.
• Clearly display signage for patients that lists symptoms and instructions to wear a face mask before entering the healthcare facility if symptoms are present.
• Incorporate assessment questions to document a detailed travel and community exposure history when patients present with fever, cough, or respiratory illness. 
• Identify, in advance, airborne infection isolation rooms (AIIR) or negative pressure rooms, for quarantine and screening.
• Outline staffing protocols to facilitate care of patients with COVID-19 to minimize patient-to-patient and patient to health care worker transmission.
• Develop a telephone triage protocol for patients to access from home to minimize community based transmission.
• Have available for immediate notification of Patient’s Under Investigation (PUI) the infection control personnel at your facility and the local and state health department. Click here for additional Recommendations for Reporting, Testing, and Specimen Collection and the fillable COVID-19 PUI case investigation form.
• For Patients Under Investigation (PUI), follow the Criteria to Guide Evaluation of PUI for COVID-19.

Isolation, Quarantine, Monitoring, and Hospitalization

The CDC recommends several steps for identification and maintenance of COVID-19 along with detailed guidelines for isolation precautions to prevent transmission. There should be a clearly displayed flowchart for early identification and assessment of COVID-19.

At this time, the modes of transmission include respiratory droplets from coughs and sneezes and transmission by touching the eyes, nose, or mouth after contact with an infected surface.

 Isolation Precautions to Prevent Transmission Guidelines

• Have masks available for PUI to don before entering the healthcare facility.
• Once identified, isolate the patient to airborne infection isolation rooms (AIIR) or negative pressure room and keep the door closed. Conduct the assessment in this room.
• Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and eye protection (goggles or a face shield).
• Don Personal Protective Equipment (PPE) before entering the room.
• Have guidelines for the proper use of PPE displayed throughout the healthcare facility.
• Have infection control personnel available to provide just-in-time training on proper PPE use.
• Notify your infection control personnel and the local and state health department of suspected cases.

Per the CDC, it is known that coronavirus is part of a large family of viruses that can cause illness in people and animals. It is known that COVID-19 is spread via respiratory droplets from coughs and sneezes. It is also possible to spread COVID-19 by touching your eyes, nose, or mouth after touching an infected surface. The CDC provides the following guidance to help prevent COVID-19 from spreading among people in homes and communities.

• • STAY HOME except to get medical care, do not use public transportation or taxis if sick.
  • Call first before visiting your healthcare provider. Notify them of your symptoms and the need for evaluation for COVID-19. Follow the instructions provided by your healthcare team.
  • Separate yourself from other people in your home, utilize a separate bathroom.
  • Wear a facemask as instructed if you are sick.
  • Use your elbow to cover your coughs and sneezes.
  • Wash your hands frequently with soap and water for at least 20 seconds.
  • Avoid sharing household items.
  • Monitor your symptoms.
  • For a full list of guidelines and recommended actions for preventing the spread of Coronavirus visit https://www.cdc.gov/coronavirus/2019-ncov/guidance-prevent-spread.html

COVID-19 - Nurses Online and Printable Materials

https://www.nationalnursesunited.org/nurses-response-covid-19-printable-materials

Coronavirus disease (COVID-19) Situation Dashboard

https://experience.arcgis.com/experience/685d0ace521648f8a5beeeee1b9125cd

What To Say To Patients About Coronavirus Video

https://youtu.be/Yk6VX_Bktik

During this global health crisis, telehealth is an effective solution for the prevention and treatment of COVID-19. 

Telehealth allows patients, healthcare providers and health systems to safely communicate. Patients with symptoms, told to stay at home, can communicate with Nurses and Doctors through virtual channels, mobile apps, video conferencing and phone calls to reduce the spread of the virus to mass populations and the medical staff on the frontlines. 

Telemedicine carts are another way hospitals are using technology to help treat patients. The carts allow health staff to roll video cameras and other telemedicine equipment into a patient's room so they can be assessed without Nurses and Doctors physically being at their bedside. 

Dr. Todd Czartoski, Chief Medical Technology Officer at Providence Regional Medical Center Everett, said "We had people outside the room talking to the patient, evaluating them with the electronic stethoscope and keeping those communication lines open. The Hospitalists, Infectious Disease Doctor and other Specialists didn't have to gown up and go in and out of the room multiple times a day." 

This technique also minimizes the use of personal protective equipment (PPE), such as gloves and masks.

The Centers for Disease Control (CDC) recommends using telehealth tools to direct people to the right level of healthcare for their medical needs. They launched a COVID-19 chatbot called the Coronavirus Self-Checker to help screen Americans who are worried about the coronavirus despite not being sick or being at risk. This would free up healthcare resources for those who need them.

Health insurers are giving providers and patients incentives to use telemedicine delivery models. CVS Health said Aetna would waive copays for coronavirus testing, and all telemedicine visits would have a $0 co-pay until June 4, 2020.

Patients can check their provider’s website or check with their health insurer on how to access telehealth services. According to the Wall Street Journal, people can also go directly to sites from Teladoc Health, Amwell, PlushCare, Doctor on Demand and MD Live for virtual visits.

If needed, Doctors can send prescriptions directly to a local pharmacy via telehealth.

According to the New York Times, health systems are racing to adapt and even develop telehealth services that can serve on the front line for patients. “Telehealth is being rediscovered,” said Dr. Peter Antall, the Chief Medical Officer for AmWell, a company based in Boston that is working with health systems across the country. “Everybody recognizes this is an all hands on deck moment,” he said. “We need to scale up wherever we can.”