Observations

Nursing on the Front Lines of COVID-19

Keeping the virus (and panic) under control at the Seattle-area hospital that treated the first U.S. case

I have never been particularly “germ-averse.”

While I’m a protocol-following professional at work, I can be a bit laissez-faire about pathogens in my personal life. I’m not the type of nurse to shed my scrubs and change my shoes like Mr. Rogers as soon as I arrive home. I never required a post-shift shower before hugging and kissing my kid. Working in acute care for over 18 years has led to a sense of invincibility when it comes to communicable diseases.

Until now.

I work at Providence Regional Medical Center Everett, in Everett, Wash., which had the dubious honor of becoming the first hospital in the U.S. to care for a patient with the 2019 novel coronavirus disease, abbreviated 2019-nCoV or just COVID-19. This is my experience of these scary first weeks.

 

My patient’s ventilator alarms blare loudly, despite being partially muffled by a tightly sealed door. This door is part of a system designed to generate a negative airflow space for patients with highly infectious respiratory diseases such as COVID-19, which my patient may or may not have. At least another 48 hours will pass before results are available, but in the meantime, we are treating this case with the utmost regard for transmission prevention.

Although the alarm is urgent — “circuit disconnection” — and my patient may momentarily not receive adequate oxygen, it’s going to take significantly longer than the standard few seconds for me to get to the bedside and reconnect. Whole minutes might pass before I’ve put on my personal protection equipment (PPE) and am prepared to provide care.

First, I don a yellow gown over my hospital-provided disposable scrubs and attach a battery pack to my waistband. Next, I pull not one but two sets of gloves over my hands; the outer pair is more typically used for handling hazardous drugs such as chemotherapy.

Hiring Now

Adding a surgical bouffant to cover my hair, I then place a CAPR (controlled air-purifying respirator) on my head and connect the respirator to the battery pack. When I sense airflow against my cheeks and the under-chin shield puffs out lightly, I know I’m protected from exposure to the potentially infectious atmosphere inside the patient’s room. I’m safe — at least, I hope I’m safe.

A second RN observes every step of my preparation to ensure no breach of the infection control protocol. She’ll also watch as I take off the PPE as well, which takes even longer. It involves using alcohol-based sanitizer between each glove layer and then bleaching both the CAPR and the bottoms of my shoes to complete the decontamination process.

 

Every day in the medical ICU delivers unique challenges, but working in the rooms of a patient with COVID-19 — a disease whose worldwide outbreak the World Health Organization (WHO) recently declared a pandemic — ensures a high-pressure shift like none other. Nearly every shift at our facility is short-staffed because the COVID-19 protocols require us to use extra nurses in the observer/secondary role for each patient contact.

In these conditions, clustering care is imperative, both to reduce the amount of time the door is open and to husband our supplies. As cumbersome as the CAPR is, it’s ultimately more comfortable than the claustrophobia-inducing N95 mask, which we anticipate using more in the weeks to come. The CAPRs, hand sanitizer and all other PPE are hot commodities. We’re not out of supplies yet, but it’s a conceivable worry.

 

The hospital has restricted visitors in the confined area due to the high risk of transmission and also because we can’t spare the extra masks and gloves. Patients with mild symptoms are bored, suffering from social isolation. The higher-acuity patients, even those facing possible mortality, are generally only able to communicate with their families via video chat apps like Skype and FaceTime.

Nursing Education

Working behind the “authorized personnel only” curtain means having food delivered, adjusting to the CDC’s rapidly evolving recommendations and fielding an absurd number of phone calls from family (as well as journalists pretending to be family). There’s a sense of sterility, vigilance and purpose.

Working behind the “authorized personnel only” curtain means having food delivered, adjusting to the CDC’s rapidly evolving recommendations and fielding an absurd number of phone calls from family (as well as journalists pretending to be family). There’s a sense of sterility, vigilance and purpose.

 

Coronavirus is the stuff movies are made of: a real-life Outbreak or Contagion in my city and my hospital. I confess that it’s tempting to get hooked on the drama of it; panic is proving more contagious than the virus itself.

Still, while the media may be provoking disproportionate public alarm (as you might have noticed if you’ve tried to buy toilet paper or Lysol wipes lately), working on the front lines makes it impossible to escape the gravity of the outbreak. There’s no arguing that people’s lives are indeed at risk.

I’m not particularly fearful that I’ll contract the virus. We’ve implemented precautions that would prevent transmission of the tragically lethal Ebola virus, much less a mild-to-moderate respiratory illness. Nevertheless, I’m now painstakingly diligent to avoid contaminating my community.

 

This is a daunting and uncertain time to be a nurse. I’m honored to have the capacity to care for those in need during this challenging epidemic. That assignment requires me to summon a variety of nursing qualities: tolerance, critical thinking, endurance, integrity and adaptability. I am often in awe as I witness these qualities in my colleagues every day. I’ve felt little choice but to rise to the occasion as well.

My message to you is this: The COVID-19 epidemic is a dramatic reminder that we humans are both so fragile and so resilient. Be kind to one another. Avoid the pandemic panic; proceed with caution. Don’t touch your face, cover your cough and please — wash your hands.


Tiffany Swedeen, RN, BSN, CPRC/CPC, is a critical care nurse and clinical instructor. She is a mom, writer, meditator and VW van road-tripper. Follow her on Instagram @scrubbedcleanrn or visit www.recoverandrise.com.


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