March 31, 2020

Special Episode: Nurses on the Front Lines of Covid-19

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Description

On this special episode of The Handoff, we’re bringing you interviews with two nurses who are the frontlines of the battle against Covid-19. First, Dan spoke with Sam Koerner, an ICU nurse who travels to assignments with her tiny home, which is where she was under quarantine after working with Covid-19 patients and starting to develop symptoms herself. Sam shared what it’s like to be under quarantine and how it has impacted how she thinks about patient care moving forward. She also shared how she manages her personal anxiety in the face of a healthcare crisis in order to focus on her patients. 

Lauren Rodriguez is a cardiac ICU nurse who has amassed quite a following on Instagram, where she’s been sharing very real dispatches from the frontlines of the Covid-19 crisis at @iculaughingrn. She talked with Dan about the disjointed response from the government, the conflicting guidance she’s getting about PPE and what it’s like working with some of the most critical patients. 

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Transcript

Dan:
Today, we're taking a break from our series on automation to bring you a special episode of the handoff focused on the COVID-19 crisis. We know that there's a huge interest in hearing directly from the selfless clinicians who are working so hard to battle this crisis. Now, we wanted to bring you two of their stories. First up, I speak with Sam Koerner, an ICU nurse who travels to assignments with her tiny home, which is where she's currently under quarantine after working with COVID-19 patients and starting to develop symptoms herself.

Dan:
I spoke with Sam while she was awaiting her test results about her experience what it's like to be under quarantine and how this has impacted how she thinks about patient care moving forward. Sam, welcome to the show.

Sam:
Hey, Dan, thank you so much for having me.

Dan:
So Sam, tell me a little bit about your background as a nurse. What's your specialty? Where have you been traveling and what are some of the main assignments you've taken recently?

Sam:
I started nursing in Virginia. I was there for about five and a half years. I didn't start med-surg so I got those mandatory requirements on med-surging first, then went to an ICU. So, I was trained actually in a Cardiovascular ICU. So, the open hearts, all of that, and after about two and a half years there, I started doing travel nursing. And I was lucky enough to start in Hawaii, which is amazing assignment.

Sam:
From there, I went to Cape Cod because my family's on the east coast. Then, I went to Arizona, and then I was in Seattle for about eight months and I just left Seattle and came to San Jose this January.

Dan:
So, two cities that are on the frontlines of the COVID infection, COVID fight, right now. So, tell us a little bit about your experience over the past few weeks with your latest assignment. What happened that moment that this infection crisis pandemic hit home with you?

Sam:
Being in a Cardiovascular ICU, they try not to give you the more infectious patients because there are cautions after surgeries. So, we didn't start with COVID patients on my unit. But as a traveler of course, we can be floated. And the other unit we can be floated to is the NSICU, which is also kind a mixed med-surg ICU as well in my hospital. And so, they started taking the first COVID patients on that unit, and I happened to be floated there the day that we took our first COVID patients.

Sam:
And to be honest, I felt like my hospital prepared me pretty well for what they knew and for what we knew in the moment. My manager came in, it was a Saturday, so she came in before the patients even came up from the emergency room and she explained what was happening, what the plan was, what the proper protective equipment, at the time that we were being told was that we were going to use one of the negative pressure rooms and then I had the filter in another room.

Sam:
And that we were admitting a couple, it was a husband and wife. And so, we were admitting them together because they had just recently been on a trip with somebody who had been positive. So, they didn't know they're positive at the time, but they were being admitted as rule-out. But we did find out they were positive a couple of days later. So, that first day we had them in, I did feel my manager did a good job, some supervisor was there, she came in, and they really tried to talk us through everything we needed to do.

Sam:
And they also said we were going to have spotters outside the rooms so not for the negative pressure room where you have an ante room but for the room with they have the filter. Yeah, we will be coming out of the room and somebody would be watching us take off equipment. And as nurses, you do PPE a lot, but this is of course, a little bit more than the usual so you had the goggles and the N95. And then, you could wear hairnet and shoe covers if you wanted to. I just didn't have a hair elastic on me that day.

Sam:
It was a way for me to get my hair out of my face. So, I chose to do that. So, it was helpful to have somebody outside the room telling me, "Okay, this is where you start with your PPE and this is what you're going to take off first. And this is what you're going to do first." Because especially in those moments where no matter how many times you've done PPE, it feels new in a situation like this and it helps to have somebody else have an eye on it and say like, "Okay, make sure you're taking this off right so we can minimize the spread and minimize the chance that you're going to get this as well."

Dan:
Yeah, all that essential donning and doffing training that we don't get a practice all that much at the frontlines, but it sounds like you were really well-supported. So, they knew that that patient was exposed to somebody with a known disease. Did you have all the PPE and all the resources you needed at your disposal at that time?

Sam:
At the time, we started with N95 masks. Since then, that floor has had a lot of poppers come in. But at the beginning, just starting with just the N95s and the goggles. And I did feel we did have the proper supplies at the time. Of course, we were just starting and the thing I try to explain to people who aren't in health care, I'm like, "N95 masks are not the mask that healthcare professionals are generally using the most of," right? We don't stockpile them because just like everything else, they end up having expiration dates and things that you end up having to get rid of if you're holding on to them for years.

Sam:
And the masks that we normally use are usually the flu masks. So, the N95s, they did have a couple of different brands because at this hospital, they do have two different brands they work with [inaudible 00:05:54]. So, we did have all of that equipment available. So, I did feel at the time that I was being well-protected. And let me just say, I went into this with not much anxiety in the sense that in my mind, anxiety is while it can be a good thing in some cases, and of course, we have evolved to have anxiety to help protect us, it can also make things so much worse.

Sam:
And as nurses, we're in so many situations where you have to remove your own emotional baggage or your own emotions in certain situations, because you need to provide that support for the patient at the time that I think we've almost been trained to be able to do that. And so, for me, I was just thinking of it as these are patients that are going to need our help just as much as any other patient, and I wasn't really anxious. There were definitely some nurses who were expressing some concern about taking COVID patients.

Sam:
And concern over, "Well, if I'm taking this patient, I'd rather have them in the negative pressure room," or things like that. And I went into it being like, "There's a chance that we could all end up with this regardless." And for me, luckily, I'm not in an older population and I don't have a lot of comorbidities. So, I was hoping if I got it, then it would be less of a serious case for me. But I definitely tried to go into this being like, "Okay, I understand there's going to be anxieties and people are going to be scared and I'm going to try to not be anxious about this and just help people the best that I can."

Dan:
That's putting that nurse mindset on, right? You drop away the things that worry you in your personal life and focus in on the task at hand. And I love your comment about the N95. I'm an ER and trauma nurse as well and we never use the N95 mass. I think I put one on in clinical care two or three times ever in the ER and it's like a suspected tuberculosis patient or viral meningitis patient or something where we didn't know what was going on so we would wear that. But yeah, you don't usually... the N95, you get fit tested once a year, and that's about the extent of the time you put them on.

Sam:
And the time you get tested, it's like, "Oh, I'm doing another fit test."

Dan:
Right, exactly. And you never remember what your size is or anything. And so, when it actually happens, you actually have to look it up, and "What did I do again?" So, that's a really good point. It's not something you use all the time. And so, now, you've been exposed and you're currently waiting test results and all that stuff. What was that experience learning that you had been exposed outside of the PPE land?

Sam:
At first, I just started having a few symptoms that didn't seem like much. The first day it was, "I'm feeling a little off. This could just be anything, right?" I think the mindset changed for me was that while we're dealing with COVID and COVID is our main concern, I also had to think about the fact that there's still so many other germs and viruses and colds going around. This is that time of year where everybody's getting these things. And COVID is our concern right now but what do we do when we don't know if it's COVID but you don't want to take that risk?

Sam:
But what if it's just a common cold? Do you stay home? And I'm sure you know this, as a nurse, we don't often have that mindset of, "Oh yeah, I'm going to stay home and take care of myself." We're like, "It's fine. It's a little bit of a ticklish throat. I'll be fine. No problem. I'm going to go to work." So, I had a little bit of a sore throat on Saturday, and I figured it was nothing. And Sunday, after working, I woke up and I was like, "Man, I'm just really achy. Oh, this doesn't really feel good."

Sam:
And I'm like, "Well, I did work out the other day, and it was a pretty good workout. Maybe that's what it is." And then, at the end of the day, I'm like, "Well, I've got chills and a headache and sore throat's worse. And maybe this is the flu. Maybe that's all it is." But because of everything that's going on with COVID, I was like, "I'm just going to call out of work. Let's see what happens. Maybe I just need another day of rest." So, I called out of work on Monday and then trying to figure out what to do and where to go.

Sam:
And it's crazy because my mom says to me, "Well, aren't they setting up all these mobile pods? Have you seen them out there? Are they out?" I have no clue. I haven't seen any of this. So, we're seeing so much. And I think people are so inundated by what's going on in the news and what we're supposed to be getting. And people are like, "Yeah, it's fine. Tests are coming. Pods are coming." And I'm like, "But are they?" Because now, I'm that person in this situation, who is like, "But where do I go? What do I do?"

Sam:
Becoming the patient as a nurse is always a weird switch. So, I became the patient and I was like, "Okay, I guess I'm just going to look up some places around me." And I called a place that was like, "No, we are not testing for COVID." I'm like, "Okay." And I called my employee health and they were like, "It's hard because you're a traveler. So as a traveler, you're not really under the hospital. But you're not really under... you have an agency but our agencies, of course, are across the US."

Sam:
So, I was like, "Okay. Now, what do I do?" And she said, "I did tell another traveler to go to a clinic. And she also told me that when she went to the clinic, they freaked out, and they tried to quarantine her." And I was like, "Man, okay. Why don't we have something streamline? Why don't hospitals have the tests to test their employees? We're the ones that are really having to deal with this and they should be more available." And you think about all these things, but not necessarily until you're in the moment.

Sam:
So, I found a clinic that had an online screening form for COVID as well. And that was helpful because you're able to just fill in all the reasons why you think you should be tested for COVID. And, of course, being in contact with other people who are positive and being a healthcare provider are two reasons why I would be able to be tested. So, I was able to make an appointment. And then, when I walked up to the clinic, the woman at the door came to me with a mask and had me put it on before I walked in.

Sam:
The check and pass was all online before I got there. So it was streamlined. They put me into a room. I didn't see anybody else, the doctors said she was... or she was actually a nurse practitioner, she said she had been really busy. So, there must have been other patients there. But honestly, I didn't even see anybody else. So they must have been trying to do a good job of separating people. So, I went in and my manager called me at the time I was waiting.

Sam:
And she's like, "I really think you should get tested for COVID. You have been working with these patients. And then, we need to know if it's positive because we have to backtrack who you've been with and where you've been and what you've been doing." So, I did feel that support from my manager and my nurse advocates you trusted told me, "Hey, for your peace of mind, if you can get tested, I think this is a good idea. Let's try to do it."

Sam:
So, I got tested and it definitely made me realize, "Oh, my gosh, this is how all our patients feel when we shove things up their nose." My poor patients. I haven't been apologizing enough for the discomfort.

Dan:
Like, "No, it's just a little tick. Oh, wait, no, no, it's not."

Sam:
It's real uncomfortable. They tested it. And they said it'll be three to five days. And they said self-quarantine. I was like, "Okay, well, the self-quarantine, what exactly does that mean? Am I allowed to go outside? Can I walk my dog?" And she was like, "No, you can't."

Dan:
Yeah. You're inside.

Sam:
So, I have been in my house. And I live in a tiny home. So, I live in 250 square feet, which I love. But you don't realize that there aren't very many places to go when you live in a small place.

Dan:
Yeah. Oh, man. That was a great detailed description of the process. And so, now, you're in this waiting game, and what's going through your mind?

Sam:
It's up and down. Part of me is like, "Ah, this probably isn't COVID because I am feeling better now. And I seem to get over it." But then, it's like who knows how long I had it for if it is positive, right? The incubation period is so long and I did work with some patients and people. And then, you start to just think about those people and that you hope they don't get sick. And then, part of me thinks, "Well, maybe it would be good if it came back positive, because maybe that means I'll have some immunity."

Sam:
As we know from the epidemiology and the study of most of these viruses is that your bodies can recognize a virus if you get it again, and then hopefully shut it down a lot faster, so that you don't really get as sick. And that's the hope, but we don't really know, and what if I got it another time and I got really sick. But I think, "Well, maybe if I got it, if this is it, I've already been quarantined for four days now. So I'm already at least partially into my quarantine."

Sam:
And then, I'm like, "Okay, well, maybe once I get back to work, if I do have this immunity built up, it will help prevent me from getting more sick in the future." I just think that by the time I get back to work, whether it's going back on Monday or going back in 10 days, there's going to be more patients and less supplies.

Dan:
Yeah. Yeah. Yeah, that's definitely running through the minds of a ton of nurses right now as we're seeing supplies get short and patients increase across the country. You've obviously worked with patients in quarantine or in isolation in the past before COVID became the latest isolation diagnosis. How has that experience shaped your thoughts about working with COVID patients and now how is working with COVID patients and all the PPE and everything you have to do there, and how you interact with patients shaped, how you're going to move forward?

Sam:
What's interesting is when you're taught as a nurse going in and you're taught about different types of viruses or bacteria, and you're taught about C Diff and MRSA, and the different precautions for each of these things, we all know about them, right? And hospitals still have outbreaks of all of those things even if people are doing good PPE. But it does make you sometimes think, "Okay, we do PPE for all that, but no one ever watched me. What if I was doing something wrong?"

Sam:
You do your best but how many times have all of us been so busy that you're running from one patient to the next. Or there's something that happens and you take your PPE off really fast and you try your best to keep your patients safe. But I have thought about that. "Well, what if I wasn't doing PPE as great in the past, maybe I need to be more cautious because now, I have a spotter." I reached for my mask in the wrong spot and she was like, "No. You cannot touch your mask there." And it was just instinct.

Dan:
It's like nursing school almost.

Sam:
Yeah, I was like, "Oh, you're right. Okay. Wow. Okay, maybe I need to think about those things a little bit more." And when I'm going into my patients' rooms, I know we've all had those moments where you just went into a patient's room to stop a beeping pump without being fully account. Right? And you're like, "It's fine, it's fine." But what if it was COVID. Maybe we need to not be as crazy but maybe some of these other diseases would be a little less rampant if we were more intense about making sure we really follow everything to a tee.

Sam:
And I don't know, maybe making those isolation patients if possible if we had the staffing, which would be fantastic. But if you couldn't make some of those ones that are more serious that you're spending so much time in those rooms and you having to get up every time not a one to six patient, those nurses.

Dan:
That's great advice. And as an ER nurse, it's the same thing. We didn't know they had MRSA, VRE, whatever disease it was down there. So, we didn't even gown up unless there was some major history of it or something. And so, you get exposed, but then you never see the consequences. It's like, "Well, I don't have VRE. I don't have a MRSA infection. So, I guess I was fine." But now, we're seeing it like you make one mistake by taking your mask off wrong, and now, you're exposed and you're on quarantine. I mean, not you personally but nurses are. And it's almost instant like, "Oh, crap, maybe I'm not doing this the right way."

Sam:
Absolutely. Yeah.

Dan:
It's an instant behavior change almost.

Sam:
Yeah. And that being said, anybody listening to this, we as nurses, I mean, we're human, but we all do our best. And I have to say, Dan, as an ICU nurse, you know how there's always that little ICU ER nurse [crosstalk 00:18:08].

Dan:
Totally. I'm surprised you're even talking to me.

Sam:
You know what, I'm on isolation and I haven't talked to everybody. So, I decided to give you a try. You passed the test so far. But I have so much respect for ER nurses because... I mean, of course, I always did. And there's always that little kidding around tip but you think about times like this where yes, nurses are the frontlines, but ER nurses, you guys are the frontlines. These people came in, especially the first cases, before people started screening, before they set up those tents outside of emergency rooms.

Sam:
They were coming in and you guys were figuring out, "Okay, maybe he should be an isolation. That would be helpful." Yeah, we might take care of them longer, but you guys have just as much, if not, more exposure. So, shout out to all the nurses because I know everyone's working so hard out there. But ER nurses, so much respect for what you have to go through when you people come in the door and you don't have a clue.

Dan:
Yeah, well, I appreciate that. And the same goes back to ICU, med-surg, Tele clinics, school nurses. Right now, we are banding together. And each skill set is so needed and the people stepping up and not back are the ones that deserve a huge round of applause. So, I appreciate that.

Sam:
Yeah, absolutely. They really do. I've read so many scary stories being at home of hospitals that haven't been prepared and protocols that they haven't put into place. And it scares me because as a nurse, I feel we always know that how much nurses do and how much we don't necessarily get support sometimes. And I think hospitals are trying to at least get some of that rolling now that this has happened and they're like, "Wow, nurses need these things. They need support, right?" But we needed to stop being all talk, we needed to really be actual support of our nurses. This is the year of the nurse and what do we get? COVID.

Dan:
Yep. What a better way to show the value of nursing, right, is right now.

Sam:
Right. That's a really good point. I think it just goes to show nurses, we've always been the ones doing these things. And it's nice to see people banding together and supporting us and us coming all together to say, "Hey, these are the things we need. This is what we need to do. And we're going to take care of our patients." But I really hope that this continues outside of all that's going on right now. And that nurses can continue to get this support.

Dan:
Yeah. Yeah. 100%. And that's one of the reasons we're doing this podcast is get that information out so we can help nurses across the country. So, what advice would you give other clinicians who are dealing with COVID-19 patients right now? Do you have any pearls of wisdom, anything that they should think about as they take care of those patients?

Sam:
I think the only thing I can say is try to remember... And this is not talking down to any nurses or anything in particular, but just something that I had to tell myself before I went in that first COVID room was, "This woman did not choose to be here. She did not choose to get this virus. Her husband is in the next room and he's about to be intubated. She's doing well. She's isolated, she can't see friends or family. She's only seeing the provider that's us mainly going in and out of this room."

Sam:
So, remember that these people are still human. And whether we're scared or not, maybe not show that to them, and maybe just try our best to still connect with them on those humane levels that we know how to do and that make all of us really good nurses.

Dan:
Yeah, that's a great piece of advice. Despite all the chaos, remember that there's a human just as afraid of this as some of the nurses are. And so, that therapeutic relationship is key, and we can't forget that. What advice would you give hospital leaders whose clinicians are on the frontlines? Any tips there?

Sam:
I think just to continue the support, but make sure it's not just all talk. I would hate for a lot of the things that they're saying in the media, "Hey, we're doing this, we're prepared for this or that." I would hate for all of that to be false for these nurses to not be getting the support that they need and that they deserve. And of course, not just nurses, we're supported by a huge ancillary staff of people that make our jobs work better. Everybody in the hospital, this important staff and you need to be there.

Sam:
We need to continue to support each other and I have seen the CEOs and the CNOs and everything walking around and coming down more. And I think being more in touch with our managers and having lots of meetings about all of this. And I just hope that, yeah, the support continues to show and I hope they keep fighting for us. There's a lot we're hearing on TV, "Oh, more masks are coming. Like I said, more tests are coming, well where are they? Fight for us, fight for the people who are fighting for your patients, because nurses are always advocating for their patients, and we need you to advocate for us."

Sam:
Yeah. I couldn't have said it better. Exactly. And we're getting reports around increased bullying and some of these other toxic behaviors that exist within healthcare systems and this is not the time for that. And I think nurses need to band together and make sure that they stomp that out really quick and find those people that are willing to support them, because we need to band together. This is where 4.5 million nurses come together and show the entire world what we're up to and support our patients and really lead through in uncertain time.

Sam:
Yeah, absolutely.

Dan:
Sam, I really appreciate you on the show today. Is there any social media that you're on that people can connect with you if they want to give you a kudos or ask questions or get in touch with you?

Sam:
I'm a terrible social media person. I am on Instagram. But to be honest, I'm also really terrible at it. I just got bullied into doing it by my friends and family when I started travel nursing and they were like, "But we want to know what's going on. We want to see where you're going." And I'm like, "Okay." But I'm really not great at it. So, they're more than welcome to look me up. It's @_thewanderingnurse.

Sam:
I have to say, though, for anybody who doesn't already follow one of my friends account, theiculaughingrn, she is where she's really sharing a lot of people's stories and shout out to that as well and making sure that all the nurses' voices are getting heard.

Dan:
I love it. No, that is a great resource. And we are so happy that we could learn from you. I hope you feel better soon and that you can get back to the frontlines and help us battle this crazy time and disease and just really appreciate you being on the show today.

Sam:
You too. Thanks so much for having me, Dan.

Dan:
I hope you enjoyed my conversation with Sam. Unfortunately, after we spoke with her, she found out there was a mix-up with her test results. And she still wasn't sure if she was positive for COVID-19. We're in touch with her and I've heard she's feeling better. But I wanted to highlight this as an example of the ongoing issue with testing both for patients and clinicians. Next up, I speak with Lauren Rodriguez, another ICU nurse who is on assignment in San Francisco.

Dan:
She's on the frontlines working with COVID-19 patients. Lauren has been detailing some of her experiences on Instagram as the handle iculaughingrn. And I was grateful to get a chance to speak with her about this in more detail. Lauren, welcome to the show.

Lauren:
Thank you so much.

Dan:
So Lauren, tell us about your background as a nurse, what's your specialty and how long have you been traveling?

Lauren:
I basically was super fortunate right out of school to get handed an adult cardiac ICU position in the Chicagoland area. And then, I gained most of my experience working in Chicago. And then, about three years into my career, I decided to start travel nursing. And I headed to San Diego, and then San Francisco, and then Seattle, and now back in San Francisco. And basically, I've always stuck with mostly cardiac ICU even while traveling as much as I try sometimes to get away from it. It somehow finds me and I end up right back. That's pretty much my specialty and what's going on. But yeah, I've been traveling for almost two years.

Dan:
Awesome. Loving it. Going up and down the West Coast. The best coast for sure. And you're one of the few ICU nurses that... my background's ER, so one of the few ICU nurses that I'll talk to, so I'm glad that we could have that collegiality. Well, so you're fully aware that it's been crazy the last few weeks with the COVID outbreak, how are you dealing with that? What has been the communication? What have you seen different in the facility? Tell me what's going on from your perspective?

Lauren:
I think that my perspective is definitely oversaturated, it's how I would describe it. I have a meme account on Instagram that has been acting as this safe space and community where everyone from... it's mostly throughout the United States. But it's also actually a lot of international nurses are coming and sharing their personal experiences anonymously with me. And then, I'm sharing them to the audience. And so, I'm doing that. And then, at the same time, I'm also working the bedside.

Lauren:
And so, I'm seeing how all of this is playing out for me individually and then for people that I interact with online, and then for all of my nurse friends that I have in real life. And so, I'm getting a ton of different perspectives, as I'm sure a lot of people are. But basically, it's been a whirlwind. I think a lot of the general public would even agree that every single week had a different theme, had a different leveling of how this is all transpiring. And I think that as a healthcare professional, we're feeling that too.

Lauren:
There was the week in January where I caught wind of this where I was still in Seattle. And then, I forgot about it as I came to San Francisco. But then, at this point, it's wherever you are. It's everywhere. And so, yeah, it's just been a whirlwind. I think I'm doing okay. There's definitely moments where I have to check in on my mental and physical health and how that is responding to a more chaotic work environment, or a more chaotic home environment.

Dan:
Yeah. The media tends to play this up like it's craziness all the time. And there definitely are spots in New York, California, Washington where it is literally like a warzone. What are you seeing on the frontlines right now in San Francisco? Is it craziness like it's being portrayed? Or are there times to sit back and be able to reflect on it and not run with your hair on fire?

Lauren:
I think both. I mean, for me personally, I basically just walk in to every single shift and hope that I don't even have to interact with anything COVID. And that probably sounds so selfish, but it's because it's not organized. It's not ready. Every time that you're interacting with it, it's like when you were a new grad, and you get handed a patient, and you're just really hoping that you can get through the shift and take care of them and do your best and provide quality care.

Lauren:
I feel like with COVID, all of these facilities are reacting instead of being proactive. And so, you're walking into a shift that like you get this assignment and everybody's just scrambling. It's gotten better. I'm probably being a little harsh, but it has gotten better. But in the beginning, it was pretty chaotic, yeah.

Dan:
Yeah, it seems like COVID's definitely spreading faster than other outbreaks, I think, we've seen in recent years. I was a big part of the Ebola response in the Bay Area as well. And that was really slow, there's a few patients that came in, it was organized. From the transport all the way through the care at the hospitals was just very prescribed and coordinated. It seems like this is people show up the front door and no one knows what's going on. And even when they get up to the units, people aren't comfortable taking donning and doffing like all this stuff that that just you don't do every day.

Dan:
I mean, the general public doesn't understand you don't put on N95 masks all the time. That's not just a routine practice every day. You don't put on these big biohazard suits every day. And so, to remember how to do that right is a different skill set. And it just seems like we weren't prepared for it.

Lauren:
Right. And then exactly like you're hitting on is just the transportation of them and every single aspect of care that deals with protecting the patient, the nurse, the general public, the other patients that protects everybody, that we're supposed to be handling this in the right way. It's all not as organized as what Ebola might have sounded like.

Dan:
Yeah, yeah, yeah. Tell us about some of the patients' population you're working with. Are you seeing a fair number of suspected infected, confirmed infected on your units or within your hospital?

Lauren:
Again, I feel I have like a broader perspective because as a traveler, I am first to float. And so, I have seen COVID patients on my unit, which is a cardiac ICU. They are, unfortunately, that picture perfect news patient or that fear-mongering patient have acute respiratory distress syndrome that is prone, that is paralyzed, that is not doing well, that is maybe and, or possibly cannulated on ECMO, that is just very, very, very sick. I've seen a few that have that "no past medical history."

Lauren:
I think that's a whole other topic because I think a lot of times, it's just that they had no past medical diagnoses, they had no past medical interactions. Aside from that, when I get floated, I'm on the floor and I'm having interactions with rule-out patients. That's just a whole other thing in itself because I think that the floors are surprised that this is happening to them because this seems like a very acute scenario that belongs in critical areas of the ED of the ICU.

Lauren:
And so, I think it's just a lot. And then, they have a full patient load, they have a lot to do, and having this on top of it is not fun. For the most part, when we get that negative, we feel pretty good.

Dan:
Yeah. Celebrate the negatives.

Lauren:
Seriously. Well, so tell me a little bit about what you're seeing in the progression of the disease because you're seeing it from the normal med-surg floor or the cardiac Tele floor to the ICU. What is the biggest difference? Or what do you... what's the triggers that you're like, "That patient's not going to do well."?

Lauren:
Unfortunately, I feel I can't really speak to the progression because I've never seen the same patient. There's only really probably one or two patients that I can attest that I've seen them over the last few weeks and they're, from what I hear, they're just in the same state. And, or maybe a little bit better one day, a little bit worse the next day, that teeter-tottering that happens. I think, in general, it's a hard pill to swallow. But a lot of patients in cardiac ICU or NICUs don't necessarily do as well as we would all hope that they would.

Dan:
Yeah. And is it mostly supportive care? I mean, you're basically trying to ventilate them with every possible way.

Lauren:
That's the other thing, whether or not these patients are getting cannulated seems to be in line with whether or not other people get cannulated on other terms. I guess what I'm hitting on is I've worked in facilities that will cannulate everyone no matter what. They won't look at that at any recommendations as to like, "Oh, this is a no, no." Or like, "Oh, we should probably stay away from this." And then, I've worked in other facilities that follow those guidelines to a tee.

Lauren:
And so, I think the same thing is happening with COVID patients. When I talk to friends across the country, strangers across the country, I think some facilities are cannulating, and some facilities are not.

Dan:
And for those that don't know, can you describe what cannulating is?

Lauren:
Particularly with the COVID patients, it seems to be a lung machine operating outside of their body. So, taking the patient's blood, circulating it, oxygenating it and sending it back to their body because their lungs are not able to do that.

Dan:
And what about your supply of PPEs? So, this is obviously a national topic. There's the nursing unions, the American Nursing Association, everyone is screaming for PPE. What have you seen in your work environment around the supply and use of that?

Lauren:
That's like the other big part of it, that week by week, we were just seeing rapid changes in our everyday work environments. What I mean by that is that now, before we enter the building, we get screened. Now, when you have a patient that was probably before on some precautions, they are no longer on those precautions, because at this point, it seems like my facility and a lot of other facilities are rationing. And they are thinking, I don't want to call it like, war mentalities but kind of.

Lauren:
And so, they're thinking about the end all be all and the moments that we would need all of this protective equipment the most, which is scary because the way that we are educated on this protective equipment is that we always need it when we need it. So, to pick and choose which scenarios we are allowed to be protected in according to our facilities doesn't seem fair, doesn't seem protective o safe.

Lauren:
So, I'm at a facility that is reusing PPE and continually telling us to reuse of it "properly." And we get emails that explain how to do this properly. We get videos on how to don and doff while reusing a ton of equipment. And it's just really alarming. I've been shocked this entire way through because it doesn't feel safe. It doesn't feel anything that I've ever been taught or have experienced to speak to. So, it's very different.

Dan:
Yeah. No, that doesn't sound like a great situation. And now, we're hearing that California is supposed to get hundreds of thousands of supplies soon, but that soon is never a date. And so, it continues to be scary, I'm sure.

Lauren:
Yeah. I think in general, I mean, I'm happy that you're doing things like this. I'm happy that a lot of healthcare professionals are making noise because I think that the view that the public has on... they're just learning what PPE stands for. It's going to take a while for everyone out there to wrap their heads around the fact that we need this, why we need this, why they need it for us to need it. So yeah, I'm glad that we're hopefully gaining some transparency in the fact that words are words but I'm ready for actions. And I'm ready for new equipment and I'm ready for safe work environments.

Dan:
100%. And I read an article that the ANA actually published recently. That was done a few years ago but it was an evidence-based review of PPE basically. And they actually evaluated bandanas which the CDC is saying in the worst case scenario use a bandana, wrap around your face and put a shield over it or whatever. The data was showing that a bandana by itself, let through 98% of the bacteria-

Lauren:
It's just for looks.

Dan:
Yeah, it's basically for looks. It's not going to do much for you. So, I really hope we don't have to get there because it's not safe.

Lauren:
And it's terrifying that all of these governing bodies from the CDC all the way to the United States government are supposed to be protecting us and supposed to be having our backs, and it just doesn't feel that way. It feels like guidelines are rapidly diminishing in response to supply rather than science. And it's super frustrating.

Dan:
Yeah. And I posted something on LinkedIn recently that was like, "Let's go back to the evidence, people. Let's figure out an evidence-based approach to this. Not just what feels good." And I feel we have a lot of opinion out there on a lot of things COVID, but specifically PPE. And we need to go to the science on it. So, how is your mental state right now? It's got to be, maybe you mentioned, it's scary and unknown. How is that, and what things are you most worried about right now?

Lauren:
I love travel nursing. I've been doing it for two years, I just feel I'm in a really vulnerable spot right now just because I'm away from home, I'm away from family, I'm away from those close circles that you build wherever you're from. I try my best. And I am successful in building small circles wherever I travel to. So, I'm very fortunate right now to be in a city that I have really close friends with. And I'm actually living with some close friends.

Lauren:
So, I'm really fortunate because honestly, without that, I think I would have hightailed it out of here probably about a week and a half ago. How could you expect anyone to... I don't want to say how could you expect anyone to stay but I just want to say it's really hard.

Dan:
Yeah, it's a moral dilemma. I mean, it's honestly... or moral injury. You're having to choose delivering care which you have been trained to do in an environment that is putting your life at risk, without the right supplies and yeah, I can imagine that's a really tough decision to process almost daily probably, right?

Lauren:
It basically responds to however work is going or however the general public is moving in their processing of all this. And so, it's always changing the same way.

Dan:
So support network-wise, you have friends in the city, I'm sure you have some fellow nurses, what advice would you have for nurses that are working on the frontlines to help them cope with some of this stuff?

Lauren:
I feel like maybe that's why I'm also pretty active throughout this on Instagram just because I feel like I want nurses to understand that just because maybe you're seeing your unit respond a certain way and it's not sitting right with you, or maybe you're seeing your coworkers respond in a certain way, and it's not sitting right with you, I just want people to know that there's a ton of people out there that are probably feeling the exact same way that you are, having the exact same thoughts that you are.

Lauren:
And it's okay to have them whether they're the good ones or the bad ones as long as we're processing that and saying it out loud versus covering it up, I think that's really important, being heard and being seen and feeling you matter despite all of these diminishing guidelines that are telling us that we don't. So, I feel I'm utilizing that. And then, I don't know, I mean, I'm just trying to stick with what I did before quarantine.

Lauren:
I'm big on physically moving my body and exercising a lot during the week. I'm big on music. I'm big on my pre and post shifts making those looks the same. Just because we're on this lockdown doesn't mean that my pre shift or my post shifts should look any different than they were before. In fact, they should probably be revved up, whatever it is that you do to prepare for your shift should probably be in overtime right now.

Dan:
I've listened to your target, sounds very ICU nursey. Like to the team. Not that that's a bad thing, but I'm just thinking like when I do that, I'll be like, "No. I just figure out. Whatever happens happens, it's got an ER nurse. It's funny. But I'm glad that you identify with that.

Lauren:
I know, seriously. See what I mean? I try to get away from it and then it's like, well, I mean, I don't know what it is in me, so.

Dan:
Yeah, you're a nurse, whether you're on shift or not. So, it's just how you live. No, that's great. So, what advice would you give hospital leaders who have clinician on the frontline? What do you want them to hear?

Lauren:
Oh, man.

Dan:
Keep it positive.

Lauren:
I was just going to say without any profanity. No, people that are in hospital leadership that have no hand in treating patients, I think that they need to do a serious reflection on what their healthcare system has been putting out there. I think that we've been focusing on the wrong things as a country, as hospital industries. We've been focused on business, business, business, profit, profit, profit, and look how it's turning out.

Lauren:
In the time that we need the healthcare system to be acting accordingly, it is unsafe and ineffective and not helpful. And then, for hospital leadership that has a hand in directly overseeing healthcare professionals or directly overseeing patient care, I think for them, I would just say be transparent. No nurse ever would ever tell a patient... well, I shouldn't say this, but I personally, I don't tell patients that it's going to be okay if I don't know that it's going to be okay.

Lauren:
I don't tell them that these test results that they've been waiting all day anxiously are going to be great or that they're overthinking it. That's crazy. And so, the fact that we're basically getting talked to like that right now is mind-blowing, because I'm learning from this side of things that it's just not therapeutic, it's not effective. And it really shouldn't be happening.

Dan:
Now, you bring up some good points. And what's interesting is... so I did my whole dissertation on healthcare leadership. And one of the things I found was when you're not transparent with information to really smart people, like nurses, physician's care providers, then they know that you're not being transparent. They see through it, you lose a lot of respect. And the other thing is in a lack of information, people make stuff up.

Dan:
And so then, the rumors start and then there's the stress starts and the anxiety starts because people don't have the information to make the right decision or the decision that's in front of them because people are hiding things and they're just, "Well, it'll be fine. Don't worry about it. We got it," and who knows. And so, I think that's a really good piece of advice is if nothing else like you can't get PPE, you can't invent it and 3D print in your hospital, you can control transparency of information.

Dan:
And I think that's probably the number one thing that we're lacking in this whole crisis. Well, Lauren, this was awesome. And I think you gave a really good description of what it feels like to be on the frontlines. Is there any other key points that you want to bring up and make sure that the listeners hear about what nurses need? What the healthcare system needs or any anything else?

Lauren:
No, I think I just want to shout out Trusted and just say that I'm also hearing about a ton of traveler's nightmares right now with other agencies that maybe they're getting talked to a certain way by a recruiter or maybe other scenarios are happening that just aren't making them feel supported. And so, I just want to say that all of my conversations with my nurse advocate at Trusted and all of my conversations and experiences with Trusted have made me feel the total opposite. We were talking about my mental health and how I'm getting through this, working with you guys has been so beneficial for this time period.

Dan:
That gives me the feels. Who's your nurse advocate, by the way, because I got to make sure I shout out at them.

Lauren:
Oh, my gosh, Russ.

Dan:
Oh yeah, Russ. Russ and I have a very special bond because of the male nurse thing. But yeah, that's awesome. And Russ is 100% there all the time so that you couldn't have a better experience, I'm sure.

Lauren:
Seriously.

Dan:
Lauren, you mentioned that you have a social media site, and you do some of that as well. Where can we find you?

Lauren:
It's called @iculaughingrn. It's just an Instagram page. It's normally just a meme account for the weird sense of humor that healthcare professionals have that we can only relate to. But right now, it's just acting as a total noise maker during all this time.

Dan:
That's awesome. So, check it out, @iculaughingrn on Instagram. And check out the funny memes because in a time of crisis, you got to laugh, right?

Lauren:
For sure, for sure.

Dan:
Lauren, it was great having you on the show. Thank you so much. Take care of yourself. Stay safe. Again, if you need anything, contact us and we're happy to be there to support you in any way we can.

Lauren:
Thank you so much.

Dan:
Thank you so much to both Lauren and Sam for sharing their experiences with us over the last several weeks, all of us at Trusted Health. I've been overwhelmed by the sheer number of nurses who have raised their hands to work on the frontlines of COVID-19. We've been highlighting inspiring nurse stories from across the community and I encourage all of you to check them out using the #stepupnotback or on our Instagram account at Trusted Health. Trusted has also launched a resource center with verified information about the latest COVID-19 developments as they pertain to nurses.

Dan:
It includes updates on state licensure and policy changes regarding the healthcare workforce resources to authoritative sites like the CDC and WHO, links to view Trusted's open COVID-19 jobs, a comprehensive list of other companies that are stepping up to offer discounts and promotions to health care workers, and stories from nurses on the frontlines. You can access it all by going to trustedhealth.com and clicking on the red banner at the top of the page. Thank you to all our listeners. Please stay safe.

Thank you and welcome to the Trusted Community!
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