Rosary for the republican national convention

IMG_4560Tonight when I watch the RNC I will be holding two things: a) a glass of wine, and 2) the Rosary of Modern Sorrows. I have a large collection of rosaries that have been given to me by my husband, Priests, friends, and some I picked up because I wanted to support the people that made them. Why I want a glass of wine should be obvious, but the Rosary of Modern Sorrows is different. I like it because it represents what I think are the issues we need to address to make America a better and more equitable community. 

I will pray this rosary for all people that have turned a blind eye to caging children, denying access to refugees, or discrimination against those who are LGBTQ. I pray for those that don’t understand Black Lives Matter, believe people chose poverty, and refuse to see the harm that is being done to our environment. 

Rosary of Modern Sorrows

We pray for the lives of women and their children, born and unborn, and the unjust societal structures that steal hope, healthcare, and economic security from these, our most vulnerable mothers.

We pray for mother earth, our fragile environment, the animals, land, and oceans entrusted to our stewardship and care.

We pray for immigrants, refugees, Dreamers, and all who seek a life free from violence and the threat of death and abuse. May we imagine ourselves in their place, knowing we would do anything to secure safety for ourselves and our families.

We pray for those discriminated against because of the color of their skin. We pray for those who are caught in the school-to-prison pipeline, trapped by corporations that gain financially from incarceration. We pray for our innate biases, that we may recognize these and then choose to move beyond them. We pray for awareness of the attitudes and structures that remain from our history of slavery.

We pray for a welcoming of LGBTQ people by all churches, temples, mosques, and synagogues. We pray for LGBTQ couples, their children, and extended families. We pray that they may be supported and loved, with full acceptance as people truly created in the image of God, a creation that God saw as “good”, and who deserve to live every aspect of life to the fullest.

ANA’s Lack of Moral Courage is Shocking

When the ANA PAC called me for a donation I declined and took the time to explain why. I have been an ANA member since I graduated in 1991, have been actively involved in many ways over the years, and am a fairly reliable donor. However, I believe that the ANA failed us when they showed up for a photo op with President Trump. It ignored the early failures of the COVID-19 response and the harm it had caused to nurses, in fact the death of nurses. Those early failures were only the beginning of what what has now been the worst response in our history with over 154,000 deaths including the deaths of many nurses, physicians, and other healthcare workers who are still reusing N95 masks despite the evidence that it isn’t safe. Nurses in some hospitals are even being told they only need a surgical mask when caring for COVID patients if the patient isn’t getting an aerosol treatment.

I went on to explain that by not supporting a candidate for President they in-fact did just that by their silence. Through their silence they are ignoring children who were locked in cages and separated from parents, the gassing and beating of peaceful protesters in the streets, the call for the delay of the elections by the President which is a clear threat to our democracy. They ignored it when the President did nothing as bounties were placed on the heads of our soldiers defending us abroad. And they are silent as the President continues to disrespect women, people of color, and anyone that disagrees with him. This administration has been all our code of ethics opposes. By their silence ANA is saying the code of ethics is meaningless words. They are silent as nurses and their patients die.

Last night I received another call from the ANA PAC and this time from someone in a leadership position who heard I was not happy. She tried to convince me that I should overlook this because they didn’t want to alienate Republican nurses to which I must ask what they would have done not to alienate Nazi nurses in Germany? I want to make clear there are many Republican nurses that don’t support Trump or his tactics. This isn’t about a party but a particular candidate that is evil.

The representative went on to say that they had members that were friends of Al Gore to which I replied that is like saying I have a black friend so I can’t be racist. Not giving up she told me that the decision was made two years ago by a task force. Really? Who selected the task force and under the current conditions when children are caged, citizens are gassed and beaten in the streets, white supremacists are referred to as some good people, reporters are surveilled by the Department of Homeland Security, citizens are arrested without charges and thrown into unmarked vehicles, and our President thinks he can delay the elections isn’t it time to reverse that decision? Does ANA not recognize that if you are silent in the face of evil you become part of that evil?

Bad men need nothing more to compass their ends, than that good men should look on and do nothing. – John Stuart Mill

Finally, she tried to tell me that ANA PAC post on their website their view on issues and that she had been to Homestead and been at a protest. Mind you I’m an active person on social media and ANA PAC is shockingly uninvolved on any form of social media and silent in the news. If it were not for the nursing unions, other nursing organizations, and individual nurses our voice would not even be heard on these critical issues.

My question is not whether I think ANA PAC has lost their moral compass, I do. The question is whether I’m willing to stay a member of the ANA if they are not willing to take a stand during the greatest moral challenge of my lifetime. ANA is notable by their silence and by being silent in the face of inhumanity you are indeed taking a stand. You are saying rather than offend those that support caging children, gassing and beating people in the streets, surveilling the media, not providing a national response to a pandemic, grabbing people off the streets in unmarked cars and holding them without charges, and even delaying our presidential election, you will be silent and let the myriad forms of abuse continue.

You are not the ANA I joined. I don’t know you.

Wear A Mask

Over the last few weeks, I have been angered by the large number of hospitals threatening nurses and physicians for wearing masks and telling the truth. Nurses have primarily been told to remove their mask or be fired. While physicians seem to be told to remain silent about shortages and conditions or be fired and while at the same time to remove their masks. I’ve collected a large number of such stories from people I know and trust. They have come from nurses and physicians. One physician, a friend of a friend, was working in an ER and the administration told him to take off his mask or be fired. He quit on the spot rather than take off the mask. The husband of another friend is also an ER physician and he actually had to go to his car and get a mask when a symptomatic patient came in because they had absolutely no N95 masks in the rural hospital.

This was sent to me by a friend who has spent her entire career at the beside.

I can’t speak out publicly and be identified because I cannot afford to lose my job. I can tell you that nurses are being bullied not to use their own PPE especially if they are working in areas that it was previously not routinely necessary. Even nurses and therapists with asthma, COPD, immunosuppression and/or recommendations from their personal physicians are being bullied about not wearing an N95/PPE that they provided themselves. My area was recently told we “can” but are not required to wear a surgical mask after repeated complaints from the Radiation Therapists we work with that their professional body (ASTRO) is recommending they wear a mask during all patient care. However, the administration here has been “working around” the nurses in administration to roll back that protection in the name of not “wasting masks”. None of them wear masks when they come through the clinic. Combined they’ve spent almost no time in the clinic before or after this began. They act as if we are overreacting when we wear masks to work with our patients, but in the same breath tell us to stay out of the clinic if at all possible and “protect ourselves” as if our front line staff is disposable. With the transition to no visitors we have folks that counted on caregivers coming in with them that are now upset and unable to do their own intake paperwork and needing more hands on care. But the culture coming down from the top is that the front end staff are overreacting if they want to protect themselves and patients by wearing masks. I feel like we are a pressure cooker ready to go off. We have young folks that are going home to families and roommates (that are working in Walmart’s and driving busses) and they are the ones helping immunosuppressed patients with their paperwork (so much more because now they can’t have a family member to help them) and when they use a physical barrier mask they get side eye from our nurse manager (whose boss is non clinical and was on the Hoax train up until last week and still makes flippant “just wash your hands, you’ll be fine, comments”) and others. They along with the rest of the management team are hoping/thinking they will “roll back” the decision to allow our folks wear masks this week… all of this from the big executive suite where a few folks, all sitting in private offices are dictating what the hands on people can do to protect themselves. It’s just wrong. They are intentionally talking amongst themselves to reach a consensus against protecting our folks before including equally/higher ranking nurses on any conversations. At a time when nurses should be at the forefront of decision making we are being railroaded and overridden. I am the only one that seems to understand the magnitude of what we are facing. Since our doctors are a separate group they can do what they want for themselves and although they can ask that we protect the patients and employees, they have no sway.
I have been working to make sure we have local seamstresses lined up and donations of fabric surgical masks so that we have some protection. However our hospital system will not allow employees to wear them, even/especially when we are in areas that they don’t deem masks “necessary” which is almost all our front line folks in non COVID19 treatment areas. It’s incredibly short sighted. One of our employees was sent to employee health after they developed a nasty cough this week. They were told no test needed, no quarantine needed, no mask needed, they could go back to work, the cough alone was not concerning.
Thank you.

CDC Failure

The guidance on the use of masks needs to be clear for both clinicians and the public. While CDC says it has been updated that does not appear to be the case and remains so vague that there is great flexibility for facilities to do what they want. Fortunately, the Joint Commission has now been clear in their recommendation that not only should staff be allowed to wear their own PPE if they have it and the hospital is not providing it, but they refute the CDC guidance and cite evidence while admitting it is incomplete. The Joint Commission confirmed that they are receiving reports from across the country of hospitals refusing to let staff bring their own N95, surgical, and homemade masks.

Use of Mask for the Public

As bad as the CDC guidance has been for healthcare personnel it has been equally bad for the general public. Statements have ranged from it isn’t need and handwashing is adequate to masks can increase a person’s risk of contracting the disease. Both are clearly misleading. The rational was first:

  • We need to conserve the PPE for healthcare personnel and the general public is at low risk. Because the virus is spread through droplets from coughing or sneezing you would need to be within 6 feet of the person that is sick.

When it became clear that many cases were actually being spread by asymptomatic people and that the virus may linger in the air longer than they first thought they still did not change their recommendation. They did change their approach.

  • People do not need to wear a mask when outside because they will wear them improperly and may increase their risk because they will be more likely to touch their faces and it will give them false confidence.

Obviously, we all know that we need to conserve N95 and surgical masks for healthcare personnel. They are our front line and deserve all we can do to protect them. However, the government is now telling us that a minimum of 100,000 to 240,000 Americans will die and 50% to 70% of the country may contract COVID-19. Spare us the rhetoric that the risk is low. Also, don’t insult people. No one thinks a mask is a protective forcefield. What the average person feels is that even a homemade mask is better than no mask. When a homemade mask or other non N95 mask is worn and combined with social distancing, handwashing, and not touching one’s face it decreases an individual’s risk when a person must venture outside.

As the nation’s leading public health organization, the CDC should remember that education is critical. If they believe that putting on a mask makes the average citizen suddenly forgets that they should social distance, wash their hands, and not touch their face then the answer is a public service campaign to remind people. If they believe that people will wear masks improperly again education is critical and they should immediately make an infographic or short video demonstrating how to properly put on a mask, take it off, and clean it or dispose of it. The real risk would be people reusing disposable masks and/or not cleaning masks. Of course, this ignores the fact we are asking healthcare personnel to do just that. This is public health 101. Treating the public as if they lack any reasonable amount of intelligence is insulting and not helpful.

What Does the Research Show

In a Lancet article  that reviewed different countries’ use of masks and the available evidence they pointed out that “there is an essential distinction between absence of evidence and evidence of absence.” They concluded, “community transmission might be reduced if everyone, including people who have been infected but are asymptomatic and contagious, wears face masks.” A cluster randomised trial of cloth masks compared with medical masks in healthcare workers found that medical mask are significantly better and should be preferred during a pandemic for healthcare providers. However, they also pointed out that medical masks are not always an option. It was suggested that cloth mask with multiple layers and tighter weaves would be more effective than the current cloth masks that they tested.  Testing the Efficacy of Homemade Masks: Would
They Protect in an Influenza Pandemic provides some insight into what materials may be best for a homemade mask. Smart AIR took the information and put it into a useful graphic that compares homemade masks to surgical masks.

Screen Shot 2020-04-01 at 10.05.30 AM

While the graphic below also isn’t evidence it makes clear that places that routinely do wear masks have fewer cases of COVID-19. Of course, there are other confounding variables and this is just one piece of data.

Screen Shot 2020-04-01 at 9.21.55 AM

Information on Making Your Own Mask

I think everyone should take the time to make their own mask. It will serve as a reminder that we are in a battle to save lives. It will remind us that in many poor countries this is all they have when they care for patients. It will give children a craft project while they are out of school that can be used to teach science, health, public safety, social responsibility, and even math. And most importantly, it may give you just a little extra protection when you absolutely must go out.

Making your own mask is not that difficult for anyone with basic sewing skills.  I’ve provided a couple of links that have instructions.

I wish you all good sewing.

Nurses Must Stand Together Against COVID-19 and Unjust Demands

Nurse X quit her job as a nurse in an ER. She was wearing a N95 mask in the ER lobby. A supervisor said she didn’t need it and asked her to take it off…He told her to quit. She did. Her child needs a mother. It’s only a matter of time before you see more healthcare workers making this choice if they don’t have proper PPE.

I am hearing disturbing stories of supervisors forcing nurses to remove their masks. Nurses have always been advocates for our patients. I don’t know a single nurse that is not willing to go toe to toe with a physician, administrator, or even a family member in advocating for their patients. Yet when nurses need to advocate for themselves they would rather quit than take a stand. The fear of retaliation is stronger than the fear of being unemployed. The dirty little secret of nursing is that we have a reputation for eating our young and not standing together when a colleague is targeted by a supervisor or peer.

The Largest and Least Heard Healthcare Profession

Nursing has 3.8 million women and men many of whom now fear for their lives just by going to work. While I see physicians on the news virtually every hour of the day I have rarely seen people discussing what is happening with nurses or having nurses as guest experts. People continually vote nurses the most trusted profession, but apparently, we are not respected for our expertise. The consequence is when nurses are being forced to take off their PPE (mask) by their supervisors or be fired or threatened with being reported the general public is not hearing our stories.

Many nurses feel they cannot quit their jobs so they remove the mask knowing the risk while others quit their jobs and walk away from the work they love. I have yet to hear of one nurse that refused to take off the PPE and instead told the supervisor to fire them if that is what they must do, but they will not practice in an unsafe manner.

What many people do not realize is that many hospitals have social media policies that prohibit nurses from publicly saying anything against their employer. If the nurse does not remain anonymous they can be fired. Essentially, to be a nurse one must give up their freedom of speech. They must give up the right to safety. They must be willing to risk their lives to stay employed while apparently, the employer has no obligation to provide a safe working environment.

If we have plenty of PPE as the President says almost daily, where is it. Why are nurses and physicians being forced to wear the same N95 mask for days? Is there anyone or even a single expert or one bit of evidence that says that it is safe to wear the same mask for days? We all know the answer is no there is not.

Do Not Quit

I firmly believe that nurses should not walk away from their patients and their jobs. I also believe nurses must learn how to say NO. No, I will not take off the mask I bought because you can’t seem to find them. No, I will not move to a unit when I have health and family obligations that I made known when I was hired. No, I will not wear the same mask for days because we all know that it is not safe. No, I will not be silent if my employer will not keep me safe.

What I will do is file an OSHA complaint, write my Representative, and talk to the press. I will contact a union and ask them to help us organize. I will continue to buy my own PPE and refuse to remove it. I will speak out. I will cancel my memberships to my professional organizations if they don’t start advocating for us in a way that is visible to the country.

Nurses Must Stand Together

I  suggest that we take this opportunity to come together as one strong profession and take our place as the largest healthcare profession in the county. It is time to make our voice heard and to let the country and the healthcare system know what we expect and we expect to be safe at work. It is also a good time to change our culture and trust our colleagues as much as the public trusts us. This is not a time we can afford for nurses to quit. If a nurse is told to take off PPE then absolutely ever nurse in the facility should stand together and say either that nurse is allowed to wear the PPE or we will all quit. If we speak with one strong voice the hospitals and healthcare systems will have no choice, but to step up and keep our colleagues safe.

PPE Shortage

I keep hearing that we have a shortage of PPE. We apparently had enough medical supplies including gowns and mask to send 17.8 tons to China last month to help them, but we don’t have any to keep nurses and physicians safe. We have yet to use the Defense Appropriations Act to force companies to make more PPE. And, we have safety standards that seem to be weakened by the day. We have policies that prevent many companies from selling medical supplies to the U.S. Most significantly, we have a government that is not doing enough to address the problem.

Stand up, speak out, and be heard. Caring for patients requires healthy nurses and physicians.

Three Deaths in Three Weeks

Three weeks ago I had work-related travel to New Mexico. The timing was horrible. COVID-19 was starting to explode, but my career, at least in my mind, was tied to this trip. While many people were starting to cancel trips I planned to travel. There were no cases in my state and none in the state to which I was traveling. A few days before my trip things started to change.

Three weeks ago and a few days before my flight I received a text message that Bill Stokes had died. Bill was in his late 70s and had Parkinson’s. He had a profound influence on my young life. When I was a teenager he was the voice of reason. I can’t say how many evenings he stayed up past midnight talking to me and encouraging me to study, pray, work hard, and examine my conscience. He was my model of what a man should be and what a deacon of the church should be. His children remain my brothers and sisters and his wife will always be a second mother to me.  Throughout my life when I had a moral dilemma or needed advice or wanted to celebrate a success he was the person to whom I turned. My heart broke when his daughter called. I have never been good at expressing my emotions and was not able to tell them how much he meant to my young life, my young adulthood, and my faith.

Last week Jim O’Connor died after a long battle with cancer. Jimbo was a lawyer by education and a pianist by passion. He was known around Knoxville for playing at Club LaConte. He was the father of my niece and my twin brother’s best friend. When my brother was shot and killed my niece was the only person who seemed able to express her grief. While she was my brother’s stepdaughter she is the child I never had. She and Jimbo have been in my life since I was a teenager, but it wasn’t until my brother’s death that we truly connected. Jimbo played at my brother’s funeral and it was as if angels were singing. I could hear and feel his love through music. When I returned to Knoxville a couple of years ago I went to a faculty pub and the pianist was Jimbo. I spent the entire evening talking to him, listening, and grateful that fate had brought us together again. It was as if, for a brief moment in time, work didn’t matter. Family was first. I’m sorry I was out of town when he passed and sorry I didn’t have the special gift to offer him that he offered for my brother.

A couple of days ago a student in my Health Policy class at the University of Missouri – St. Louis died. Judy Wilson-Griffin was a shining star in nursing. She was a leader, an educator, and a loved member of the community. She was to lead us into the future. She died too soon from COVID-19.

I can accept that the mentor of my youth died in his 70’s after years battling Parkinson’s disease. I can accept that Jimbo died after fighting cancer for years. He led a life of love that was filled with music and left behind an incredible young woman that teaches English as a second language and has dedicated her life to immigrant children. But damn COIVID-19 for taking someone that should have been leading for years to come. A person who was the next generation of nursing leaders.

I was stoic when my brother died, stoic when my parents died, and remained stoic during the recent deaths. I find it hard to express my grief. Yet I don’t find it hard to express my anger over a wrong. My brother was murdered and I was angry. I’m still angry. Every time I read of a gun-related murder I’m angry all over again. And now I am angry about COVID19 deaths. I know we can’t prevent all gun deaths any more than we can prevent all COVID19 deaths, but we are all culpable because we have been too silent and too stoic. We have a government that has failed us and it has been failing us for a long time. We have counted the failures everything from income disparity to climate change, from ill-advised wars to an epidemic of gun violence, and now we see it in the rich and famous getting tested for COVID19 with minimal or no symptoms and the working class having to beg for testing and being denied. People will die because of the failures, but our Senators made sure to sell their stocks before protecting nurses.

In three weeks I’ve lost a mentor, a friend, and a student. I’m ready to stand up and fight for a better future because what is happening right now isn’t acceptable.


There is No Greater Day to be a Nurse

This morning many of our neighbors woke up without jobs for the first time in their adult lives. They have worked hard to learn a trade, build a business, and build a comfortable life. Due to no fault of their own, they are worried that they will now lose it all. It is new to them because they have always believed in the American dream that through hard work and perseverance they can succeed.

Nurses, physicians, and all those in healthcare that must do their jobs during this crisis do so with dedication and more than a little bravery and self-sacrifice. Sadly, a couple of days ago I saw a post by a nurse practitioner that suggested he should get paid “hazardous duty” pay if others are being paid to work from home. I, of course, replied that he was doing his duty… I’m sure he isn’t the only one that has had a similar thought, but we should work to dispel such ideas.

As nurses, we should be thankful that we are getting paid to do the job we love. At this moment we are asked to do it for our neighbor and our country. When others are worrying about how they will pay their bills, feed their children, and recover when this is over none of us face those concerns.

Once in a lifetime, if we are lucky, we are given the opportunity to serve selflessly. Don’t sully it by making this calling about money.

The American dream will live again in others because you see them through this difficult time and provide them the care they need to recover. There is no greater day to be a nurse.

Nurses Struggle with Duty to Respond

Last night I had a conversation with a friend and former colleague who is concerned about reporting to work. She was told there would be no masks for students and faculty. If that wasn’t enough added stress she also has an elderly parent over 80 years old that lives with her and 3 small children. Her fears are not unfounded and they are the tip of the iceberg.

We have all heard the stories of nurses being told to reuse masks which is a supremely bad idea and risky under the best scenarios and foolish during a pandemic. Too many nurses and physicians in rural hospitals have no N95 masks in the emergency department. Other nurses are making masks out of gowns and we know that there are already many nurses in self-isolation due to work exposure. Fears are well-founded, but we have a duty to report to work.

Duty to Report

Willingness to report to work is largely related to role conflicts: nurse, parent, caregiver for elders, and self-care. Nurses’ willingness to respond has a profound impact on disaster planning, hospital preparedness, patient care, and policy. Chaffee (2009) did an integrative review of the literature on the issue of willingness to respond. As it relates to pandemics she wrote:

Biological outbreaks appear to be a significant barrier to willingness to work. In the Balicer et al study of public health department employees, 53.8% indicated willingness to work in a pandemic influenza outbreak. This is consistent with other reports. Qureshi et alfound 48% of health care workers in New York City indicated they would be willing to work in a severe acute respiratory syndrom outbreak.

In a quick review, I found that between 35% and 65% of nurses say they would not be willing to respond during a pandemic. Many cited fear for children or other family members. Fear under these circumstances is legitimate, but duty should outweigh the fear. I can’t imagine what it must feel like to have small children or frail elders in the home, but I do watch as my 67-year-old husband with asthma and hypertension goes off to the clinic each day. I suppress my desire to ask him to take all the vacation and sick leave he has built up over his workaholic life. I resist because his team and his patients need him. He was surprised as a psychologist that he had a full load of patients today. Rather than his patients canceling it appears that their stress may be increasing visits. Also, when the nurses are busy the other staff (psychologist, social workers, etc.) are helping with the screening of patients at the door to help keep the clinic safer.

I can’t tell you how to examine your conscience and make the decision to report to duty. What I can say is that this time will define how you see yourself for the rest of your life. One day you will look back with pride or regret, but you will look back. Responding to 9/11, anthrax and many other crises profoundly impacted my life. They gave me strength and purpose that I still find hard to explain. As a person of faith, I believe that every nurse is given a gift of healing. Use the gift and bring comfort to the sick, the frightened, and the dying. And know that the nurses and physicians that walk with you through this crisis will be your brothers and sisters for the rest of your life.

Greater love has no one than this, than to lay down one’s life for his friends. –John 15:13

Let May Registered Nurse Graduates Practice Now

Each May over 100,000 nursing students graduate from programs across the country. Most of those students are now being pulled out of clinical and their classes have moved online. Some are being told their graduation may be delayed. The faculty will make every effort to deliver the content, but it will not be the same as the in-person classes. As anyone who has developed an online class knows it is an extreme amount of work that can’t be done in a few days.

Considering the current 8% nationwide vacancy rate for nurses and that the additional need over the next few months may exceed 100,000 nurses, it would help with the surge needs of hospitals to grant the May graduates their degrees now and waive the NCLEX. I know that some will think this is radical and how will we ensure quality. The truth is most students pass on the first try (88.18%) and if you add a second try (72.85) it is near 100% total pass rate. While students may go back and study more they do no more clinical. Thus the clinical skills they have at graduation are the ones they will have when they enter practice even if they take the exam a second time. If we can get the students out now, it may be a substantial help to hospitals that are likely to become quickly overburdened. Additionally, most of these nurses will be in the age group less impacted by COVID-19.

A second option would be to allow them to graduate now, practice for 6 months as an RN and at the end of that time take the NCLEX. As a faculty member, I prefer option 1 because we know that the longer the student delays the NCLEX the less likely they are to pass on the first attempt. Universities are assessed based on that pass rate and it would be unfair to penalize them, or the students, as the result of a national emergency.

I can hear the uproar now from people saying they need to be oriented, we don’t enough people now, and so on. However, much of the orientation could be condensed. Much of HIPAA is waived during a public health emergency so do they really need that training right now? Most have used the electronic medical record in school, so it could be taught very quickly. They are all required to have the necessary vaccines, CPR, and many other items just to enter their clinical practice settings. The truth is there is a lot of redundancy between what a hospital requires for the new employees and what schools require for students in clinical.

It is time for the National Council of State Boards of Nursing and all Boards of Nursing to take bold action. We should think out of the box and while we are at it break it down and throw it in the recycling bin. If we continue to practice as normal and hold tight to our policies we will do more harm than good if the worst-case scenario occurs with COVID-19. It is the time to act and let our May graduates have their degrees right now. If we wait until we are facing the worst-case scenario it will be too late. We must put the patient first.

Let May graduates practice. Let them join the fight against COVID-19.

The Ministry of Nursing in a Time of COVID-19

I woke up this morning and said a prayer for all the nurses and healthcare workers leaving the safety of their homes for hospitals and clinics around the country. Today your practice should be guided by the science and the best available evidence. When you practice know that it is also an art and for the coming months as you pass through this difficult time help to draw a beautiful picture of compassion and love for those in your care.

One of my favorite books is Spirituality in Nursing by O’Brien. It speaks to me as a nurse and my favorite passage reminds me of what it means to care for the sick. I hope you can carry it with you as you care for those with COVID-19.

I had been invited to attend an early morning church service at “Gift of Peace,” a home for persons with terminal illness operated by Mother Teresa’s Missionaries of Charity. On arrival, I settled quitely into a back corner of the small chapel. There were no pews; the sisters sit or kneel on the floor. As I began to observe the saricclad Missionaries of Charity entering the chapel I noticed, with some astonishment, that none were wearing shoes; they were all barefoot. I knew that the sisters wore sandles when they cared for patients but these had apparently been put aside as they came to kneel before their Lord. Not wanting to violate the spiritual élan of the service, I proceeded, as inconspicously as possible, to slip out of my own sandals. Somehow, becoming shoeless in church, a condition I had not experienced before, provided a powerful symbol for me. I felt that I was truly in the presence of God, of the Holy Mystery, before whose overwhelming compassion and care it seemed only right that I should present myself barefoot, in awe and reverence. Near the end of the service, as I went forward and stood before the altar in bare feet to receive the sacrement of the Eucharist, I sensed in the deep recesses of my soul that I was indeed “standing on holy ground.” That memory will, I pray serve as a poignant reminder that whenever I stand before a suffering patient, I am there also, just as surely in the presense of God, and I must take care to remove whatever unnecessary “shoes” I happen to be wearing at the time. I  need to allow the “bare feet” of my spirit to touch the “holy ground” of my caregiving, so that I shall never fail to hear God’s voice in the “burning bush” of a patient’s pain. –Sister Macrina Wiederkehr

Nursing is your ministry. Never doubt that you were called by God to care for the sick and in the coming months, you are going to see more than you imagined. If we don’t flatten the curve you may see more than it is possible to treat. You may not be able to offer a ventilator to every person that needs one. When your heart is breaking and you are exhausted slow down and take off you “shoes” and know that in the “burning bush” that is your patient God has called you to be present at that moment. It is at that moment your art and your ministry are one with your patient. You will not be able to save them all, but they will forever know that you cared.

New York is already reaching out to retired nurses and faculty to help them with surge capacity. I believe it is time for every state to do the same and make sure they have a mechanism to identify nurses that can serve.

Patron Saints of Nurses

  • St. Agatha of Sicily
  • St. Catherine of Siena
  • St. Camillus of Lellis
  • St. Elizabeth of Hungary

Nursing Schools Closing as COVID-19 Spreads

I spent the last ten years of my U.S. Public Health Service career working in public health emergency preparedness. I was fortunate to be able to help plan for some of the issues related to surge capacity for nursing in disasters and public health emergencies. In much of our planning, we made the assumption that we would be able to add nursing faculty and students to the surge efforts. We understood that schools may close but I don’t think we believed that schools and hospitals would exclude students, especially senior students, from assisting during a national crisis.

Nursing Shortage and Disaster Preparedness

Nationwide there is an 8% RN vacancy rate. The rate is even higher in many areas and especially rural and underserved communities. Added to this the average nursing students receives virtually no training in public health emergency preparedness. However, it isn’t just RNs; When we surveyed students and administrators from across the country MD, DO, and MPH students don’t feel confident to respond and the administrators were only slightly better. Screen Shot 2020-03-16 at 1.31.42 PM

(Red = not confident, Yellow = moderately confident, Green = Confident)

Healthcare students expressed dissatisfaction in their curriculum coverage related to disaster and public health emergency preparedness. Our study found similar results to others—a combination of poor curriculum coverage of disaster topics and a lack of confidence in acting on what was learned in their future positions.  This low coverage is concerning due to documented links between disaster training and willingness to respond.

MPH students reported the most coverage and NP students the least.  However, these differences did not correlate with confidence, with NP students expressing the highest confidence in their abilities to utilize their disaster knowledge. It could be because NPs already practicing as RNs.  When we interviewed 13 expert trainers we only had one that said population health was even considered in the training they provided. In short, we don’t do adequate training in school and we don’t do it in the workplace.

Bad Assumptions

Assuming that nursing faculty and students would step up has now been proven to be a bad assumption. Nursing schools across the country are moving classes online and clinical rotations are being canceled. This may cause multiple problems.

First, some states require a certain amount of clinical to be with patients rather than in simulation. Even if the schools could add more simulation they cannot do so if students are not in residence. This will lead to a reduced graduation rate in May 2020 by thousands of nurses when we are in a crisis.

Second, if nursing students are sent home then they will not be present to assist even as a volunteer with the supervision of faculty.

Compare this to England where the National Health Service is considering temporarily registering 18,000 students to provide care on a voluntary basis.

Utilization of Volunteers

Not surprisingly, nurses are the most requested health professional for most types of disasters.  A combination of modeling supported by the Agency for Healthcare Research and Quality and past experience in deployments led to estimates for the number of nurses required to respond to a disaster ranging from a low of 436 for hurricanes to a high of 507,150 for pandemic influenza (R. Lavin & R. Knouss, personal communication, September 10, 2005).  The federal, state, and local professional responders, such as USPHS officers and DMATs, could easily deploy 436 nurses, but the concern is for how long.  All of the nurses have full-time jobs elsewhere, frequently in direct patient care settings.  However, the total number of federal nurses and DMATs combined do not equal 507,150. therefore it is necessary when considering worst-case scenarios to include citizen volunteers and to enhance the existing ability to effectively and efficiently identify, credential, and utilize those volunteers. 

I’m a little concerned that we did not consider how we would allow students, especially senior students, to assist at least as a CNA during the crisis. Instead, because of the legal concerns most hospitals and schools are choosing not to have students present at all. Not only will this not aid in the response, but it is likely to delay graduations in a time of extreme need. I hope going forward we will revisit this issue and find a way around regulations that restrict licensure during public health emergencies.