Expected to Respond: The Plight of Nurses

From the hospital to the classroom nurses are being asked to do more. When I say asked I actually mean ordered. It really is not a choice for a nurse to care for more patients than can be done safely. It is not a choice for many to decline over time. It is not even a choice to demand proper safety equipment. As more states implement Crisis Standards of Care where does it leave the bedside nurse?

Recently, I visited a couple of emergency rooms. I had the opportunity to talk to a travel nurse. She told me she did not leave her job to be a travel nurse for the money, but rather because she was tired of being taken out of the emergency room to work on COVID units. She had only wanted to be an ER nurse from the time she was in college and that was all she had done until the pandemic. The travel agency promised her she would only be assigned to emergency rooms and they had been true to their word – hospitals take note.

The surprising thing I noticed in both hospitals was that most of the personnel were only wearing surgical masks. No one was wearing either a KN95 or an N95 even though we routinely hear from the experts that even when we are out in public we should be wearing higher quality masks. How could it possibly be that I can now order KN95 and N95 masks online, but the nurses are still not all wearing the ideal personal protective equipment in hospitals? Is it any wonder nurses are fed up and burned out?

According to a 2021 survey of nurses by the American Association of Critical-Care Nurses:

  • 92 percent of respondents said they believe the pandemic has depleted nurses at their hospitals, and because of this, their careers will be shorter than they planned
  • 66 percent of respondents said they feel their pandemic experiences have led them to consider leaving nursing
  • 76 percent of respondents said unvaccinated people threaten nurses’ physical and mental well-being
  • 67 percent of respondents said they believe taking care of COVID-19 patients puts their own families’ health at risk

Gualano et al. (2021) looked at the research on burnout in those working in emergency departments and intensive care. They found high levels of stress, anxiety and depression. Globally the rate of burnout in the emergency room and intensive care ranges from 49 to 58 percent. Sadly, this is not new. A study from 2016 showed that burnout was high in nurses due to short staffing, excessive workload, and overtime. As Lasater et al. (2021) put it, “chronic hospital nurse understaffing meets COVID-19” and the result is that half of the nurses give their hospital an unfavorable grade on patient safety and 70% would not recommend their hospital. Part of the reason is a chronic shortage of not only staff, but supplies and properly functioning equipment.

Many people want to cite a preexisting shortage of nurses for the current situation, but the truth is colleges and universities are producing record numbers of nurses that should be able to meet the need if they all stayed in nursing. The shortage that has existed for decades is not because of an inadequate number of nurses. It is due to nurses leaving the hospital and voting with their feet as their voices are not only not being heard but actively silenced.

It has been a common practice to fire or discipline nurses that spoke publicly but nurses are starting to stand their ground and take such cases to court. The federal appellate court recently ruled that firing one nurse for speaking out about safety issues violated the law. If your hospital has a policy that bars you from speaking they are going to lose in court and it is past time. Media policies are an effort to hide safety issues forced on nurses by the administration and are part of the reason hospitals have gotten by with unsafe nurse staffing and overtime requirements for years. COVID brought this to a boiling point as already overworked nurses were fired for speaking out about safety concerns.

1st Circuit panel made clear that an employer cannot bar an employee from engaging in “concerted actions” — such as outreach to the news media — “in furtherance of a group concern.” That’s true even if the employee acted on her own, as Young did in writing her letter. The key in her case was that she “acted in support of what had already been established as a group concern,” the court said.

Meyer – Kaiser Health News

Who of us will ever forget the nurse yelled at by a supervisor to take off her mask during the early days of the pandemic because it would scare the patients with absolutely no concern for the safety of the nurse or the nurse’s family. We should all be grateful that nurses went public as did so many others. It should not be the case that we are expected to advocate for the patients and ourselves only in private. We have years of evidence that does not work.

Many administrators and government officials put Crisis Standards of Care in place to help address the issues of too many patients and too little staffing and supplies. Crisis standards of care are peer-reviewed guidelines that help health care providers and health care systems decide how to deliver the best care possible under the extraordinary circumstances of a disaster or public health emergency when there are not enough resources. Indeed, they provide some limited protection in most states. However, what they continue to fail to address is the moral injury to the healthcare workers that are making decisions about life and death, quality of care, and even saying “I can’t work another shift without rest.” It makes sense to implement crisis standards of care, but two years into this pandemic someone should have addressed the long-term psychological, behavioral, social, and spiritual harm to healthcare workers when such policies are implemented.

I’m not sure how we get hospitals to move away from their profit-making business model and to a model of high-quality compassionate care, but what I do know is that what you are doing right now is not good for patients or nurses. We must all stand together and support nurses at the beside. I am curious if any nurses working in the emergency room or intensive care have had any tasks reassigned during this pandemic.

Open to the path
The sun lights the way ahead
Clear of distraction

Mike Haynes

Don’t Let COVID Kill Friendships

When COVID first began I understood what was occurring, but never imagined it would do anything other than bring us together as friends, family, and a country. I imagined a community that would organize through faith-based and community groups to get food delivered to the sick. I imagined nurses coming out of retirement to help. I imagined schools of nursing graduating students more quickly and working side by side with them to be extra hands in clinical settings. I never imaged us turning on each other.

I have trusted science my entire life and am fortunate to understand health sciences. None of what was occurring seemed out of the norm to me with the expectation of the all-out effort to work fast. I know that as evidence becomes available recommendations are modified to match the new evidence. To those that think in terms of politics or religion, this can seem like a flip-flop.

I was caught off guard by the number of people that didn’t trust scientists including health science professionals but were willing to fully accepted conspiracy theories with no evidence. To me, this seemed foolish and on the verge of mental illness. It was as if a well-organized effort had been implemented to infect our country not with the virus but with verifiably false beliefs. Then they stepped back and watched the false beliefs lead to death and illness of men, women, and children.

A few weeks ago I lost a friend to COVID. I assumed he was not vaccinated though I never heard him express a political view or any view on the vaccine. Even though I didn’t share his faith beliefs he had been a friend I had loved since high school and I always considered him a good man. Over the last eight weeks, I have been following another friend as he struggles with COVID. He has now been in the hospital for seven weeks. I wanted to scream when he posted if anyone knew where he could get X drug which is unapproved and another that is proven not to be effective. Then his sister started posting updates and as the weeks go by my hope is fading and my prayers for him are unanswered.

All of this is probably familiar to all of us. What is new to me is people openly asking if a person who is sick and possibly dying was vaccinated. I wish everyone was vaccinated, but asking the family member if their brother was vaccinated is representative of the lack of charity we have shown for each other throughout this pandemic.

My friends are my friends and I love them even when we disagree. I don’t love everyone’s politics. I worry about the mental stability of some as they slip into conspiracy theory beliefs. I worry about their health when they are unvaccinated. I even go through periods of avoiding posts and contacts because I know they will upset me. Friendship, family, and neighbors are more important than a vaccine and they are more important than death. When this is over I hope we haven’t lost much more than 700,000 beautiful lives. I hope we haven’t lost the ability to love with open hearts.

Life may end - COVID
Loving with an open heart
Keeps kindness alive

Don’t Turn on others over COVID vaccines

In the last few days I’ve seen a growing number of people turning on others they perceive cutting the vaccine line. Most of the people complaining of line cutting are not healthcare workers but community members. I’m sure many mean well are are trying to be supportive of physicians, nurses, and other frontline workers while some come across as angry.

I understand that many people are justifiably frustrated with those politicians that either directly said or through their behavior made clear they thought COVID-19 was a hoax, but were first in line for the vaccine. Then there were those people who are not healthcare workers at all, but hold positions of privilege like religious leaders. Finally, there were healthcare administrators who do not have direct patient contact but managed to be in the first group. Of course, there are also people like me that volunteered to give vaccines and as a result of being present at the end of the day when they needed to use up the vaccines that would expire was lucky enough to be given one.

I don’t think we should be frustrated or angry with any of these people. Let me begin with the politicians that promoted COVID-19 as a hoax and or acted in ways that were irresponsible by not wearing masks, social distancing, and encouraged others to do the same. By taking the vaccine and rushing the line they are clearly admitting they were wrong. Their vaccine selfies are their public confession of misleading the public, errors, and/or dishonesty. We should accept it as the statement it is and recognize that the. people that voted for them would never listen to someone like me. However, they may follow the example of that person they trust. If that gets people in communities to line up for the vaccine that is good.

One person who was the brunt of public outrage was a 70 year old Bishop. I agree by any current criteria he was not on the list of first in line, but the reality is there are a lot of people that will see him getting vaccinated and follow his example. We need people in positions of leadership (political, medical, religious) to be examples and show their belief in the vaccines. I think it is especially important for the Bishop since there have been a couple of Bishops that were very negative with weak arguments about abortion that were refuted by moral theologians. Thus seeing a Bishop getting vaccinated sends a strong message that the claim that getting vaccinated is complicity with abortion is inconsistent with Catholic teaching.

As for the hospital administrators that never touch patients getting vaccinated ahead of front line providers it is important to remember they are part of the structure that keeps hospitals going. The average clinician has no idea how the supply chain works or how to keep the facilities going. Administrators are as critical to the a well functioning hospital as the facilities staff and custodians. A hospital is a team activity. It will not function well or long with only physicians and nurses.

As a country we are tired, frustrated, and honestly a little scared. We have made it this far together and will make it to herd immunity by working as a country. We need to pull together and support vaccinations because vaccinations are the solution to COVID-19. If anything we need to focus our efforts toward better vaccination plans, getting the vaccines out into the communities, and arranging mass vaccination clinics. This may mean we need to make people more responsible for their record keeping and get shots in arms rather than time consuming computer data entry tasks. My experience was the paperwork was taking much longer than the vaccinations and thus slowing the process.

I don’t care how much you denied that COVID-19 was real or dangerous. If you are willing to get a vaccine I’m willing to volunteer my time to give it and thank you for showing up. Please don’t let this divide us. Remember, some of those people being criticized have been asked to get vaccinated as a show of public support, others because of the federal continuity of operations plans, and others maybe out of fear. Let’s support everyone with a compassionate heart.

Nurses giving injections

covid-19 vaccine blessings

This week I had the pleasure to be a volunteer vaccinator. Day 1 I supervised nursing, pharmacy, and medical students who had volunteered to be vaccinators during their holiday break. Day 2 I was one of the people blessed to be giving vaccines to frontline healthcare workers. The entire event was well organized to make sure not a single vaccine went unused and that the vaccinators were not pulled from the frontline staff, but rather faculty and students. Everyone was prescreened and consented. They were then entered into medical records and the appointment for the 2nd vaccine schedule with an appointment card handed to each person. When each got to the vaccine station everything was triple checked and they were again ask about history of fainting or allergic reactions. Each vaccine was appropriately labeled and rechecked for dosage.

In my career I’ve been part of flu vaccine clinics and many emergency responses, but this felt different. This time the people I vaccinated were my friends, colleagues, and neighbors that had been risking their lives for others for the last 11 months. They were tired and stressed, but when the needle went in their arms it was as if months of fatigue and stress melted away. The expression was a cross between relief and gratitude. And yet, with each vaccine my sense of respect and love grew for them. They served knowing the risk and when they got vaccinated not one responded as if it were owed to them, but rather they were grateful. These men and women who had given their all for months were grateful to us because as one young man said to me, we were told that all of you volunteered your time to help us. I almost cried looking at what months of wearing a mask had done to the bridge of his nose and he was thanking of us. It gave new meaning to selfless.

When I became a nurse I felt that it was a calling. Most days I can’t imagine having ever done anything else, with maybe the exception of viticulture. I hope when you look at these physicians, nurses, housekeepers, and other frontline healthcare workers you see the love of God. They did their jobs when no one knew if there would be a vaccine. They did their jobs as people continued to not wear masks and acted irresponsibly. And, they did their jobs with inadequate PPE, squabbling politicians, policies made by people who knew and cared nothing about public health, deaths of coworkers, and through myriad lunatic conspiracy theories.

When I imagine the love of God the mental image will be of the masked face of a healthcare worker.

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.

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

Faith Communities and COVID19

I love my faith community, but I think this week they failed the community. It is Sunday and I stayed home. I am not sick, but I did get off a plane at 2:00 AM Saturday morning. I took all reasonable precautions and probably some that were overly cautious, but I would feel horrible if I went into what is a mass gathering and unintentionally put others at risk.

I fail to understand why we canceled university classes and religious leaders are not canceling services. For example, the University of Tennessee closed until April 3, closed the library (I chuckled that they feared a mass gathering), and put all classes online.  Why didn’t the university parish which serves the larger community also cancel services? They are creating a mass gathering. Do people of faith really believe that they are not creating a risk situation by gathering, or do they think God will protect them, or is it that their own self-interest is more important to them than the health of the community?

If I am sitting in a pew there are going to be a minimum of 12 people within 6 feet of me. That means one person that is infected can easily expose 12 more. They may not be coughing or sneezing, but they are touching the pews, singing, and reciting prayers. Even talking distributes droplets. I think we have all had the experience of talking to someone and have spittle land on us. Singing is likely to spread those droplets further than talking in a normal tone. Now add 100 – 500 people in a church, synagog, mosque, or another place of worship and imagine what you are potentially doing.

I am saddened to see our places of faith being less responsible than sports teams. Next time you talk about universities being the places that teach self-interest and are concerned that they don’t put the community first or don’t teach moral values,  you need to take a look at all the churches that chose to hold services knowing the risk and then compare that to all the universities and sports teams that cared enough for the community to act quickly.

We don’t have to be physically together to pray together. While it may help to clean the church, not pass collection baskets, and remove the holy water that is not social distancing. It doesn’t stop droplets and it doesn’t stop the respiratory spread from droplets in the air. People with no symptoms can spread coronavirus without knowing they have it. Be compassionate and know that God doesn’t live only in church. I am grateful to all of those that did cancel services and for all of those that took the time to pray at home. If you didn’t cancel your services you are not helping to flatten the curve.

I know for many their place of faith is a support system and not being able to attend is emotionally difficult. If you are sick or worried during this time I will promise to pray for you daily by name if you post a request and I will ask my friends to do the same. We can be a community and be in community with each other without being physically together.

Joshua 1:9 “Have I not commanded you? Be strong and courageous. Do not be frightened, and do not be dismayed, for the Lord your God is with you wherever you go.”