Six Sentiments for Season Six: Nurses Week 2020

Heeeeeeey Nurseeeeeee!

In honor of Nurses Week 2020 and what will be my sixth year of nursing, I wanted to make a post with the six observations I have about who I am as a nurse and pieces of wisdom I wanted to share.

  1. I came into this profession shiny and new with clean, pressed edges and resounding hope. While I still believe in the goodness of people, my cotton is a bit wrinkled now from the disregard shown by humanity. It’s intact still, not threadbare and laid waste from years of abuse quite yet. You can see the change notably from six years ago. Sometimes something really good happens that irons out the wrinkles and makes the cotton look renewed though. Sometimes when a small tear happens, a kind soul will come along a patch it up. In our profession, we can’t expect our cloth to stay immaculate–we should expect it to become a bit dirty and a bit worn. But we need to allow ourselves to let it be repaired and refreshed. Our work is meaningful.
  2. Protect your “helpers.” Value them. Now when I say “helpers” I don’t mean that these people are there to serve YOU (The Nurse)–you are all there for the common goal of bettering a patient. These individuals help in making your jobs easier though. So value them. Protect their interests. Are your respiratory therapists lobbying for better equipment? Join them. They know their specialty and there is probably a reason. Is another nurse abusing her patient care technician? Step up. Be a leader by advocating for that person. Is the department paramedic pushing for more privileges their license allows them to do? Speak up! These are our team mates. Rally to their sides.
  3. Pass on what you learn. It is so easy to find information and hoard it but its better for a department when you disseminate it. In this pandemic, I early on volunteered to moderate a Facebook Group Covid-19 Healthcare Professionals (click for link) which at the time (early March?) had like 300 people. The idea was to have a place for professionals to share information and develop a community. It quickly grew to over 84,000 people (at time of writing). Ideas flew like crazy from how to prevent skin breakdown from face masks to setting up vents and pumps outside negative pressure rooms. But the idea was this: knowledge sharing. Teach what you know to others–precept new team mates and if more experienced or older staff ask for help with something, teach without judgement. Do all acts for the betterment of the whole.
  4. Nursing will disappoint you. A lot. Frequently. Management will promise you the world only to give you scraps whether on purpose or not. Toad, Four Year Degree in Bladder HoldingPatients will burn you despite you breaking your back for them. The pay will never equal the work some days. Lunches won’t come some days and your bladder will harden to that comparable to those weird frogs that hibernate for years in Australia (I pulled out that metaphor from somewhere…don’t @ me).
  5. You don’t always get what you want (to quote the Rolling Stones). In fact–get used to it. I had a lot of “no’s” told to me in six years. Career paths I thought I wanted that went to other people. It hurt, guys. Baaaaaaaad. But the funny thing about “no” is sometimes it’s just a primer for “because here’s this instead! TA-FRIIIIGGGGIINNN-DAAA!” And it really is better. I didn’t always trust that I was told no for a reason. I felt like that no was my own resounding failure when in reality it was just because I was a better fit elsewhere. That job I thought was perfect? It took a wiser nurse sitting me down and telling me I wouldn’t be happy doing it. I didn’t believe her for a while and I was bitter at her assumption–how could she possibly know what I wanted? But she was right. I should’ve listened instead of being angry. Because my dream job offer came half a year later. Even if you don’t get that dream offer like I did right away, keep at it. Something I always tell new nurses or nurses trying to strive for something is this: Never accept “no”–rephrase it as “not right now.” By accepting that no and letting the door slam in your face, you’re missing possibilities of three more doors opening just down the road to even better opportunities.
  6. While nursing has given me the most painful memories and caused me some of the worst heartaches–it has given me so much more. It has given me purpose. Friendships. Meaning. It has saved my life when I felt it didn’t mean anything. Days I didn’t want to get out of bed–I knew I was needed by my coworkers and patients. Somedays that made the difference for me just knowing that the work I did with my two little hands caused change gives my career meaning. I’m proud of what I do and I couldn’t imagine doing anything else even on my worst days… find meaning in your work. This will help you power through the ugliest parts of our job.

 

So this week… this whole month… this whole year… hold your heads up high, Nurses.

We have faced insurmountable odds in some parts of the world and in those not necessarily being inundated by viral illness but rather facing unemployment from low-census or budget-cuts. The world sees us and while they may not necessarily empathize with our plights and administration may still gift us pizza parties (not you night shift–you get half eaten stale donuts because “tradition”) instead of safe staffing and all the things we really need…we’ll still keep showing up and providing top-notch care.

Happy Nurses Week!

 

 

I’m Sick With COVID-19 but Not How You’d Think

Does anyone else feel a strange blend of fear and normalcy? Like, you turn the news on and see the world going to shit around us, the death toll rising, the numbers of infected rising, the virus spreading, people in a panic and hoarding supplies, and yet you still have to go outside and pick up dog poop out of the yard? You still need to buy toilet paper? Not because you’re afraid to run out but because you genuinely just need it? You still get emails from every website you ever put an item in their e-shopping cart and didn’t check out with coupons.

It is eerie. Surreal. The entire country of Italy has been brought to its knees yet people are still getting take-out Chinese here. Countries have shut their borders and I’m sitting here looking in the mirror thinking how my one eye’s set of eyelash extensions are looking ratched. Which, the shallow part of me wants to scream “my eyelash extensions ARE essential! Open that business back up, Gov’nuh!” But I’m a healthcare provider, so… I’ll survive. I’m going to look like Gollum by the end of this but I’ll manage (stay tuned for the #Pandemic2020 before and after pics on my IG).

 

The real question is which is the before and after…

By now, you don’t need me to tell you the state of the world. Its closed–moose out front twinkiesshould’ve told ya! The acronyms (WHO, CDC, NIH, etc etc) all pressing for social distancing and hand washing (which by the way, I am perturbed by the fact so many people apparently WERE NOT already doing this….) to help mitigate the spread of the virus. Meanwhile, the general population is torn between “the end is near–panic!” and “we’re over-reacting; it’s a media induced frenzy; the flu kills more; it’s a political plot…. *insert more bullshit*” You do have the warm and creamy center that doesn’t really know what to think or just follows advice calmly. (Shoot for the warm/creamy center–its the best part of the Twinkie, guys… and Twinkies survive. Consult every zombie movie, ever. They’re the cockroach of the snack food industry).

Jokes aside….

Depending on the day, I can swing like a kid on a swing. I don’t fear for my self, really. I’m relatively healthy. I understand nothing is certain and I very well could be that case that ends up on a ventilator. My fear stems from “knowing too much.” I worry about those I care about that fit the category “vulnerable population.” I worry about the side of the pendulum that is the Devil May Care attitude. The ones out living in complete normalcy and disregard for recommendations because they feel invincible. I fear them. This recklessness is what will prevent us from flattening our curve and expanding our disease doubling times.

Let us get really real for a second. Healthcare workers: during flu season, do we have enough beds for our patients? No. We’re holding them in the ER. We’re seeing hospitals IMG_3407go on critical care divert. Do we have an abundance of nursing staff? Again, no. They’re leaving the bedside in masses from retirement of our boomer population (thank you folks for your service), burnout from unsafe/unfavorable working conditions and general malcontent, better work/life balances, and for advancement in careers. Ok, so maybe we have enough doctors? No. That is why medical schools are beginning to offer medical schooling free to certain specialties. It is expensive AF to be a doctor.

So what about the ability to actually house COVID-19 patients? Recent estimations suggest that the patients requiring hospitalization could number 4.8 million, 1.9 million requiring intensive care, and 960,000 requiring mechanical ventilation (source here). Its sobering.

What do we have here? According to The American Association of Hospitals (AHA) data from 2018 (most recent set), of the 5256 AHA registered hospitals in the US, 51.4% were ICU capable (10 acute care beds and at least one ICU bed).

  • 534,964 acute care beds: 96,596 ICU beds out of those.
  • Those ICU beds can be adult, pediatric, or neonatal.
    • 68,558 adult ICU beds (46,795 Medical/Surgical, 14,445 Cardiac, 7318 Other ICU)
    • 5,137 pediatric ICU beds
    • 22,901 neonatal ICU beds
    • 22, 157 step-down unit beds
    • 1183 burn unit beds
    • Worth noting: There was no data on how many rooms were negative-pressure rooms
    • If needed, post-anesthesia care units and operating rooms can be accounted as resources.
  • ’09 survey results showed 62,000 full-featured mechanical ventilators
    • 46% can be used on pediatric or neonatal patients
  • Some hospitals kept older models as contingency plans but only add basic function– adding another 98,738 to the overall supply.
    • 22,976 non-invasive ventilators (which are being discouraged due to aerosolization of the contagion so potentially these may be meaningless depending on the patient presentation/physician discretion and availability of filtration)
    • 32,668 automatic resuscitators
    • 8,567 CPAP units
  • The CDC and Prevention Strategic National Stockpile (SNS)– the country has 8,600 (estimated) reserves for emergency deployment which offer basic ventilatory support. These require hospitals to requisition them from the agency with up to 24-36 hours from decision to deploy to receive them.

So obviously, the numbers don’t balance well. And remember, COVID-19 doesn’t stop our flu season or heart attacks, strokes, traumas, and really any other reason for hospital admission. It adds another layer of burden on to an already over-burdened health care system.

This is why it is a problem and why the government is acting like it is. Not because it hates Coachella. We just can’t support life otherwise. The Italians had to make the hard decision to begin resource triaging–if this is a foreign concept to you let me clarify.

If you did not have a good chance of survival, you’re not being given the resources quite like you would if your chances of survival were higher. It sounds a lot colder than it should. However, this concept has been around for a long time.

Emergency department and service workers are no stranger to the concept of “triage.” It derives from the French word trier or sort/shift/select/separate. It found its roots during wartime when surgeons sought to damage control and remains in use today during mass casualty situations. In recent mass casualty shootings and natural/manmade disasters, we’ve seen how first responders move through the casualties to handle the injured much like the triage nurse sorts through a full waiting room to discern the most acute patient for his or her last treatment beds.

It finds base in the philosophical concept of Utilitarianism. I know it may have been a long time for some of you since Ethics/Philosophy class so let me refresh you: Utilitarianism was the idea that the morally right action is the action that produces the most good. It is a form of consequentialism, that is, it defines the right action is understood entirely of terms of the consequences produced. It is distinguished by impartiality and agent-neutrality–everyone’s happiness counts the same. No one’s good is more or less than another’s.

Me personally, I’ve been that triage nurse. I’ve looked in the eyes of my patients in pain or feeling unwell as I’ve taken people ahead. It breaks your heart knowing they sit and wait. Does that one have a surgical emergency in their belly? That child’s fever–is it something more? So the idea of actually deciding to redirect the minimal resources I outlined earlier to those with higher chances of survivability is not something I relish. It makes me feel a little down and I’m sure you may feel that way too.

So when I say I’m sick with COVID-19, I don’t mean in the literal, physical sense. My heart is sick, you guys. We are not prepared. We cannot handle this if allowed to propagate, unchecked. This isn’t some elaborate political hoax. The science doesn’t lie. Some projections see this epidemic infecting the entire country at some point. This virus doubles every three days and there is a very real possibility that most American hospitals will  become overwhelmed within 30 days (Source here).

I am sick because every time I read a new news-article on Facebook, there is an inundation of commentary from people who insist the gathering restrictions/businesses closure mandates are a violation of rights. And while I am empathetic to why they think so, these individuals miss the point. Here in America, we were founded on a principle above all others, the unalienable rights listed in our Declaration of Independence and that is “the right to LIFE, liberty, and the pursuit of happiness.” One cannot pursue the second two aspects of that phrase (liberty and the pursuit of happiness) without first protecting the first life. This isn’t about politics, you guys. This is about staying alive. This is about keeping our people safe. It is not a democrat vs republican issue… this is greater.

We see movies about the world coming together to fight back alien invasions. This is our alien invasion. We are one people coming together to fight back an enemy invisible to the naked-eye. There will be a life-time to argue about who is right or wrong later, right now, we need to do the smart thing and focus our energies on this.

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Coming to flight medicine, I provide a necessary service. I have talked before how it requires a great deal of dedication and hard-work to get where I am. But I am going to make a confession: I don’t feel like I am contributing enough to the cause, you guys. I am watching my colleagues in the emergency departments hustle and give it everything. That used to be me. The call to serve is so deeply ingrained that I feel guilty for completing only my assigned duties with my job. This is probably just me, though.

I’ve been watching my colleagues post online about how stressed they are, their fears, their fatigue, and frustrations with their administrations. I am lucky–my administration seems forward thinking. But supply chains are not health-care system specific, we see them nationally and globally. It weighs on us all.

Despite this. I want to leave this post with this. This will be a defining moment in our history. This is our medical “9/11”. Now is the time to band together like we saw on 9/12. We need to stay positive, work together, and look to the future. It is a dismal time for us all.

But I am reminded of a few things. Despite all of the ugly and the terrifying, the helpers emerge. Doctors and nurses are getting a disproportionate amount of the thank-yous in this. As a nurse, I’m not saying this to negate the massive impact we have in this. Continue to be grateful for their (my) work.

However, let us not ever forget that this is a team effort– thank your ancillary personnel. Thank the patient care technicians/CNAs, the radiology technicians, the respiratory therapists, pharmacists, advanced practice providers, and every other of the myriad of amazing providers in the healthcare system. Thank the housekeepers, unit clerks, food service workers, the facilities workers, the aviation mechanics for helicopters and fleet mechanics for ambulances. Thank the firefighters, rescue/haz-mat technicians, dispatchers, police officers, emergency medical providers, and other first responders for continuing to go out/go to work, with little protection sometimes to protect and serve the community. Thank the retail workers and grocery store clerks, truck drivers, warehouse workers, factory workers, and postal/delivery personnel keeping us in our supplies of goods we need. Thank the sanitation workers, plumbers, handy-men, line-men, and other tradespeople for keeping the world clean, lit, and comfortable for us while we shelter in our homes.

I am missing so many people worthy of being thanked…but my point is this: there is no small job. Ever. I talked about this once in a post about ever calling yourself “just an anything” in healthcare. But now, I want to throw that post away. There is no job unworthy or “just a” right now. We all make a difference, guys. Even those sheltering at home–you are making a great sacrifice unknown to many in our generation.

So look to the helpers. They’re out here helping.

We can get through this. We will get through this. We’ve survived worst in our history of humanity with less. We will get to the other-side of this. But we need to do it together.

 

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I will leave you all now with some quotes, stay strong everyone:

  • Valor is stability, not of legs and arms, but of courage and the soul.” -Michel de Montaigne
  • I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.” -Nelson Mandela
  • Hope is being able to see that there is light despite all of the darkness.” -Desmond Tutu
  • While there’s life, there’s hope.” -Marcus Tullius Cicero
  • “I don’t think of all the misery, but of the beauty that still remains.” -Anne Frank
  • Upon the conduct of each depends the fate of all.” -Alexander the Great
  • Solidarity is not a feeling of vague compassion or shallow distress at the misfortunes of so many people, both near and far. On the contrary, it is a firm and persevering determination to commit oneself to the common good; that is to say to the good of all and of each individual, because we are all really responsible for all.” -Pope John Paul II

 

-Clear skies and tail winds, friends — stay strong and healthy