This isn’t a jog, a sprint, a mile run. The fight against COVID-19 is a marathon.
“And this isn’t just a marathon for us as staff, but for families and our patients,” said Stony Brook Medicine Associate Director of Nursing Alison Rowe. “This isn’t over in a day, a week, a month. We’re going to be doing this for months, which means our patients are going to be coming in for months and our families are going to be impacted by this pandemic for months. I think that’s probably the most challenging thing about this.”
Preparing for battle, especially in her Department of Emergency and Cardiology Services, includes nurses having their temperature taken before entering the building, and washing their hands and changing out personal protective equipment such as masks, face shields, gloves, and gowns throughout the day.
“There’s a fear we’ll get sick. It’s real. That is a big hurdle,” Rowe said. “Thankfully, our numbers have been incredibly good, our PPE is incredibly strong, and we’ve done very well as a hospital.”
She and a couple of her colleagues appeared on Stony Brook University’s podcast “Beyond the Expected: The Coronavirus Effect,” hosted by interim Stony Brook University president Michael Bernstein, to discuss the challenges nurses are facing ahead of National Nurses Week — May 6 through 12 — along with some new initiatives. On April 29, the day recording took place, it had been 59 days since clinical and academic response to the novel coronavirus began. Up until that Wednesday, 2000 inpatients at Stony Brook University Hospital displayed suspicious symptoms, with more than half being diagnosed with COVID-19.
“They’re frontline superheroes,” Bernstein said of the nurses. “They are not just battling the overwhelming effects of this pandemic by providing patient care, managing teams, and leading new and innovative projects to address this emergency. They’ve also developed creative solutions that are helping to comfort patients, save lives, and keep themselves and their colleagues healthy, strong, and energized.”
Department of Regulatory Affairs Nursing Policy Coordinator Cindyann Beck began several initiatives to connect patients and nurses. The most personal to her is the My Story Project, which began after her brother was diagnosed with COVID-19.
Beck’s brother was on a ventilator with pneumonia. “There are many strange things about it. You’re separated, and you don’t see what your loved one looks like, you don’t see what the nurses who are taking care of your loved one look like, you don’t get to interact with them very much. But what I didn’t like at the time is that I couldn’t communicate to them very easily what he was like — he was just a body with a tube sticking out of it. And they were wonderful, taking great care of him, but I was trying to personalize it.”
She said the crisis environment, much like the novel coronavirus itself, is unlike anything ever seen before.
“After suggesting limiting visitation and potentially shutting it down altogether, there was a gasp in the room,” she said. “People couldn’t even imagine it.”
Her initiative involves redeployed nurses proactively calling families to find out things like nicknames, names of other family members, hobbies or interests, and taste in music. The nurses put together an information sheet hung on the patient’s door and inside his or her room.
“They haven’t been turned down yet,” Beck said. “Family members can send in pictures, too. It’s a way to help tell the story of the patient.”
Bernstein said it’s helping make the care team part of the family. Beck said it does that and more.
“When a patient does get off the ventilator, it’s important to know what that patient’s baseline is, not just the physical, but the things they are interested in, because those things can be used to draw them out,” she said. “I saw that literally happen with my brother.”
She also kickstarted the Face Behind the Mask initiative. After dealing with some patients with dementia who were diagnosed with COVID-19, she realized how scary it was, particularly for them, to be communicating with doctors and nurses you can’t tell the difference between.
“Caregivers in full PPE going in to care for a COVID patient, you don’t see anything but their two eyes behind a couple of layers of plastic, a shield, and goggles,” Beck said. “It can be frightening. You can’t tell what the person looks like, you can’t see a smile, no distinguishing features.”
Through the project, nurses print large pictures of themselves smiling with a few pieces of information about them that’s attached to their gowns to help patients put a face to the name.
Prepared For This
Rowe said over her 19 years with the hospital, many disaster drills have been conducted. They’ve included dealing with incidents from major plane crashes to epidemics and pandemics like this. Ebola is the most recent outbreak hospital staff can draw from.
“Screening patients, understanding typical signs and symptoms, isolating them early, using PPE — it’s all things we’ve practiced,” she said.
One thing that’s helped is the hospitals’ incident command structure, known as HICS, which delineates roles and responsibilities so it’s clear who is in charge of what and how decisions are being made.
“Things are changing rapidly at Stony Brook, and we need to make sure there’s a top-down approach,” she said. “The top needs to understand what the bottom needs, and we need to make sure the issue goes up the chain of command.”
The casualty care unit helps lead it. Its job early on is to identify symptoms like fever and cough, find out if a patient in triage has traveled, and ensure separation through the hospital’s split-flow model.
A new space in a tent placed in the hospital’s parking lot is now used for emergency department patients, while the hospital’s standard emergency department is now used to treat COVID-19 patients.
The rapid response team, which predates the novel coronavirus, has also been heavily utilized during the crisis.
Unfortunately, Lowe said, patients can deteriorate rather quickly, and could find themselves in need of immediate care. The team, led by Barbara Mills, assesses a patient, moving him or her to a better environment to meet his or her needs, or tells staff a patient can be safely managed maybe by adjusting oxygen levels or changing medication.
There have been some staffing puzzle issues, but the hospital has been able to work around them. If a nurse tries to enter the building with a temperature above 100 degrees Fahrenheit, he or she is sent home and the nurses shuffled around, figuring out who can care for whom. Those treating COVID-19-inflicted people, for instance, could not then go care for a non-COVID-19 patient, especially someone with a compromised immune system, such as with multiple sclerosis or lupus.
“I said often you need to have some resilience and hope. You can’t dwell too much,” Lowe said. “You need to know when you come to work that you’re doing the best you can for the most people that you can and you need to trust that there’s a sea of people that work with you, around you, behind you, that will pick up where you left off for the day, and that reassures me.”
Bernstein said colleagues who came from an upstate medical center in Syracuse to help have already expressed hope to stay once the pandemic subsides.
“I think that speaks to something that’s been quite vivid to me and quite vivid today,” he said. “What’s going on at the university hospital and our affiliate hospitals is record-setting, trend-setting. It’s being noticed regionally and nationally. All of the leadership and all of the teams are waging a battle against a fearsome enemy, and having success.”
In This Together
Besides patients, families have also struggled with being isolated from their loved ones. Nurses have worked on bridging that gap, too.
The care team becomes a surrogate family, and Surgical Oncology Center nurse Lesley Pronesti said she’s seen some heartfelt care. She recalled one instance involving a new nurse out of college and a decompensating COVID-19 patient. The nurse never left his side.
“She was all in,” Pronesti said. “He was so afraid. She was writing backward on the glass to get information to us. He knew that she was there for him. She wanted to take care of him. I saw a connection that made my heart just bounce.”
Even when the patient was transferred to the intensive care unit, the nurse would frequently check in on him.
“The patients are getting dropped off, see triage, meeting people in masks and gowns, seeing the eyes of the health care workers helping them . . . but there’s a sense of loneliness, fear, and anxiety that they don’t have anybody with them,” Pronesti said. “We inevitably become their family, the ones they depend on, the ones they look to for reassurance, to help them feel better, to even hold their hand, talk to them, FaceTime connect them with family.”
Pronesti got a call from the public relations department, and she was asked if she had a motto through the crisis. Without hesitation, she said: “In This Together.” A social media hashtag quickly formed.
“You see day-in and day-out — we work side-by-side for the good of the patients, for the good of each other,” Pronesti said. “We understand each other’s struggles and strife and fear. We’re fighting to overcome all of this. We’re there for each other. It’s so beautiful to see.”
She said personally and professionally it shows no one is alone.
“A lot of the time we wonder if we’re alone in feeling a certain way,” Pronesti said. “Know there’s support. Know there’s a place to turn to. We can lean on each other.”
She said it helps families know the hands their loved ones are in are caring and devoted.
“There’s a heightened sense of awareness — and these patients and their families are so grateful,” Pronesti said. “It’s truly from the heart — they see you. They see through your eyes to your heart and they feel you. With those severe respiratory issues, they are very afraid. It’s the scariest thing, and it’s even fearful for the nurses to see the patients struggling. They’re talking them through it, they’re holding their hand, they’re staying there and giving themselves selflessly with such courage.”