It will never be the same
I am a Director if Nursing in a skilled nursing facility. I take pride in my team and take every opportunity to work right by their side. This usually allows me to see first hand what our process issues may be. Where the room for improvement is going to come from.
Yesterday, like every other day, I walked down the hall in our Covid unit (sweating in 15 pieces of PPE and exhausted because in 4 days I have already been away from home 62 hours). I am doing my morning rounds and going from one to the next. I am trying to encourage my nursing staff, reminding them that we are strong and we are a team and we will do the best we can. I am mopping, I am cleaning and stocking, preparing for the next transfer because we can’t afford to use the extra PPE for another department to take care of it. I am calling families to provide updates, sometimes ones that encourage them to call and say goodbye. I am working with the county response teams and the 8 different counties that all want me to follow their specific protocol and call 3 different people once x,y,z happens with their one citizen who lived in their county 9 years ago. I am counting and recounting PPE, calling every paint store in a 50 mile radius looking for enough shoe covers to make it through the next 2 days. I am taking phone calls from family members that are screaming and yelling and cussing and telling me how awful I am because their loved one didn’t get to bring his recliner to his new room, amongst the 13 room changes we had to make in the matter of hours to isolate and contain. Checking in with lab every two hours to find out if we have testing results back.
Last night at 1030pm, while my 3 small children and husband are waiting for me at home, I hid in my office crying. Broken hearted, defeated, exhausted. And I cry because we did everything. We went above and beyond the guidelines, the recommendations. We had back up plans for back up plans. We educated and educated and educated.....none of it mattered. People are dying. Nurses are praying and crying and working tirelessly. It is quite possibly the most helpless situation I have ever experienced.
I have been in healthcare for 14years and come from multigenerational nursing. Nursing is in my blood. Nursing is where I thrive.
Covid may just be the thing that drains my nursing passion.
Nurses are furloughed? But nursing homes are running at 40,50,60% nursing vacancy.
Elective surgeries are starting back up? But Home Depot warehouse is almost out of our shoe cover supply, so I suppose we will just start tying bags to our legs. We’ remain at a crisis contingency, but now that the hospitals don’t have concern for a “surge” life can resume for everyone but those of us dedicated to geriatrics.
I would choose you to be my nurse. Thank you for advocating for your staff and your patients so tirelessly. I am so sorry this is happening to you and I am standing with you in your grief.
Hi.. I quickly took a look at the ebay and amazon, as of now, i just saw a listing of 100 pieces of shoecovers for $11 from ebay and $12 from amazon.com.. amazon also has prime 2 day free shipping and they can arrive earlier if needed. hope this information helps. take care..
That is an absolutely heartbreaking story. If you were in charge of the COVID response and could set it up in a way that serves patients and their caregivers, what would that response look like?
I suppose it’s always easier to make decisions in hindsight. There was so much focus on hospital systems not being overwhelmed and over capacity. This was important because if not managed well, it would mean a bigger burden on the community and therefore a higher mortality rate. Which I understand. Where the plan failed was seeing beyond that picture, the long term effects.
In my opinion, and I said it early on, there should have been designated homes for covid patients. Designated intercepts for those infected. At that point, even if you ended up with cases in unintended places, there would be a fighting chance to not spread it to everyone in congregated living situations. Even now, it was a discussion I held (even though my corporation would never entertain it, and I truly have no idea how much preservation my staff and I have left) that at this point, maybe we should be the intercept. A skilled/long term care facility that would change its focus and assessment process to facilitate this invisible beast. It would help streamline PPE priority, staffing, and health department resources.
Now, it may be a lack of my own understanding, but is this not how tuberculosis was managed? An airborne, highly contagious respiratory illness. Hospitals were designated and treatment was prioritized with one specific plan. Instead, hundreds and hundreds of facilities are impacted, drowning, and in turn-losing hundreds of patients. It is heartbreaking. We can close our doors, we can isolate people, we can take away the rights of the elderly, we can impose substandard care, and we can take the brunt of scared, misinformed, angry family members. But what comes next? What if this truly does become our standard for the next year? In a overburdened system, with high burnout rates, how will we survive?
As far as my team goes, I do everything I can to build them up. Help them understand that we must now change our expectations of what nursing means. That we are truly in a triage situation (which most long term care nurse struggle with). I highlight my staffing strengths. I try to educate them, and remind them that we, at this point, only have each other. To be honest, my team is now supporting me. Ensuring me that they feel as safe as possible with the resources we have. That they feel we couldn’t have done anything different. Which I guess in the grand scheme is the best that I can hope for. Minimizing a defeat in integrity.
If I could have done it differently, I would have helped them understand that in this ever changing process as soon as I realized the tidal wave that was coming. That there is nothing we can do but expect rapid changes. I would’ve taken more time to explain the background of our processes. I feel that people tend to work harder toward the goal if they understand the rationale.
In the same respects, I honestly feel that there isn’t much room to place blame. Everyone is doing the best they can. Everyone is tired. Everyone is scared. Everyone that is making decisions is hoping the choices they made at every moment in time, is the right one. However, it would be interesting to see how the lawmakers and state health departments would implement things if THEY were on the front lines.
The icing is reviewing the survey focuses from the state. Reading about how criminal charges are being filed for nursing home owners. It surely feels like a situation that can never be won, one with our hands tied behind our backs. But, I guess for the eyes of the public, someone has to be responsible for the masses of death. Maybe some of those situations are warranted. For most, I’m sure it feels like a slap in the face that we never had a fighting chance to produce positive outcomes.
My heart breaks. The weight of your responsibility to your patients, staff and family is beyond intense. It's clear you are doing everything you can with the resources you have in an untenable situation. How would it feel to say that to yourself in the same way you would say it to your staff--with kindness toward your limitations and acknowledging your incredible efforts. Give yourself permission to feel what you feel and to receive the support of your colleagues, family and friends. We are standing with you and are proud to call you a colleague.
Those kind words mean more than can be explained. My colleagues are very supportive. In my entire career, with most experience in long term care, I have preached that the team is really the biggest variable. Everywhere you go, you will have challenges and situations you might not agree with. With the support of a team, anything can be accomplished. It is hard to find the peace in this situation. The willingness to accept that this is out of our control. I try to allow myself the peace in acknowledging that I am doing my best. Unfortunately, my best isn’t going to save everyone. Loosing life is really the hardest part of what we do, even in a setting that expects it.
Most days it feels like sending my cohorts into war. If I have accomplished something, it is that even in that facet, we are going in holding hands.