June 23rd, 2020

Outpatient Infusion

During the pandemic what we learned most as outpatient infusion nurses was how many unnecessary visits we had pre-pandemic. Patients would come to the city for a lab draw, hydration, perhaps just for a simple long term follow up visit. They came because they are connected to the facility, to the attending, to the staff. Maybe they came 5 years post BMT follow up because they are always worried. The would spend co-pays, time, energy and stress. But during the pandemic, unnecessary appoints were put on hold. Visits that were just follow ups were pushed back. Most appointments were able to become tele-health appoints. Hydration 3x a week? Most likely not necessary, so it was canceled. Lab draw 3x a week to check platelet level, and then never needed platelet transfusion? Canceled. To my organizations credit, they were able to transform outpatient care into a tele-health center. However, there weren't enough systems in place to make this work seamlessly. Our hospital administrators should continue to have telehealth visits. The insurance systems should continue to allow for telehealth visits. A lot of the MDs were struggling to figure out the technology -- because they had never done it before. It was encouraged. The RN- infusion staff because incredibly grateful for the care coordinators who were organizing these appointments. The CC's became technology specialists. Throughout the pandemic we learned just how important technology is to the care we give, and how it can continue to play a role in how we give healthcare.

Hospitals need to work on getting supplies from several companies. Remember when there was a saline shortage in 2017 after hurricane Maria shut down the ONE manufacturer of small saline bags in Puerto Rico? Hospitals that didn't have a backup plan had to scramble about how to give patients medicine, antibiotics, chemotherapy. There was only ONE place FDA approved to make saline -- which is WILD. The same can be true of masks, face shields, ventilators. Ability to get supplies from more than 1 distributor needs to be highlighted. I hoped after 2017 hospitals would start realizing that they need to have back up plans in place when supplies from one distributor was completely cut off.

Our American health care system is completely broken. Our facility was lucky - we are in the heart of NYC, but we are a specialty center. Everyone we saw has some type of insurance or payment set up. However, every day on the news to hear about the death tolls, the uninsured who refused to go get help because they didn't have insurance. People who would show up to the ER, because they don't have a primary care doctor. Health literacy suffers when people don't have primary care physicians. And people don’t have PCP when they don’t have insurance. Universally, people need health insurance.

The higher ups in the hospitals and health care networks we work within know we struggled. -There were “thank yous,” 7pm claps, and pizzas and bagels given to us -- but will that go on forever? Will nurses, who are truly the back bone of the health care system, continually get a thank you? I'm not talking pizza on Fridays, or a towel at Nurses’ week... a real thank you. I'm not sure how that would work - but it needs to start from the top. The MDs do important work -- but many of them stayed away from the hospitals. They were ABLE to do telehealth appoints. Nurses can't virtually put in an IV. We were with the patients and absorbed their fears, anxieties, stressors. We encouraged them to shut off the news and turn on HGTV during treatment. Doctors are incredibly important; they deserve praise and thanks. But they weren't getting coughed on, sneezed on, dealing directly with patients day to day, week to week, month to month. There is a whole generation of nurses who will be burnt out before retirement due to this pandemic, especially in big cities. I have friends that facetimed family members of dying vented patients. They would stand there, hold the phone, and attempt to not shed a tear. They coded patients day after day. They saw patient after patient die. Wrapped more bodies then my mother, a nurse of 38 years, did in her whole career. Administers (as well as the government at all levels), need to be prepared for a loss of nursing staff in the future. We've been through things we never think we'd be through. We've been traumatized. We’ve lost our own friends, loved ones, colleagues. We are a generation of nurses with PTSD.

To all the nurses out there, big cities, small cities -- we all have each other. Together we can make changes.

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