Stakes have been raised immeasurably for hospitals, newly minted nursing graduates

In 1933, Dr. John Gifford of what is now the Gifford Medical Center in Randolph, Vermont, nicked his finger while performing surgery on a patient with a streptococcal infection. Gifford contracted the then-deadly disease and died several weeks later despite treatment from the best specialists and staff at the Deaconess Hospital in Boston (now called the Beth Israel Deaconess Medical Center).

“That which has been is that which shall be, and that which has been done is that which shall be done. There is nothing new under the sun.” Ecclesiastes 1:9

For my entire professional career there has existed an almost absolute divide between the patient and the health care provider. The patient had the illness, and the provider devoted all their energies toward curing the patient and alleviating their suffering. I, as the provider, operated from a position of near invulnerability. The patient with diabetes was not going to give me diabetes; the patient with a myocardial infarction posed no danger to my heart. HIV and hepatitis C could conceivably be transmitted, but such occurrences were extremely rare and required a major break in technique, like sticking oneself with a contaminated needle. And with modern medicine, even these diseases were treatable. 

Previously, our graduates from the School of Nursing were like graduates from a peacetime Officer Candidate School, heading into a peacetime military. Now, they are going to war, with the real personal risk that implies.

With the coronavirus, everything has changed. Even with the most scrupulous use of personal protective equipment (PPE), this virus can jump the provider-patient divide, and it can kill you. Or, you could bring the infection home to your family, placing them at risk. Nursing care has always been a high-stakes activity for the patient, which is why patient safety has been the cardinal principle underlying all my instruction. Now some of this risk has redounded back upon the provider, and their family.

Llynne Kiernan

The stakes for those working in the hospital have been raised immeasurably. Previously, our graduates from the School of Nursing were like graduates from a peacetime Officer Candidate School, heading into a peacetime military. Now, they are going to war, with the real personal risk that implies.

For 16 years, my professional life has been devoted to preparing the next generation of nurses to enter the medical arena. As a nurse with extensive experience working on medical and surgical wards and intensive care units (ICUs), the challenges posed by infectious diseases, the use of aseptic techniques and PPE and the importance of infection control are all concepts I have felt confident imparting to our students. They begin learning about PPE in the Fundamentals of Nursing class during their sophomore year and progress through to their senior year, becoming familiar with the various types of isolation precautions, and when each is appropriate to use.

Many modes of transmission

COVID-19 has several modes of transmission, including via droplets, aerosols, and contamination of surfaces. Full personal protection requires gowns, gloves, eye shield and mask. The N95 mask which has been so much in the news lately must be fit-tested to the user’s face to provide the maximum protection. Even then, the mask blocks only 95% to 99% of airborne particles, and the potential for infection is only lowered, not eliminated.

The practice environment is changing rapidly. Hospitals have barred visitors. Elective surgeries have been canceled. Staff members have their temperature taken before they can enter the health care environment, and if their temperature is over 100 degrees they cannot enter. Anesthesia machines are being repurposed as ventilators for patients in the ICU. Physicians and nurses are being pulled from their usual areas of practice to reinforce critical areas like ICUs and Emergency Departments.

In this time of uncertainty, the Boards of Nursing are working on emergency legislation to grant temporary licenses to graduate nurses until they can sit for their exams. Norwich University School of Nursing graduates will be on the front line of patient care. They will share the worry about becoming infected, or bringing this virus home to families and loved ones. I believe our students have received the instruction required to enable them to rise to this nursing challenge, and keep themselves as safe as possible. I feel privileged to have served as their instructor, and humbled by the sense of responsibility this pandemic makes so inescapably apparent.

Llynne C. Kiernan, DNP, MSN, RN-BC, is a licensed registered nurse and an associate professor of nursing at Norwich University. She has taught at Norwich’s School of Nursing since 2004. Joseph RC Kiernan, M.D., specializes in general surgery in Randolph, Vermont.

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