Norwich University News Edition: Voices from The Hill

With coronavirus patients surge possibly looming, health care professionals respond to greatest challenge of their careers

My mother sent me a photo of herself today in her work uniform goggles, gloves, N95 face mask, disposable gown and a surgical scrub cap. Working in her mid-60s for this Veterans Hospital Clinic was her dream retirement job as a licensed practical nurse (LPN) however, this was not what she anticipated a retirement job would be after leaving the American Red Cross with over 30 years of service. Continuing the job she loves, she wants to care for veterans in this outpatient clinic and continue the family tradition of serving during times of conflict. While my family has served in various capacities since World War I, providing medical care is the path my mother chose.

My story is not unique and is happening around the world with men and women coming out of retirement to care for infected COVID-19 patients. There are limitations on nurses who recently graduated or are close to completing their educations. Everyone is facing the biggest challenge of their careers. The potential “surge” of patients is a major concern. An exponential increase of patients who are infected and in need of medical care is fast approaching.

Around the world, health care professionals are coming out of retirement to care for COVID-19-infected patients.

By April 12, Vermont reported 727 coronavirus cases in the state and 27 deaths. The state conducted 9,841 tests, 39 people are being monitored, and 786 people finished quarantine (WCAX, 2020). These numbers seem small compared with places like New York City, Chicago, or Seattle, but Vermont is a small state and these numbers have a significant impact on the state’s ability to respond. The “surge” will make it even more difficult. It will require more resources and extend the time patients need to remain in critical care.

Pressed to the limits

Waiting for the influx of cases in a small state already pressed doctors and nurses to the limits. Before the pandemic, larger medical institutions had a few hundred open positions. Now, that need has doubled, but there are not enough people to fill those positions. In an attempt to alleviate the pressure on major medical institutions in Burlington, pop-up hospitals are being established with extra beds for those in need. Beyond hospitals, many individuals across the state need home care and “home health agencies,” which treat about 8,600 patients on any given day, are providing home care to 29 patients who have tested positive for COVID-19. That’s nearly as may COVID patients as hospitals are treating right now (Vermont Public Radio, 2020).

To accommodate this increased medical need, many emergency measures are being taken, including temporary licenses, early graduation, pop-up hospitals, single-use personal protective equipment (PPE) for multiple patients and ventilators assigned to numerous patients because there is not enough equipment. The hope is that collectively, those choosing to serve during this time of crisis are doing enough to reduce the impact of the disease on themselves and their families.

As testing becomes more readily available, the number of patients infected with the virus will continue to rise until the COVID-19 curve flattens. Stay-at-home orders across the country, and especially in Vermont, have helped flatten the COVID curve. The growing curve makes me think of the nurses from history and what daily challenges they faced without many of our modern medical advancements. Personal protective equipment was minimal, and for people like Florence Nightingale, it was all but nonexistent. Personal protective equipment was no more than soap and water.

Nurses would regularly wash their hands, face and washcloths in buckets of water to limit the physical transmission of germs, being sure to change the water regularly. Ventilation was also a major concern to limit airborne transmissions. For hospitals, this included large rooms with open windows. Home care was more challenging because rooms were smaller and individuals would confuse a cold temperature for a ventilated room. If cold air is getting in, they reasoned, the room must be ventilated. However, it did not mean the room was properly ventilated and nurses were at increased risk.

Focused on the need

While things are not this dire, as the virus continues to spread and supplies run thin, many doctors and nurses might feel as if they are lacking the modern technology needed to fight the virus. Lillian Wald, Florence Nightingale and Clara Barton trained fellow nurses in periods of pronounced need. Clara Barton believed "You must never so much think as whether you like it or not, whether it is bearable or not; you must never think of anything except the need, and how to meet it.”

Calls for some of the most basic precautions are becoming more important than ever with limited supplies — washing your hands with soap, not touching your face, washing down hard surfaces, having properly ventilated rooms. We have to meet the need today despite limited resources. Just as with nurses of the past, there is no choice. I and my colleagues in nursing will keep teaching the nursing workforce and prepare future nurses for this crisis and the next crisis. We are fortunate to have technology on our side. Digital textbooks, virtual meetings, iPads with 3D anatomy renderings and digital access to professional conferences. Using all the tools at our disposal to educate the next generation of nurses is the finest way to prepare for future crises.

I have not seen my mother in two months. I have not hugged her, her grandchildren have not gotten to play at her house and my oldest daughter will be having my first grandchild without me in the room, possibly alone. I cannot help but feel vulnerable and I find that abhorrent.

I pray for all of us that it is not just my mom, myself and many of my friends and family serving on the front lines of the COVID-19 war who are “holding the line” to care for the infected patients and in many cases trying to keep them alive — it is all of us.

Jamie Maxham-Robillard MSN, RN, teaches nursing in the traditional undergraduate program and the accelerated bachelor’s program at Norwich University.

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