BY LLYNNE C. KIERNAN, DNP
NORWICH RECORD | Summer 2020
The author is an associate professor at the School of Nursing.
For my entire professional career there has existed an almost absolute divide between the patient and the healthcare provider. The patient had the illness, and the provider devoted all their energies toward curing the patient and alleviating their suffering. As the provider, I 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. A patient with HIV or Hepatitis C could conceivably infect me, too. But such an occurrence would be extremely rare and would require a major break in technique, like sticking my-self with a contaminated needle. And even then, my infection would at least be treatable.
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. You can also bring the infection home to your family, placing them at risk. For patients, nursing care has always been a high-stakes activity. Which is why patient safety has been the cardinal principle underlying all my instruction. Now some of this risk has rebounded back upon the provider—and their family. For those working in hospitals today, the stakes have been raised immeasurably. Before the pandemic, our School of Nursing graduates were like graduates from a peacetime Officer Candidate School heading into a peacetime military. Now, our nurses 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 in 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 about imparting to our students. They begin learning about PPE during their sophomore year in their required Fundamentals of Nursing class. Their progress continues through to their senior year as they become familiar with various types of isolation precautions and the appropriateness of each in use.
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 at this writing must be fit-tested to the user’s face to provide the maximum protection. Even then, the mask only blocks 95 to 99 percent of airborne particles. The potential for infection is only lowered, not eliminated.
Practice environments for medical staff during the pandemic have changed rapidly. Hospitals have barred visitors. Elective surgeries have been canceled. Staff have their temperature taken before they can enter the healthcare environment. If it is over 100 degrees, they cannot work. Anesthesia machines are being repurposed as ventilators for patients in ICUs. 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, various nursing boards are working on emergency legislation to grant temporary licenses to graduating nurses. They can sit for their exams later. Our own School of Nursing graduates will be on the front line of patient care. They will share the worry about becoming infected, about bringing this virus home to their families and loved ones. Our students have received the instruction required to enable them to rise to this nursing challenge and to 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 is a licensed registered nurse with a doctorate in nursing practice, who has taught at the School of Nursing since 2004. She has received grants and awards from the Charles A. Dana Category I Grant fund, the Freeman Foundation, the Arnold P. Gold Foundation, and the Vermont Genetics Network funded by the National Institutes of Health. She is married to Joseph R. C. Kiernan, MD, a general surgeon working on the front line of patient care during the pandemic.