On February 25th in the New York Times, two stories appeared about nurses. Both sobering. Both timely. Both essential.
In my last post, I celebrated the fact that although the pandemic is killing scores of people and putting a strain on resources, including health care personnel, nurses have been in the forefront of the media getting the recognition that they have long deserved. And more nurses are speaking out by telling their stories. Long overdue.
However, the two stories in the NYT need to be read/viewed. One is by Theresa Brown who I have many times spot-lighted here because of her accurate assessment (my view) of nursing issues. A nurse herself, she has been calling attention to the nursing profession in the media and through her books.
Brown’s piece: Covid-19 Is “Probably Going to End My Career,” is an exposé of what is terribly wrong in the profession and what should be done. She writes bravely and honestly about the precarious state of organized nursing.
The second article, One I.C.U. Two nurses with cameras, is written, not by a nurse, but by a photojournalist. He filmed a fifteen-minute video that is raw footage of two nurses working with dying Covid patients in the ICU. Unvarnished, compelling and poignant. It’s a must watch that shows exactly what nurses experience during their shifts.
I’ve attached the links to both essays. The fifteen-minute video is imbedded in both.
I’m not writing my second book whose working title was to be “Home Visits.” The Pandemic has cast a spell on my brain, resulting in lethargy and an inability to focus on structuring another book. So, instead, I’ve decided to take each home visit story and submit it to a literary magazine for potential publication as a “stand-alone” essay. I plan to email one of the stories, Country Music, at the end of this week to an online journal.
Country Music tells the story of three patients that I cared for when I worked as a nurse practitioner in a home care program at a Veterans Hospital outside of Chicago. They were at various stages of dying. In the late 80s, the hospice movement was just taking baby steps into the medical/nursing world. I was learning about dying and death from my patients and their caregivers.
The locations of the three patients’ homes lined up perfectly for me to make the visits to them conveniently in the same day. This lasted for about three months. On the day of the story, a dreary, rainy day, I show the challenges I faced working with my three male patients and their wives (few women were enrolled in the VA health care system at that time), how each man played the hand he was dealt and how the women dealt their husband’s decline.
One of the men loved country music. Talking with him about songs and artists, rekindled my interest in the genre. I found a great country western radio station on my government-issued compact car. The earthy, raw lyrics telling of common human emotions became my therapeutic passenger that accompanied me on my home visits.
While I am editing this story for submission, I find myself checking into YouTube to listen to the familiar songs that supported me so many years ago. This is more fun than writing that second book.
Dominated by political turmoil and the COVID-19 Pandemic, this past year has been a roller coaster ride with few brief moments of slow travel interspersed with deep dives of fright and foreboding. The highs that I have enjoyed come in part from the increased attention given to nurses. I have long complained that the nursing profession has been mostly invisible to the public eye, media and policy making sectors. The increase in visibility and status of nurses in these turbulent times looks to me like a glass half-full.
I celebrate all the recent recognition direct towards nurses. When have nurses spoken up in great numbers for their profession, their practice, their patients and for their contribution to the world-wide challenge to defeat of the COVID-19 Pandemic? When have nurses received so much positive media awareness? Been frequently appointed to expert panels along with physicians and other health care professionals? Interviewed prominently by the news media? Featured favorably on TV shows?
How much of a coincidence was it that 2020 was designated by the World Health Organization as the Year of the Nurse and the Nurse Midwife?
In reviewing my posts of the past year, I have pulled out the ones that show increased focus on the nursing profession. I enjoyed revisiting them and am hopeful that the positive attention showered on the nursing profession continues.
I haven’t posted any stories about what physicians face when working on the front lines during the Covid-19 pandemic. Of course, my Blog is about nursing. In more recent years, the collaboration between nurses and physicians has grown. The professions work together with more mutual respect than when I began my nursing career. And physicians on the front line of the Covid-19 pandemic risk their lives just as nurses do.
I have reblogged a story written by a physician who is working “extra on-call time” to care for the new admissions at a local hospital. I read this essay in the online publication: Pulse: Voices from the Heart of Medicine.
I highly recommend reading Pulse, which publishes each Friday. There you will find stories that show the human aspect behind the practice of medicine.
In Need of a Prayer
Posted By Jo Marie Reilly On December 16, 2020 @ 10:44 pm In Stories
The new patient’s name is Emmanuel. He was sent from his nursing home to our emergency room with a cough and fever. The oxygen level in his blood is well below normal, and he’s gasping for air.
It’s my third week in the local community hospital ER. I’ve been putting in extra on-call time during the COVID pandemic. It’s been rough to get back into the emergency setting while continuing my day job as a family doctor and medical educator. I’ve been sharing admissions with the hospitalist, who’s joined me in the on-call room.
“I’ll take him,” I tell my colleague.
“Sure?” he asks, eyebrows arched over his face mask.
Since the beginning of the Pandemic, the visibility of nurses continues to increase. It is unfortunate that it took the Covid-19 virus to open a door allowing the general public to witness what nurses actually do: they save the lives of their patients as they risk their own, jeopardizing the health and lives of their families as well.
For years, I have believed we nurses don’t get the attention we deserve. We don’t speak out about what we do on a daily basis that makes a difference and the news media tends to ignore nurses, placing more attention on physicians.
Well, so much has changed as evidenced recently by the following:
A new show on NBC called the Nurses premiered on Monday, December 7th. I have only watched the first episode so far but if you suspend belief that a group of nurses can enter a hospital and begin to give care immediately, you will see capable, skilled nurses who work alongside physicians, not as the proverbial handmaidens, but as equal professionals. I intend to follow this show.
There have been many firsthand stories in the newspapers written by nurses on the front lines. I have covered some on these in this Blog. Most recently the Washington Post, What seven ICU nurses want you to know about the battle against covid-19, December 12, 2020, spotlighted the ICU nurses caring for the sickest COVID-19 patients. I have received comments from my friends that the stories are poignant.
Olden Days of Nursing: A Pioneer of the Past Spurs Others Forward
by Guest Blogger: Cynthia Freund
I talked with Marianna the other day about the book I’m writing (more about that later). She referred me to a post on her blog from a couple of months ago, a post describing the olden days of nursing. She added that she had some very positive responses to that post—and then she put the question to me, “Would you be interested in writing something about the olden days for my Blog?” I obviously fit the age criterion.
I read the post of August 4, 2020, Olden Days of Nursing: Dialysis, about a nurse working in the days when kidney dialysis first became available, the beginning of the 1960s. I know Marianna was asking me to write something about my own early experiences in nursing, and I may do that yet. But this particular post made me think of a dear friend who died a year ago, one-month shy of her 95th birthday. She, too, started one of the early kidney dialysis units, but this time at the Veteran’s Administration Hospital in Durham, North Carolina.
In this millennial year of the nurse, I want to pay tribute to Audrey Booth, both a typical and unusual nurse—a pioneer in many ways.
From the dust bowl of Nebraska, Audrey, a curly-haired blonde, climbed on a horse twice her height to ride to-and-from a one-room country schoolhouse and onto become the Associate Dean at the University of North Carolina (UNC) at Chapel Hill.
The interval between that Nebraska farm and UNC took her to Case Western Reserve in Cleveland, Ohio, where she earned a master’s degree in nursing. She became an expert in the care of polio patients during the height of the epidemic in the 50s, including caring for kids in iron lungs. That expertise brought her to Hawaii and Guam, and also transported her back to the mainland and the University of North Carolina (UNC). After the polio epidemic, she focused on kidney disease and, in the 60s became a leader in opening the new hemodialysis unit at the VA hospital in Durham—one of the very early dialysis units in the US.
Looking for new hurdles to jump, she joined a small select group planning the nurse practitioner program at UNC. And then, when the North Carolina Area Health Education Center Program started in the mid-70s, Audrey became the Director of Statewide Nursing Activities. (AHECs, as they are called, were designed to be centers of education and innovation, serving as magnets to attract health professionals to rural and underserved areas.) She became an Associate Dean in the School of Nursing in 1984—while continuing with all of her duties as AHEC Director.
Throughout her career, the essence of Audrey was as a leader, a role model and a mentor. She led and taught many nurses, usually just by example. She was not well-known nationally, but she was known by hundreds of nurses—and other health professionals—in North Carolina. Many of us attribute our professional success to her leadership and guidance.
And, as a matter of fact, it was Audrey who suggested to me that we interview the founders and influential promoters of the nurse practitioner movement in N.C. UNC started one of the very early family nurse practitioner programs. It was quite unique in its alliance with those starting a statewide AHEC Program and a Rural Health Program—a collaborative effort involving many. Audrey, and I, were involved in that pioneering effort. So, we conducted the interviews, but Audrey left the book-writing to me.
I am about to finish that book, titled: Nurse Practitioners in North Carolina: Their Beginnings in Story and Memoir.It will be in print in the spring of 2021—and will feature many other nursing stars of the olden days of nursing.
Audrey’s spurring me on to write this book is a perfect example of how Audrey led others—encouraging them to greater endeavors. Plain and simple: Audrey was an influencer, on a grand scale and with each individual. She was a mentor in the truest sense of that word. She was a strong voice for nursing and a strong model for women when women were still fighting for their due recognition. We indeed should celebrate all such nurses, just as the World Health Organization has done, declaring 2020 as the International Year of the Nurse and the Midwife.
Dean Emerita Cynthia Freund, MSN ’73, and Associate Dean Emerita Audrey Booth, MSN ’57, were awarded the highest honor of the North Carolina Nurses Association (NCNA) when they were inducted into the NCNA Hall of Fame on Thursday October 9, 2014. Nurses chosen for the Hall of Fame are recognized for their extensive history of nursing leadership and achievements in North Carolina.
Cynthia “Cindy” Freund, RN, PhD, worked for eight years with the newly developed Family Nurse Practitioner Program at the University of North Carolina at Chapel Hill in the early 70s. She then went to the University of Pennsylvania to start a joint program (MBA/PhD) between the School of Nursing and The Wharton School. She returned to UNC-CH and retired after serving 10 years as Dean of the School of Nursing. To her, retirement means “working without pay.” In her retirement, she worked on her book: Nurse Practitioners in North Carolina: Their Beginnings in Story and Memoir, to be published in Spring 2021.
Thank you for your openness to representation of nurses on the Biden-Harris coronavirus advisory panel. Nurses deliver most skilled health care and have valuable insight into what patients and the healthcare system need. So plans for national solutions will be more effective with their input. Below we propose nurses for your consideration, in sub-categories that address particular needs, based on recommendations from the many nurses we have consulted as well as my own experience providing ICU care to Covid patients.
As a preliminary note, while I understand that there are many physicians on the task force, they can’t represent nursing because it is a distinct, autonomous profession with a different scope of practice. In general, physicians focus on the disease process, while nurses focus on how humans react to disease, including patient education. And of course, the U.S. has struggled with Covid-19 relative to many other nations not so much because of the disease itself but because of how humans have reacted to it.
I understand that some have described the inclusion of different types of physicians on the panel as taking an interdisciplinary approach. However, we believe a truly effective interdisciplinary approach includes other types of health professionals, such as respiratory therapists, social workers, occupational and physical therapists, pharmacists, and of course nurses.
Below we introduce nurses for your consideration who are from different fields and would provide unique perspectives to the Covid advisory panel.
1. Experts in infection control
Although there is no shortage of infection control professionals on the current advisory panel, infection control nurses could give a more on-the-ground perspective to better address how people can live more safely with Covid.
Jason Farley, RN, PhD, MSN, MPH, is a John Hopkins University (JHU) professor who mobilized resources to help coordinate the response to Covid-19 in the Baltimore community, including JHU schools and hospitals, while continuing to play a leadership role in international scientific endeavors. His work has encompassed testing, addressing the needs of the vulnerable (e.g., getting pulse oximeters into people’s homes), and the stigma of infectious diseases in the community.
Ann Kurth, RN, PhD, CNM, MPH, is Dean of Yale University School of Nursing, an epidemiologist and nurse-midwife. She chairs the National Academy of Medicine Board on Global Health, and her research focuses on HIV, reproductive health, and strengthening the global health system. Dean Kurth’s work has been funded by NIH, Gates Foundation, UNAIDS, CDC, and HRSA. She chaired the 190+ member Consortium of Universities for Global Health and has published over 200 peer-reviewed papers.
George Allen, RN, PhD, is the Director of Infection Prevention at New York Methodist Hospital, and author of Infection Control: A Practical Guide for Health Care Facilities, and Infection Prevention in the Perioperative Setting: Zero Tolerance for Infections, an Issue of Perioperative Nursing Clinics. He is a Clinical Assistant Professor at SUNY and a force for improving policies to address infection control in hospitals.
Sharon Vanairsdale, RN, DNP, is the Program Director for the Serious Communicable Diseases Unit at Emory University Hospital in Atlanta. She manages unit readiness and hospital preparedness for patients with Ebola, Lassa fever, and other special pathogens. She coordinates clinical operations, staff safety, and patient outcomes. She is also the Director for Education within the National Ebola Training and Education Center, a federally funded collaborative between Emory, Nebraska Medicine, and New York Health and Hospital-Bellevue.
2. Experts in health care disparities
Considerable data shows that Covid has had a particularly severe impact on communities of color. Many nurses focus on health disparities, including how to deliver care to underserved populations.
Norma Graciela Cuellar, RN, PhD, is editor-in-chief of the Journal of Transcultural Nursing, Professor of Nursing at the University of Alabama and immediate past-president of the National Association of Hispanic Nurses. She has also researched Complementary and Alternative Health Care, which many members of the public embrace and it would be helpful to have these therapies addressed in regard to Covid.
Sheldon D. Fields, RN, PhD, NP, researches health care disparities, focusing on preventing HIV/AIDS in men of color. He also advised Senator Barbara Mikulski during the passage of the Affordable Care Act. He is Associate Dean for Equity and Inclusion at Pennsylvania State University.
Vickie Mays, PhD, MSPH, is a UCLA professor and clinical psychologist with a public health degree (and in fact, she is the one person on our list who is not a nurse). She directs the 60-person NIH-funded BRITE Center for Science, Research & Policy, working to eliminate physical and mental health disparities and reducing vaccine hesitancy in racial/ethnic minority populations. Dr. Mays has been working with members of Congress on a bill that would require better data on the race and ethnicity of people affected by the COVID-19 pandemic. She is also conducting research on creating better models to predict the spread of COVID-19, in order to reduce the number of infections and deaths in Black communities.
3. Experts in managing and improving clinical nursing environments
It is common for nurses to be excluded from decision-making panels, even though they are the ones delivering most of the skilled care. An overwhelming number of people who wrote us urged that the panel include direct care nurses and their advocates so they will have a voice in national policy.
Bonnie Castillo, RN, is Executive Director of National Nurses United, where she is also director of the Registered Nurse Response Network, a disaster relief program that has engaged in recovery efforts after various natural disasters. In 2020, Castillo was named to the TIME 100 Most Influential People of 2020. She would bring the perspective of direct-care nurses
Mary O’Neil Mundinger, RN, DrPH, Dean Emerita, Columbia University School of Nursing, has been a pioneer in the development of nurse practitioner practice and she is one of its strongest representatives.
Hilda Ortiz-Morales, RN, PhD, NP, is a direct care nurse practitioner at an infectious disease clinic at Montefiore Medical Center in the Bronx. Ninety percent of her patients are from diverse backgrounds, and this is a common feature of nurse practitioners’ practice.
Dave Hanson, RN, MSN, is a clinical nurse specialist who works to protect patients by fostering quality care environments where nurses can focus on the care only they can deliver—bringing in ancillary staff to do the rest. He is a dynamic leader with a reputation for team building, a collaborator and an extraordinary role model for nurses who strive to advance the profession and quality of patient care.
4. Expert in occupational health and protecting the workforce
So far roughly 2,000 health workers in the US have died from Covid, including many nurses, and a colleague of mine just last week. We need a strong occupational health focus to protect our health professionals and our healthcare system.
Bonnie Rogers, RN, DrPH, is an occupational health researcher and Chairperson of the NIOSH National Occupational Research Agenda Liaison Committee. She has served on numerous Institute of Medicine (IOM) committees, including Vice Chairperson for the Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A. She is currently a member of the first IOM standing committee on Personal Protective Equipment for Workplace Safety and Health. She completed several terms as an appointed member of the National Advisory Committee on Occupational Safety and Health and was recently elected Vice President of the International Commission on Occupational Health.
5. Experts in rural health
Many of the communities with critically high rates of Covid infection are now rural ones. Many nurses focus on care for underserved rural populations.
Mary Wakefield, RN, PhD, served as Health Resources and Services Administration in the Obama administration, supporting community health clinics. In her final two years she was Acting Deputy Secretary of HHS. She now directs the Center for Rural Health (CRH) at the University of North Dakota, strengthening the healthcare workforce, increasing health equity, and providing care services to patients who are geographically isolated, or economically or medically vulnerable.
6. Expert in mental health support for the public
Mental health care is critical in addressing Covid, not only because of the virus’s significant neurological effects, but also because the public at large has struggled with the challenges of staying home, lack of contact with family and friends, and overseeing children’s education.
Ukamaka Oruche, RN, PhD developed six innovative educational products for children with behavioral challenges during the Covid crisis, as well as self-care guides for parents, frontline nurses, and underserved communities. The videos can be seen at Be Well Indiana. Dr. Oruche can help guide public mental health wellness in the time of Covid.
7. Expert in palliative care
It’s not clear what was happening in this pit in El Paso, except that the patients surely needed far less CPR and far more palliative care. Hospitals and patients need more help putting a palliative care plan into action when death from Covid is the only realistic outcome.
Betty Ferrell, RN, PhD is expert in how to provide compassionate care to dying patients and their caregivers. She developed and leads the End-of-Life Nursing Education Consortium, which has trainers in 99 countries and all 50 states. She will be able to offer the Covid advisory panel guidance on how to improve palliative care and make it more widely available.
8. Experts in school nursing
School nurses are among the public health nurses who are most vital to controlling Covid, including through work in infection control and vaccine rollout. Many now work long hours contact tracing for the families at their schools, and there are plans for some to play a key role in Covid testing. Basically, they have taken on the work of the public health department, but without adequate staffing or support. Nursing takes time, resources, education, expertise and perseverance. Nurses who can bring the school nurse perspective to the advisory panel include:
Cathy Riccio, RN, MSN, MS, who had so many enthusiastic letters of recommendation submitted on her behalf. She is a school nurse with a degree in Environment Science who guided principals, teachers and staff in Newburyport, MA, on how to re-open schools safely—from health procedures and building operations to the emotional health of students, parents and faculty. She designed professional development materials in language simple enough for everyone to understand. She does contact tracing, delivers food, and acts as an air quality expert and guidance counselor. So far there has been no traceable spread of Covid within the schools she oversees.
Robin Cogan, RN, MEd, is a New York school nurse and frequent media contributor. She is a strong advocate for school children and will be able to give practical, realistic advice on how the nation’s schools can administer testing and roll out vaccines.
9. Experts in vaccine hesitancy, public education and health literacy
A large part of nursing care is aimed at developing strategies to educate patients about the disease process and paths to wellness. Because nurses are widely considered to be trustworthy, members of the public might be more likely to listen to health advice from them. And some nurses have focused on working to persuade reluctant members of the public to follow public health guidance.
Eileen Fry-Bowers, RN, PhD, MSN excels in health literacy and addressing vaccine hesitancy (countering anti-vaccination disinformation).
Blima Marcus, RN, PhD, is a nurse practitioner and assistant adjunct professor at Hunter College. She is also an excellent advocate and educator on vaccine hesitancy, especially in the Orthodox Jewish community.
10. Expert in pain management
Pain management is critical for Covid patients. Nearly every ICU patient on a ventilator is on a fentanyl (opioid) IV because being that sick and coping with all those tubes and procedures is painful. After patients recover, many continue to have pain because of the myriad long-term problems Covid causes.
Sheria G. Robinson-Lane RN, PhD, Assistant Professor, University of Michigan, focuses on pain management, especially in older people—who are hardest hit by Covid and can guide the way forward.
11. Expert in the ethical issues of how to allocate the nation’s health care resources
The panel would benefit from a nursing perspective in considering how limited resources are allocated, including how to balance support for public health measures and clinical care. In particular, as my own recent work providing ICU care to Covid patients has underlined, the current system is struggling to provide effective care with available resources. Vast sums are devoted to ICU care, but there are still insufficient ICU nurses and equipment to provide effective care to all Covid patients. For example, the survival rates for patients once they go on a ventilator is very low, unless they go on ECMO machines, in which case the survival rate is quite high. But we don’t have many ECMO machines. Should the Defense Production Act be invoked to make more? Would we save more lives if we re-directed some efforts to preventive public health work, such as educating society about protective measures and quarantine practice, contact tracing, coordinating vaccination and promising potential therapies, such as vitamin D supplementation? Nurses think about the lived experience of patients and help them plan how to cope with their new realities.
Connie Ulrich, RN, PhD, Professor of Bioethics, University of Pennsylvania, provided testimony to the Presidential Bioethics Commission on the importance of ethics education for nursing and how ethics education influences the moral action of nurses with their patients.
12. After the Inauguration—please consider current government employees
Rear Admiral Aisha K. Mix, RN, DNP, MPH is the Chief Nursing Officer of the US Public Health Service. There is no one more fitting to be on the panel than she is.
Cori Bush, from Missouri’s 1st Congressional District was just elected.
Final Note – Please consider using the Defense Production Act to protect health workers and the public
Nurses and other health workers cannot get enough N95s to work safely. In addition, if every member of the public had an N95, we could better prevent community transmission. An N95 protects the wearer, not just those around them. At my last hospital, I wore one N95 for 8 weeks straight. Other nurses have cared for patients with only a surgical mask—offering themselves up to the disease. Nobody should be sacrificed to Covid. If we invoked the Defense Production Act to fully address these shortages, we could better protect health workers and the community, and get the virus under control. On the other hand, I urge you not to encourage the manufacture of masks with valves. They only protect the wearer and we have to count on each other to protect us. Any mask mandate should make it clear that valve masks do not meet the requirements.
Thank you for considering our recommendations for how the Biden-Harris coronavirus advisory panel can better address the needs of the US healthcare system and the residents of our country. Please let me know if I can assist you in any way.
Sandy Summers, RN, MSN, MPH Founder and Executive Director The Truth About Nursing Co-author: Saving Lives: Why the Media’s Portrayal of Nursing Puts Us All at Risk 203 Churchwardens Rd. Baltimore, Maryland 21212-2937 USA phone 1-410-323-1100cell 1-443-253-3738 firstname.lastname@example.org www.truthaboutnursing.org
The Truth About Nursing is an international 501(c)(3) non-profit organization working to challenge stereotypes. We show that nurses are autonomous, college-educated science professionals who save and improve lives. Each year, the undervaluation and underfunding of nursing leads to millions of needless deaths across the globe. Better understanding of the profession will allow nurses to save all the lives they are capable of saving.