The nursing profession has been riding a roller coaster these past two years as we lived with the pandemic.
In the beginning:
The World Health Organization designated 2020 the Year of the Nurse and Midwife spotlighting the profession internationally
Nurses were applauded by New Yorkers who stood on their balconies or hung out the windows of their high-rise apartments every evening at 7 pm to show appreciation for the care nurses gave the growing numbers of COVID patients
News coverage centered on the plight of the bedside nurse dealing with daily death and inadequate supplies along with the chronic nursing shortage
Stories surfaced in the media not only about nurses but written by nurses
Nurses were getting the attention they had long lacked and their contribution to the health of our population was being recognized
When the 7 pm applause from New York City residents faded, nurses still held the attention of the public into 2021. Media coverage showing nurses treating their acutely ill patients led many to seek nursing degrees.
We continue to see nurses leave the profession due to burnout, a persistent problem exacerbated by challenging working conditions. The industry standard of 12-hour work schedules may be more efficient for the hospitals than the nurses.
What we found was that any time after 12 hours, the medical errors that nurses were involved in started to escalate dramatically. And the reason that this was important is we found in our study that most nurses that were scheduled to work 12 hours really were there 13 or 14 hours. Linda Aiken, Conditions that are causing burnout among nurses were a problem before the pandemic,NPR, January 7, 2022.
An additional problem for nurses is that they are pulled away from the bedside to do non-nursing tasks, such as patient status documentation. Sandy Summers, The Truth About Nursing, has suggested that nurses need secretaries or assistants to do this burdensome chore. To this, I can only add Amen.
Going forward into 2022 I am cautiously optimistic, given that the pandemic has demonstrated that nursing does make a positive difference in the health care of individuals and communities, we will begin to see corrections to the problems stated above.
Back in the 70s we rented a townhouse in Arlington, Virginia that was haunted.
Now what made me remember this? Maybe because I, like many others, have been fixated on food while sequestered in my home over this past year due to the pandemic. Food and kitchens and houses. Now there’s a connection. Right?
Back in the 70s, I was young and energetic and loved to cook and entertain—even though I had a toddler and worked part time in the recovery room at a local hospital. Some of my best creations came from that tiny kitchen in the townhouse. My husband and I often hosted dinner parties for the other young families who lived in our cul-de-sac. Once, inviting several couples, I made my husband’s favorite meal: Sauerbraten, sweet and sour red cabbage, potato dumplings and, from scratch, Black Forest Cake. Foodies out there will know that Sauerbraten marinates for five days and then is cooked long and slow and Black Forest Cake is a bear to make. Not to mention the challenge of that cramped kitchen.
Back to the haunted townhouse. First, you have to know that we moved into a friend’s townhouse. Karl and his family outgrew their two-bedroom house and moved next door to a three-bedroom. He suggested we move into his vacated rental. We loved the idea of being close to our friends and having more room than our one-bedroom basement apartment, especially since I was expecting a second baby.
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.
The World Health Organization designation of 2020 Year of the Nurse and Nurse Midwife has taken a back seat to the sensational political news alerts that fill our lives as if nothing else is important. This post is just a reminder that nurses still are on the front lines of COVID-19 and make a difference in our lives every day.
Seton Hall students and faculty in the College of Nursing shared their stories and thoughts on being a future health care worker during the COVID-19 pandemic.
Caroline Pascasio, a sophomore nursing major, said her drive to become a nurse has remained steadfast in the face of the pandemic. She said she always knew she wanted to enter a field where she could help other people and feel as though she was having a direct impact on their lives.
“I remember when we were in the peak of COVID, I would always see on the news that they needed more nurses,” Pascasio said. “I wished I was just a few years older so I would have the proper training to help.”
The pandemic has also highlighted many stories from health care workers. Colleen Osbahr, a sophomore nursing major, worked in a hospital over the summer and said she experienced a situation like this firsthand.
“One woman was working as a nurse, and her mother tested positive for COVID and was in the same hospital as her,” Osbahr said. “She was not allowed by regulations to go into her mother’s room, and unfortunately, her mother passed away.”
Oshbar said the pandemic has been stressful for nurses working in “understaffed” hospitals with limited resources.
“All nurses are putting the health of not only themselves, but also potentially their families, on the line for the benefit of the greater good,” she said.
Dr. Katherine Connolly, a clinical assistant professor at Seton Hall, has been teaching nursing students amid the pandemic.
“I had the opportunity to work as a nurse practitioner in the hospital setting during the height of the COVID-19 crisis,” Connolly said. “I was very proud of the leadership and collegiality I observed given the uncertainty of the situation. I will never forget the deserted hallways decorated with beautiful cards of encouragement and thanks coming from school children or the loving support from the surrounding community.”
Some nursing students said they worry about adapting to the lasting changes that the coronavirus could leave on their field.
“This pandemic has definitely made me anxious because I know that our nursing curriculum will be different than anything it has ever been,” Pascasio said. “It’s just a little nerve-wracking because you don’t know what to expect. It’s not like you can ask an upperclassman because they’ve never done a clinical in the era of COVID.”
Connolly said she has heard many pandemic stories from her students.
“These students described feelings of helplessness as they were unable to assist COVID-19 patients due to shortages in PPE, which was reserved for doctors, nurses and respiratory therapists,” Connolly said. “As the supply of PPE improved—allowing many to move into the role of bedside provider—the task that most touched their hearts was assisting patients to FaceTime with family members at home, especially when the patient was not doing well.”
We are excited to announce a series of web discussions “Overdue Reckoning on Racism in Nursing” starting on September 12th, and every week through October 10th! This initiative is in part an outgrowth of our 2018 Nursing Activism Think Tank and inspired by recent spotlights on the killing of Black Americans by police, and the inequitable devastation for people of color caused by the COVID-19 pandemic.
Racism in nursing has persisted far too long, sustained in large part by our collective failure to acknowledge the contributions and experiences of nurses of color. The intention of each session is to bring the voices of BILNOC (Black, Indigenous, Latinx and other Nurses Of Color) to the center, to explore from that center the persistence of racism in nursing, and to inspire/form actions to finally reckon with racism in nursing.
Lucinda Canty, Christina Nyirati and I (Peggy Chinn) have teamed up…
I still remember the teenager but not his name or how long he had been getting peritoneal dialysis (PD). I recall him walking between his parents down the long hospital corridor. He was going home to die. A father with small children had preempted the teenager’s spot on the dialysis unit. Restricting patients was necessary because supplies and personnel were in short supply at the time. Dr. Norman Lasker, head of the Renal Division made that decision unilaterally.
I had taken care of the teen when he came in for twice weekly treatments. His mother and father came with him bringing magazines with pictures of sweaty wrestlers, which I found repulsive. Not having any brothers, what did I know about teenage boys? However, we did have something in common: the new TV show, Batman. I would watch the show each week (no binge watching then) so when the teen came on the unit, we would have something to talk about.
What happened to him after he was sent home? Hospice or palliative care hadn’t evolved, as yet. How did his parents manage? Did he wind up in a hospital at the end of his life?
I called Carol Passarotti-Novembre. She and I worked on the same research floor: a 15-bed unit at Pollak Hospital in Jersey City. Carol was the first renal nurse in New Jersey, working alongside of Dr. Lasker in one of the first Dialysis Centers in the US in 1961. Only three other major Dialysis Centers existed then: Boston, Seattle and New York City. Dialysis nurses received on-the-job-training.
Carol didn’t remember the teenager.
Of course, she wouldn’t since she had so many other patients. Some were on chronic PD, like the teenager. Patients came twice or three times a week, interspersed with emergency dialysis for acute problems like drug overdose, end stage renal failure, and post-surgical renal shutdown. For eight years, Carol was on call 24/7. Only once did she miss an on-call emergency. Another staff nurse from the research unit stepped in. The patient survived.
Later on, Dr. Lasker was no longer the lone decider. Carol told me that a “board consisting of physicians, administrators, clergy and others reviewed potential patients to receive dialysis treatments.” She sat on this board.
Carol ran the show at the Dialysis Center. The “Dialysis Center” was in reality four beds devoted to renal patients on the 15-bed unit.
The procedure for PD was as follows:
After warming two-liter glass bottles of dialysis solution in the sink, Carol hung them from an IV pole. The fluid flowed into the peritoneal cavity and remained in the patient for 30 to 40 minutes. The bottles were taken down from the IV pole, inverted and placed on the floor so the fluid would drain back into the bottles, which took another 10 minutes. Repeat. The patients stayed overnight since each treatment lasted 36 hours.
Carol managed up to four patients on Monday, Wednesday and Friday or Tuesday and Thursday. The day shift helped when we could. Evening and night nursing staff managed the PD during their shift. Carol discontinued the PD the following morning only to see the same patients come back the next day.
Not surprisingly, Carol got to know her patients and their families well, as did all us nurses, since each patient came to the unit so frequently.
One patient, Ellen, a slight Italian women with a large family, stopped breathing and became pulseless when I was in her room. I did what we were taught to do at that time. I slipped her on to the floor, struck her sternum with the side of my hand, breathed into her mouth and started chest compressions. The doctors on the unit came to assist me. We revived her. When she awoke, she told us she didn’t want to be resuscitated. We didn’t ask these questions in 1965. Happily, for me, when Ellen stopped breathing next, I wasn’t in the room.
Carol had an uplifting story to share:
“One of our patients was on PD for four years. Her local internist came to her home for each treatment, inserted the trocath [to make the pathway into the peritoneal cavity], and left. Her husband carried out each treatment. Even her little children helped with warming the bottles of dialysate. She switched to home hemodialysis for five years, then continued In-Center Hemodialysis for ten more years. At that point she received a cadaver kidney transplant, which lasted for a good number of years after.“
The following is from a speech Carol gave to nephrology nurses and technicians of North Jersey at Marriott Newark Hotel, Newark, NJ, May 6, 2011:
“The role of the nurse has changed along with each modality of treatment, the changing needs of the patients and families, the advances in technology and the increasing demands for specialized education in nephrology.
. . . My knowledge of nephrology was ‘on the job’ everyday type of learning. I depended upon the physicians I worked with. . . .Working for the medical school had its advantages. The most important being able to be involved in research projects. e. g., vitamin studies, various solute clearance studies, cardiac output studies in the chronic PD patient and also, in developing the original cycler and starting home training programs for PD and hemodialysis.
(Carol was the first nurse to be included in a research study citation in the Annals of Internal Medicine.)
Today’s nephrology nurse is involved in direct patient care, teaching in all the fields: PD, hemodialysis, transplantation to the patients and their families as well as research and development. National and local organizations, such as American Association of Nephrology Nurses and Technicians were formed in order to ensure a high standard of education on both a local and national level and making nephrology nursing an accredited and recognized area of nursing.
For me, the rapid growth and development in this area of medicine over the past 49 years, has been totally mind blowing, awesome, most exhilarating. The potential for future development is limitless!”
Carol married in 1968 and remained with the renal unit of the New Jersey College of Medicine and Dentistry Renal Division until mid 1969 when she left to have her first child. In 1971, she worked as a staff nurse in hemodialysis unit and later in the Hemodialysis Home Training unit at Saint Barnabas Medical Center in Livingston, NJ. In 1976, she joined a Renal and Hypertension practice as both an office nurse and researcher in many drug studies. Carol worked full-time, sometimes 50 hour weeks, before she retired in 2010 at the age of 70.
After reflecting on Carol Passarotti-Novembre’s long career in nephrology, I ask the obvious question. How could the development of peritoneal and hemodialysis have progressed without the collegial partnership between nurses and physicians?
I asked Martha Barry who worked with me at the Erie Family Health Centers in the early 80s, to remind me if the Certified Nurse Midwives delivered babies.
Here’s what she said:
The model for the Certified Nurse Midwives (CNM) when I arrived was outpatient care only. The CNM did all of the New OBs and sorted out the high-risk patients and cared for the other patients throughout their pregnancies, post-partum and follow-up gyn care. Prenatal care was intense case management. (We took) a lot of care and time to be sure no one fell through the cracks and got “lost to follow up.” Luckily, we could utilize the community health RNs to help find patients who did not show up for a visit. At the beginning, Medicaid was not widely available to all low-income pregnant women and especially not to non-citizens. The patients would be on a payment plan and would need to pay by “7-months” and it was a deal that included their prenatal, postnatal and delivery costs. I remember patients bringing their money stuffed in their bras to pay up at that 7-month mark. Deliveries were at Ravenswood Hospital. I wish I could remember the cost. The consulting OB physician would come to Erie for a few hours each week.
I also remember a few patients who worked at the live poultry plant and they said that although they had no health insurance, the boss would pay their delivery fees!
I was preparing for my talk to the first class of AdvancingPractice, a one-year fellowship to develop quality care and nursing leadership at the clinic I had worked in over 30 years ago and written about in my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers.
I read Martha’s words to the group of eight APRN Fellows especially showing the generosity of the poultry plant employer. Then I told the Pigeon Lady story from my book that ends with a neighborhood funeral home director footing the bill for the wake and burial of one of our patients. He then turned around and donated that amount back to the clinic. (It’s complicated) I wanted to stress the interrelatedness of the surrounding community on the health care clinic.
Part of my presentation was to discuss the historical context of the advancement of nurse practitioners and nurse midwives (collectively labeled Advanced Practice Registered Nurses, APRN).
One of the handouts for the class (Expanding Access to Primary Care: The Role of Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives in the Health Center Workforce, National Association of Community Health Centers, September 2013) plunged me back to the time I and other new APRNs in the Chicago area were struggling to justify our right to practice to the full extent of our training.
How much had I forgotten—maybe wanted to forget. For example, back in 1957 the American Nurses Association developed a definition of nursing that would retard the advancement of nursing practice for decades: nurses were neither to diagnose nor prescribe. And some groups of nurses called us “little doctors” and didn’t support developing educational programs in nursing colleges.
I hope the new Fellows I spoke to learned from my presentation something about the historical context of the role, the significance of the role in the community setting and the potential of the APRN career choice.
I close with a quote from the NACHC fact sheet:
An expanded role for nursing is an idea deeply rooted in nursing’s past and from it, much can be learned for today. Indeed, nurses should take this historical opportunity to think creatively about recycling elements of past practice for today’s unique context—perhaps initiating state-of-the-art nurse-run clinics in rural and inner city areas; reaching others by telenursing; and collaborating with designers in technology firms to create Apps and other high tech solutions to bridge gaps that exist in healthcare today. To do so, they must first read and understand the impact of the historical antecedents, cornerstone documents, and legislative acts that contribute to the nursing profession’s rich history.
Expanding Access to Primary Care: The Role of Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives in the Health Center Workforce, National Association of Community Health Centers, September 2013, Page 9
Sandy and Harry Summers review in their June 2020 The Truth About Nursing Blog a story that appeared in the Washington Post. I am always happy to see another example of the media covering nurses and nursing issues. And this time the authors talk about “what nurses actually do!”
However, it’s sad that it has taken a pandemic to call attention to the nursing profession.
The Summers, as usual, have done an exceptional job in their textual criticism of the essay.
Washington Postreport on nursing in Covid era offers unusually deep look at profession
A long April 2020 piece in thePosthad information from a diverse group of nurses. Of course, they were able to explain how itfeelsto be a nurse in the Covid-19 era—a common press theme now. But they also described the nature of the profession, what nurses actuallydofor patients, and nurses’ protests about inadequate PPE.
April 28, 2020 – Today the Washington Post had a good story by Dan Zak and Monica Hesse headlined “Nurses are trying to save us from the virus, and from ourselves.” That last part signals that this won’t be just a standard “nurse-hero” piece about how difficult it is to care for Covid-19 patients. Instead, the article manages to provide a surprisingly in-depth look at the nursing profession, from its historical roots to its key roles in patient surveillance and advocacy, including why many nurses are now protesting about shortages of personal protective equipment (PPE). One highlight of the piece is a capsule description of what direct care nurses do by Laurie Combe, the president of the National Association of School Nurses. Combe talks about the subtle but critical assessments and the vital psychosocial care nurses provide. The piece also discusses some of Florence Nightingale’s work to revolutionize care settings and improve survival rates in the 19th Century. And it describes nurses’ protest activities during the current pandemic, particularly efforts by members of National Nurses United to push for the federal government and hospitals to ensure that nurses have adequate PPE. One nurse protester mocks the “hero” narrative nurses often hear now as just “gaslighting” when it’s accompanied by a failure to provide them with PPE. These elements point to nurses’ key patient advocacy role, although the article does not make that link specifically. And the report is not perfect, as a few elements tend to support the incorrect notion that nurses are virtuous adjuncts of physicians, rather than autonomous professionals whose focus is serving patients. But overall the piece gives a vivid sense of what nursing is about and the situation of nurses trying to care for Covid-19 patients now. We thank those responsible.
Strong and smart
The Post report does start by discussing the demands of Covid care. It explains how hard it is to provide expert and empathetic care for 12 or more hours while wearing burdensome PPE in an under-resourced setting while “confronting the most frightening pandemic in 100 years.”
But then the piece backs up and asks what nurses really do. Apparently they are “the glue” and the “link between patient and doctor,” and their profession is consistently rated the “most honest and ethical” in Gallup surveys. Those descriptions are all somewhat problematic—the familiar polling point because it often masks a lack of true respect for nurses’ skills, and the earlier descriptions because they present nurses as adjuncts to physicians, which they are not. Nursing is an autonomous profession that exists to serve patients, not physicians. The reporters do say that nurses don’t want to be called heroes, but for the public to stay home and stay alive. And then they turn it over to a nurse expert, who picks up on the standard “most trusted” message the piece has just presented.
“But I don’t think that means people really understand what nurses do,” says Laurie Combe, president of the National Association of School Nurses. It’s a complex job, requiring knowledge of both biochemistry and psychology, in myriad environments. Nurses are helping your fourth-grader learn to track her insulin levels at school, and they are putting pressure on a gunshot wound at 2 a.m. while noting that the victim has no pulse. They are monitoring both your heart rate and your spirit. When they touch your arm, in what would appear to be a simple gesture of friendliness, they are also testing if you’re hot, swollen, dehydrated, tremoring. “I can observe what is on your bedside table that you’re reading — if I can talk with you about that, I can strengthen our connection to build trust,” says Combe, who has been a nurse in the Houston area for 45 years. “I can see who’s in your room visiting, what the interaction looks like, and see whether that’s a trusted person or not, so I know what I can talk about during that visit.”
This is one of the best capsule descriptions of nursing that we have seen in almost two decades of doing this work. Ten stars for Laurie Combe! She identifies the problem with the angel narrative, and then she addresses it, with a short, compelling description of how nurses help people in ways few even realize are happening.
The piece moves on to note that the coronavirus has changed what nurses do, as they may be working in unfamiliar units under extreme conditions without adequate PPE, “facilitating virtual goodbyes with dying family members” and “organizing protests against hospitals and the White House.” Some are running Covid testing sites, and the article profiles Brenda Lagares, who had been a “night nurse” in New York City before being recruiting to be a “sampling nurse” at a drive-through testing site in Bear Mountain, NY. She tests motorists after having “been given 15 minutes of training to potentially save their lives.” These descriptions do not convey a very full picture of nursing education or expertise. Fortunately, Lagares gets to explain what she does for patients even in the fast-paced and limited drive-through setting. She describes how, even encumbered by PPE, she can read patients’ emotional state (by examining their eyes) and provide reassurance (with explanation, encouragement, a wave and a thumbs up). The article also talks to another nurse at a test site, in Orlando, FL. Sasha DeCesare went to nursing school in Venezuela. DeCesare believes it’s great to be a nurse in the U.S. because (in the report’s words) “it’s a female-dominated profession, filled with strong and smart women.” But now she has worked 22 days straight, and sleeps in a hotel to protect her family from infection.
The piece has some history. This starts with Nightingale’s work for soldiers in the 1850s Crimean War, which the article explains in some detail. It involved better hygiene, ventilation, nutrition, and fundraising. As the piece explains, “the death rate for admitted patients fell by more than half. [Nightingale] wasn’t only a caretaker. She was a revolutionary.” And she wrote Notes on Nursing, which “became a bible for modern care.” The piece quotes Barbra Mann Wall, director of the Eleanor Crowder Bjoring Center for Nursing Historical Inquiry at the University of Virginia, on the diversity of early nurses in the United States. (The piece might have noted that Mann Wall is herself a prominent UVA nursing professor with a PhD.) Apparently relying on Mann Wall, the piece describes the growth of nursing during and after the Civil War, as well as the development of nursing education from a two-year apprenticeship based mostly on skills — wound care, bedsores prevention — to a four-year program equally based on science. … Eventually, nursing would encompass a range of specialties and career paths; a nurse anesthetist might make $175,000 a year, while a nursing assistant might make $14 an hour.
Not surprisingly, the piece pauses at the 1918 flu pandemic. Apparently relying again on Mann Wall, it notes that the best treatment available then was “rest, hydration, hygiene — the pillars on which Nightingale had built her practice.” And it quotes then-health commissioner of Philadelphia Wilmer Krusen on what was needed in that epidemic, given that beds and physicians were in sufficient supply: “Nurses, more nurses and yet more nurses.” That is a timely comment today, when much of the early media on Covid-19 focused on beds and ventilators, ignoring the nurses who would be needed to care for the patients using that equipment.
And the article has a substantial amount of material on the protests, i.e., the patient advocacy. The reporters explain:
People keep saying that nurses are on the front lines, but they are actually behind enemylines, surrounded on all sides. They are trying to save us, and save us from ourselves. Nurses are protesting protesters, standing in their scrubs and masks to glare at “freedom-loving” citizens who spew insults as they rally for the economy to reopen. Nurses are taking to social media to convey the extremity of their situations: They talk about war zones, about titrating a dozen IV drips while troubleshooting fluky ventilators, all without reliable stockpiles of supplies.
The piece relies fairly heavily on Elizabeth Lalasz, a Chicago union steward for National Nurses United (NNU). Lalasz herself was out of the clinical setting for 18 days with Covid-19, which she says she got because of inadequate PPE; she calls the nurses “cannon fodder.” The report explains that Lalasz became a nurse in her 40s, after watching an oncology nurse caring for her dying father advocate successfully for him “against a phalanx of male superiors” to go home to die, 35 years ago. Presumably that means a group of physicians; of course, they were not “superiors,” but surely they had far more power, so that sounds like some impressive advocacy.
And Lalasz does some advocacy too, pointing to the dysfunctional U.S. health care system, which even before Covid-19 “left front-line workers feeling burned out, with high rates of attrition and suicide.” The reporters also talk to nurses at the California hospital that suspended 10 nurses for refusing to care for Covid-19 patients without an N95 mask. One of the suspended nurses, Jack Cline, explains why the surgical masks are inadequate, regardless of CDC guidelines saying otherwise. The piece also describes the recent White House protest by NNU members seeking more PPE for health workers—over 230,000 of whom have been infected with the virus, and 600 nurses have died from it. One protesting nurse was Charles Dalrymple, who spends hours caring for Covid-19 patients in negative-pressure rooms, in some cases helping them say goodbye to family through virtual means. He held a sign saying “20 SECONDS WON’T SCRUB THE BLOOD OFF YOUR HANDS,” with “HERO” in quotes. Why the quotes? Dalrymple said:
I feel that it’s being used to placate us — gaslighting this entire situation. A ‘we signed up for this’ kind of thing. But we didn’t. We didn’t sign up to go into a room without proper gear. . . . They can’t be throwing this word around just to make it seem like, ‘Oh, it’s okay that they’re dying. It’s because they’re heroes.’
Right. Nurses have always faced the virtuous-angel narrative, in which they get lip service but are expected to endure abuse and resource shortages without complaint. But now, the “hero” narrative seems to be functioning in a somewhat similar way for everyone on the Covid-19 front lines. If we call them heroes enough, and have the Blue Angels fly overhead to say thanks, then apparently it’s OK that we are still not giving them the PPE, tests, and other supplies they need.
On the whole, because of the detail about what nurses actually do, the material about the history of nursing, and the reporting on nursing advocacy—particularly the PPE protests—the piece is an unusually valuable one in the Covid-19 category. We thank those responsible.
As I write my second book, which is about the home visits I have made over the years, I am resurrecting memories from my mind and the pages of my journals. Today’s post shows a time when I didn’t use common sense and how home visits can be fraught with danger.
One day in early fall, on my drive back to the hospital after making all my scheduled home visits, I found myself passing by a patient’s apartment on the westside of Chicago. Since I was ahead of schedule, I decided to drop in, unannounced. I had the time. My patient had a caregiver: a tall, muscular man who always opened the door to the first-floor apartment wearing a long blond wig and thick make-up. Despite his flamboyant appearance, he gave competent care to his charge: a bed-bound, uncommunicative middle-aged man with multiple sclerosis. An exotic array of visitors wandered in and out of the apartment. My patient’s mother, strikingly average looking compared to the rest of the visitors, lived in rooms above her son’s and was often present when I came. However, this day I walked into an unlocked and empty apartment. Only my patient, lying in bed in the darkened bedroom, was present.
Neither the caregiver, nor the patient’s mother, or anyone else familiar to me entered the apartment while I was there. However, as I finished with my evaluation, a man opened the unlocked apartment door. He wasn’t anyone I had seen before. My patient smiled at him knowingly.
The man removed his jacket and tossed it on the sofa. We introduced ourselves. His eyes moved down my body. Acutely aware of the precarious situation I was in—alone in that apartment with a strange man and unhelpful patient—a band tightened around my chest.
“I’m just leaving,” I said as I promptly packed up my nursing bag.
Safely back in my car, my breathing heavy and my hands shaking, I chastised myself for making this impulsive visit. No one back at the office knew where I was. It was a time before cell phones. What If something had happened to me? I didn’t want to think of that. I never again made an unscheduled home visit.
Sometime after that impromptu visit, at a nursing conference, I sat fixated as another home health nurse told a story about the time that she had made a scheduled visit. She rang her patient’s doorbell. He didn’t answer. It was later that she found out he had been murdered. And in hearing more detail, she discovered that the murderer had likely been in the house the exact time she was ringing the bell. Good thing the door wasn’t unlocked.