While it was time consuming, I loved doing the April Alphabet Challenge A to Z. It got me writing new stories, released memories I had forgotten and expanded my writing skills. Going forward with my Blog, I will intersperse more personal tales.
This is a timely decision since nurses are getting greater attention being on the forefront of the pandemic. Look what nurses do, shout the headlines. Plus, nurses are writing their own stories in essays, news media and books in greater numbers. This is just fantastic. I feel more comfortable cutting a back bit on my emphasis to show how nurses make a difference.
Also, there seems to be a national movement to grant nurse practitioners the legal authority to practice independently. That is, to practice without physician oversight. While I was busy constructing a daily post for the month of April, a friend emailed me an article about nurse practitioners titled: We trusted nurse practitioners to handle a pandemic. Why not regular care? (Lusine Poghosyan, The Niskanen Center Newsletter, March 9, 2021). Before COVID-19, only 22 states allowed NPs to practice independently. Since then, governors of 23 states have signed executive orders to permit NPs to practice without physician agreements.
Sadly, it took a pandemic to unearth the truth that nurses and NPs do improve patient care and make a difference in the health care system.
I’ve signed onto The Blogging from A to Z April Challenge 2021.
The challenge is to blog the whole alphabet in April and write at least 100 words on a topic that corresponds to the letter of the day.
Every day, excluding Sundays, I’m blogging about Places I Have Been. The last post will be on Friday, April 30 when I finally focus on the letter Z.
C: Coney Island
Last year, I had planned on taking my grandsons to New York City with a side trip to Brooklyn to scour the neighborhoods and check out the restaurants and, especially, to see Coney Island. The COVID-19 Pandemic interrupted my plans.
Truth be told, I really wanted to go to Coney Island. I haven’t been there since the 50’s. My high school friend, Gloria, and I would take a couple of trains from Jersey City to Brooklyn at least once a week during summer vacations. Besides slathering baby oil on our bodies and roasting in the sun, we also went on the rides:
Steeplechase horse ride
I’ve read that the Parachute Jump still stands since it has been designated a city landmark but Coney Island as I knew it is gone. No matter, when I return the beach and ocean will greet me.
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 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.
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.
In my post on September 22: Nursing Students Provide Insights into the Pandemic, I spotlighted the thoughts and experiences of the nursing students from Seton Hall University, New Jersey, as they cared for Covid-19 patients.
Today’s post has the same focus but this time nursing students from the United Kingdom share their stories about working on the front line of the pandemic. ITV News from the United Kingdom discusses a new book: Living with Fear: Reflections on Covid-19 that was written by twenty-two nursing students plus other health care providers. The feelings that were expressed by American nursing students are mirrored in the UK nursing stories. The pandemic serves as a backdrop to reinforce the positive impact that nursing has on health care delivery and shows the general public how nursing care makes a difference.
United Kingdom Nursing Students Launch New Book About COVID-19
Video report by ITV News Correspondent Lucy Watson
Wednesday 14 October 2020, 7:16pm
Student nurses who were recruited to work on frontline NHS services to respond the coronavirus crisis have shared their stories in a new book
The trainees faced the daunting task of being placed in frontline positions at hospitals around the country whilst finishing their studies amid a global pandemic.
Now, some have written about the personal and professional challenges that inspired them to flourish at a time of national crisis.
Entitled Living with Fear: Reflections on Covid-19, the book tells the stories of 22 nurses and other frontline professionals reflecting on what they experienced and how it impacted them.
Ikra Majid reads from the book. Credit: ITV News
Student nurse Ikra Majid did placements at various hospitals in London and Hertfordshire during the pandemic.
She now works at Chase Farm Hospital in Enfield.
“There did get to a point where I thought, why I am I doing this, it’s too much. I didn’t sign up for this pandemic,” she said.
“We have to make the best of it. As people say, when life gives you lemons you make lemonade. I tried to make the sweetest lemonade possible.”
She added: “The pandemic has made me realise even more what an important job we do.”
“This book shows that fear doesn’t define or take away the skills and experience of medical professionals, but rather helps them to grow a new way of thinking and working.
“When our students were called into practice, it gave them a true sense of what nursing is. They helped to saved lives and became superheroes in their local communities.”
Another one of the authors, Estelle Kabia, helped patients at the Hammersmith & Fulham Mental Health Unit during the pandemic.
“Covid taught me to be the nurse I want to be,” she said. “It’s an unbelievable feeling, I don’t think I will ever do anything as big in my whole life.”
Estelle Kabia helped patients at the Hammersmith & Fulham Mental Health Unit.Credit: ITV News
The book also explores the concept of ‘moral injury’ where nurses feel unable to provide the care the patient needs leaving them to question their own ability.
Ms Kabia said: “Sometimes I felt moral injury as we were picking up new practical skills whilst dealing with sick patients coming in, but it would come and then go, because after a few weeks I could see the impact I had.
“In one way, stepping up was nerve-wracking but it also gave me the passion to go out there and help. You’re treated as a professional, not a student. I had no fear when I was on the ward.”
Claudia Sabeta, who finished her postgraduate course specialising in mental health nursing at Buckinghamshire New University this summer, worked at Northwick Park Hospital in Harrow helping vulnerable and elderly mental health patients.
She said: “At first, I felt very overwhelmed by the Covid situation and I was worried about joining. I wondered how I would cope and if I’d put my family at risk.
“But it was a great experience in the end and an opportunity I will never have again in my life.
“It had a positive impact on my knowledge and training, and boosted my confidence. I learned so fast and it will stay with me forever.”
In mid-April, NHS England reported that nearly 15,000 student nurses, midwives and medical students had joined “frontline NHS teams as part of the nationwide coronavirus fightback”.
Proceeds from the book will go to the Central and North West London NHS Foundation Trust (CNWL) Charitable Fund, which supports staff and service users.
Dr Scott Galloway, one of the book’s authors and Chief Clinical Information Officer at CNWL, said: “Every day, frontline healthcare professionals manage the challenges and stress of making difficult and uncomfortable decisions about how to provide the best possible care to patients.
“Sometimes, however, our capacities are so overwhelmed by extraordinary events, such as Covid-19, that we are unable to provide what we know the patient needs.”
One of the book’s editors Margaret Rioga, Associate Head of School in the School of Nursing and Allied Health at Buckinghamshire New University, said: “The Covid-19 pandemic had an impact on everybody and created fear within us like never before.
“This book shows that fear doesn’t define or take away the skills and experience of medical professionals, but rather helps them to grow a new way of thinking and working.
“When our students were called into practice, it gave them a true sense of what nursing is. They helped to saved lives and became superheroes in their local communities.”
I drive to the Farmers Market on this dreary Friday. Frankly, it’s nice to have a break from the sunny, humid days. The gray skies impersonate an early Fall and lift my spirits.
This trip gets me out of the house and into a semblance of normalcy that I remember before the COVID-19 pandemic and stay-at-home orders began.
Since I plan to write this week’s post about the Farmers Market, I park the car near the entrance to take a picture of the main signpost. On my way back to the car, I notice a white face mask on the road. It looks like mine. It is mine. What are the chances it dropped onto a smear of COVID-19 germs? After a brief hesitation, I pick it up and put it on my face.
When I come to the Farmers Market, I like to start at one end of the Farmers Building (which is 30,000 square feet) and work my way down the main aisle checking produce and prices on either side. Then, I turn around when I reach the end and retrace my steps, this time making purchases.
Today, all I am going to do is buy peaches and take pictures.
The market organizers have done away with the wide middle lane running north and south. Now, multiple one-way aisles travel east to west, bisecting the individual farm stands and promoting safe-distancing.
Without the pressure of buying ingredients for a dinner, I am free to enjoy the lovely presentation of produce. I snap pictures as I travel past the arrangements of bright red tomatoes, varieties of eggplant and various chilis categorized according to heat index.
I stop by one of the many corn stalls. A women is husking corn. Before we moved to North Carolina, I had never seen a trash bin near the corn displays at Farmers Markets or in grocery stores. Shoppers are invited to husk the corn and dump the husks into a trash bin provided by the grocery store or market before purchasing the corn. While this may be more convenient, as my southern neighbors tell me, I adhere to the common knowledge that corn in their husks stay fresh longer.
I take some pictures of the corn stall only after asking the permission from the woman who is husking corn. She nods and continues to husk, not paying me any mind. As I’m leaving, she tells me the corn season is winding down. At that news, I steel myself not to buy any more corn since my husband and I have had corn in many reiterations and there is a large container of corn and crab chowder in the refrigerator.
As I turn to leave the corn stand, I see a woman at the other end of the market waving at me. She smiles and points to her head and gives me a thumbs up. She’s commenting on my purple hair. Pandemic purple I call it. I give her a thumbs up, too. When coloring one’s hair was more popular, I kept my white hair. Now it seems I am pretty much an oddity. I like swimming against the current. I may change colors when this hue fades. Maybe a soft blue or intense red will be the next dye. Social isolation has a strange effect on me.
I leave the Farmers Market carrying one bag of peaches.
Black bean and corn salad
Original recipe yields 6 servings
⅓ cup fresh lime juice
½ cup olive oil
1 clove garlic, minced
1 teaspoon salt
⅛ teaspoon ground cayenne pepper
2 (15 ounce) cans black beans, rinsed and drained
1 ½ cups frozen corn kernels ( Use fresh in season)
1 avocado – peeled, pitted and diced
1 red bell pepper, chopped
2 medium whole (2-3/5″ diameter) tomatoes, chopped
6 medium (4-1/8″ long) green onions, thinly sliced
½ cup chopped fresh cilantro
Place lime juice, olive oil, garlic, salt, and cayenne pepper in a small jar. Cover with lid and shake until ingredients are well mixed.
In a salad bowl, combine beans, corn, avocado, bell pepper, tomatoes, green onions, and cilantro. Shake lime dressing and pour it over the salad. Stir salad to coat vegetables and beans with dressing and serve.
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.
Anthony Langley contacted me to ask if he could send me a copy of his book to review and possibly discuss on my Blog. I am always happy to support a fellow nurse who takes the plunge and writes a book about nursing, so I said sure.
About the Author
Anthony Langley has been a registered nurse for twenty-nine years. He also has a bachelor’s degree in criminal justice. His interest in nursing started after getting a job as a security officer in the emergency room of a hospital. A male nurse who worked in the emergency room showed him the things that nurses did, which got him interested in nursing.
He got his bachelor’s degree in nursing in 1990. At his first job, he started on a medical-surgical unit. He has worked in many areas of the hospital, which include surgical stepdown unit, surgical intensive care, same-day surgery, and the post-anesthesia care unit (PACU) recovery room.
I have had pandemic on my mind since last April. I can assure you that I am not a prophet or clairvoyant. The reason is quite personal: my grandmother died in the Great Spanish Influenza pandemic in October 1918.
My father had told me his mother died when he was only 5 years old; she was in her 30s. But he never told me how she died and I never asked. But last April I begin doing ancestry research and discovered the cause of her death. Having learned how she died, I continued to wonder about the circumstances in her family and her community in 1918.
Actually, I have been mourning the loss of a relationship I might have had with my grandmother. And imagine my surprise when I found out during that search that her birthplace and home were in Westfield, NC – the place…