Throughout the 43 years I've practiced nursing, I'd be lying if I said I have never felt anxious when going into work. As a new nurse, my anxiety centered around what I did not know and how it might affect my care. Over the years, transitioning into new roles, new areas, or new facilities also elicited some anxious feelings.
I don't ever remember actually feeling a bit afraid to go to work though, not even when we were screening for Ebola patients. But that has changed. I'm 63 with high blood pressure that is controlled, and I work in the emergency department, meaning I am one of the first contacts for people with coronavirus. And, I have a healthy dose of caution when I go into work.
Here’s how my morning starts
I prepare for potentially spending a day in full personal protective equipment (PPE).
Our facility, like many, has set up a tent area by the emergency department (ED), so those stable patients who screen positive for COVID-19 symptoms can be tested, treated with Tylenol for fever, and await results of flu and strep tests and a chest X-ray before being sent home with instructions on self-quarantining. We are only doing rapid coronavirus testing on admitted patients, so those sent home have to wait 6-8 days for results.
Those of us manning the tents wear full PPE—an N95 mask covered with a surgical mask (we use the one mask all shift), goggles, face shield, gown, head cover, shoe covers, and gloves. This week, we started changing into hospital-provided scrubs prior to donning equipment to save us from wearing dirty scrubs home. So, I decide to not put on makeup because it comes off on the mask anyway. I put my hair up so it will fit under the cap. I carefully check that I have my work tools in a plastic bag—general items I use frequently, like my special magnifying goggles (because I can't see close up and taking glasses on and off in full PPE is an ordeal), my change of clothes and slides to wear home (I might not be in the tent today), my industrial half-face respirator with the 30-day filters (if I have a patient in main ED who is a person under investigation, I want to be prepared), and my special long gloves that fully cover my wrist for the same reason.
Reporting for battle
At work, I figure it is my turn to go to the tent, and I’m right. Our area has started seeing a few more cases, but we have been eerily, unseasonably, unprecedentedly slow. Many spend the whole day in the tent without seeing a single patient.
A couple of my coworkers step forward to volunteer to go instead of me. They've been protecting me since this started, and it fills my heart, but it's not fair to them. So, I explain that I actually feel a bit safer out in the tent with full protective gear, knowing that these people are being ruled out for COVID-19 rather than being given a patient we might find out is positive after a couple of hours. Because we are still triaging patients who screen negative wearing only masks and goggles, we've been asked to ration gowns and wear one only if the patient is under investigation, not for the general population. We also must reuse the gown until the patient is gone. I ordered some of my own gowns a week ago. Hopefully, they will be delivered before the hospital runs out. I'm also making more face shields, as those have been in short supply from the beginning. Fortunately, many in the community have stepped up and made face shields for us to use.
The patients we do see in the tent are stable but have suspicious symptoms. They sit in a circle around the nurse, who is seated at a workstation with a computer in the middle of the tent, at least six feet from each other. All have been screened in Tent 1 by a provider, swabbed where indicated, X-rayed, and masked before being sent to my tent to await results. The numbers are few right now—rarely more than two patients at the same time. Still, I think about what it may be like to be surrounded by persons under investigation who are coughing into their surgical masks, some taking them off to do so. I think I may consider moving my station to the tent door when that happens.
My facility has approved use of equipment brought in from home, as they recognize the benefit of having employees feel their safety and welfare are important to those in leadership. I feel most hospitals are trying desperately to source PPE for their staff; unfortunately, they are bidding against each other, which seems wrong and unfair. The federal government dropped the ball on this one—their role is to provide in times of disaster, and they've not fulfilled that role, in my opinion.
Another day down
After my shift, I change into street clothes at work, including my shoes. Dirty scrubs go into a plastic bag, securely tied off. Shoes are wiped with disinfectant, then placed in their own bag, to be placed into a plastic bin in my car which I spray with disinfectant. Anything I've touched gets wiped down and placed in a separate bag. My N95 goes in a paper bag with my name on it since we have been asked to use them for three shifts. When I get out of my car at home, I wipe down the seats, steering wheel, and anything I might have touched with disinfectant wipes, too. My first stop at home is the shower, to clean off anything residual that might infect my 65-year-old husband.
This is my new reality and that of healthcare workers across the world. One I will repeat tomorrow, and next week, and probably for the next few months, even though I am more anxious than I ever was through the AIDS epidemic, the Swine Flu, H1N1, and Ebola. Because this time, we might run out of the equipment that keeps me from getting exposed and getting sick. And getting sick may be deadly for me. However, I chose this path because I wanted to help people and make a difference in this world. So, I will be there for those who are likely more afraid than I am.
Penny Blake, BSN, CCRN, CEN, is an emergency room nurse in a large community hospital in south Florida and is the president of the Florida Emergency Nurses Association. She is a member of Sigma’s Phi Pi Chapter at Chamberlain University.