South Florida Hospital News
Friday October 23, 2020

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May 2020 - Volume 16 - Issue 11


Nurses Serving Through COVID-19

Nurses have always had a difficult job, whether caring for patients on their daily rounds, handling emergency room traumas, or reacting to crises on a regular basis. But treating a broken leg or responding to someone who had a heart attack or stroke does not necessarily result in danger to the nurses themselves.

However, the COVID-19 virus has put all of the individuals who care for patients in the proverbial line of fire. Not only are the nurses working longer hours and often being separated from families, but they are also in danger of contracting the virus themselves and possibly passing it along to loved ones.
As part of our Salute to Nurses month, we asked nurses in top positions to share their thoughts on some timely concerns. Participants include: from Baptist Health South Florida, Melissa Durbin, MSN, RN, NEA, Chief Nursing Officer, Vice President of Administration, Boca Raton Regional Hospital; and Diane Amado Tate, MS-HSA, MSN, RN, NE-BC, Chief Nursing Officer, Vice President of Administration, Doctors Hospital. From Memorial Health Care System: Shelly Delfin, APRN, MSN, NP, Memorial Regional Hospital South and Memorial Rehabilitation Institute; Leslie Pollart, Memorial Regional Hospital; Denise Reynolds, Memorial Hospital West; and David Starnes, Memorial Hospital Pembroke. From Tenet Healthcare, Armando Aguilera, BSN, RN, Nurse Manager, Coral Gables Hospital.
We asked:
You and your staff are under extraordinary stress … what are you doing to take care of yourselves?
Melissa Durbin – "We are supporting each other. Our leadership is present around the clock – days, nights and weekends – to ensure that our nurses have everything they need. This includes training, assistance, encouragement and proper equipment, such as PPE. This level of support has provided our team with a sense of comfort."
Diane Amado Tate – "We take time to celebrate the victories. We are working as a team, looking out for each other and making sure everyone takes time to reenergize. As a faith-based healthcare system, we also pray every day, and this has been immensely helpful during this difficult time."
Shelly Delfin – "At Memorial Regional Hospital South, we were working on balance and healthy resilience before the pandemic, but have obviously increased that of late. We start our daily huddles with a mindful/grateful minute, our psychology department has been doing mindful meditation by WebEx, and we have prayer time every Tuesday and Thursday. I personally make sure that I round daily to look for signs and symptoms of overburden and stress, and we make sure to have healthy nutrition around. Also, a little humor goes a long way!"
Denise Reynolds – "We've mostly focused on the health and well-being of frontline doctors, nurses, and support services. The response to a twice-daily community prayer for healing and protection has been overwhelming. We’ve also converted an area of the hospital into what we’re calling the 'Hero's Lounge.' It's a place where licensed clinical social workers and mental health counselors from our Behavioral Health team are available to staff for two to three sessions a day, serving both day and night shifts around the clock. Memorial has also offered hotel accommodations to employees who have small children or elder parents at home to lessen their fears of bringing the virus home to them.
"Last, but certainly not least, I can’t forget to mention the support we’ve felt from the community. Small and large businesses, restaurants, faith organizations, first responders, and the Chinese-American community have reached out to feed our staff, pray, donate valuable personal protective equipment, and send us cards and letters of encouragement. This support has been so uplifting. Our employees KNOW they are doing meaningful and important work, and that is what inspires them to keep going."
David Starnes – "We conduct multiple prayer vigils each week and the Memorial Healthcare System has redeployed outpatient behavioral health staff to the hospital to act as counselors. It's important that staff are able to release their anxiety, since much of what nurses do is very personal.”
"We've decorated our main hallway with a 'Hero Hall' theme by placing large cutouts of superheroes for staff to see when they come in the front door. We're not only caring for the community during the crisis, but are also susceptible to the virus ourselves, which elevates tension, so it's super important that we continue to focus on our people's needs and support them during these historically difficult times."
Armando Aguilera – “It is not a secret to anyone that this COVID-19 pandemic has taken a toll on all healthcare personnel ranging from doctors to janitors. The way I personally get rid of stress it by reading. I will be graduating with a master’s degree in 2 weeks from today, so I have a lot of reading to do preparing for my finals.”
What has been your main function in patient care?
Durbin – "My main focus is to ensure all patients and staff are safe. Our nurses are highly trained to practice the proper protocols and have everything they need to keep themselves and patients safe. COVID-19 patients are separated from the general population of patients. They are cared for on separate floors within our hospital and by a team of select nurses."
Amado Tate – "My main role is the oversight of patient care – ensuring that every patient receives the highest-quality care. We have highly skilled and competent nurses caring for our COVID-19 patients. I make certain that our nurses feel safe by providing them with a safe practice environment and the supplies and equipment they need to deliver outstanding patient care."
Reynolds – "We focus on timely evaluation of sick patients who come to the hospital for care and treatment, determining early on if a set of symptoms is related to COVID-19 or not. This allows us to take early action implementing infection control measures that protects the staff, while also triggering early clinical interventions that can influence the severity and progression of the patient's illness. The good news, if it can be called that, is that this illness follows a similar pattern in patients, both those with other co-morbid conditions, and without, so we know what to look for. Our medical and pharmacy teams collaborate closely on order sets that address the specific needs of these patients, and we've been successful in discharging many patients who initially came to us testing positive for the coronavirus. These are the ultimate victories for our team, and we take time to acknowledge and celebrate those wins."
Aguilera – “At this moment I have the role of Assistant Nurse Manager at the ER at Coral Gables Hospital. We do huddles in the morning prior to start the shift and discuss difficulties we might have had the day before in order to be better today.”
How are you caring for patients who do not have the coronavirus?
Durbin – "Our census of patients who do not have COVID-19 is down at this time. These patients are separated from patients with COVID-19 and are cared for by nurses who are not treating patients with the virus."
Amado Tate – "We have established special, dedicated care environments for patients with COVID-19, and our patients who do not have the virus are treated in a separate area."
Leslie Pollart – "We're providing the same level of patient and family-centered care Memorial Healthcare System is known for, but have implemented COVID-19-specific measures to reduce anxiety for patients who don’t have the virus. We test 100 percent of admitted patients and have designated specific units and operating rooms whose use is determined by whether someone is positive or negative for coronavirus. Restrictions on visitation have been a major source of anxiety for patients, so nursing has partnered with our information technology team to use iPads for video conferencing so patients can communicate with their families, and families can participate during physician and nurse rounds. Using technology in this way significantly improves communication and decreases the isolation of being hospitalized during the pandemic."
Aguilera – “All patients are screened for the disease, now those patients who do not show signs and symptoms of it will be placed in a separate area in the ER. We let the ER physician know to expedite their care.”
How do you determine which patients need greater care than others?
Reynolds – "People infected with this virus require a medical/telemetry level of care or critical care. Our early preparedness activities have positioned us to meet the needs of both types of patients, while also caring for patients with non-COVID illnesses and other health emergencies. We know people in the community are somewhat fearful of coming to the hospital now, but we’re here to care for them as we always have, which includes protecting them from spread of this virus."
Aguilera – “Clinical expertise is the key to this. After taking vital signs and triaging the patient then a nurse for sure will know to which area of the ER the patient belongs to receive proper care.”
Has anything gotten easier/better since this has started, e.g., perhaps better procedures or a more efficient process?
Durbin – "Processes have improved because recommendations from the CDC and other agencies have become more consistent. The protocols we follow have always been at the highest level."
Amado Tate – "The Doctors Hospital team spent a lot of time preparing to receive COVID-19 patients, so we were ready. For example, our facilities department constructed tents outside our hospital, and walls and partitions within our hospital, and established negative pressure units to isolate the infectious condition. Our leadership team enacted emergency preparedness protocols, and our amazing providers have consistently delivered the very best care."
Pollart – "If there’s a silver lining in all this, it might be the acceptance of telehealth as a viable alternative to the traditional in-person office visit. This virtual care platform has been quickly adopted by physicians, patients and their insurance companies out of necessity. Patients have embraced this technology due to its convenience, efficiency, and lower cost, and the pandemic helped break through the barriers that were affecting reimbursements. It has served as a catalyst to transform healthcare, and telehealth will continue to gain traction."
Reynolds – "As testing has become more widely available, we have certainly seen less of the 'worried well' population coming to our ER. The people who are coming now, almost universally, have a real health concern for which care, treatment, and perhaps, hospitalization is necessary."
Starnes – "Memorial Healthcare System continues to offer new and rapid COVID-19 testing strategies for patients and staff members. This allows us to better understand where the virus is and make quick clinical decisions to keep patients and our frontline employees safe. Throughout this crisis, MHS has been at the forefront of testing, and it's been a blessing to be part of such an inspiring and unique organization for the past 20 years."
Do you think more focus should be placed on the positive, such as how many people contract the virus, yet recover?
Durbin – "I think it is important to highlight both positive and negative reports. The reality is, our society seems to pay more attention to negative information. It is because of the negative stories that people take positive action to protect themselves and their families. And the positive stories give people hope and motivate them to stay vigilant."
Amado Tate – "The stories about the rising number of cases and deaths remind people that this is a very infectious condition. But we also need positive stories highlighting the many recoveries to calm the sense of panic and remind people that we will beat this."
Delfin – "YES! The kindness and love that we’ve seen during this crisis has been amazing and, in my opinion, restored a lot of people's 'lost faith' in humanity. The outpouring of support from communities for positivity and to hear about good outcomes is refreshing. With social media, it's easy to get pulled into negative news, I've experienced it myself, so I've tried to share a positive picture or story every day to remind healthcare workers that we are strong, united and healing."
Reynolds – "Absolutely. Just as we celebrate new babies being born by playing a lullaby theme over our PA system, we have recently added the theme from 'Rocky' to recognize every safe discharge of a patient who was diagnosed with coronavirus. We've also established a 'Victory Garden' around the flagpole in front of our hospital, which includes a white ribbon for every recovered patient. Our team finds strength in celebrating these battles won, and it provides the inspiration needed to keep fighting the virus in all the patients still battling inside."
What has surprised you most about the whole situation?
Durbin – "I am surprised that, in the early stages, many people did not take this seriously. Some people seemed to think this was a hoax. The reality is, this is like nothing else we have seen. We are going to battle every day."
Amado Tate – "I am not surprised, but I am very proud of our healthcare team members who have adopted new roles, new responsibilities, and new routines, and are working together to get through this pandemic."
Reynolds – "The resiliency, ingenuity, and commitment of our staff in working conditions that have never been more challenging. The PPE they take on and off dozens of times each day, staying behind an uncomfortable mask for 12-hour shifts, taking on challenges every day, and each time our team willingly steps forward to offer solutions and support. After we closed our facility to visitors, one of the first things we did was create ways to connect families with their loved ones. We've set up video calls, so family members can see and not just talk to patients, and, with the patient's permission, we provide updates on their status from the clinical team. In one particularly sad case, we were able to connect a wife and several children with their husband and father, to pray and say goodbye just minutes before he passed away. The team that cared for this gentleman received the most heartfelt thank you from his grieving family just days later. It's something none of us will soon forget."
Starnes – "Memorial Healthcare System has always had a robust disaster preparedness system in place, but what was surprising to me was the sheer size and scale of this pandemic and how quickly and decisively we were able to scale up. We're a large organization (14,000 employees), and without skipping a beat, we empowered a high-level clinical steering committee, arranged daily conference calls, enabled non-essential staff to work from home, and did it without any negative impact on the healthcare delivery system. Our frontline staff members are supported in a way few other healthcare systems could manage. It all proved to me there was no disaster too big for MHS to tackle together. They say it takes a village, and our village is as strong as they come."
Aguilera – “The reaction of the community. When I see so many people on the streets in this so called “quarantine” I truly think that people see this disease as a joke when in fact it is not.”
What have you learned since this started?
Durbin – "I have learned more about the strength and resolve of our incredible nurses. And I have been reminded about the power of teamwork, communication and support within our hospital and across our community."
Amado Tate – "I have learned the importance of a strong foundation and an effective leadership team. Our organization was prepared for the unexpected."
Pollart – "That the public now views nurses, doctors, respiratory therapists, and other frontline workers as first responders and respects our work in the same way police and fire departments were seen after 9/11. Nurses are now being thanked for their service and sacrifice by a grateful community. The healthcare team is now described as heroes, and it has invigorated our workforce with a rejuvenated sense of pride and dedication. The cohesion and mutual respect among nurses and physicians has strengthened exponentially as a result of the pandemic. We are creating new workflows and innovations that improve efficiency and safety for our patients and healthcare team. I think the notoriety the nursing profession is receiving will have a long-term, positive impact, attracting more people to a profession that is regarded by society as one of the most trusted."
Aguilera – “This ordeal reinforced me that life is the most valuable gift we have.”
If you could do or have one thing, what would it be?
Durbin – "If I could have one thing right now, I would have the medical intervention that would treat and stop this virus and save lives."
Amado Tate – "Truly, I have everything I need to work through this. I have the support of our nurses, respiratory therapists, physicians, administration and entire healthcare staff at Doctors Hospital. I am grateful that I work for Baptist Health."
Aguilera – “The hugs of all my family and co-workers. I cannot wait for this to be over so I can hug my co-workers again and tell them THANK YOU for the great job you have done.”
People have differing opinions: Do you believe wearing masks or bandanas in public will help the situation?
Durbin – "I believe that wearing a mask or bandana does help – it certainly does not hurt. At the very least, it keeps people from touching their faces while in public. And when people see others with masks, it reminds them to take this seriously and maintain social distance."
Amado Tate – "I believe everyone should be wearing masks to protect themselves. This is a very infectious condition and it is out there in our community. As demonstrated by other countries, the number of cases drops when people wear masks."
Delfin – "As humans, we need to feel psychologically safe in our choices, so if wearing a mask brings someone comfort, we should accept that and allow that person their freedom of choice. By allowing people to make their own choices, we help the situation in a way."
Reynolds – "I'm personally very supportive of the general public being required to wear a mask in places where several people are gathered, or where there is high probability of virus transmission via contaminated surfaces. Combined with social distancing, I believe we are seeing that these interventions are working to prevent widespread transmission of coronavirus."
Aguilera – “Absolutely, wearing masks in public areas is key to prevent spreading the virus. As well as wearing gloves and washing your hands.”
The number of cases and deaths around the country has escalated dramatically. Have you seen comparable percentages in your hospital(s) yet?
Durbin – "Fortunately, our statistics have been very low compared to the hot spots around the country."
Amado Tate – "At this point in early April, we are still seeing a rise in the number of presenting cases and ICU admissions."
How can the public help you do your job?
Durbin – "People can help us by following the guidelines to stay home and keep themselves safe. By doing this, they help to keep us safe."
Amado Tate – "The public can help us by wearing masks and practicing social distancing. We want people to be well – we do not want to see patients coming to our hospital or ICU with COVID-19."
Aguilera – “By staying home during this time of pandemic unless they have symptoms that require medical attention such as shortness of breath, high fever, low oxygen saturation.”
Is there anything you would like to tell the public?
Durbin – "I want to thank our community. We are so very grateful for their love and support. We’ve had local businesses bring lunch to the entire hospital. We’ve had community members line the road leading out of the hospital and honk and hold up signs as our night shift nurses left to go home. This made them cry. We feel appreciated, and it lifts our spirits."
Amado Tate – "We are here to help you. We need you to do your part by staying home. But, if you do get sick, we will care for you. And, together we will get through this."
Delfin – "Thanks for the outpouring of love and support for the healthcare community. Also, please understand that the measures we take – limiting hospital visits, social distancing, etc. – are only done so that we can provide the safest and highest-quality care. Following the rules ensures all our safety, whether there's a crisis or not; and while we're always willing to take care of the community, we need them to take care of us as well."
Aguilera – “With your help we will be back on our feet again in no time.”
To these and all nurses, we say THANK YOU!
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