health care workers dealing with COVID 19

Helpers in Health Care | The Helpers Next Door

May 7, 2020  | 108

by Laurel Bower

The numbers in Iowa regarding COVID-19 are constantly changing, making it especially difficult for those working in health care. Doctors and nurses are on the front lines trying to keep up — some treating patients with the virus and others facing the reality that they too will come across someone who tests positive. Each case of COVID-19 is different and each person in health care experiences their own unique set of circumstances. Iowa PBS caught up with two women working in health care. They share their experiences with COVID-19 so far, their struggles and their concerns for the future.

Sarah Brown is a family nurse practitioner who works in an urgent care clinic, an emergency room and a family practice clinic. Brown wishes not to name her places of work.

What kind of work do you do and for what kind of places?
I am a family nurse practitioner and I work in urgent care, ER and at a family practice clinic. I am the sole provider in the ER and the family practice clinic. As a nurse practitioner I evaluate, diagnose and treat the patient for various illnesses and manage chronic health conditions.

Have you been caring for people that have COVID-19?
I have been evaluating people in the urgent care with suspected cases of COVID-19. At this time, we are initially evaluating for fever. If fever is present then a rapid influenza A/B test is performed. If the influenza test is negative, then a COVID-19 test is obtained.

If we suspect COVID-19, patients are told to go home and quarantine for 14 days since the test results can take up to one week to arrive. I encourage fluids, acetaminophen, ibuprofen (if acetaminophen is not sufficient), hot tea and honey. If they have underlying chronic health conditions, I may recommend the above measures in addition to nebulizers, steroids and/or antibiotics. They are told to go to the ER if they have severe respiratory distress or chest pain.

What kind of symptoms are you seeing? How do they vary?
We are seeing fever with measured temperatures above 100.4 F. However, I have seen positive COVID-19 results in non-feverish patients. Coughing, body aches, shortness of breath, chest discomfort and sore throat are all potential symptoms. Some have very mild symptoms, others more severe.

Can you give some examples of some of your experiences so far?
Our urgent care put up signs right away to direct people back to their vehicles if they were experiencing any COVID-19 symptoms. However, one patient ignored our sign and walked into our clinic. At that time, we only had surgical masks, no gowns or face shields. We had to isolate the patient to one room, go to another department to find gowns and eye shields for a nurse and the physician’s assistant to wear while evaluating the patient. We had to call the State Health Department for direction. She was then transported to one of the metro hospitals for COVID-19 testing — we had none available. We had to shut down our urgent care for 15 minutes to clean and the room where the patient was evaluated was kept off limits for the remainder of the shift.

When the virus broke out, what kinds of preparations were your facilities making?
In our urgent care, there were signs placed upon entry into the building that asked patients to return to their vehicle and call their provider if they were experiencing any COVID-19 symptoms. We still did not have the proper personal protective equipment (PPE) like N95 masks or face shields. It was soon realized that patients weren’t reading the signs and checked in despite the warning. Because of this, our urgent care was the first in the Des Moines metro area to set up drive-up testing. This allowed for patients to be tested in their own vehicle, without potentially spreading the virus. We also received multiple emails daily from our medical director, keeping us apprised of every change (which was sometimes hourly). The family practice clinic I work for is very rural. The administration made no preparations and told us to continue business as usual.

Was the reaction in the places where you work delayed? Problems?
The reaction in our urgent care was not delayed, and continues to evolve, but there continues to be a lack of PPE. Many nurses are only wearing surgical masks and not the required N95 masks. Providers (doctors, nurse practitioners, physician’s assistants) are either wearing just the surgical masks or reusing their N95 masks. One of our physicians handmade several face shields.

The rural clinic continues to let potential COVID-19-positive patients in to be evaluated with healthy patients. We try to keep them in one room, but they are walked back through the waiting room, through the patient care area and nurses desk and into their examination room, potentially contaminating the whole building. Our administration has been very reluctant to set up proper screening areas, allow for pre-screening and rescheduling patients for routine visits like physicals or well child exams. We have been told repeatedly to continue “business as usual.”

Fortunately, the healthy patients coming in for routine issues are canceling their own appointments to avoid exposure. There is a disconnect between the frontline providers and administration. The administration is not staying up-to-date with the most recent recommendations, which change daily, and if they are aware, the recommendations are ignored. Administration members get to sit in their office or at home, while clinic staff and providers are working without adequate protection.

Are these kinds of facilities always prepared for a pandemic like this?
No.

When the virus arrived in the U.S. and specifically in the places that you work, did you as a health care provider feel prepared?
No. We did not have the recommended PPE — and we still don’t.

What kinds of shortages are you dealing with?
We do not have any N95 masks in urgent care. We do have gowns, gloves and homemade face shields. However, we are being asked to reuse our PPE when it is usually worn for one-time per patient use. We have a shortage of masks (both N95s and surgical) in the rural clinic. The corporation that owns the rural clinic is asking us to collect our surgical masks at the end of the day and send them in for sterilizing. No one knows how they are sterilizing the masks. These masks are made for one-time use, just like the N95s.

Do you feel like you are able to give your patients the care they need?
Yes, but there is an element of fear present because we know that we are not properly protected. I also fear unknowingly exposing a healthy patient because of my lack of PPE.

What are the main issues you are facing currently?
Hospital/clinic administration in the rural area is not taking this seriously and telling us to conduct business as usual. The rural clinic is not allowing us to use homemade PPE even though we do not have adequate supply.

Are you concerned for your own safety? What about for your family?
I pray every time I don protective equipment that it is enough to prevent me from contacting COVID-19. I am not worried about experiencing the disease myself and I am worried about exposing my child and other patients that are at higher risk.

What are your concerns or fears going forward?
First, I do not think we will see the end of COVID-19 in the near future. Once the quarantine is lifted, people will go back to normal life and we will see a resurgence in the fall. I also fear that we will lose many frontline providers that are irreplaceable.

Why are you proud of the work you and others in health care fields are doing to save lives?
Most people in health care have a calling to care for others. We are the helpers, the ones that make people feel safe. We are able to put our personal needs aside to care for our patients. There is so much uncertainty in the world today, but I am certain that we will continue to help others with our work, day-to-day, as we always have.

 

Maggie Peterson is a nurse at an adult day center and, more recently, has been working in long term care. Peterson wishes not to name her place of work.

Where do you work and what kind of work do you do?
I am a nurse at an adult day center, a place for older adults to have safe, social interaction while still living at home. It was closed in March because of COVID-19. Since the shutdown, I have been working as a nurse with older adults living in the long-term care department of the company for which I work.

When did things at your facility change?
Things were business as usual until March 17th. That was the day that the governor declared that adult day centers be closed throughout the state until further notice. About a week before the closing, the center was working very hard to keep COVID-19 out of the center. We were working on hand washing and sanitizing, along with travel and temperature screenings. Families, participants and staff were screened before coming into the center. Once the center closed, I started working in the long term care area of the facility. I am helping with medications, mobility, socializing and anything else I can do to fill in.

Have you been caring for people that have COVID-19 and, if so, what kind of care are you providing?
At the moment, no one has an active COVID-19 diagnosis in my facility. I believe the quick quarantine action taken has been the biggest reason for this. All staff continues to be screened and visits in and out of the facility are very limited. This, however, has probably been the hardest part for the residents. Without family and friends to visit, older people can become lonely, and those with dementia may not fully understand why family cannot visit. We are working with technology like video calls to help keep families connected. I am taking the time when I can to just sit and talk to the residents. All staff members are doing this as much as possible.

Can you give some examples of some of your experiences so far?
I have seen first-hand how a video call can change a person. It may not take much, but to see a family member can help ease emotional pain. Every day, I see this help the residents.

When the virus broke out, what kinds of preparations were being made by the facility where you work?
Before the center closed, we had a visit from one of the nursing leaders. She let us know that there were daily briefings with the State Department of Health regarding specific needs of long-term care that provided instructions on keeping the center and participants safe. At that time, we were not wearing masks or other PPE. We still didn’t know what was coming. I know that the purchasing areas were having trouble getting supplies like masks, hand sanitizer and similar items. I don’t think I understood what the reality was until I moved to working in the long-term care facility. The use of and requirements for PPE changed daily and, finally, we were required to wear masks and eye protection while at work. It was hot and clumsy, but after almost a month, it seems like a normal part of my uniform.

Was the reaction delayed? Did you see any problems?
I don’t think actions were delayed at the place where I work. Once recommendations were made by the Department of Health, they were ready with a mask and a set of goggles. I do wonder why there were no established protocols to begin immediately. I have a personal interest in historical nursing and have always followed the story of the 1918 flu pandemic. I became a nurse around the time of the H1N1 influenza outbreak in the mid-2000s. I had the opportunity to attend a public health conference in Des Moines that featured many breakout sessions on the topic. I guess, perhaps, too much time has passed or we think that it just won’t happen again. It’s hard to be thinking the worst thing ever is around the corner, but I have to wonder why as a society we weren’t more prepared.

Are these kinds of facilities prepared for a pandemic like this?
In general, I would have to say no. Each year the seasonal flu comes around and, perhaps, we are ready for a small number of cases. But there is always a “what if” and I don’t think anyone knew COVID-19 was coming and how serious it was going to be.

What kinds of shortages are you dealing with?
We don’t have enough masks appropriate for the situation. At the time the restrictions came into place, I was given one surgical mask and was advised there were no more. We had no active cases, so they were appropriate for patient care, but it did scare me.

I placed a request on my personal Facebook page for assistance in finding more surgical masks and I was notified by many people that were willing to donate some to me. Additional resources are now available at my workplace. These masks are not meant to be used indefinitely, so I am still collecting things for myself.

The public has been donating many other things that are needed, and I am very grateful for the masks and gowns that have been sent in by family and friends. I see them as a sign that they are thinking about me. The real challenge will come when I am needed to treat COVID-19 patients. Items designed to protect healthy people are different than items to care for the sick. I hope there will be appropriate PPE that will protect me as a caregiver should the need arrive.

Do you feel like you are able to give your patients the care they need?
At this time, yes, in terms of physical care. Many of the residents need social connections that I can help with in small ways. But, for them, I am hoping the restrictions end soon. Loneliness can have severe consequences.

What are the main issues you are facing currently?
The reality is that my employer has worked very hard to keep me at full-time status and working according to my skills. I see other facilities that are reducing hours, pay and positions. I will continue to be as flexible as needed to keep working. I know this is a personal concern, but it is one that I think about. I’m glad to not have financial concerns at this time.

Are you concerned for your own safety?
I don’t have concerns at the moment, but if I have to care for COVID-19 patients, I will be scared.

What are your fears going forward?
This virus seems insidious. It appears to only take one mistake, like touching the face, and it’s too late!

Why are you proud of the work you and others in health care fields are providing?
I think the way everyone has stepped up. I’m not going to lie, there are times that I want to complain, but what good would it do? As cheesy as it sounds, we are all in this together.

Is there anything else you’d like to say or share?
I’ve received many thanks and have been given the “hero” designation. To be honest, I think the heroes are the health care providers who are actually on the very front lines. That being said, I still eat the free donuts when they are brought in.

Editor's Note: Photos provided by the subjects - Sarah Brown, left; Maggie Peterson, right.