At the Bedside: Teamwork and Flexibility During COVID-19

In This Episode

As critical care nursing moves toward a post-surge “new normal,” it is natural to pause and consider where we have been and where we are going. Join direct care ICU nurse Niki Raymond as she reflects on facing challenges and overcoming barriers at the bedside along with her nurse colleagues during the height of COVID-19. By sharing her experiences of uncertainty, doubt, fear, hope and support, she demonstrates the strength and perseverance of all nurses through the most chaotic of times.

“Now that we're no longer a COVID unit, we're back to business. You've got to remember how to skate and put on those running shoes … It takes a lot more out of you physically, whereas I feel like COVID took more out of you mentally.”

— Niki Raymond, BSN, RN

Highlights

02:59 —

Adapting to the new reality of care delivery overnight

05:51 —

Getting “back to normal” as the COVID surge slows

09:13 —

What it’s like standing in for family members and keeping patients connected

13:10 —

Practice innovations to maintain for the next wave

16:40 —

The scariest part of being a nurse during COVID

Transcript

Jamie Davis:

Welcome to the American Association of Critical-Care Nurses COVID-19 Support Podcast. I’m your host, nurse journalist Jamie Davis. Our goal is to discuss important nursing practices during the COVID-19 pandemic and offer tips for nurses on the front lines or behind the scenes. We hear you, we’re with you and we support you.

Thanks for joining us. In this podcast series, we will do our best to provide you with the most current information from our incredible community of nurses. However, you should always check with the nursing practice standards for the state in which you’re licensed and working, as well as with the organization or healthcare facility where you work.

Today we have bedside nurse Niki Raymond on the show to discuss how she and her colleagues manage patient care amid the COVID crisis on a daily basis. Let’s listen to Niki discuss how she and her colleagues work together as a team to manage patients with COVID and support each other.

Hi, Niki. I want to welcome you to the show and ask if you’d give us a quick introduction about yourself, so we can learn a little bit about who you are.

Niki Raymond:

Hi, thank you for having me. My name is Niki. I am a critical care nurse. I have worked in critical care for about 14 years, currently working at a hospital in Los Angeles in a surgical intensive care unit. On the side, I love to garden. I think spending that time in nature just relaxes you and helps you just recenter.

Jamie Davis:

We’ll come back to that, because I think that’s an important point as we’re talking about bringing ourselves back around in the midst of everything that’s going on. But I’d like to talk a little bit about what things were like as your facility and you yourself prepared and ramped up for the onset of the COVID surge as it hit your area.

Niki Raymond:

My experience is, I feel, a little bit different. When the onset of the COVID surge hit my facility, I was called out to be home for a couple of weeks after being tested for COVID – because, it turns out, I started this experience with an exposure. One of our resident doctors who tested positive was symptomatic. He was working among all the nurses, and the facility initially took all of those people out, tested them. Then once we tested negative, we were able to return to work. No one was positive; thank God for that.

When we came to work, it was just being thrown in. My first day back, I worked in our COVID unit where all the patients were mostly COVID positive, and it was new. Just learning the precautions we had to take in addition to previous precautions we had taken when taking care of an isolation patient. A little bit scary, but we worked together and we figured it out and the changes were hour by hour. You know, OK, wear two gloves, wear one glove, wear one gown. Where by the end of the day, we had tried a million different routines, it felt like.

Jamie Davis:

What was it like for you to adapt to that? Because what we’ve heard from other people is the need to be really flexible, because so many changes happened in a quick time frame. We talked to an educator who discussed having to turn around education for the nurses within a couple of hours.

Niki Raymond:

Like I said, a little bit nerve-wracking because when you are doing one thing and someone comes to you an hour later and tells you essentially what you were doing was wrong, you think, ‘Wrong how? Wrong, was I exposed? Was I exposing others?’

That’s a question you ask yourself as a person who’s at the bedside constantly, every time they ask you to change what you have been doing, because this new thing is better. So you did have to be flexible and realize that you can change very little in that situation, and just accept that and move forward and do your best. Remember that, as nurses, we do understand the basic principles of contamination, so we’re ahead of the game. We understand. Don’t touch your face. You’re going to be fine.

Jamie Davis:

What about an example of something that you saw or you participated in that was an outside-of-the-box-thinking moment, where you had to improvise and adapt with that flexible mindset to something that you weren’t expecting?

Niki Raymond:

A lot of the nurses picked up new habits to protect themselves further. We have isolation gowns; most nurses are familiar with those, and the back can be a little bit flimsy and left open. Nurses were protecting each other further by making sure they went behind each other and taped the gowns shut to make sure that there is less exposure when you’re in the room. And that’s something nurses came up with on their own.

Jamie Davis:

And it’s a great example of really watching out for each other, which is great to hear.

Niki Raymond:

Yeah.

Jamie Davis:

Because, like you said, we’ve all worn those things and you have no idea how wide open it is in the back when you’re going in to deal with patient care.

Niki Raymond:

Exactly. Yeah.

Jamie Davis:

What does it look like and feel like now, as things have kind of started to calm down in most areas, at least in part, and we’ve kind of settled into a routine. What does that routine look like for you and your colleagues?

Niki Raymond:

It looks a lot different. COVID for us was different in that they transformed the unit that I work in into a COVID unit. A lot of those surgeries we usually take care of are considered elective surgeries, and so if you could be pushed back, you were pushed back.

We were the secondary COVID unit. We had one ICU COVID unit and a secondary ICU COVID unit. For the most part, we didn’t fill up. We were waiting for the surge and, as such, there was extra staffing available. We know what it’s like when you have extra staffing; it just makes your job that much easier when you have plenty of extra nurses.

Now that we’re no longer a COVID unit, we’re back to business. It’s like, you’ve got to remember how to skate and put on those running shoes because those COVID patients, unfortunately, they were so sick. There are intubated and sedated patients; they’re not really calling and there’s not much you can do for them. Whereas these patients, you’ve got to get back to the basics, you’ve got to get back to mobility, making sure everybody’s walked, everybody had all of their therapy. It takes a lot more out of you physically, whereas I feel like COVID took more out of you mentally.

Jamie Davis:

What about things you brought with you as things returned to normal? Is there anything from your process during COVID care that you’ve changed and adapted to bring back to your normal routine?

Niki Raymond:

For me, we’re still making sure we’re sanitizing our surfaces and things like that, and making sure we remind others who may not have had those practices about how to stay safe and how to sanitize their surfaces and how to keep themselves and our nurses safe. We’re being more vocal about that. We’ve learned to be more vocal about the resident who really didn’t wash his hands that well, or the people who aren’t really foaming their hands when they walk out of the room.

Jamie Davis:

You mentioned the doctor who was symptomatic and potentially exposed you, although it turned out to not be the case. Have you lost anyone else from the staff who has become ill or left the unit because of COVID?

Niki Raymond:

Not due to illness. I do know of a couple of other staff members who have become ill, but not critically ill, and then they were able to return to work. But there were nurses who chose not to work in the COVID unit.

Jamie Davis:

What do you think that process is like? Because, obviously, you chose to work in a COVID unit and it’s a difficult decision that is very personal to each one of us, and we often have underlying family factors affecting that decision. Do you have any thoughts about how hard that decision was for you, or from conversations you’ve had with other nurses?

Niki Raymond:

For me, it wasn’t a thought process that was difficult. I just felt it was my job and it was something I was able to do. I myself don’t have children, so that’s one factor. I feel like that weighs heavily on the mothers and the fathers who are taking care of COVID patients. I’m healthy. There are nurses who do have immunosuppressive diseases that we don’t know about and it’s none of our business. I think that there’s so much those nurses are going through, and I respect everyone’s decision to make the best decision for them because it’s not easy.

Jamie Davis:

I know visitation practices have changed in all sorts of hospital units. How has this affected things going forward for you in your patient area?

Niki Raymond:

It makes things a bit difficult. You feel for those patients who don’t have their loved ones to rely on, to hold their hand when they’re coming out of surgery and they’re experiencing pain, or just to encourage them. Some of our patients are very sick, and some of our patients are newly sick. So, you had patients who’ve been through it many times and they used their loved ones to rely on to get them through it. And then you have some newer patients who are younger, 21 years old having their first surgery. At that age, you still really rely on Mom, and moms can’t be there to hold your hand, so you can really feel for them.

During COVID, the visiting hours were nonexistent, so you had to literally be dying, heart rate down, dying any second before they would make any exception to the rule of someone coming in, potentially, and that’s only if your patient had recently tested negative for COVID. So there were people who were dying alone and that’s unfortunate.

Jamie Davis:

Talk a little bit about how the nurses adapted to having fewer contacts for the patients to rely upon and having to rely more upon you as the nurse. You mentioned how you had to get back up to speed because the patients in your regular unit were, I don’t want to say more demanding, but definitely more vocal and able to reach out for help when they called for you. We often rely on family members in those situations and, when they’re not there, it puts additional stress on our performance.

Niki Raymond:

We use technology. We use our phones and we use their phones, and we help our patients log into their Skypes and their Zooms and their video chat so they can see their family members.

I had a patient who, prior to visiting hours opening up a little bit, had surgery. He was going through a lot and his family was going through a lot. His daughter called me and said she wanted to set up a meeting where they could be at a far distance and hold up some signs for him, and so they did. We went outside in front of the hospital. He was able to get some fresh air and they, from maybe 12 feet away, held up signs saying, we love you Dad. And he loved it, it lit him up. It lit up his family members.

We had to just kind of think outside the box. We definitely did whatever we could to help them video chat when they couldn’t see their family members in person.

Jamie Davis:

You mentioned earlier that you love to garden, and fresh vegetables are great at this time of year especially. Tell us a little bit about how important it was for you, in your process, to have something outside of the hospital to go to and kind of de-stress and get back to nature and find a centering place for yourself.

Niki Raymond:

I think it was extremely important. I feel like it’s something I didn’t even realize I needed until I was just doing what I have to do to take care of the veggies. If I don’t tend to them, they will not survive. Just tending to them and then realizing the time totally escaped you. A couple of hours later, you’re still out there just picking at this and picking at that, and how much more relaxed you feel. It’s very important for everybody to have that little space where they can get away, that kind of pulls them away from the stressful parts of the hospital and Facebook and the news. It’s just, you’re surrounded by it. The vegetables do not talk about COVID, and so it’s nice.

Jamie Davis:

We anticipate potentially another increase and surge sometime in the fall. If there’s a likelihood that your unit becomes a COVID unit again, what kind of innovations are you looking at reimplementing to help you do your job? Things that maybe changed and adapted over the time you were working with COVID patients, and those are things that you know are going to be able to help you as this returns.

Niki Raymond:

I feel like there are a few things that were really a grace for us when we were taking care of COVID patients. One was, we treated ourselves. We were able to take advantage of the delivery services, and the nurses always joke in my particular unit about boba. Every day, the nurses would drink these boba teas and have them delivered to them, and it just made you feel good. It's easy, just have a little sip and cheers to your nurse friends, and go back to business.

On the business side, we did have a staff member who was assigned every day to be a PPE coach – protective equipment coaching. They watched you every time you came in and out of your room to make sure you were protecting yourself and doing it correctly, and they were ready to stop you and give you those corrections to make sure you kept yourself protected. That was helpful, and it’s definitely something I hope the hospital continues to implement moving forward if we do experience that surge.

Jamie Davis:

Anything that surprised you about how the nurses in your unit adapted to having to change your unit into a COVID unit and adapt to all these different things? Was there anything that surprised you about their resilience or how they rose to the challenge?

Niki Raymond:

I work with amazing people – not surprising at all. The team is so amazing. One example would be, if you were admitting a patient, a COVID patient, and you go into the room. You know what it’s like to admit a patient; it takes a lot of your time. You’re in the room for an extended period of time and you’re wearing all the PPE and you’re sweating. There would be nurses who were thinking about how long you had been in the room, and they would be willing to just switch with you. ‘Whatever you’re doing in there, I’ve been watching the clock and you’ve been in there for almost an hour, and I don’t think you need to be in that room for that long. Let me switch so you can minimize your exposure and we can all minimize our exposure.’ They’re just an amazing bunch of people, so not surprising.

Jamie Davis:

Something I hear you saying over and over again – whether it’s with your garden or with the tea breaks, or with watching each other’s back when they’re in stressful parts of the admission process, or things like that – is this idea of self-care and care for each other that seems to carry through your unit. Talk a little bit about that process. Is it something that was always there? Or is it something that adapted because you were in a more high-stress situation?

Niki Raymond:

I think it’s something that’s always been there. I’ve been in that unit for 10 years and we have visitors, travelers, registry people, and the first thing they say is, ‘Wow, what an amazing bunch of people you have here.’ It's something that’s always been there, that willingness to help each other.

Jamie Davis:

Looking back at your experience with this COVID surge and adapting yourself and your practice to a different type of patient care, what are your thoughts about how you’re looking at your nursing career and your nursing life moving forward? Because this is part of your history now.

Niki Raymond:

You know, as an intensive care unit nurse, it’s something that crosses everyone’s mind. It’s such a labor-intensive job, and you wonder how long your body will allow you to carry out that type of work. For me, I haven’t found something else that would let me have the same amount of passion as I have working at the bedside. When I see that, then maybe I’ll consider jumping, but I’m so happy right now that it’s hard to imagine what else could make me happy.

Jamie Davis:

Niki, was there ever a time when you felt afraid in the midst of handling COVID patients? Was there a time when you had a moment of fear, either for yourself or for others?

Niki Raymond:

Definitely. I feel like the times where I would feel the most scared would be when you would hear those changes from the educator coming around and telling me that you did this wrong, and this is the right way to do it. In your mind, you just keep thinking, ‘How long was I doing this wrong?’ Those things definitely weigh on you a bit.

We had a practice where we would – this is the wrong thing to do – take off our masks and put them in this little box that had UV light inside of it. Then we would push the button, and it would zap it for a small period of time. Then we would take the mask and put it in a bag and use it for the next go around. Our educator came in one day and saw us doing it, and we’re like, ‘Oh, we’re just zapping our masks.’ And the look on her face, like you’re doing this all wrong. I think everybody felt really bad that night because we felt like all day we might as well have not been wearing the mask, and we were definitely in patient rooms that were positive for COVID. That was one of the scarier days.

For me personally, I’m like, OK, what’s done is done. So just relax and move forward. Don’t stress yourself out about it because it could be completely unnecessary, right? I moved forward, but some people don’t have that luxury because they’re going home to their children. I look over to my co-worker and she’s got tears in her eyes because she’s going home to her 2-year-old baby, and so it’s different. Everybody has different experiences. Everybody handles stress differently.

Jamie Davis:

Any piece of advice that you’d share with other bedside nurses who’ve been in this situation, or maybe are going to be? We have a lot of new nurses coming into the workplace from graduate nurse positions, and some of them are going to end up on COVID units and maybe they’re listening to this. Do you have a piece of advice for them as that potential for a second surge comes along?

Niki Raymond:

I think my advice is always just to do your best. Remember that you’re doing your best and keeping yourself safe and that’s all you can ask for. You’re really, really doing your best. If you can sit back at home and reflect on your shift and say, ‘I really didn’t do my best in this area or that area of my day,’ learn from it, move forward. The next day, try your hardest, do it again, and that’s all you can do. Once you really feel like, in your heart, you have done your best, then celebrate yourself for that. Give yourself some credit.

Jamie Davis:

Niki, thanks so much for coming on and chatting with us. It’s been a wonderful time learning from you about your experiences and how we can all take that to improve our patient care down the road. Thank you.

Niki Raymond:

Thank you for having me.

Jamie Davis:

That will conclude today’s episode of the American Association of Critical-Care Nurses COVID-19 Support Podcast. You can stay up-to-date with us at our website, www.aacn.org. For more great updates, connect with AACN through Instagram at @exceptional nurses. Make sure to listen to our next podcast when we will be talking to Kishun Moolsankar, a nurse manager at North Shore University Hospital, about how his organization converted the neurosurgical intensive care unit into a COVID unit at the height of the COVID pandemic in New York.

I’m nurse journalist Jamie Davis thanking you for taking the time to join us in the midst of your busy day. We hear you, we’re with you and we support you.

Host and Featured Guest

Jamie Davis, BA, RN, NRP (ret.)/p>

Host Jamie Davis is a nurse, healthcare journalist and novelist. He began his healthcare career in emergency medicine, ultimately advancing to chief of EMS. Jamie continued his love of patient care by transitioning to nursing. Since 2005, he’s worked as a journalist covering nursing and emergency care topics, and also serves as adjunct faculty for nursing at Cecil College in Maryland.

Nikesha “Niki” Raymond, BSN, RN

Featured guest Niki Raymond is a critical care nurse working in the surgical intensive care unit of a Greater Los Angeles Area hospital. Niki’s 10-year nursing career also includes working in a mixed ICU at an Orange County, Calif. trauma hospital. She loves her job at the beside and can’t picture herself doing anything else – except tending to her vegetable and flower garden.