Beyond My Comfort Zone: A New Nurse’s Take on COVID Care

Welcome to the American Association of Critical-Care Nurses COVID-19 Support Podcast, episode six. 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. Thank you 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 chat with nurse Emily Shands. Emily stepped up and offered to work in her hospital’s COVID unit only months after graduating from nursing school. We’ll explore how she found the confidence to work in the COVID unit so early in her career and what her time there changed about her views on nursing. Let’s listen to Emily as she shares her experiences and offers a few nuggets of advice for other nurses.

Welcome to the show. It’s great to have you here today. Why don’t you take a few moments and tell us a little bit about your nursing experience before the COVID crisis struck.

I graduated from Texas Christian University in May 2019, with my BSN. I got my RN licensure here in the state of Missouri. In June 2019, I started a four-month critical care fellowship at Mercy Hospital St. Louis, and I was training to be a nurse in the medical-surgical ICU, which included a preceptorship. So, I felt pretty prepared for that aspect of entering into the profession. I switched over to the night shift in August 2019. And then, in October, I was finally on my own in the ICU. Ever since then, I’ve been in the ICU. In March, I was in the COVID ICU unit.

Tell us a little bit about the transition from when you ended up having a COVID unit, and they started asking who wants to work there. Because that, I think, is part of the story we want to hear about.

I think we have to start at the beginning with how I first entered the ICU. My manager warned us before we actually went in that there would be one person in each fellowship who was thrown curveballs, who was thrown some crashing patients. And I just happened to be that nurse. A lot of things, you learned quickly. You saw rapid changes in conditions. And you had to be thinking on your feet and just kind of roll with the punches.

When COVID came around, I felt scared. This is a pandemic that’s being talked about on the news, and people are dying from it. And there’s the lack of PPE; our resources are limited. When I first heard about COVID coming to our hospital in St. Louis, I was pretty scared. And then I took a step back and talked to my family about it and really weighed my options here. They were really supportive of my decision to go work in the COVID unit. My father is in the medical field. So he was in and out of the hospitals, too. I just received a lot of support from my family, and that’s kind of why I took a leap of faith and chose the COVID unit.

You’d had all these myriad advanced experiences, I guess I would call them, in the ICU. We all know those things happen, and the learning curve can be steep. Did you feel that same way going into the COVID unit?

I think at first it was really challenging. A lot of us weren’t prepared for the level of PPE going into these rooms. And where do we don and doff? That was an additional challenge you faced with just gearing up to go into these rooms, let alone coming face-to-face with this virus.

The first couple of months, the first couple of weeks even, were definitely a challenge. You kind of had to just go in there with an open mind. Over time, you started to recognize what the pattern was. What did this virus look like? What should you be looking out for maybe tomorrow or the next day? Going in, I think that was also one of the reasons I wanted to work in the COVID unit. If this is going to be as big as New York, here in St. Louis, how do we prepare for that? How can I help others better prepare for that if I’ve done it kind of before it hits its peak?

As you look back at those first few weeks, was there something you’ve identified that you might do differently? What advice would you offer to someone else in that same situation?

I think that clustering care was probably the first thing that I learned. I was going in and out of a room maybe every 30 minutes, because labs were ordered kind of haphazardly. And that’s no one’s fault at all. I didn’t cluster my care. I wasn’t going in with the medications and maybe drawing labs at the exact same time. Or the patient would put their call light on and it’s so natural to walk into the room and say, ‘What can I help you with, sir?’ For COVID patients, you should get on the video chat and see what it is they need before you walk into the room. A lot of that was just learning. Then you started to understand what you can do to prepare to go into the room. What can I bring the patient? What do I need to do to prepare this room for the next nurse?

When you think about being in the COVID unit, you talked about PPE and learning all the things you had to learn a little differently, clustering care, certainly all the important things. Was there anything in particular that was most difficult for you in the COVID unit as you were caring for your patients?

Family wasn’t able to come to the bedside. And some of these patients were really critical. So, you’re calling the family members, giving them updates as best as you can and as often as you can, but it’s not the same as them being there at the bedside. It was personally very hard for me to see a patient on a ventilator very sick, and there’s not a family member there even to hold their hand. Something as simple as that, I felt that I could maybe spend 10 minutes of my time just doing that and praying over the patient. Because if it were me in that bed, my family member might be doing the same thing.

I think that gave families some peace of mind that someone was there in the hospital for them doing something a little different that was a little more geared to what a family member would do at the bedside. I don’t know. I just didn’t want them to be alone in there. And I know those rooms are so isolated.

What would be another hard thing? Just the process. I mean, we’re all going into this not really knowing. I know the doctors, respiratory therapists, techs, nurses and experienced nurses were going into this blind. Think back to March when you’re hearing all of these horrible things on the news and what’s going on in China and Italy with the lack of ventilators. I think that gave me some courage, though. Also, everyone else was kind of in the dark here. Only by putting our heads together and really working as a team were we going to come out successfully from this thing.

Everybody was new, right? I mean, you were feeling new as a nurse, but for this situation, it was new to everyone.

Like I said, that was helpful in a way. Because you’re like, oh, I’m not alone here. I’m not the totally new nurse who doesn’t know what they’re doing. Everyone here really ... I mean, it was a team effort. I liked that a lot of the other nurses you’ve interviewed so far have said the same thing. But this was a cohesive effort on everyone’s part just to do good by the patient and provide high-quality care as best as you can in these uncertain times.

You’re right. All the other nurses we’ve interviewed have said some very similar things. One of the things that they’ve mentioned is the constantly changing treatment patterns, advice or even methods of PPE donning. What did you encounter, you and your colleagues? And how did you adapt?

I think that when we first started, we were using one mask a day. And that changed, of course, slowly over time. It was one mask for three days in a row. And now you need to discard, and we’re going to repurpose these PPEs and masks and you’ll get them again. It was definitely shocking that we would be reusing them. But things are changing all the time. You might as well just get on board with it. I felt like everyone was doing their best to maintain a clean, safe environment.

Another thing that changed was the MRI tubing. I don’t know if you heard about that. The lines in the rooms allowed a nurse to titrate medications outside the room. That was an infection risk too. We actually had to limit our use of the MRI tubing at the end, because we realized this actually has a higher potential to cause infection because it dangles on the floor. We had monitors. When we went into the rooms, we had patient safety officers who stood in the hallways watching us go back and forth. They would tell us to remember to wipe down our goggles or whatever when you come out of the room, because it’s just a habit to put it back on your head and keep walking out. So, again, I felt safe and I was glad for those reminders.

I’ve been heartened by your story and other stories of nurses caring for each other. What kind of examples do you have about you and your colleagues forming a team to make this happen?

I’ll start with the COVID corner. That’s what we called it, because the hallway was angular and so long that you had these four corners, and there would be maybe three nurses to one corner of this hallway. We were a team back there. If you were in a room and you needed quick intubation drugs, you need help. You’re banging on the window or whatever it is. And people come running right away. So, that was our name for it.

I remember, I think it was probably my second week in the COVID unit, my patient had taken a turn for the worse and needed to be proned while paralyzed and heavily, heavily sedated. Proning is when you put the patient on their belly. Then, you start the paralytics to improve their ventilation once they’ve reached that ARDS point. That was my first time actually proning and paralyzing a patient. I had seen it done many times before, but actually doing it myself … I walked on shift my second week in the COVID unit and the day shift nurse was walking out. She said, ‘I think you’re probably going to prone tonight.’ I looked at the monitor and the patient is statting 84% oxygen. It’s like, oh, heck yeah, we are. I was really nervous about it too. I probably had the look on my face. And she said, ‘You know what? We’re going to call the doctor and we’re going to do it now while I’m still here and I can show you the ropes.’

Let me tell you, this was, I think, everyone’s first experience doing that in a COVID room. I mean, it took a whole team. It took four of the other night nurses, the attending, the fellow, respiratory, to get that patient on their stomach. I mean, it’s a group effort. I was just really impressed that day, really impressed. And it made me want to go back. That sounds silly, but I mean just the hard work that was put into flipping that patient was amazing. And that nurse stayed late for me. I don’t know. It was just great.

It’s that appreciation for a job well done. I think you certainly are giving great examples of that. I’m curious. I remember when I was right out of nursing school, there were a few ... I don’t know, sayings or tenets that I had gotten, little nuggets of information I received from some of my instructors while I was in nursing school that helped carry me through those early days. I’m curious if there was anything that stuck with you that kind of helped you move forward in your early days, both in the ICU and then in the COVID unit.

I think probably the most common suggestion and piece of advice I got from my nursing professors was to take every opportunity you can. Do not be afraid to ask questions. So I asked every single question I possibly could. I probably annoyed the heck out of people, especially in COVID because you have no idea sometimes. Where’s this? I don’t know where it is. Oh, what’s that?

Especially when you’re taking on extra roles, I felt like COVID really reinforced that. Respiratory therapists are split between so many different rooms. Maybe you’re doing the spontaneous breathing trials or you’re adjusting the oxygen on the ventilator settings. So you take on these extra roles. Before you do that, ask questions. Make sure you’re doing the right thing. That was really cool, I thought, just learning the aspects of other jobs in the hospital. COVID really helped you see that and take on some of the extra responsibility, for sure.

It sounds like you really picked up a vast amount of experience in a very short period of time. I’m curious what you’ve learned from this overall experience, now that things maybe are in a little bit of a lull and moving on. What do you think you’re going to take with you from all of this into the rest of your nursing career?

That teamwork definitely makes the dream work. It sounds silly, but I mean really, oh my gosh, just the team effort there. I want that to continue after this crisis. I think the team effort was just amazing during COVID. I also think that I’ll take to my practice this sense of extra responsibility and autonomy. I really liked that COVID kind of forced you out of your comfort zone and made you realize what all other professions do in the hospital, how you can help them to do their job, how they can help you, and just everything you can do for a patient, even when they have this deadly disease. What else can you do and really get in there?

What will you change about how you approach patients moving forward?

I’ll always encourage them to keep fighting. I think I said that to a couple of my patients. ‘You’re a fighter and you can make it through this. I believe in you.’ I really try to instill that in most of my patients. When you give up hope, a lot of times they do. Actually, I just saw my patient, my very first COVID patient, again the other day. And it was really a great experience. Sad that he’s back with us again in the ICU, but not the COVID ICU. I’m glad he made it out.

A lot of new nurses are coming into the workforce right now. The semester just ended. People are finishing up their nursing boards and getting ready to enter the workforce. What piece of advice would you offer them, as you think about all that you came through to get to where you are today? What would you say to those new nurses coming into the workforce?

Trust your gut. Even after COVID, but during COVID, a lot of times the doctors are in their own corner or whatever. And you’re the eyes and ears for this patient. You think something’s different than your 8 p.m. assessment and it’s midnight. You don’t want to bother the doctor. Is this really serious or not? Trust your gut instinct; call them. Tell them something is up. ‘I want you to come lay eyes on this patient. I know something is wrong.’ I can’t tell you how many times that saved me or saved the patient.

I’m still glad that I brought it to someone’s attention, that I took that leap of faith again. I really urge all those nurses out there who are new and kind of scared to speak up. If they just aren’t really sure it’s a big a deal or not, do it. There’s no harm in bringing it up if you think something is wrong.

As talk of a second wave in the fall is coming around, what would you say to any nurse, especially new nurses, who might have an opportunity presented to them to enter their COVID corners?

I would highly encourage them to do it, as long as their families are okay with it, they feel safe, and they’re not at risk for anything going into COVID. I really learned a lot in COVID. I learned a lot about myself, about this virus, about my team. There aren’t a lot of drawbacks there, at least from my perspective. I thought there was a lot I could learn and a lot I could do in there.

What do you have planned on the horizon for your career?

I definitely want to pursue higher education in the field of nursing. The extra responsibility and autonomy that I saw in COVID land was great. I want to get that again. I want to see my profession excel, go above and beyond. I feel like COVID really showed what nurses can do and how respected the profession is. I would just like to contribute to that in some way.

Emily, thank you so much for joining us and sharing your insights about all the wonderful and sometimes scary things you learned along the way on this journey. We’re excited to have you share that with us.

Thank you very much.

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 on our website, www.aacn.org. For more great updates, connect with AACN through Instagram at @exceptionalnurses.

If you haven’t already done so, check out the first five episodes of this podcast series, and watch for future updates from AACN as other special podcast content is added on a variety of topics. Make sure you share this podcast series with other nurses you know, so we can all be prepared to manage care for patients with COVID in the future.

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