The Front Lines Through the Eyes of a Nurse Manager

Jun 10, 2020

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Fear has turned into 'we are tough' and 'we are stronger than COVID.'

Cindy Little

As facilities and healthcare providers adapt to the new normal and anticipate future waves of COVID-19, nurse leaders are in the optimal position to support and lead their staff to the best possible outcome.

Cindy Little, a nurse manager for the ICU and Rapid Response Team at Novant Health Presbyterian Medical Center, in Charlotte, North Carolina, provides a glimpse of her experience.

As a nurse manager of a COVID-dedicated ICU, you’ve seen first-hand the toll this crisis is taking on direct care staff. What effects are you seeing on your staff?

Early on, there was more fear and uncertainty. Since this virus was novel, we did not have a basic understanding of how it spread, and the rapid spread was scary. We were getting mixed messages early on from the CDC, WHO and our local health departments about PPE, and the messages were often changing within hours. We did not know how to treat our patients adequately, and this was a source of anxiety.

What other challenges did you face?

Staff did not want to float to our unit for fear of the unknown about this virus. To reduce exposure, our in-person clergy and interpreter services were canceled. Medical records, EVS, and food and patient transport would not come into our unit. Yet here we were. We understood the reasoning, but my staff’s feelings were hurt.

How did your team adapt to the crisis?

After the first two weeks, we realized that mixed messages were the new normal. In the middle of this was the reduction in PPE availability, which added to the fear. The men shaved their beards to wear N-95 masks instead of waiting on PAPR hoods. We were not sure if PPE was truly protecting us. N-95 masks changed from one design to another, and we were fit-tested again.

During the next two-week period – which we hoped was our peak – fear was replaced with exhaustion. For days we had 21 rooms with 21 ventilators with 21 COVID-19 positive patients. It was during this time I saw the sadness more pronounced. I heard the sadness in my staff as well as in others. I took a phone call from the microbiology lab calling to report a COVID-19 positive test result. That tech said, “I hate making these calls.”

What was it like for your staff to be isolated from their families?

The younger staff were missing their parents, and the parents were wanting their children to leave nursing. The nurses with children were getting anxious about their kids’ schooling, day care, money and summer camp.

How is your team functioning now that you’ve been in this crisis for a while?

In the last four weeks we’ve had better success. Fear has turned into “we are tough” and “we are stronger than COVID.”

Through this, we searched for ways to connect families with their loved ones. One of the staff members suggested that we Zoom and FaceTime with families. That nurse led the Zoom efforts at our facility (not only in the ICU), and families have loved it. It’s been the only way that families could contact their loved ones. The nurses jokingly said, “We thought we didn’t want as many visitors, but we didn’t want it to happen this way.” Nurses miss interacting with their patients’ families - that’s part of the art of nursing.

We’ve had too many deaths, but we have worked hard to have “good” deaths. Our “Zoomie” nurse, as we have affectionately called her, helped families make tough end-of-life decisions and has been present via Zoom for withdrawal of life support. Yesterday, 20 members of a family sang their loved one to heaven. We had a novice nurse and an expert nurse in the room, and outside were several of the team including our respiratory therapist looking on. We smiled through our tears.

Many nurses can relate to these experiences, and maybe some new perspectives have developed as a result of caring for patients and their families during COVID-19.