Caregiving in crisis: Nurses balance duty with lack of protection

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When COVID-19 reached central Oregon, where Tiffany Simmons works, personal protection equipment was in short supply, so she found her own through farming store purchases and gifts from worried relatives. (Courtesy/)

An exhausted emergency department nurse in New Jersey, too worried to sleep, jots down her 401K password in a note to her husband in case she dies. A single mother in rural Oregon spends $250 of her own money to buy protective gear from a farming supply store, mindful that her 9-year-old boy now dissolves into tears when she leaves for work. A nursing director of 13 skilled nursing facilities in Upstate New York describes how her entire family works in health care: “I realized my whole family could be wiped out by COVID, just based on what we do,” she said.

Nursing is the nation’s largest health care profession, with 3.8 million registered nurses, or three times the number of doctors, according to the American Association of Colleges of Nursing. That means the hour-by-hour care of hospitalized victims of the novel coronavirus falls largely on their shoulders.

See the complete Year of the Nurse section in The Star-Ledger.

Their dedication and professionalism during the pandemic have prompted a nightly chorus of cheers from big-city balconies, free pizza delivered to local hospitals by grateful communities, and a flood of homemade masks sewn by an impromptu army of civilian seamstresses.

Their work has required frontline exposure to COVID-19, an illness whose vicious and unpredictable severity has left them stunned and fearful. They’re afraid for themselves, but even more terrified that one tiny lapse in caution could bring the coronavirus home to their loved ones.

That fear has been exacerbated by spotty availability of the most basic personal protective equipment, or PPE.

“I’ve dealt with every kind of infection you can imagine: H1N1 (flu), MERSA (drug-resistant staph bacteria), and was able to do so without getting sick and dying. The difference is we’ve always had the equipment to do that,” said Tiffany Simmons, the Oregon nurse who bought her own equipment, including a half-face respirator from a welding shop. “There is a threat that when I go to work, I could contract something that they don’t have a treatment for.”

“I never thought I’d be fighting for my life at my job,” said 57-year-old Sheryl Mount, who volunteered to return to the intensive care unit because she knew she’d be assigned there once the wave of COVID-19 cases hit her South Jersey community. “Everyone is scared to death.”

By mid-April, more than 9,000 health care workers had contracted COVID-19, according to a report by the U.S. Centers for Disease Control and Prevention. The average age of those testing positive for the virus was 42; the bulk of the 27 reported deaths occurred among workers older than 65.

“I’ve never been so scared to be a nurse — and so proud to be a nurse,” Mount said.

Adding to the stress are shifting COVID treatment protocols that mean nurses can’t practice their profession the way they always did, or even the way they were trained. They have to limit their interactions with their patients, and some safety protocols have abruptly changed. They have always discarded surgical masks after leaving each patient’s room; now they’re being told to wear the same one all day.

Jennifer Tinn, an ICU nurse at Robert Wood Johnson University Hospital in Somerset, New Jersey, describes herself as a “Type A” who would normally pop into a patient’s room as often as she could, even if just to straighten out the sheets.

Now, she has been told to “bundle” her tasks so she completes them all in a single visit. Patient IV poles have been outfitted with extra-long tubes so they can be rolled into the hall and adjusted there.

She sits on the safe side of a glass partition, monitoring her intubated and eerily silent patients but unable to soothe them. On many of her 12-hour shifts, she’ll arrange a FaceTime call to relatives so they can glimpse their sedated loved one or watch the chaplain praying over them.

“You can’t reach out to touch their hand. You can’t talk to them,” says Mount, the veteran South Jersey nurse. “They can’t really see your face or your expression. You can’t stay in their room for very long. It tears away at your insides.”

That kind of nursing takes its toll.

Tinn, 27, said she drives to each shift consumed by dread that never lifts.

“There’s just this emotional aura, or vibe, that is just emotionally heavy. I don’t usually go to work feeling anxious or feeling worried. But this is a type of anxiety I’ve never had, because I don’t know what the day is going to bring for these patients, who are so, so sick,” she said.

Just as COVID-19 patients appear to be improving, the virus can throw a sucker punch that causes their vital signs to plunge. The medical term is “decompensating.” The hospital lingo is “crumping.”

“I’m sleeping late, which isn’t like me. I think it’s just emotionally exhausting,” she said. “I go home and all I think about are my patients. I think about them even in my dreams.” “You cry, then you get better, then you go back to work, then out of nowhere you cry again,” said Simmons.

Nurses have a long, proud history of combating contagious disease, whether polio, AIDS, or the 1918 Spanish flu, said Arlene Keeling of the University of Virginia School of Nursing and editor of the Nursing History Review. In both the AIDS and polio epidemics, nurses worked before effective treatments were available and while the means of transmission were still unclear, she said. Traveling nurses often took care of polio patients on the assumption they’d already acquired immunity.

“I’m not sure they knew exactly how it was transmitted either, so maybe they didn’t know what to be afraid of,” she said.

During the 1918-19 Spanish flu pandemic, many of the patients were tended to by student nurses, since most experienced nurses were away at war. The nurses were mostly single as well because a student had to leave nursing school or a hospital job when she got married, Keeling said.

That meant they were treating contagious diseases unburdened by any fear of infecting their own children, unlike today’s nurses grappling with COVID-19. Nor did those earlier nurses have to deal with home-schooling their children after their shifts ended.

But that’s Jessica Collum’s schedule. She works three overnight shifts a week in the emergency department of Ocean Medical Center along the New Jersey coastline, returning home at dawn.

When she gets home from her shift, she strips off her uniform in her garage, steps carefully along a series of bathmats placed in a connecting hallway, then jumps into the shower. She washes her blonde hair so rigorously she jokes she now looks like “that guy from Van Halen.”

Normally she’d see her three boys off to school and her husband off to his construction job, then get five or six hours of sleep. Schools are closed, however, so she spends big parts of her day overseeing online lessons for her 7-year-old while keeping her 4-year-old twins occupied. She survives on brief catnaps.

She takes only a reference book on medication and a pen and scissors with her into the hospital, leaving her coat in the car. She’s wary of sharing keyboards and desk phones with her coworkers. Wearing a mask and gown for her 12-hour shift often causes her to overheat. She frets, unable to decide if she’s just too hot or actually developing a fever. The possibility she might be coming down with COVID-19 herself has triggered panic attacks, she said. On one recent day, five nurses went home with fevers.

Simmons, of Oregon, strips in the garage as well, then makes sure to sanitize anything she has touched, including her car keys and cellphone. She doesn’t even remove her contacts until after she’s showered.

While nurses are going to extraordinary lengths to prevent exposing their families to the virus, the looming danger is evident not only to them, but to their loved ones.

“I constantly hear, ‘This is not what I signed up to do,’” said Mount, the veteran nurse of nearly 40 years. “Husbands are pushing back: ‘This is not what our family needs. You’re being exposed to something that could kill us all.’”

Planning for and around that fear is on the To Do list of MaryPat Carhart, vice president of clinical services for a Syracuse-based company that operates 13 skilled nursing facilities in Upstate New York.

Since February, she’s kept a little notebook on her bedside table to jot down issues that need addressing, no matter what time of night they occur to her.

The current pandemic reminds her of her early years in nursing, when treating AIDS patients was fraught with concerns about the unknown. “It’s just human nature. People are going to be afraid. They’re going to be paralyzed,” she said. “But that’s my goal: to eliminate the paralysis.”

“They’ve chosen this, and this is their calling,” she said of her nurses. “But their biggest fear is taking it home to their families. So we have to make sure that if we get COVID in one of our facilities, they’ll be OK.”

That means rigorous safeguards, plenty of safety equipment, back-up plans for the back-up plans, and training, training, training. “This is what we do in health care — but really on steroids,” she said. “But this is what we do.”

Kathleen O’Brien is a freelance writer in northern New Jersey. She can be reached at ksobksob@gmail.com.