Interviews with Nurses on the Frontline of COVID-19
Our group wanted to use our pandemic course project as a platform to share the nursing experience from the frontlines. On March 23 through March 27, we interviewed three nurses who work at different hospitals (two in Boston, one in Worcester) and on different units (Linda: respiratory unit, Kelsey: intensive care unit (ICU), and Amanda: emergency department (ED)). Here is a summary of what they had to say:
1.What is your daily schedule like? What changes have been made thus far?
Schedules are the same but the routine is different. Linda and Kelsey now work on COVID-19 positive floors. To limit staff exposure, they are clustering patient care by scheduling medications, labs, and rounding at the same time.
In the ICU, there is more weight placed on the morning nursing assessment. The residents no longer pre-round, so the nurses are the only ones who have examined the patients before rounds. To reduce exposure, only the attending physicians assess patients during rounds.
2. How has it been interacting with other members of the healthcare team during this crisis?
Working on floors designated for COVID-19 positive patients has increased anxiety for everyone. People are worried about getting sick or bringing the virus home to their families. However, everyone (RNs, MDs, techs, support staff) have taken a team approach to patient care and are working hard to support one another.
3.How do you feel about how your hospital has been handling the limited supply of personal protective equipment (PPE) for healthcare workers on the frontlines?
They understand there is a shortage of masks but it’s hard not to wonder if they’re even protected when using one N95 mask per shift or for multiple days. There is some sense of frustration that because of the mask restrictions, they could also be spreading the virus between patient rooms.
4.What is your hospital doing to prepare for the possible surge in COVID-19 cases?
To prepare for the surge, hospitals are designating more floors for COVID-19 patients only. In the ICU, they have pulled nurses with ICU experience who now work on other floors back to the ICU. The ED has removed all hallway stretchers and have created a surge tent outside for ambulatory patients. Also, there are thoughts of looking at the DCU center for additional hospital beds if necessary.
5.Has the hospital administration been receptive to the needs of the nursing staff during this time? What could be improved?
The hospital administration has been very receptive to needs of staffing, which is helping support the units. The support improves the workload for each nurse. The obvious thing that could be improved is the PPE issue.
6. What is it like caring for patients with COVID-19? How has this crisis impacted the way you care for patients?
Patients in the ED are COVID-19 positive until proven otherwise. Caring for COVID-19 patients is anxiety-inducing. The patients are scared and lonely. The nurses are anxious but have to put on a calm face for their patients. It’s very hard to provide emotional support to every single patient they are taking care of. In the ICU, there is added stress because a patient’s condition can change rapidly, and it takes a long time to gown up before entering the room.
7. Do you feel that working during a crisis like this can lead to more errors?
Absolutely. There are fewer nursing assessments of the patients. They are doing all the charting for blood draws, labs, and medications away from the bedside, which has already been proven to increase errors. The silver lining is that the increase in staffing has reduced the nurse-to-patient ratio which helps reduce errors.
8.What do you think medical professionals who AREN’T on the wards can do to help?
Continue to educate the public on the virus (transmission, prevention, signs/symptoms, when to come to the hospital). Already, there have been volunteers helping to get additional PPE, which is incredible. All around there has been more support of the ED and COVID-19 floors from other hospital units, which is encouraging for those on the front lines.
9. Does having this virus affect patients’ mental health? How about your mental health?
Linda: Patients are anxious and lonely; they are isolated to their rooms, they cannot have visitors, and the medical staff only enters their rooms when absolutely necessary. I feel stressed out and it doesn’t help that my floor is very tense.
Kelsey: I have seen how distressing the diagnosis can be for families of patients especially because of the horrible stories in the news and the rising death count. What makes it even harder is the strict no visitor policy. However, social work was able to coordinate FaceTime with the parents of one of the younger patients on the unit. Even though the patient was intubated, he was able to respond to his parents by nodding his head. This had a huge impact on the patient’s level of agitation as we were weaning his sedation.
Amanda: Even in these challenging times, most of the patients are thankful for everyone in the hospital which makes me remember why I became a nurse: it gives me hope! I would be lying if I said I haven’t felt the stress and strain of this pandemic. My fiancé keeps me sane throughout this.
10.How is this crisis affecting your life at home and your relationships with family or those you live with?
Linda: I moved out of my parents’ house to reduce the risk of infecting them and moved in with my fiancé. It has been very difficult not seeing my family and I worry for my parents, especially since my dad has had lung cancer in the past and only has one lung now. My fiancé has type 1 diabetes and the possibility of spreading the virus to him is nerve-wracking. At first, our relationship was difficult. He was upset that I had to work with COVID-19 patients and initially insisted on me quitting. He understood after I explained to him that I became a nurse to help others and that I’m not going to run away in times of crisis.
Kelsey: I live with three other nurses who also work with COVID-19 patients. It’s a great support system because we are able to relate to each other. I talk with my parents regularly, and they are worried about my health. Likewise, I am worried about their health after seeing how sick people can get.
Amanda: My fiancé is an anesthesia resident and we are able to decompress together. It’s hard not to worry about the high-risk intubations he performs. We are both away from our families and FaceTime them often. We talk a lot about the precautions they should be taking to stay safe.
11.Anything else you want to share about your experiences working on the front line?
Linda: It’s been a really scary and stressful time, but I think because of this pandemic, my relationship with my friends, family, fiancé, and coworkers have become much stronger. In times of adversity, I think people realize what is most important, and that is the important people in your life. Even though I have gone through the stress of completely postponing my wedding and risking my health being a full-time COVID-19 nurse, this pandemic has a silver lining to it.
Kelsey: I feel like in Boston we all kind of have a pit in the bottom of stomachs because we feel like things are going to get exponentially worse. Right now, we still have adequate PPE, and we have enough hospital/ICU beds and we have enough ventilators. We are all just worried for if/when that is no longer the case. It’s hard to watch the news and see what’s going on in New York and not be scared that the controlled chaos we have now may become just chaos.
Amanda: This entire pandemic has really shifted how I do my job, how I go to school, how I have lived my life. I am scared but I love my job and the people I work with will get us through these tough times. I am thankful for my fiancé and all of the amazing residents and doctors I am working with. We are all in this together and I think medicine will be forever changed after this. I am also excited to continue my career as an acute care NP to continue to work with the critically ill inpatient population.
For more detail, below is the full, unedited transcript of each nurse’s response)
What is your daily schedule like? What changes have been made thus far?
Linda: Depending on whether working days or nights, I would wake up at 5am and leave for work at 5:45am to get there at 6:30 for report. My floor has been designated the special pathogens unit, taking patients with MERS, SARS, and now the new COVID-19. Since the pandemic started, my entire floor has been filled with COVID positive and COVID rule- out patients.
Kelsey: My daily schedule has not changed much. The changes so far have been more in how we go about providing care. We are trying to limit staff exposure. We do this primarily by clustering care, limiting aerosolizing procedures and limiting who goes in the room. It just takes a lot of planning how we can schedule meds and labs and care.
Rounding is different. Typically in the unit, we round with the care team on each individual patient and the whole care team goes into the room to examine the patient. While we still round with the team to go over the patient and the care plan, the whole team does not go into the room. The attending only goes around after rounds to examine each patient. This puts more weight on the morning nursing assessment, because if there is something on our exam that has changed we have to make sure to articulate that to the MD so that they go evaluate the patient and adjust the care plan as necessary. There are less eyes daily on the patient.
Amanda: My daily schedule is pretty much the same of course without going to the gym or out with friends. I work 4 shifts a week 3-11p.
How has it been interacting with other members of the healthcare team during this crisis?
Linda: My hospital has instituted a new policy where ALL employees are given a mask upon entry of the hospital, and must wear a mask during their entire shift. We may only change it if it becomes visibly soiled. Interactions between the healthcare team have been same as usual, however many of my coworkers have had majorly increased anxiety with our floor being the designated floor for COVID patients. One nurse specifically shared with me that she is seeking therapy more often and requesting anti-anxiety medications for this stressful time. In terms of multidisciplinary interactions, responding clinicians have been more responsive to pages and are more present on the floor.
Kelsey: I feel lucky to work with such a great group of RNs, doctors, and support staff. Everyone has really taken a team approach to caring for these patients. It is however clear that there is some underlying stress on the unit. People are stressed about getting sick and/or getting their families sick.
Amanda: I think we as healthcare workers have really come together during this time, we are all in this together and it’s nice to know I have a supportive group tackling this head on. ER has always had this amazing sense of teamwork between the doctors/ nurses/techs and it was one of the reasons I loved working in the ER so much. That bond between us all is now stronger than ever. Going into work I am scared and anxious but it is nice to interact with my coworkers, we talk about normal things, what recipes we are making, and what the hospital might look like when this is all over. I know I am trying to normalize my job and I try to not watch the news so much cause it just makes me more upset about what is going on.
2.How do you feel about how your hospital has been handling the limited supply of PPE for healthcare workers on the frontlines?
Linda: As of right now, we are only using N95’s with COVID patients who are receiving nebulizer treatments. For COVID patients who are not receiving nebulizer treatments, we are using surgical masks. This is scary because the CDC has said that it may be airborne for a certain amount of time. That being said, when we ARE using N95’s we are required to reuse them for the rest of the day, same with surgical masks. We are also required to reuse our goggles for the entirety of the day, wiping them down after every use. I feel upset because we were the single floor that took COVID patients and they are restricting the amount we can use. I don’t feel protected when using surgical masks with COVID positive patients, which is even more of a problem because I can be spreading it to patients who end up ruling out negative. As a nurse, I do not feel protected being on the front lines, even at one of the most prestigious hospitals in the country. Luckily, gloves and gowns are still one time use.
Kelsey: I understand that there is a national shortage of PPE, therefore I know I’m not the only person working on the frontlines wondering if I’m protected. We are using one N95 mask until it no longer has a seal, ideally they want you to use it for multiple shifts. It is frustrating because I wonder how effective a N95 is after a 12 hour shift. But I am more scared for the day I show up to work and they say that we are completely out.
Amanda: I think the hospital has been doing a pretty okay job, we just started to reuse our n95 masks for multiple days which is a little scary to me but I understand that there is a shortage of these crucial masks. They are using a UV light to sanitize our masks after every shift. I just hope we are being safe, 2 weeks ago we were using a new n95 mask every time we went into a room. Thankfully we have gotten donations of glasses so I have a pair that I keep in my bag and use for my shift. Especially for the ED and COVID units I think we should have access to a scrub machine where we could change our scrubs before going to work. We still have enough gowns and gloves which I know some other hospitals are running low on so I am thankful for that.
3.What is your hospital doing to prepare for the possible surge in COVID-19 cases?
Linda: Our floor had been blocking beds for COVID patients only. Our floor had been the only COVID floor at my hospital up until last week, they finally opened up two more floors to take COVID patients, which took the workload off of our floor.
Kelsey: To prepare for a possible surge in cases we have had some nurses with previous ICU experience who now work in different areas in the hospital who have come back to reorient in the ICU. The education department has already started a series of “refresher” classes to help them get comfortable with current best practice in the ICU. We have a written plan laid out on what ICUs/ medical floors we will fill with COVID patients and in what order.
Amanda: Currently on the University campus we have a designated ICU for COVID-19 which has around 20 beds and they have converted 2 floors for med surg/ tele COVID-19 patients who do not meet ICU criteria at this time. I think each floor has over 20+ beds. On the Memorial Campus they have converted the CCU to a COVID-19 ICU and 2 West is the med/surg floor for these patients. I know they are trying to send patients to memorial first so often we are working these patients up and sending them to Memorial. I also know they are looking at the DCU center for additional hospital beds if needed. The Emergency Room has removed all the hallway stretchers and we now have a surge tent outside of the ED to see patients who are ambulatory. Honestly everything is day by day and things have changed rapidly over the last 2 weeks and I anticipate more changes as the weeks go on.
4.Has the hospital administration been receptive to the needs of the nursing staff during this time? What could be improved?
Linda: The hospital administration has been very receptive in terms of staffing. Right now, the nurse to patient ratio is 1:2. They have been floating nurses from other floors to work on our floor to meet this ratio, which helps our workload a lot. The only thing that can be improved is the PPE issue.
Kelsey: Currently hospital administrators are supporting the nursing staff by making sure there is adequate staffing. We have an extra resource nurse on staff to help on the unit. I think one thing that has been difficult is it feels like the policies and procedures are changing everyday. It feels like everyday we are getting updates changing how we are using PPE and how we should be caring for these patients, it is difficult to keep up with all the updates.
Amanda: I think hospital administrators are doing their best with the situation but of course they aren’t the ones going into these rooms caring for these patients so there definitely is animosity felt. I’ve been a nurse for 6 years now and there is always a disconnect between the higher ups and the people on the front lines. We don’t get any breaks, there’s usually no food for us to eat especially on 3-11p it would be really nice if they could work to give all the shifts food, snacks, bottles of water…a break! Again I am thankful we still have gowns, face masks, gloves, and goggles because some hospitals don’t have any of the proper PPE.
5. What is it like caring for patients with COVID-19? How has this crisis impacted the way you care for patients?
Linda: It is anxiety-inducing. Patients (both positive and rule-outs) are extremely anxious, so in response, I try to act more relaxed and reassuring for my patients. It is difficult for the patients because they are in isolation, even from medical staff. We are required to cluster our nursing care to limit the amount of times to go into their rooms, unless absolutely necessary. Patients are lonely and scared and it has been very hard as a nurse to provide emotional support to every single patient we have.
It is also scary as we also receive behavioral patients who are assaultive and do not adhere to their isolation. We had one specific patient who was a rule-out who refused to be in the hospital, opening the door and getting in the nursing staff’s faces without a mask. We had to call security (around 8 of them) who all had to gown up and use PPE to escort the patient out of the hospital.
Kelsey: One thing I have found hard about caring for these patients is how long it can take too properly don PPE. Patient condition can change quickly and sometimes a change such as a desaturation requires a quick response like a suction or a turn and now it’s not as easy to get to the patient bedside. But everyone keeps saying “there is no emergency in a pandemic” and it makes sense. The priority is donning PPE to protect yourself.
We have found little ways to help limit the number of times we are going in and out of patients rooms. One big thing we have done is we have all the iv pumps outside of the rooms, with extension tubing to the patient. It seems so minor but it makes it easier to titrate and manage drips.
Amanda: Truthfully at first in February when information first started to come out I really didn’t think much of it. “Fever” and “Shortness of Breath” are two of the most common complaints in the ER and when they lifted the travel ban from rule out cases it caused our ED to go into a tailspin. Once the seriousness hit us it became a challenge to get everyone fit tested, sit up the rooms, and to manage the volume of ED patients. I think it took a few days before the seriousness hit because some providers weren’t putting precautions on patients especially with vague symptoms. As more data came in the practice has changed and now it does not matter the complaint we assume COVID until proven otherwise. Pretty much all patients coming in from nursing homes/rehabs are automatic rule outs due to the high risk nature of their living facilities. There have been multiple instances where precautions were placed 9 hours into a patient’s stay. I’d like to think now we are getting better at this but just yesterday a patient was in the department for 8 hours and then the admitting team wanted a COVID swab. Yesterday I had an 80 year old trauma patient who fell and broke his hip. Lives at home with his wife, no sick contacts, no cough, fever, or SOB. Initial CT read was pulmonary contusion and then they changed it to a questionable glass opacity and he was put on COVID precautions. Thankfully we are all required to wear surgical masks our whole shift but still it makes you think about your exposure to this patient population.
6.Do you feel that working during a crisis like this can lead to more errors?
Linda: Absolutely, donning and doffing of PPE has been changing constantly in the past several weeks. At first we were told never to reuse N95s, now we are reusing N95’s, and theoretically, the outside of the mask is dirty, and if we are reusing it, we are just getting ourselves dirty with every single use after the first use. In addition, because we are limiting the amount of times we can go into the room, we may be missing nursing assessments that we would normally notice when we are able to go into the room freely. Sending off labs (blood, sputum, urine, stool) has become more tedious and error-prone. There is a system that we have to follow in order to take out the bottles and specimen bags out of the room to send to the lab without it being dirty, however it is almost impossible to follow. I feel like we are taking them out of the room while they are dirty no matter what, and infecting everything else it touches.
Amanda: Absolutely! (great question) We cannot bring our computers to the bedside to scan our patients. We need to do everything (blood draws, medications, lab testing) away from the bedside which is already proven to have more errors. Also if we are in a COVID room we are trying to get in and get out as fast as we can, clustering our care so we can limit exposure status which of course can lead to more errors. I know for us in the ER since the volume is significantly less we have fewer patients typically we would have around 5 and now the max we have is usually 3 so I do think that helps us as nurses manage better.
7.What do you think medical professionals who AREN’T on the wards can do to help?
Linda: They can help by reducing the possibility of transmission. Washing hands, not touching their faces, wearing a mask, and not interacting with other people if not needed. And what I think everyone can do is just try to stay positive during this hard time.
Kelsey: Just continue to educate the public on the virus, it’s transmission and prevention, and signs/ symptoms including when to come to the hospital.
Amanda: I think the volunteers who have been helping to get us PPE has been nothing short of incredible. We’ve had some of the med surg floors and non COVID ICUs send us cookies, and coffee. A lot of them send us messages of support. Previously before this there was an us vs them mentality in nursing (I can speak more of this if needed) but basically it’s the ED vs the floors vs the ICUs. People complaining about the patients coming to their floor, not taking report… etc. All of that has gone out the window, we are all in this together and that has been a welcome shift in nursing.
8.Does having this virus affect patients’ mental health? How about your mental health?
Linda: Like I said above, patients have been very anxious and lonely. They are alone in an isolated room with their thoughts, and even medical staff are restricted from going into their rooms. There have been much more anti-anxiety meds being prescribed during this time and for a good reason. I have been stressed out, but I think I have been taking it okay in comparison to other coworkers. It has been a very very difficult time on our floor and the tension has been extremely high on our floor. Some people still try to joke around to alleviate the mood but for the most part it’s been very tense.
Kelsey: I cannot comment on my patients’ mental health because the population of patients I have seen in the ICU have all been intubated. I can however say that I have had 1st hand experience with how distressing this diagnosis has been for the families of patients. It is hard for these family members knowing that their loved one is in critical condition diagnosed with COVID19 when they are hearing all these horrible stories in the news, and seeing the death count of this news virus rising. It is also really hard for families because we have a strict no visitor policy so they cannot come and see their loved one.
One really special moment I experienced this week at work is social work was able to help one of our patients FaceTime his parents. This patient is still intubated, we are weaning his sedation and preparing to extubate him but we have been having a hard time controlling his agitation. The other afternoon social work brought in an iPad and FaceTimed his family with him. The patient was nodding his head to his parents and even had tears in his eyes. The social worker and the nurse who was in the room with the patient both came out with tears in their eyes and the patient was much more calm for the rest of the shift.
Amanda: I think most of our patients’ mental health has been pretty impressive, a lot of them are so thankful for everyone in the hospital. It makes me remember why I became a nurse, these people are so incredibly grateful despite being in the hospital and being alone (no visitors). They are brave and thankful and it honestly gives me hope! I never really struggled with anxiety but I would be lying if I said I haven’t felt the stress and strain of this pandemic. I am a true nurse hypochondriac ( Last year my ANC count was slightly low and I convinced myself I had some sort of blood disorder) so I think every little symptom is a sign that I might be sick. My fiancé usually talks me off the ledge and keeps me sane throughout this. I miss being able to work out at Orangetheory but I still try to do a home workout, I love cooking so I’m making tons of new recipes to get me through. This all helps keep me somewhat sane throughout the process. Also I am trying to plan my wedding for 2021 which is a good distraction from what is going on.
9.How is this crisis affecting your life at home and your relationships with family or those you live with?
Linda: I realized my increased risk of becoming infected and have moved out of my parents house so as to not infect them and moved in with my fiancé in New Hampshire. It has been very difficult not seeing my family and I worry for my parents, especially since my dad has had lung cancer in the past and only has one lung now. I have taken some masks from work (I know this is frowned upon) to give to my dad so that he can be protected when he goes grocery shopping.
It has been nerve-wracking the possibility of me giving my fiancé the virus, especially because he has type 1 diabetes. But otherwise he is healthy, which makes me feel a little better. At first, my relationship with my fiancé was difficult, he was very upset that I had to work with COVID patients and initially insisted on me quitting because he was so terrified for my safety. But after having a conversation with him and explaining to him that I am a nurse for a reason and want to help others, and that I am not going to run away in times of crisis, he finally understood. Now he constantly says he’s proud of me and supportive of me. My parents are also upset that I am exposed to the virus but understand that I want to and need to do this. I have moved out from their house since the pandemic so as to not infect them. I talked to my mom today and she cried and said she misses me, and I miss her too.
Kelsey – I currently live with 3 other nurses, who are also working in settings with COVID patients so we are able to relate to each other, they are a great support system. I talk to my parents regularly on the phone and they are worried about my health but likewise even though they are isolated at home I am worried about their health! Because I am seeing just how sick people with this virus can get.
Amanda – My fiancé is an anesthesia resident at UMass so we both are in high risk situations but thankfully together we are able to decompress a little when we are home together. I worry about the high risk intubations he performs but we are both trying our best to get through this together. We both are away from our families so we facetime and talk to them often. A lot of what we talk about is making sure they are staying home, only going out for essentials etc. I am looking forward to getting back to our new normal when this settles down but for now we are watching a lot of Netflix and working on our wedding. Eventually we are gonna take a big vacation when this is all over!
10.Anything else you want to share about your experiences working on the front line?
Linda – It’s been a really scary and stressful time, but I think because of this pandemic my relationship with my friends, family, fiancé, and coworkers have become much stronger. In times of adversity, I think people realize what is most important, and that’s the important people in your life. Even though I have gone through the stress of completely postponing my wedding and risking my health being a full-time COVID nurse, this pandemic has a silver lining to it.
Kelsey – I feel like in Boston we all kind of have a pit in the bottom of stomachs because we feel like things are going to get exponentially worse. Right now we still have adequate PPE, and we have empty hospital beds(and plenty of ICU beds) and we have enough ventilators. We are all just worried for if/when that is no longer the case. It’s hard to watch the news and see what’s going on in New York and not be scared that the controlled chaos we have now may become just chaos. In New York they are possibly going to be using one ventilator to support two patients and that’s something I can’t imagine doing.
Amanda – This entire pandemic has really shifted how I do my job, how I go to school, how I have lived my life. I am scared but I love my job and the people I work with will get us through these tough times. I am thankful for my fiancé and all of the amazing residents and doctors I am working with. We are all in this together and I think medicine will be forever changed after this. I am also excited to continue my career as an acute care NP to continue to work with the critically ill inpatient population. Thank you all so much for your hard work! Can’t wait to be working with you shortly
This project was created by Ellen Franciosi, Leanne Ondreicka, Skelly Enabulele, Cameron Thomson, and Alan Xie, all third year medical students at the University of Massachusetts, who recently completed a two week pandemic course while third year clerkships were on pause because of the COVID-19 pandemic.
Amanda is a a DNP year one student in the Acute Care NP track. She has been a nurse for over six years, and for five of those years she has worked in Emergency Medicine. She currently works in the Emergency Room at UMass Memorial University Campus.
Linda has been a nurse for one and a half years. She has a year of experience working in an acute respiratory floor taking care of vented patients as well as on a medical special pathogens unit taking care of tuberculosis, MERS-CoV, and SARS, and now COVID-19 patients. She works at Massachusetts General Hospital.
Kelsey has been a nurse for four years. She worked on a medical-surgical floor for three years and for the past year, she has worked in on a medical intensive care unit.
