‘We are the front line.’ KC nurses share fears, joys of caring for COVID-19 patients
Rebecca Rice takes the elevators a lot more these days.
Wearing a protective mask around St. Luke’s Hospital over a 12-hour shift, she can easily get winded. With her own breath bouncing back onto her face, she gets hot, especially when she enters the room of a patient who likes to keep the thermostat up.
So the stairs are out.
The layers of personal protective equipment that nurses must now wear are the most physical sign of how much the job has changed as the nation finds itself in the middle of a global pandemic.
“Physically it’s not comfortable at all,” Rice said.
A registered nurse, she generally works in a unit dedicated to intermediate cardiac care at St. Luke’s near the Country Club Plaza. But her unit has been converted into a temporary ward treating patients with COVID-19.
“It’s crazy to think how fast all of this has changed,” Rice said. “If you walk on the unit, it’s almost not recognizable.”
The pandemic has changed the way of life for all Americans, but nowhere is the transformation as pronounced as inside hospitals. Some units have been converted to temporarily house the influx of coronavirus patients, bracing for a possible surge that could overwhelm the amount of available equipment, staff and hospital beds. But other parts of the hospitals have seen their daily census sink as administrators canceled elective procedures in attempts to preserve resources and slow the spread of the virus.
The pandemic has underscored the key mix of medical care and emotional support that nurses always provide. Only now, they’re doing more of both.
With access to contagious patient rooms limited, nurses in some hospitals are taking over tasks usually completed by support staff. And without visitors, patients — whether they’re admitted for coronavirus or another ailment — rely even more on their interactions with nursing staff for their social well being.
Several local nurses interviewed by The Star acknowledged their own feelings of uncertainty and fear in these unusual times. But many have signed up to fight in hard-hit cities like New York and New Orleans. Others have volunteered to work inside the COVID units of Kansas City hospitals — putting their own safety on the line.
“Honestly, I think a lot of us feel privileged,” Rice said. “A lot of people want to feel like they’re up there in the middle of it, they’re in the fight.”
‘We are the front line’
As local cases of coronavirus began to mount, the unit Ashleigh Adams works on at the University of Kansas Health System pivoted to house patients awaiting the results of their coronavirus tests.
At that time, nurses were able to deliver the good news when patients received a negative result. But the unit changed again in late March, and is now solely dedicated to treating positive patients.
“You can tell they’re exhausted,” Adams said in a video interview done for the hospital system. “You can tell they don’t feel good.”
In discussions with coworkers, Adams realized they were all a bit afraid of the largely unknown virus. Where she usually is confident in her own ability to care for patients, she’s now learning about the disease alongside them.
But it also dawned on her that she and her team were at the foreground of the global fight against the virus.
“Today I’m like, ‘We are the front line,’” she said. “This is us.”
Dr. Steven Stites, chief medical officer at KU Hospital, said nurses rapidly shifted gears as coronavirus took over. First, a unit that treats cystic fibrosis patients was converted to treat COVID-19 patients. Then a unit dedicated to pulmonary hypertension, then a transplant unit.
In all those instances, nurses quickly embraced the challenge — and the patients inflicted with the contagious virus.
“I can’t say enough about how the nurses who are on the front line of this are doing just a remarkable job of embracing folks who could be scary to some,” Stites said during a hospital briefing earlier this month.
Nursing makes up the nation’s largest healthcare workforce with nearly 4 million registered nurses, according to the American Association of Colleges of Nursing.
“We certainly see that nurses are critically important in these times,” said Sally Maliski, dean of the University of Kansas School of Nursing. “It’s important to understand that nurses are the care providers who are there 24/7 with patients. Nurses are the largest component of the healthcare workforce. They’re the largest component of any health system or hospital workforce.”
Maliski says nursing students aren’t specifically trained for something as catastrophic as this pandemic. But their underlying skills — both in science and in social well being — should serve them well in an ever-changing environment.
“They’re dealing with emergencies and life and death every day,” she said. “And certainly this situation does create that need for creativity and adaptability that we hope we imbue our students with.”
Nurses are adapting constantly.
For many patients, nurses are the primary caregiver. To keep other aides and staff out of the room, they draw blood for labs and feed patients, said Suzanne Ford, vice president of nursing operations at HCA Midwest, which owns five hospitals in the Kansas City area.
She said most nurses got into the profession to provide compassion and care to others. And isolated patients need both more than ever.
“Nursing has become hugely important in this type of crisis,” Ford said. “You can’t treat these folks like regular patients in the hospital.”
‘Are we protected?’
Pascaline Muhindura experienced several complications when she gave birth to her first son at the age of 27.
The stress of delivering her first child was overwhelming. But a nurse at Overland Park Regional Medical Center took time to care for her, help her bathe and allay her fears, she said.
“Just the way she made me feel, I knew I wanted to do that,” Muhindura said. “I wanted to make people feel the way she made me feel.”
Now a nurse on a critical care floor at Research Medical Center, she recently cared for two patients who have tested positive for COVID-19.
Walking into the room was unlike anything she’s ever experienced on the job.
“I was immediately like oh my gosh, if my mask is not working this could be the end for me,” she said. “I could be breathing in COVID-19.”
Muhindura, 38, was among several nurses who protested outside of Research on April 1, saying the hospital’s parent company, HCA Midwest, was not doing enough to protect staff from the virus.
She said the hospital had since moved to better isolate patients and protect staff. But with the potential for asymptomatic carriers to spread the virus, she said fear is never far away.
“It’s something that is on all of our minds,” she said. “Are we protected? Is this good enough?”
With no known cure, doctors and nurses are largely treating the symptoms of COVID-19, oftentimes running out of options with the seriously ill. But Muhindura said she has seen some patients improve.
“And that gives me so much hope to encourage those that are not doing well to fight,” she said. “Because I feel like half the battle is mental.”
Just fight. Don’t give up, she tells them.
She said the pandemic has her worried about her two children. She’s considering a temporary separation from them if things escalate too much. The crisis has caused her personal anxiety and stress, but she’s not backing down from the fight.
“I’m glad that I can do something to help, even though it is scary,” she said.
Connecting more with patients
Jennifer Dopson hasn’t treated any COVID-19 patients. But the virus has still reshaped her workplace on the medical surgical telemetry unit at the KU Hospital.
The hospital is performing more procedures and tests in patient rooms to limit patients’ movements throughout the hospital. Her unit has several double occupancy rooms. But in the last two weeks, with many surgeries canceled or postponed, none of those rooms has housed more than one patient.
That has lightened the load on stretched nursing staff, she said.
Dopson is president of the Kansas University Nurses Association, the union that represents nurses at KU Hospital. She said many nurses were already resigned to the idea that they will contract the virus — whether inside the hospital or at the grocery store.
While she isn’t treating any confirmed COVID patients now, she knows that could change at any time as staffing needs shift.
“I love what I do, but ultimately I get paid the same no matter what,” she said. “If they send me up there, that’s my lot.”
This new reality has brought silver linings.
Dopson said she’s able to slow down and spend more time caring for patients. Without visitors, many are lonely. And the pandemic has everyone on edge, regardless of their particular illness.
“I’ve had patients that damn near had parties in their room. You had to elbow your way through the room to get to your patient to do what you needed to do. And now they don’t have that,” she said. “Basically, unless someone is essentially giving birth or dying, they don’t get a visitor.”
Dopson has always tried to connect with her patients, but now she’s making more conscious efforts to just talk and listen. She’s mindful to turn her attention away from the monitors or computer screen while connecting with patients.
“I listen to their stories. I’ll tell patients some innocuous personal story of mine, what idiot thing my dogs have done lately, or what idiot thing my husband has done lately — whatever,” she said. “It’s just being a little bit more chatty with them than I’ve done in the past.”
Like Dopson, the unit Kelley Sivits normally staffs at KU Hospital has seen fewer patients as surgeries have declined.
With no dependents, Sivits said he realized he was in a better position to volunteer to help in a COVID unit than some other nurses.
He recently worked one overnight shift in a COVID unit, where the biggest change he noticed was the aggressive measures around protective gear and fewer patients per nurse.
Sivits, 40, came to nursing after teaching English in Asia and Africa for several years. He said he long ago fell in love with the language of healthcare and human anatomy. Without enough educational background for something like medical school, he found nursing “a perfect fit.”
Though his personal experience caring for COVID patients has been brief, he said playing a part in battling the virus has reignited his professional passion.
“This whole pandemic thing for me has a little bit revitalized, strengthened that sense of purpose about my profession,” he said.
Nursing ups and downs
In a gut-wrenching Facebook post that was shared widely, Dr. Evan Shaw, who practices at Research Medical Center in Kansas City, wrote of the helplessness that healthcare providers feel during this pandemic.
Oftentimes, no medicine or treatment can stop the virus’ destruction of the body. Though he said that situation had been emasculating for him as an internal medicine physician, he said nurses have it far worse.
For the most critically ill, a nurse might be tied to a patient’s bedside — hardly unable to leave lest alarms start going off. They wear gowns, masks and gloves for hours at a time and can even be isolated from their own team of peers if their patients’ needs are very demanding.
“A nurse’s job is already so hard,” Shaw said. “Even on a regular day, you’ve got five patients. Everyone needs something. You’re going to disappoint someone. You can’t win.”
Healthcare providers are taught to make objective decisions about treatment. But those lines can be blurred when nurses have to play the role of surrogate family members to isolated patients.
Shaw said one nurse whose patient died from COVID-19 refused to leave the room afterward. He said the nurse was one of the toughest he knew, but broke down in tears nonetheless.
“She just felt such a strong duty to stay. Because she knew she was it,” he said.
Yet in some ways, the challenge has brought nurses closer together.
Joan Pool, a nurse treating COVID patients in the ICU at St. Luke’s, said she’s working with nurses she’s never met before. But there’s a lot of teamwork and camaraderie among those who volunteered to work the COVID unit.
To limit trips to patient rooms, nurses cluster several tasks into one trip and tape lists of needed items like medications or syringes on doors for coworkers outside to fetch.
Pool said she’s seen some COVID patients improve. As is common with many other diseases, some patient conditions wax and wane over time.
But she’s been struck with the duration of the disease and the time patients spend fighting it in a hospital bed.
“It’s that, ‘Hmm, how much longer is it going to take for them to truly get better?’” she said. “And I don’t know the answer. I don’t think any of us do.”
She said she worries about taking the virus home and infecting loved ones. After each shift, Pool changes clothes in her garage, bags her dirty ones to be washed and heads for the shower.
“My husband follows me with a Clorox wipe and wipes everything I touch,” she said. “So we’ve got a process down.”
Pool said she loves getting to know patients and their loved ones. She likes to learn where they worked, where they traveled. Even for sedated patients, the stories of relatives help her build a personal connection to the patient, identify some common thread.
“It feels like you’re always crossing paths somewhere,” she said.
That’s harder now.
Her mask obstructs her face. And her patients’ relatives only know her from the phone. A former special education teacher, Pool has worked at St. Lukes for 34 years, most of them in the ICU.
“Helping people and being in that team environment, I’m just not sure why more people don’t want to be bedside nurses,” she said. “I feel like we give a lot, but at the end of the day, I think we also take a lot of good rewards home.”
