Front-line nurses urge Covid-19 skeptics to wake up
In April 2020, U.S. nurses appeared in the media to tell the public why Covid-19 must be taken seriously and managed with social distancing measures. An anonymous California nurse did that forcefully in an installment of the Guardian’s “ER Diaries” series, explaining that Covid patients were pushing his hospital to the brink. And on PBS’s NewsHour a Miami nurse manager likewise pleaded for distancing, describing how hard it is stay safe while providing critical care.
April 15, 2020 – Recent press items have featured U.S. nurses explaining how hard it is to care for critical Covid-19 patients—and trying to persuade the public that the virus is a deadly crisis that merits serious measures like social distancing. On April 14, The Guardian ran an installment in its “ER Diaries” series by an anonymous nurse caring for Covid patients entitled “‘And then my patient begins to crash’: a California nurse on the hardest shift in his career.” The short first-person narrative suggests that nurses play a central role in caring for Covid patients on the brink of death. But its main theme is trying to convince people who are not taking the virus seriously, or who complain about distancing, that containing Covid-19 is worth some sacrifice. That’s because it is a deadly disease that could kill anyone and that is pushing the health care system to the brink. And today, the PBS NewsHour television show included a segment in which reporter William Brangham interviewed Joseph Falise, a nurse manager at the University of Miami Health System. That piece takes readers inside the work of Covid nursing, especially the mental and physical challenges posed by burdensome personal protective equipment (PPE). Falise also delivers a message that no one is immune and that the only way to reduce the damage is through distancing measures. Consistent with most reports about nurses and Covid-19, the focus of these two is more on the nurses’ experiences in the clinical setting than on their expertise. But both items do portray nurses saving lives in accord with their own practice model, largely ignoring physicians. And both show nurses to be strong public health advocates, conveying a sense of urgency about Covid-19; with the California nurse, the urgency borders on exasperation at dangerous public misconceptions. We thank those responsible for these items.
The Guardian item is subtitled “A nurse explains just how much it takes to keep Covid-19 patients alive.” But it’s really more about the advocacy, and the anonymous nurse gets right to the point, noting in the first paragraph:
I desperately want everyone who subscribes to some half-baked conspiracy theory or complains about shops and beaches being closed to walk in my shoes for a day.
The nurse is tired of hearing, on days off, that the pandemic is no big deal and everyone should go back to work and school. To address that misconception, he emphasizes how different nursing work is now with Covid patients. Usually, he says, he can manage multiple patients. But now it can take more than one health worker just to keep one Covid patient alive. Now the nurse spends hours in one room as the primary nurse for a Covid patient, staying gowned up to preserve PPE, while another nurse brings supplies so the primary nurse need not cross the clean / dirty infection barrier (we have made a proposal about this type of system as a way to support nurses). The patient crashes, more nurses arrive and they all “work to keep the patient from dying.” Meanwhile, two more Covid patients are deteriorating, and soon the entire “module” is working to save those three. Yet there are a dozen more Covid patients, and if any decline, “our entire system will come crashing down.” The nurse says patients have filled up his ICU, but hospitals across the nation are also overwhelmed.
Nurses and doctors are stressed, anxious, sick and exhausted. They’re not lying when they say this threat is real. … Now is the time to believe the computers in your pockets that stream news from around the world and the video stories of healthcare workers showing the reality from inside our hospitals. Believe that this invisible virus can kill you, that it is killing people all over the world, that it is stretching our healthcare system to the brink. And believe that doing your part, along with all the pitfalls of doing that, is a noble cause that is saving lives.
The piece does at least suggest the central role nurses play in saving lives, although without many details that might stay with readers. The better element for nursing is the public health advocacy. This nurse is engaged and keen to argue strongly against views that Covid-19 is no big deal and the current precautions are overboard, using the first-person evidence of the nurse’s own daily work. It’s sad that the nurse has to urge readers to believe the generally reliable news reporting and expert health commentary available to them, as opposed to the nonsense they may be listening to instead. But in the current environment, that is potentially life-saving patient advocacy. And it also subverts the submissive-angel stereotype of nursing.
The NewsHour segment’s online version is headlined “The intense physical and mental effort required by health care workers amid COVID-19.” Anchor Judy Woodruff explains that Florida is one of the states still seeing Covid-19 cases grow, so reporter William Brangham spoke with nurse Joseph Falise from the University of Miami Health System. Brangham first asks what it’s like to provide care with all the PPE, physically. Falise stresses the sense of urgency that comes from knowing how dangerous the virus is to health workers, so colleagues are very focused on complying with protocols. Brangham follows up about the actual physical process. Falise explains that similar to the aviation industry, the nurses use checklists to guide how they don and doff the protective gear, and that they have observers watch both processes, to be sure they are completing the steps safely. Brangham says he knows the work is physically exhausting, but it must be mentally hard as well to provide good care while being so concerned about your own health. Falise agrees that “the hardest part is the mental exhaustion.” He notes that nurses stay in the Covid patient rooms for “hours at a time.”
We have to be there to monitor those machines, address any alarms that may go off, change I.V. fluid bags. You know, most of these patients are 10 — and have been on six or seven or eight infusions. It takes a lot of monitoring to make sure that none of these tubes come out, that all of the infusions are running, and that the bags don’t run out. The gear that we wear, you know, the bunny suit and the outer gown, it’s very hot inside, extremely hot inside. And if the nurse stays in there for a couple of hours, yes, the evidence is, when they come out, they look like they are completely drenched in sweat.
Brangham notes that Falise has a special perspective because of his front-line work. So he asks whether Falise has any message for those outside the clinical setting who are debating whether the restrictions are too much, and whether we should re-open the economy.
I think probably my most important message would be, nobody is immune to this. And the only way that has been proven to stop the spread of this is through distancing, is through staying home. … But it’s hard to do. And I understand that. … As somebody who’s seeing it day in and day out and dealing with families who really are heartbroken … — their lives are shattered because they’re losing their family members, and their family members are having to die without them, and we do our best to try to ease some of that suffering by FaceTiming and by promising to be there as a surrogate. But the reality is, it could be you next. You have an option.
Brangham closes by reminding viewers that Falise is a “clinical nurse manager” at the University of Miami, and wishing him luck in his work.
This piece gives a more specific sense of what is involved in caring for Covid patients (i.e., monitoring the machines and infusions), as well as the physical and mental challenges posed by the PPE, including the stress of knowing how dangerous every clinical move is because of the risk of infection. The closing identification of Falise as a manager is also helpful (nurses can be managers!), although it may get past many viewers. Brangham also invites Falise to offer some advocacy about social distancing. And Falise delivers, with a powerful message about how lives are being “shattered,” people are dying without family, and “it could be you next.”
See the article “The ER diaries: A California nurse on the front lines of the coronavirus pandemic: ‘And then my patient begins to crash’: a California nurse on the hardest shift in his career: A nurse explains just how much it takes to keep Covid-19 patients alive,” by Anonymous, published on April 14, 2020 in The Guardian.
See “The intense physical and mental effort required by health care workers amid COVID-19,” by William Brangham, appearing on April 15, 2020 on PBS’s Newshour.