From the beginning of the COVID-19 pandemic, nurses on the front lines have had to innovate and adapt, filling not only the role of caretaker but also the role of family for coronavirus patients in the hospital.
Janet Tomcavage, executive vice president and chief nursing executive at Geisinger, says words that come to mind when thinking about the pandemic are “consuming,” “enlightening,” “challenging,” and “resiliency.”
Even at the start of the pandemic when much about COVID-19 — including the best ways to treat it and to avoid catching it — was still unknown, nurses cared for their patients. “They’re the ones who had to gown up, glove up, mask up, before we really even knew much about the disease,” says Tomcavage. “They are literally the front lines, in with the patients 24/7.”
Nurses have learned new skills to help coronavirus patients. They’ve found innovative ways to care for patients and for themselves. They’ve adapted to new procedures to deal with surges that strained hospitals’ capacity limits. And they’ve been like family members for patients who were unable to see their loved ones while in the hospital.
“We became their extended family. We held their hand while they passed away. We wiped their tears,” says Tomcavage. “We really did have to be that connection. We felt for the loss. We felt for the challenge, the tragedy. And through it all, our nurses were innovative. They were creative.”
Tomcavage says the nurses’ ability to develop and adapt to new methods for caring for patients has been inspiring. Nurses at Geisinger hospitals installed bike racks on the walls to hold their protective gear. They got extension tubing to move equipment out of the rooms so they wouldn’t have to put on all their gear if a patient needed quick assistance.
When a surge in cases around the end of 2020 strained Geisinger hospitals’ capacities, the healthcare system found ways to create more space for COVID-19 patients in the facilities. They also utilized home-based teams to discharge patients from the hospital sooner than usual and provide additional care for them at home, opening up beds in the hospitals more quickly.
Another innovation involved installing baby monitors or iPads inside rooms with solid doors, so nurses could check on COVID-19 patients while the doors were closed to prevent the virus from spreading around the facilities.
“Despite the exhaustion the teams have felt and the 24/7 [work] over the last year and a half, it really has been inspiring as well,” Tomcavage says.
Protecting patients has been a priority for nurses during the pandemic, so Geisinger has worked to protect its nurses. While things like PPE, hand washing and vaccinations help protect nurses’ physical wellbeing, working on the front lines during COVID-19 has taken a toll on their mental health.
“It’s been, as I said, exhausting. We’ve lost more patients than we’ve ever lost,” says Tomcavage. “This post-traumatic stress syndrome that we often hear about from folks that have gone off to war…we really did stage a war here with COVID, and we lost a lot of neighbors and friends and people that we knew and we became attached to when they came into the hospital.”
Tomcavage says she recently spoke with a nurse who told her that she thought she was tough and was managing the pandemic well, “But this has been hard,” she said.
To care for nurses’ mental wellbeing, Geisinger emphasized communication between executives and frontline healthcare workers. Senior leadership often spent time in the hospital with the nurses, discussing their needs and any changes that could make their jobs easier. And those conversations led to many of the innovations the healthcare system implemented.
Geisinger also created access to their behavioral health team at all hours via telehealth, and members of Geisinger’s emotional and physical wellbeing team were stationed in and near the COVID-19 units at the larger hospitals.
“That immediate access right close physically to the unit was the best thing that we did,” says Tomcavage. Nurses could talk with the team members without an appointment, whenever it was convenient for them. Tomcavage says nurses’ feedback about this was very positive, and they’re planning to expand the practice to all of the healthcare system’s campuses.
Physical safety also contributes to nurses’ sense of wellbeing. Tomcavage explains that providing PPE for frontline healthcare workers was a priority. While they did have to clean and reuse N-95 masks when PPE supplies were limited toward the beginning of the pandemic, Tomcavage says Geisinger nurses were never without proper protection.
The COVID-19 vaccines help protect nurses, as well, and Tomcavage encourages all individuals, whether or not they work in healthcare, to get vaccinated to help stop the spread of the coronavirus.
“Thousands and thousands of patients have come through our doors. Some have had minor symptoms from the infection, and some have had the most devastating symptoms and have suffered significant consequence, whether it be vascular, amputations, long-standing pulmonary problems, cardiac problems or death,” Tomcavage says.
Along with getting the vaccine, Tomcavage says masking, social distancing and frequent hand washing can also help mitigate the spread of the virus.
“People are sick, and the consequence is real, and so I would just ask people — and this is what nurses say to me when I say, ‘What can we do?’ Their comment often is ‘Get the public to understand that we need to stop the spread of COVID,'” says Tomcavage.