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Nursing in a ‘Hot Zone’ Fighting COVID-19

UVM Medical Center Fanny Allen Nurse conducting intubation training 

Posted April 22, 2020 by UVM Medical Center

There's really no wonder why I jumped out of bed to an alarm clock on a Sunday morning thinking that I was late for work, and also why I spilled orange juice all over myself when I tried to screw the cover for the peanut butter jar onto my cup of juice. We were in the thick of COVID-19 care and my days were long and full and racked with the stress and anxiety from this disease. 

I am a nurse manager and the unit that I manage at UVM Medical Center’s Fanny Allen Campus is a designated hot zone – otherwise known as a contaminated area – where people suspected of having COVID-19 are undergoing testing and treatment. Within this unit we also maintain a separate process and area to treat patients who are not under suspicion of having COVID-19 (or a respiratory virus). They all come in through the same entrance, and we are diligently sorting people out as they arrive. 

"People are tired, bravely working through difficult situations, and continuously adapting. I am completely humbled by how everyone has come together and pitched in to help out." Joanne Rheaume, DNP, RN, CEN, CPHQ,

Leading people in the hot zone during COVID-19 has been challenging. We are constantly changing process and protocols as events unfold. We’re making adjustments, readjusting, and making difficult decisions. We're dealing with a PPE shortage, fear, anxiety, and for a period of time, a high volume of high-risk work. We are continuously working with a variety of departments, and things move at a rapid pace with new challenges coming our way, sometimes several times each day.

People are tired, bravely working through difficult situations, and continuously adapting. I am completely humbled by how everyone has come together and pitched in to help out, or offered to help in any way that they are able too. Everyone is assuming a certain level of personal risk, despite meticulous safety precautions as we prepare for a possible surge in patient volume.

Overcoming Fear and Anxiety

Imaginary obstacles are insurmountable. Real ones aren't. ~ Barbara Sher

To do the work that we do, it's important to maintain perspective, keep things in context, manage the anxiety, control the chaos, and ensure good decisions are being made. This is a team effort. I do this by being transparent, continually updating and educating staff as new information comes to light, focusing on how to stay safe while providing patient care, working together to create safer processes as things evolve, and bringing in additional resources (staff and equipment) to help support staff with what they need. Meeting with staff regularly throughout the day, as often as needed, to see how things are going, to find out what they need to address concerns, and brainstorm ideas for how to improve our processes help keep us moving forward. We try to keep our focus on solutions and what we are able to control, and pitch in and help out with whatever needs to be done - everyone does. We control the chaos through the safety processes we developed, slowing the pace, and controlling safety while providing care for patients.

Volunteer donating pie to UVM Medical Center staff 

Meal and food donations give staff a much-needed boost.

Additionally, we created a relaxation space to allow staff a place to disconnect for a few minutes during their shift, and I encourage staff to go out for a walk outside the clinic when it’s not busy, keep the humor, and support each other. One of our medical assistant’s hosted an impromptu yoga session during a period of low census to help reduce stress. Through the kindness and generosity of others, we have had meals, chocolate, coffee, and wellness items donated which gives everyone a much-needed boost and helps them feel better as well. I email daily and weekly COVID updates where I highlight what’s new, all of the good things that are happening, fun pictures, and staff kudos. 

Lastly, I am constantly reviewing trusted websites for new information (CDC, WHO, Department of Health, to name a few). I scan the news, read about what's happening in other countries and states, and take into account what has already occurred and the measures that other organizations and communities have taken. This gives me foresight, and helps me make sound decisions.

Health Care Heroes

Courage isn't having the strength to go on - it's going on when you don't have strength. ~ Napoleon Bonaparte

As a nurse manager, my typical day during what I’m hoping is the height of this pandemic doesn’t look like the average day of a “hero” what with daredevil adventure and rooftop hopping. Instead it looks something like this: Up early, exercise, head in to work, see what's changed overnight, meet with the staff, address concerns, discuss things that are working well and things that need to be adjusted, brainstorm ideas. Along the way I check emails, respond to high priority items and answer critical questions. At this time my phone starts to light up with calls from other departments to notify me of something important. They need to collaborate to develop new processes, deal with issues and resolve problems.

The pace is fast and everything is serious. While on the phone, staff come in to my office to talk about an active issue that needs immediate attention. And when I'm meeting with staff on the unit, my pager starts sounding with another high priority issue from another area requiring immediate attention. All the while text messages flood my phone from other areas with high priority issues about positive patient results, quarantine needed for exposed staff, and the resulting staffing changes needed. 

Instead of a hero cape and utility belt, I grab my salad to eat at my desk while sitting in a 30 min leadership update meeting. Emails, texts and calls continue as we meet. I see cell phone numbers requesting me to call them back as soon as possible - often from incident command.

12 hours have passed and my shift is over. I head home, grab a bite to eat and field several text messages from the parking lot. Later, I scan the news, websites, double check emails before I head to bed and wake up to do it all over again.

This is health care in the wake of COVID-19 and I am so grateful to be working alongside the many, many frontline staff keeping our communities safe. Thank you all for the work you do. 

Joanne Rheaume, DNP, RN, CEN, CPHQ, is nurse manager of urgent care and infusion at UVM Medical Center’s Fanny Allen campus.

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