Frontline Healthcare Workers Must Care for Themselves

It’s been a rough ride for nurses, infection preventionists, and other frontline healthcare workers ever since the coronavirus disease 2019 (COVID-19) began. “Until we can see the light at the end of the tunnel, it’s very crucial that we look out for one another and make sure we address our mental health and emotional needs,” Ernest Grant, PhD, the president of the American Nurses Association tells Infection Control Today®. Grant, the first man to hold that position, has a long history of rising to face the challenges of the moment. In 2002, President George W. Bush presented Grant with a Nurse of the Year Award. Grant received that distinction because of his work treating burn victims at the World Trade Center site after the 9/11 attacks. That’s just one of many of Grant’s accomplishments. He tells ICT® of the challenges that nurses and infection preventionists have overcome during the pandemic, and what hurdles may still lie in store.

Infection Control Today®: Has the COVID-19 pandemic changed the way nurses and infection preventionists do their jobs?

Ernest Grant, PhD: Absolutely. It’s changed the way nurses have begun to not only view their jobs, but also how they take care of patients. And, also, the profession itself is will be changed once this crisis is over as a result of COVID-19 in a number of ways.

ICT®: What ways?

Grant: The first thing we’re noticing is, obviously, the preparedness for when a pandemic such as this comes along. One of the things that we’re anticipating is that COVID-19 is just the latest of perhaps future and more frequently occurring pandemics. So being prepared for future pandemics is very high on the list. The other, of course, is the way that we will be prepared to provide care for the patients, also. One of the things that COVID has taught us is that not only with using PPEs and things of that sort, but also just modifying teamwork. Going in and caring for the very critically ill patient. And it’s having quite an emotional toll on nurses who are seeing so many deaths per shift. If you’re working a 12-hour shift, there’s a possibility that you may see anywhere from six to maybe 16 deaths occurring on your unit because of how critical the patients are. And that within itself creates quite a problem for the patients.

ICT®: One of the most heartbreaking things about this pandemic is that so often people have to die alone without family members present. Often the only one in the room at the end of a life is the nurse.

Grant: Absolutely, the nurse is playing two roles, if you will. And that’s another aspect that has changed is that you’re also being the family member. You’re there either holding an iPad, so that the family member can view the patient, or the patient can communicate with the family member. You’re keeping them updated on their progress. Whereas, in the traditional method, I guess, air quotes there, the family member would be there in the room and be able to actually visualize what it is that you’re doing and how the patient is progressing. You have to set aside that special time several times a shift, I’m sure, to contact family members and give a progress report. And of course, that’s time that you’re having to take away from the patient. But that is still critically important because that family member, their encouragement, words that they can send to the patient, also helps to determine whether or not this patient is going to recover or not, or give them the incentive to want to go on and have a speedy recovery.

ICT®: As I mentioned, a lot of my readers are infections preventionists and a lot of them have nursing backgrounds. How does a nursing background feed into the job of infection prevention?

Grant: Well, as nurses, we’re taught to look at the whole body, as well as the environment and we take that information and also try to personalize that, if you will, for the patients that we’re caring for. We try to get some idea of: How was this patient before this illness struck? And what are some things that we can design the plan of care for this person that is unique to them Even though the person in the next bed may have the exact same illnesses, and etc., they’re going to be treated differently because of who they are and their life’s experience. So, in a way, as a nurse, and as an infection control person, you’re sort of playing the detective, so to speak. And by doing that, then we can obviously be prepared to highlight our care for that one specific patient that is going to help them to get over that particular hump. So, taking in the environment, knowing that they may have got infected perhaps attending maybe a birthday party or being out in a very heavy crowd, or things of that sort. Those are some things that are going to also help to drive their care and help us to get a better picture of who it is that we’re caring for and what can we plan that’s going to be the best for them.

ICT®: Infection preventionists also have to look after their healthcare colleagues. Does a nursing background help with that?

Grant: Oh, absolutely. One of the things you have to think about is someone may be in a patient’s room for several hours doing various nursing duties and tasks. You want to make certain that this person at least gets some sort of relief so that they’re not overwhelmed, or taxed. So we have to look out for one another, and look for those little subtle signs that this person may need to have a tap on the shoulder and say, “You know, why don’t you take a time out? Go have a bathroom break. Go have a Coke or get some lunch or something like that, while I watch the patient for you.” Because it can be very, very, very demanding. You’ve got a lot of technology equipment that you’re dealing with that is helping you to take care of this patient. You’ve got to interpret all that data. And, of course, be prepared to present that to our physician colleagues or our advanced practice nurses who may be helping to care for those patients as well. And so that you’re ensuring that the patient is getting the optimal care. Failure to do that, obviously, you’re going to have a nurse who is very tired. And studies have shown that when we’re tired, there’s the increased chance of the possibility of errors happening. We want to minimize that as best as we can. By recognizing that: Yes, this person needs some time out. They perhaps need to have a mental health day or refer them to some mental health resources. Because keep in mind, this crisis has been with us now for about eight months, and we don’t know where it’s going to end. Most crisis or disasters, usually we know that they’re going to end in about 24 to 48 hours or so. Everybody comes in, they triage and then go. Here, we don’t know when this is going to end, even though there’s promise of vaccines down the road. That still doesn’t mean that this crisis is going to be over. Until we can see the light at the end of the tunnel, it’s very crucial that we look out for one another and make sure we address our mental health and emotional needs.

ICT®: When the COVID-19 vaccine comes along, do you think that getting vaccination should be a condition of employment for nurses?

Grant: That’s a very tough question. But obviously, it probably will be. I do know that in the majority of the healthcare institutions around the country, the flu vaccine is a requirement for healthcare personnel, unless there is some religious objection, or some other reason that they cannot take that. So, yes, I would say that it probably is going to be part of a requirement for employment, that that person gets that unless there’s some other reasonable objection that they may have.

ICT®: What are some of the main hurdles to caring for COVID-19 patients these days?

Grant: You know, back in March and April, it seems like every day we were learning something new about the virus. So obviously, the questions surrounding those and also the policies and/or procedures, if you will, of providing the care to the patient will change as well. And in some cases, some of the questions have not changed. We’re still hearing from nurses that are on the frontline that there’s still a lack of PPE—personal protective equipment—particularly the N95 mask that is so desperately needed. We are working with the COVID-19 Task Force and other areas of the federal government to ensure that the supply chain is kept up to date so that the desperately needed supplies and other pieces of equipment are gotten to the places where they need to be. So that, again, life can be a little bit easier for those frontline workers. Patients will be on the ventilator. They would just be on their backs. Now we’re finding that they have better results turning the patients on their stomachs. Different medications that we may try. Steroids as well as the remdesivir helps quite a lot with the recovery. And so, again, as those are done, your nursing care is going to change as well. Because, obviously, as the patients are getting these medications, you need to be on the lookout for any particular potential challenges that they may have. Is the person having an allergic reaction to that and the sooner we’re able to catch it, the better, it’s going to be. Also, obviously, from an infection control standpoint, again, just making certain that everyone that goes into the room, that they’re properly gowned, masked and gloved and wearing the correct equipment. And then, also, when they step out of the room, that they take the equipment off in the correct order so that you don’t run the risk of spreading the virus to your colleagues, or worse yet, potentially taking it home to family members.

ICT®: What do you see as the main challenge going forward for nurses?

Grant: I think the main challenge going forward is the fact that, again, not knowing when this crisis is going to end. And nurses still having to face just so much death day in and day out on their shifts. The potential mental anguish that this is going to cause. And they’re not seeking the appropriate assistance that is offered to help deal with that. We are great at caring for patients, and others, but sometimes when it comes to caring for ourselves, we always put ourselves last. And in this case, the frontline workers need to recognize that it’s important that they take care of themselves first. Because you’ve got to operate at your optimum in order to take care of all the challenges that are going to come along. You’re not going to be very beneficial if you yourself are not up to par.

ICT®: Any final words of advice for either nurses or infection preventionists?

Grant: Well, I would say for the nurses and all the frontline workers, thank you for all that you’re doing day in and day out. We will continue to advocate on your behalf, with trying to ensure that you get the proper equipment and such that you need. And for the infection preventionist as well, or infection control folks. Again, it’s extremely important that we continue to study this virus and make changes to our standard of care or standards of practice accordingly as we find out new information and get that education out there as soon as we possibly can.

This interview has been edited for length and clarity.