Canadian Nurse

https://www.infirmiere-canadienne.com/blogs/ic-contenu/2020/05/19/exposition-a-la-covid-19-au-travail-lexperience-du

May 19, 2020, By: Crystal McLeod

Since the World Health Organization declared the novel coronavirus disease (COVID-19) a pandemic on March 11, 2020, life has changed for every Canadian (Young, 2020). From coast to coast, people of all professional backgrounds are making sacrifices, living in uncertainty, and following government direction to alter their everyday routines. These changes are creating immense mental health stressors for everyone, and could inflict long-lasting emotional trauma in all sectors of society (Higgins, 2020).

Yet, I can’t help but put myself in a slightly different category of stress than the mainstream public. I am a critical care nurse, and during this first month of the COVID-19 pandemic my life has shifted in innumerable ways. Most prominently, the burden of being exposed to COVID-19 at work has been heavily weighing on my conscience. Comprehending and managing this new occupational risk has put my individual well-being to the test. Coming to terms with this risk, something that I am still grappling with, has led me down a unique path of self-growth.

The staff meeting

Well before the Ontario government began announcing the closure of schools, businesses, and other non-essential services, my employer was already hard at work. Behind the scenes, administrators had been putting in long days, calling staff, and evaluating resources. I knew when my unit’s leadership team called a remote staff meeting in mid-March that they would have important planning and policy to share with us. Working in critical care, I had seen via social media the strong demands that COVID-19 was placing on European critical care units. I wanted to be ready.

Using a telephone-based meeting system, I called in to the forum and listened intently. I was immediately pleased with what I heard from my director during that meeting. Drawing on creativity and ingenuity, the leaders had pulled together what I thought to be a detailed proposal to triple our intensive care patient capacity. Leaders also discussed how they would support staff at the bedside, and keep us abreast of changing communications. I felt the sentiments of hospital leaders in this meeting, both then and now, were genuine and compassionate. I felt prepared for COVID-19.

For the last half of the meeting, leaders opened up the conversation for questions from clinical staff. As I had earlier in the meeting, I listened closely for any “red flags” or signs that I should be worried. I did hear numerous staff, almost echoing one another, about the risk of contracting the emerging illness and bringing it home to vulnerable family members. I did not linger on these concerns, being in my twenties and living alone. But in many ways, I was wrong to dismiss these anxieties and fears.

An accidental exposure

“I am so sorry, but we need to send you home now,” my manager said.

Like many nurses, I work a “waterfall” or “day-day-night-night” schedule. As a result, I often have the same patient or work in the same region of critical care for most of my clustered shifts. After the telephone staff meeting, I had been placed by chance in the “clean” or non-COVID-19 area of critical care. I don’t remember thinking I was safer in this area, but I didn’t feel any anxiety or fear in working these shifts.

The two day shifts ended up being unexceptional, as I was assigned a cardiac patient that was routine to the unit (I work in a cardiac surgery program). So when I began my night shift, I was a bit surprised to see my manager at the bedside. I thought, Maybe she is here to help me? as all the leaders had been pitching in with clinical care. Yet, as I got closer to her, she motioned that we talk over to the side.

Away from other colleagues, she explained that my patient from the day shift had developed respiratory symptoms and subsequently tested positive for COVID-19. “I am so sorry, but we need to send you home now,” my manager said. My patient had been quite elderly, and still in a professional frame of mind I asked, “Will the patient be okay?” She smiled and said, “I’m not sure… but you need to look after yourself right now.” Looking back, I heard her words, but didn’t really know what she meant.

Emotional fallout in self-isolation

I packed up my gear and headed home. I didn’t feel much at the time, but as I entered into self-isolation my mind began to race with a spectrum of emotions. Mostly I felt a growing sense of anxiety and fear, which caught me off guard. I had not been worried about contracting COVID-19 previously. Perhaps I truly didn’t believe it could happen to me until I was faced with the actual possibility.

At times, I worried that I hadn’t adequately picked up on the patient being COVID-19 positive—that I had left myself and other staff vulnerable. Then I would fear that the personal protective equipment I had used that day had not been enough to protect me. I replayed every action that I took in the patient’s room, noting any moment when I was in close physical contact. I felt my risk for transmission was high, and this gave my emotions more momentum.

Furthermore, I was suddenly terrified about what would happen to me if I did have COVID-19. I wondered if I would I need a bed within my own critical care unit. This fear was exacerbated by the fact that I knew treatment options for COVID-19 were severely limited. In my panicked mind, I reasoned that this emerging disease was just too new to be managed with anything beyond anecdotal evidence. On my last day shift a physician had even told the team, “Each time you go into a positive patient’s room, you take your life into your own hands.” In hindsight, he sounded so ominous.

… it is important to not underestimate the impact of a COVID-19 occupational exposure (whether illness occurs or not) on the mental health of health care workers.

During this time of uncertainty, family and friends reached out to chat through social media. I explained to them that I had experienced a work-related exposure to COVID-19, and expressed some of my concerns. I hoped they would reduce my feelings of uneasiness. Instead, their comments—“Thank goodness you’re so young” and “You’re going to be fine”—hurt. It just felt like so much was on the line for me coming out of this exposure, and few seemed to understand that. One person even made me feel embarrassed, saying, “Well, that is your job; you have to deal with it.” Was this just part of the job, and I was not cut out for it?

The rest of my self-isolation period remained emotionally difficult.

Restoring mental well-being

The silver lining to this experience was that I never ended up contracting COVID-19, and for this I am grateful. I worked with occupational health, public health, hospital administration, and the nursing union to return to the bedside. However, I did also take away a few other positive pearls of information from this experience with regard to mental health.

Foremost, I think that it is important to not underestimate the impact of a COVID-19 occupational exposure (whether illness occurs or not) on the mental health of health care workers. I truly did not think that my mental well-being would be brought down so acutely. I find it difficult to attribute my emotions to any one aspect of this experience, but I think the unique obligations, pressures, and ethical code that health care workers are subject to all contribute. Recognizing the effects of occupational risk, at the level of the individual and community, could mitigate additional harm to mental health. For myself anyway, I know that once I identified my experience as emotionally traumatic, I felt more at peace.

Taking time to restore well-being should then follow recognition of mental strain or injury. I had the most success in relieving my fear and anxiety by reflecting on how I felt and leaning on nurse mentors. Fellow nurses related best to my experience, but I imagine any empathetic person would have helped. Reading a good book, crocheting a blanket for my soon-to-arrive nephew, exercising daily, and indulging in a few subscription boxes also helped to boost my mood again.

Finally, I think the continual changing of health care policy and infection control measures during this pandemic creates an added level of stress over occupational risk. Although my workplace exposure was not the result of a failure to comply with policy, I feel it is easy to make an error, or just worry that an error has been made because of so many changes. Fortunately, my health care facility ended up supporting my return to work with additional education on infection control policy. I think this education gave me renewed confidence in resuming clinical practice, and would recommend that other workplaces adopt a similar practice.

The COVID-19 pandemic is widely considered an “unprecedented event” that is testing the human race in new and challenging ways. I would argue that the challenges experienced by health care workers are only starting to emerge, and could last well beyond the formal pandemic period. That being said, I am optimistic that by sharing our collective clinical experiences health care workers can help support one another in this difficult time. I hope in sharing this experience I can assist the practice, professional outlook, and personal well-being of health care workers who find themselves in a similar situation.

References

Higgins, T. (2020, March 27). Coronavirus pandemic could inflict emotional trauma and PTSD on an unprecedented scale, scientists warn.

Young, L. (2020, April 11). Timeline: How Canada has changed since coronavirus was declared a pandemic.

Crystal McLeod is a registered nurse with more than 7 years of experience in acute care. Away from the clinical setting, she is an avid writer, researcher, and life-long learner.