Canadian Nurse

https://www.infirmiere-canadienne.com/blogs/ic-contenu/2021/05/12/a-travers-les-protocoles-covid-une-infirmiere-urge

May 12, 2021, By: Laura Eggertson

Every day that COVID-19 causes the Edmonton emergency department where she works to fill with critically ill patients, veteran nurse Jean Harsch worries she won’t be fast enough.

She’s afraid the extra seconds it takes her to don the full personal protective equipment (PPE) the pandemic demands will one day cost a patient their life.

Before COVID, if an overhead code summoned staff to the waiting room at the Grey Nuns Community Hospital where she’s a clinical nurse educator, Harsch would run from her office to join the resuscitation team.

The call means someone has fainted, quit breathing or their heart has stopped.

Now, when Harsch hears the code, she checks herself.

She stops to don her gown, goggles and gloves.

Since the pandemic began, nurses and doctors can start chest compressions, but not respiration. They can no longer clamber atop a stretcher to begin rescue breathing because that would expose them to potential contamination from their patient’s droplets.

Now they must stop compressions and breathing while they transfer their patient to a stretcher and rush it to a room with four walls and a door. CPR begins again once everyone in the room has their N95 masks in place.

Because the SARS-CoV-2 virus can become airborne, starting CPR without being in a safe space or without full protective equipment puts everyone at risk, says Harsch, who is the past president of the National Emergency Nurses Association.

Feels wrong

She supports the COVID procedure wholeheartedly. But it feels wrong.

“It’s brutal to see someone in need lying on the floor and know that you are not to be touching them until you are fully garbed in your PPE,” says Harsch, who has worked as an emergency nurse at the community hospital for 13 years.

“That’s a whole culture change for all of us.”

Harsch believes she and her colleagues move fast enough that these delays don’t jeopardize lives.

Still, she worries patients, or their loved ones, will be afraid their care is delayed.

Harsch’s role as a nurse educator is to train staff in emergency procedures and skills, including certifying them in Advanced Cardiovascular Life Support (ACLS), ECG dysrhythmia and how to interpret 12-lead ECGs.

Investing in nurses

Before COVID, she held quarterly training days for nurses, where even staff members on break could stop in to hear a speaker. She cooked breakfast and lunch for them during training.

“A big part of that is my desire to communicate their value, that I’m investing in them,” says Harsch.

During COVID, Harsch and the other nurse educator she works with cancelled their regular education days. They orient new staff, but only in small groups. They wear full protective equipment while they teach.

Anxiety is high among nurses and other hospital staff across the country.

They can train only six of their 200 nurses at a time.

“You feel like it’s such a small drop in the bucket,” Harsch says.

“My colleague and I both feel the weight of moving staff into more critical areas in the department before they are fully trained. You worry that they are going to feel ill-prepared.”

Anxiety is high among nurses and other hospital staff across the country, says Harsch. Many nurses are burnt out, she says. Some are opting into other specialties; others, including in her own department, are leaving nursing altogether.

Not only are their workloads climbing, but the nurses are also home-schooling children and caring for sick family members.

And they are absorbing patients’ distress.

Earlier in the pandemic, one nurse told Harsch that when she entered the room of a patient who had tested positive for COVID, the patient told her, “You’re the first person that’s actually come into my room. Everyone else talks from the door.”

To hear about patients’ isolation was crushing, says Harsch.

As the pandemic wears on, many nurses have adapted to the new routines. They are faster at donning PPE. They spend more time in patient rooms; there is less speaking from doorways. Some nurses — including Harsch — are now vaccinated against COVID.

“There’s a sense of huge relief,” she says. “It’s a wary hopefulness, because … we believe this will make a difference, but all of our social distancing and PPE is still in effect.”

Nurses are struggling because emergency departments are filling with sicker patients, not only because of COVID but also because people have delayed seeking medical care for fear of catching the virus, Harsch says.

People are arriving in full cardiac arrest or with infections that have become septic. More people seem to be overdosing on opioids, have attempted suicide or are experiencing other mental health emergencies, Harsch says.

The severity of patients’ conditions puts even more pressure on the emergency staff.

Increasing support

In her own hospital, Harsch is increasing the emotional support that’s always been part of her job.

She can no longer stand alongside a nurse who is leading a resuscitation team for the first time, guiding her through it. Instead, she waits outside the resuscitation room and answers questions.

She can’t put her hand on the shoulder of a colleague who’s had a difficult shift or hug her colleagues, patients or the family members of those who have died.

“These things are hard not to be able to do. It’s a huge loss,” she says.

In her own hospital, Harsch is increasing the emotional support that’s always been part of her job.

But Harsch has found other ways to communicate support.

She spends extra time walking through the department, checking on nurses’ mental and emotional health. She asks more purposeful questions, not just about how their shift went but also how their lives are going. She makes herself available for those who send her private messages and need to talk.

Harsch has long loved what she calls the “chaotically organized” atmosphere of the emergency department, which stands in stark contrast to her early career as an ICU nurse, where patients were already diagnosed and being treated.

She recognizes, however, that the intense nature of emergency work is emotionally challenging, particularly now, when people are isolated.

That’s why Harsch leaves gift cards at the triage station, or in the tray containing code supplies, with notes on them: “Bad shift? Have a coffee on us.”

Nurses need to talk, Harsch says. “I feel like our place in that, as the clinical nurse educators in our department, has just intensified. There’s no solutions for what we’re going through — it’s just venting.”

Venting helps

Harsch does her own venting to husband Terry Harsch, a pastor, and her three grown daughters.

“I’ve become quite a good crier, I have to say. It’s a great release. My husband is very good at listening,” she says.

Although they can now see their daughters and grandchildren only by Zoom, the Harsches still gather as an extended family. They have weekly calls. Recently, they played an escape room game over Zoom for one daughter’s birthday.

“It was excellent,” she says.

Harsch finds the isolation hard. To reduce her stress, she resigned as president of the emergency association before her term was up in August.

“It was too much to juggle that and my own staff,” she says. “I made the decision that if I am going to lay awake at night, I am going to lay awake at night thinking of my own staff and what I am doing for them.”

Harsch also quilts, sews, makes cards and plays piano and guitar — all vital creative outlets that restore her spirit.

Cycling and riding motorbikes, whenever possible, also help keep her positive.

Harsch tries to focus on what she can do during the pandemic instead of what she can’t. She loves encouraging others to embrace the same attitude.

“What gives me hope is watching people find the ‘can-dos,’” she says.

Laura Eggertson is a freelance journalist based in Wolfville, N.S.