Maternity Care in the Time of COVID-19

Maternity Care in the Time of COVID-19

While so many businesses are shut down and people are staying at home, there’s one thing that will keep happening no matter what—women are still having babies and need access to safe maternity care during the COVID-19 pandemic.

In this dangerous and uncertain time, we wanted to know what’s going on in labor and delivery (L&D)—at least from one nurse’s perspective.

Morgan Michalowski, CNM, WHNP-BC, IBCLC, RN, who works at a large urban, educational and research medical facility in Chicago, Illinois took time to answer our questions regarding the state of L&D.

What are hospitals currently doing (or should do) to keep their maternity/L&D patients safe right now? 

Hospital-wide we have a visitor restriction in place, but in L&D we allow one support person to be with the mother. We are universally testing anyone admitted to the hospital for COVID and, in L&D specifically, utilize rapid point-of-care testing. It takes just a few minutes to determine if she is COVID positive.

Hospital workers in L&D wear N95s with a surgical mask over it when in contact with any patient, even if they are not COVID positive.

How are things different in the midst of COVID-19? Is someone still allowed to be with the mother during labor/delivery?

The first two months, March and April, were a whirlwind. From creating new policies to providing high-quality care to figuring out how to promote bonding when NICU restrictions limit parental access, it was a steep learning curve for all.

We do allow one support person with a mother during labor, delivery, and postpartum. That visitor has to stay at the hospital with the mother through discharge. This seems to be working fine for the moment. We have had patients express interest in leaving the hospital as soon as possible, so they can be home with the rest of their family. Our team has been accommodating those requests. One of the biggest hurdles was figuring out how to support mothers if they’re separated from their baby due to a NICU admission. Most NICUs don’t allow any visitors, which is really tough on a lot of families. We coordinate video calls and check-ins so they feel connected to their baby, but it’s not the same.

What changes have occurred during COVID-19 that you think should be permanent either for the near future or forever?

One strategy in responding to COVID has been to expand the scope of practice for Nurse Practitioners and Midwives, which is having a positive and meaningful impact on care. I hope more states allow for this and continue this practice post-COVID.

Universal testing for COVID will become standard of care, in the same way that TB tests are required prior to starting school or a new job.

What’s happening with the newborns to keep them safe?

Healthy term newborns born to mothers without COVID room in with their mother until discharge. If mom and baby are low-risk, we try and discharge them within 24 hours. During that time, mom and her support person are required to wear masks.

If a mom is COVID positive, her baby goes to NICU until discharge.

Is everyone involved—mother, guest, child—getting tested?

We are currently only testing the mother, no one else. If mom is COVID positive, the NICU handles the care and testing of the baby.

Have the guidelines changed for when Mom and child are released?

No. While we try and discharge clients as quickly as possible, making sure they’re safe with adequate follow-up care is of the utmost importance. If a mom and baby are low-risk with a vaginal delivery, we discharge around 24 hours. If she’s low-risk, but had a c-section, discharge is around 72 hours.

Regarding post-natal care: are moms/newborns getting home nurse visits if

necessary? Is any other treatment happening or have some things moved to

telehealth?

Most postpartum visits can be handled through telehealth. We do see them in person for the six-week postpartum visit. We do not send anyone to the house.

Is there any other information that is important for our readers to know?

I think it’s important for readers to know that hospital workers are doing their very best to keep you, your loved ones, and themselves safe. Some of the restrictions—and the implication those restrictions have on the laboring mother—might not make sense or feel supportive. Every woman deserves to give birth with support and care in a safe environment. We are doing our best to make sure she gets all three.

What it’s Like Working in the ICU Right Now

What it’s Like Working in the ICU Right Now

While coronavirus has turned the health care field upside down, with general practitioners, specialists, and even urgent care facilities turning to telehealth as much as possible or limiting hours, we wanted to know what it’s like in one of the more difficult places to work in a hospital: the ICU.

Rachel Norton, RN, an ICU travel nurse with NurseFly, is currently based in Denver, Colorado. She’s been a nurse for 13 years, working her entire career in critical care.

Norton answered our questions to provide a glimpse into an ICU during COVID-19.

What’s it like to be working as an ICU nurse now? How does this differ from how it was to work as an ICU nurse before COVID-19?

This pandemic is by far the worst experience that has happened during my career. I’ve never seen nurses as anxious and fearful as they are right now. Working in an ICU has been tough, especially when the number of admissions to the ICU is still well above what we would see on a normal daily basis.

As ICU nurses, we worry a lot about lack of personal protection equipment (PPE), supplies, and the survival of our patients. A recent NurseFly survey found that 70% of nurses are concerned about personal safety with their assigned hospitals. I’ve spoken with nurses from all over the country and the general sentiment is: “I am terrified. I am scared for my patient’s livelihood. I am scared for my life.”

In the ICU, I have also seen a lot of change with our doctors. Our doctors are running nonstop as they are trying to care for the rapidly declining COVID-19 patients and also trying to care for the other patients in our unit. This means that we are still taking care of patients with heart attacks, strokes, and all of the other patients that we would see on a normal daily basis.

The patients that are being admitted are requiring an excess of resources—staff/equipment/medication—to care for them. With hospitals running lean for years with staff and equipment, this has only caused additional strain on ICU nurses.

One of the major differences between now and before COVID-19 is the lack of family members at the bedside. Families have instilled their trust in us to care for their loved ones and that is such an act of bravery, and it is an honor to be a part of. Nurses have been voted the most trusted profession for 18 years straight, and this only shows why we remain at the top. We are taking care of humans. We are serving the country like never before.

What are the working conditions like now with COVID-19? How is this different than they were before? 

Day in and day out, our ICU is consistently full. Almost 75% of our patients are still confirmed positive for coronavirus. While the media paints one picture of the type of individual most vulnerable to COVID-19, my patients fall within all age ranges and not all have comorbidities or other medical problems. This virus does not discriminate.

Given the volume of patients that come in the door, it is impossible to keep everyone in negative airflow rooms. We are keeping one negative airflow room vacant to use for emergent “aerosol generating procedures.” We are about to open off-site units to accommodate the influx of patients. Nurses are asking: Do we have enough ventilators? Enough IV pumps? Enough medication to keep these patients comfortable and alive throughout their illness?There are no good answers. As health care professionals, we have to adapt our practices to give care with limited resources and supplies.

While we have found ways to adapt, we need a solution that will fix these questions and issues in the long term—we cannot wait until we have another pandemic or public health crisis to acknowledge and fix this.

Currently, hospitals are still cutting nurses. Travel nurses are scrambling for contracts and rates are becoming less competitive as the desperation rises. Yet, hospitals are still short staffed. In fact, NurseFly’s recent survey found that 30% of nurses do not believe their current placement or full-time position is secure for the next 2 months. Patients still need care. We cannot treat health care as a business and decrease the number of workers as the needs are still present.

Before the COVID-19 crisis elevated, our working conditions were already less than ideal. Many facilities often ran short staffed or made last-minute changes to the staffing to accommodate needs. This is stressful for nurses. Now, just as we are beginning to see an improvement, staffing is being cut again. Companies like NurseFly have been working to fill needs that are being posted. Yet, hospitals and health care systems continue to cut staff at alarming rates.

Describe your typical work day. How does this differ from the ICU before COVID-19?

My typical workday is a 12-hour shift and I work 7:00 a.m. – 7:30 p.m. I arrive at work at 6:45 a.m. and count the positive patients listed on our staffing board.

Staffing at our hospital has survived so far, but as we prepare to open additional ICU beds in off-site areas, many questions are being asked about who is going to take care of those patients.

On an everyday basis, our jobs are inherently fast-paced and demand a lot of physical and emotional resources. I am feeling the most anxious I have felt in a long time, maybe ever. ICU nurses are generally high-energy people with an ability to handle enormous stress levels, but this is different from what we’ve seen before.

How are you managing your own stress during this time?

My day-to-day job involves stressful and emergency situations. This level of stress has been heightened during the pandemic, where it is my responsibility to control, contain, and treat coronavirus patients, and where I am at risk of being exposed. Many nurses are feeling the same way—NurseFly’s recent survey found that nearly 80% of health care professionals feel more stressed in their day-to-day job since the COVID-19 crisis elevated.

However, as ICU nurses, it is our duty to stay healthy, mentally prepared, and protect ourselves and keep our patients safe—it’s crucial for health care workers to take 5-10 minute mental health breaks to refocus and re-center our thoughts. This is one of the ways that I manage my own stress.

In terms of managing stress from my day-to-day role, I stay focused on routine nursing care and continue to provide safe and adequate care. This can be especially challenging in this crisis, as there is extra work in donning and doffing personal protection equipment (PPE) constantly, which is particularly exhausting, but so important.

Another way I maintain calm and manage my own stress is by staying organized and advocating for myself and my coworkers—this is more important now more than ever. We always need to make sure we have adequate PPE supplies, that we cluster nursing care to avoid multiple re-entries into patient rooms, and decrease the amount of people necessary to enter each room.

With patients’ families and friends not allowed to visit, how has that changed the care that you provide? Are you having to help keep them calm/relaxed?

One of the hardest things to experience is not allowing patients to have visitors, but this is absolutely critical to stopping the spread. Being a support system for the confirmed and ruled out patients is just as important as basic care but can be even more emotionally taxing. It breaks all nurses’ hearts to watch people suffer and have no one to help them cope with this illness.

As nurses we treat the patient as a whole person and try our best to help patients keep calm and relaxed. We know how important human interaction is, and we are trying our best to connect patients and family members. We are doing what is necessary to protect ourselves and the immunocompromised patients we are caring for. Of course, exceptions can be made in life-or-death situations, but we are dealing with something like we have never dealt with before.

Is there anything else that is important for our readers to know?

There are no solid predictions on the course of this pandemic. Nurses need to stay vigilant and continue to treat every patient as a possible positive. The public needs to stay aware and stay protected. Masks reduce the risk of one person passing it to another and are a great way to prevent the spread.

As places start to reopen, stay smart. We cannot return to “normal.” I know this is frustrating, boring, and economically depleting. But is it worth the cost of human life? Is it worth burning out our health care system? We are not prepared to accommodate another massive wave of cases.

If you are asking yourself, “Should I cancel?” the answer is yes. Cancel and reschedule routine appointments and stop the spread. The most likely way to stop this virus is containment.

And most importantly, advocate for what is right for our health care teams. We actively and knowingly are putting ourselves at risk to help those that can’t help themselves. What we are doing is unprecedented. Consider our perspective and do what is right. And thank you for trusting us serve you.

Nursing Side Gigs: Children’s Book Author

Nursing Side Gigs: Children’s Book Author

This is part of a monthly series about side gigs—nurses with interesting side jobs or hobbies. This month, we spotlight a children’s book author.


Children's book author Scharmaine Lawson
Dr. Lawson

When Scharmaine Lawson, FNP-BC, FAANP, FAAN, was looking around to find children’s books that both talked about the role of Advanced Practice Nurses and included children from various cultures, she was disappointed.

She couldn’t find any.

So Lawson took charge and decided to write and publish some of her own. In 2015, the first book in her series of Nola the Nurse books was published under the publishing company she established, A DrNurse Publishing House.

To date, Lawson has published 17 books, for children ages 4 to 8, with 15 of them being about Nola.

“I felt it was important to show the role of the Advanced Practice Nurse. I felt like our children needed to see what these frontline professionals do and be able to at least pronounce their titles,” Lawson explains. “It was equally important for me to create culturally sensitive literary works for the new generation of future health care professionals.”

Lawson admits that she never had a desire to be an author. In fact, she was actually searching for books for her newborn daughter that talked about Mommy’s work and had characters that looked like her. But when she realized that there weren’t any books of that kind for an older age group, she knew she needed to step up.

“Our books are the only children’s books that introduce children to the world of Advanced Practice Nursing, foster cultural sensitivity, and provide authentic cultural recipes to the reader at the end of each story. Nola learns about a new culture in each story, and they eat a special meal from that featured culture at the end of every story,” says Lawson.

Currently, she is finishing up the “Germ Series.” Lawson explains that the series talks about all the germs around us, including the coronavirus. “It’s a new format, and I’m excited about it,” she says.

Lawson admits that she’s always writing and publishes a new title every quarter. “We are constantly expanding the brand and looking to add animation in the near future,” she says. “Children need more options for careers, and they need this information early. The sooner, the better.”

How Hospitals Are Keeping Patients and Workers Safe

How Hospitals Are Keeping Patients and Workers Safe

During this unprecedented time when COVID-19 is affecting everyone in some way, one of the biggest worries that health care workers and lay people are focusing on is how medical centers and hospitals are keeping patients and their workers safe.

Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, is Chief Nurse of Health Learning, Research and Practice, Wolters Kluwer. In addition, Dabrow Woods is also a critical care nurse practitioner at a large health system in the Philadelphia area, and Adjunct Faculty for Nursing and Health Professions a private research university with its main campus in Philadelphia, PA. She took time to answer our questions about what hospitals and medical centers are doing to keep patients and health care workers safe.

What are hospitals currently doing (or should do) to keep patients and their workers safe right now?

To ensure the safety of all clinical staff and patients, many hospitals have restricted visitors entirely to prevent COVID-19 from unknowingly entering the building. This measure is also helping sustain the availability of personal protective equipment (PPE) for hospital staff, which otherwise would need to be shared with patient visitors, amid a national shortage.

Hospitals have also established screening measures for staff entering the building for their shifts. As soon as they walk-in, employees have their temperature taken and are encouraged to disclose if they are or have been experiencing any symptoms related to COVID-19—such as dry cough and fever.

Upon entry into the hospital, all staff members must then don a mask and wear it while they are in the building. When with patients, staff must properly use personal protective equipment (PPE) based on the patient’s infection control precautions.  In addition, hospitals have established hotlines for staff to call if they think they have been exposed. The hotline, which is typically monitored by an infectious disease specialist, assesses whether the health care professional is at a low, medium, or high risk and determines the appropriate response measures for the hospital and for the individual employee.

How bad is the current situation right now in health care facilities?

The current situation is very serious, especially in areas with large outbreaks. New York, Massachusetts, California, and Louisiana are just a few examples of states that are reporting widespread transmission to the CDC. These areas are critical zones that are experiencing a shortage of PPE and other equipment such as ventilators, with facilities reaching capacity while trying to accommodate a growing surge in infected patients.

To address this situation, some facilities have set up triage tents outside of the property’s main entrance for screening, as well as have begun utilizing a single ventilator, in some under-supplied areas, to ventilate two patients of similar size and lung capacity. Hospitals have also begun implementing alternative staffing models, such as fast-tracking training for staff that are outside of critical care expertise, but can provide a helping hand—including many fourth-year medical students, nurses from other areas, and recently retired nurses and physicians (who have also been asked to rejoin the workforce).

It is important to note that the impact of COVID-19 and the required safety measures have also created a unique and unfortunate situation where many patients are made to die without their loved ones by their side. As health care professionals, we do our best to provide comfort, holding the hand of our patients, and making sure they are not alone at the end.  

What are nurses doing to keep everyone safe? How are they coping?

To keep everyone safe, nurses are following strict safety protocols and working as a team, now more than ever. Collectively, the mentality is “Let’s do this.” We’re at war with this virus, and to effectively fight it requires putting aside emotions and working together to focus on our patients and what we can do for each patient in the moment.

To cope, we have the support of our fellow nurses and other care team members, as well as the option of utilizing employee assistance programs and social workers, who offer a great resource and comfort in times of struggle. We have also found tremendous support within our communities. Hospital staff has been so busy, and some haven’t even had the time to pack a meal or make it down to the cafeteria to eat, so when community members drop off food at the hospital entrance, it is an amazing act of generosity and one that is deeply appreciated.

What are some steps that are recommended to keep everyone safe?

The CDC issued a Comprehensive Hospital Preparedness Checklist to help hospitals assess and improve their preparedness for responding to COVID-19, but an essential step to keeping everyone safe is encouraging non-health care workers to just stay home. The best way to prevent illness and reduce the transmission of COVID-19 is to not leave your home, except to buy food and/or receive medical care.

What resources are out there that nurses can utilize in their health care facilities?

Nurses need to have the latest evidence-based clinical decision support content at their fingertips, so they are taking the proper precautions in caring for COVID-19 patients. The CDC and WHO are consistently updating contact precautions as well as droplet and airborne precautions, and hospitals should ensure that point-of-care tools and evidence-based resources are readily available for frontline clinicians.

What are some things that nurses should never be doing in these kinds of situations?

During this crisis, nurses should never neglect their own care. If they don’t care for themselves, they will not be able to care for others. While nurses often run towards adversity, it is important to stop and put on protective gear before we put ourselves in harm’s way, regardless of the situation. We are at war with this virus, and therefore we need to wear the proper protective gear when going into battle. There is never an emergency that is too great to forego PPE.

Is there any other information that is important for our readers to know about keeping patients and workers safe?

I think it is important for your readers to know that we will get through this, one patient at a time. Resilience is vital for situations like this one. If we look at what we can do for our patients, not what we can’t do for them, we can reframe our perspective to think not of the of the patients we lost, but rather the many we saved.

Flight Nursing: Into the Wild Blue Yonder with Tonya Barnard

Flight Nursing: Into the Wild Blue Yonder with Tonya Barnard

Tonya Barnard, BSN, RN, CEN, CFRN, CCRN, CTRN, CPEN, TCRUN, EMT-B, had a dream. After she graduated from nursing school, she knew that she wanted to work in the emergency room. “I liked the fast pace and high-acuity patients,” she says. But she wanted to help people while having even more of an adrenaline rush.

Barnard would often see medical helicopters and think about how amazing it would be to work in one, but at the time, she didn’t realize that the job of “flight nurse” existed. After she attended a Landing Zone class for Pafford Air One, she learned that each medical helicopter included a nurse and paramedic team.

Flight nurse Tonya Barnard and her colleague
Photo courtesy of Pafford Air One

After having worked for two years in the emergency department, Barnard began studying for her CEN. Also while in the ED, she began obtaining a plethora of other certifications. But it wasn’t until she had attended a boot camp for Pafford Air One in Ruston, Louisiana that her other dream came true: she was offered a position as a flight nurse and began working for them in February of 2016.

“I get to see sights not many people get to see while providing top care to patients in their time of need,” says Barnard.

According to Barnard, “Flight nurses fly alongside a flight paramedic or respiratory therapist to provide emergent and/or critical care to patients while getting them to definitive care. There are different types of air medical teams that do search and rescue, 911 response and transfers, or specialty transfers. The company I work for does 911/transfers with a flight nurse/flight paramedic team,” she says. “Combining nurses with paramedics brings knowledge from hospitals and scenes to whatever patient we encounter. Combined with your partner, you are responsible for providing quality critical care assessments and interventions to patients of all ages and types while also being active in promoting aviation safety and always going home at the end of the shift.”

While she loves her job, Barnard admits that there are difficult times as well. “One of my biggest challenges as a flight nurse was returning to work after dealing with the tragic loss of three of my colleagues in a HEMS crash from multiple waterfowl- Pafford Air One Bravo. In this type of field, your colleagues become your work family, and we function as such. So when you have this type of tragedy, you band together as a family and support each other through it. However, it will always be in the back of our mind how dangerous this job I,” Barnard explains.

But there are many, many rewards that outweigh the fear. “The greatest rewards of flight nursing are getting to see people recover to a high quality of life after a potentially life-altering event due to the interventions I was able to provide early in their care,” says Barnard. While not all patients are able to survive their injury or illness, I know the care I provide will give them the best chance.”

Barnard has proven to be exceptional at her job and received the BCEN Distinguished CFRN Award. “It’s an amazing honor, as there are many deserving CFRNs,” says Barnard. She is humbled that her base manager/mentor thinks so highly of her that he nominated her for the award.

As a flight nurse, Barnard says that she has learned that the medical field is constantly in flux. But no matter what, she wouldn’t trade her job for the world. She knows how important it is. “You and your partner are often the only thing that stands between a patient living or dying. It is your responsibility to provide these patients with the best care possible,” says Barnard. “Having specialty certifications gives me, my partner, and my employer confidence that we will make the best possible decisions for the patients.”

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