Cases of monkeypox have greatly diminished in the U.S., but that doesn’t mean it’s gone for good or won’t come back in another form.
Daily Nurse spoke with Jennifer Meyer, Assistant Professor at the University of Alaska Anchorage, Division of Population Health Services, about monkeypox and what nurses should be aware of treating patients. (The interview has been edited for length and clarity).
Q: I know that monkeypox is a virus, but is it similar to COVID?
Although both are viruses, and we have vaccines and antivirals that can significantly prevent infection and reduce serious outcomes like prolonged hospitalization/death, several critical differences exist. Since May, about 20,000 Monkeypox cases have been reported.
First, monkeypox is not a novel virus like SARS-CoV-2, the virus that causes COVID-19. Monkeypox was identified in the 1950s, while SARS-CoV-2 was identified in 2019. Follow current U.S. case data here and Global data here.
The second key difference relates to transmission. Early versions of SARS-CoV-2 appeared to predominantly be transmitted by droplets in the air from one person to another. Current versions appear to be far more efficiently transmitted in aerosols. How does this happen? Consider the three D’s.
If a virus is changing and finding ways to infect more people, it usually means you need less of a dose or exposure to the virus to cause an infection or less duration of exposure to the virus to cause an infection and/or changes in the distance the virus travels or survives while moving from one host to another.
These days current SARS-CoV-2 variants (like Omicron) can easily transmit through the air in tiny aerosolized particles that can travel greater distances. This has been one of the lessons learned regarding our primitive descriptive terminology for infectious disease transmission.
Traditional terminology would indicate that monkeypox is predominantly transmitted via direct close contact with an infected person with symptoms (rash, sores, feeling ill) or soiled/contaminated surface/linens, etc. However, there is some evidence that Monkeypox can be transmitted via respiratory secretions. Scientists are still investigating how often that occurs along with how infectious someone might be just before the onset of symptoms.
Q: What are the symptoms? How do healthcare professionals know to test for monkeypox?
Symptoms include any combination of the following: rash that can go through several stages, from blisters to scabs, and may include fever, chills, swollen lymph nodes, aches, exhaustion, headaches, muscle aches, congestion, sore throat, etc.
The incubation period for monkeypox is quite long, up to three weeks. Once symptomatic, the person usually gets a rash 1-4 days later. The person is most contagious from when symptoms start to when blisters and scabs have healed, which takes 2-4 weeks. Review clinical guidance here.
Clinicians should be on the lookout for any unexplained rash and, of course, if a patient has been exposed or is suspected to be exposed to someone who has tested positive. Get more guidance here.
In general, viruses don’t live very long when outside the body. Monkeypox, however, can survive a long time–up to 15 days. For comparison, SARS-CoV-2 can survive a maximum of 5 days and HIV a few hours. These experiments are done in controlled lab settings, but you can see a clear difference.
Q: What precautions should nurses take to protect their patients?
Correctly don and doff PPE, wash hands, and disinfect equipment.
Q: What are the myths about monkeypox?
That the infections only occur among gay and bisexual men. While this population is disproportionately affected by monkeypox at this time, anyone can contract it.
Q: Is there a potential for it to have variants?
Certainly, however, pox viruses are not known for changing quickly, while coronaviruses are known for rapid changes.
Q: Is there anything important for our readers to know?
Nurses play a critical role in educating their patients and community. I encourage nurses to stay up-to-date on monkeypox information from high-quality resources. Help patients and community members understand how to protect themselves and each other, especially from health misinformation. Reach out to underserved and historically oppressed members of our community to ensure they have the information and resources they need to stay healthy. Consider inclusive communication strategies, read more here.
Learn more about the new Vaccine Equity Project and if your employer can apply to participate here.
Prior to finding out about Mercy Ships, Christel A. Echu, RN, admits that if you asked her if she wanted to volunteer for any organization and not get paid, she would have said, “No.”
But when a friend who was an authority in the church she attended in Cameroon, Africa, she changed her mind. “I decided to volunteer with Mercy Ships because I was interested in being a part of the great work they were doing for the people of my country, and I wanted to help in any way that I could,” Echu says.
Mercy Ships Bring Hope and Healing
Mercy Ships is a non-profit Christian organization, she says, that sails across West and Central Africa with the mission and vision to provide hope and healing to patients who are poor and/or forgotten in countries there.
When Echu began volunteering with Mercy Ships, she had just graduated from nursing school. First, she worked as a volunteer translator when the ship, the Africa Mercy, was docked in the port of Cameron. She volunteered as a translator for 10 months.
Mercy Ships bring hope and healing
By then, Echo says, she was hooked. She ended up continuing to volunteer for another two years. “I transitioned from that [working as a translator] to working as a volunteer screening nurse until the end of my commitment,” she says. “Screening nurses, we see all the patients before they are seen by the rest of the hospital. We screen, assess, and ensure patients are healthy enough for surgery.”
She says that they pre-screened more than 6,000 patients in a day when they were in Guinea Conakry. “That was the longest shift I have ever had,” she says.
One of the aspects that Echu loved about Mercy Ships is that she got to work with nurses from all over the world: including the Netherlands, Canada, Australia, the United States, and others.
“I loved working with patients and with my team. We also worked alongside our wonderful translators, which was a blessing because they helped to facilitate communication between the patients and nurses,” she recalls. “I think I enjoyed the fact that we could learn from each other to provide the best care to the patients we served. I enjoyed seeing the joy the patients felt whenever we announced to them that they were getting surgery. “The dance of joy” was a thing in the screening tent and I enjoyed seeing the patients come back to show us their “new self” without the tumor or the deformity. Moments like that, reminded me why I decided to volunteer in the first place and kept me going on difficult days.”
Biggest Challenges
There were tough days. Echu says that one of her biggest challenges while working with Mercy Ships was being away from her family, home, and community. But another difficult part was when she had to say “No” to people they couldn’t help.
“This is a part of my job that we don`t talk much about. The ship has specific surgeries they do when they sail in a nation. However, there are patients who present with conditions that are not within Mercy Ships scope of practice and that`s when we get to do ‘no’ conversations. Screening nurses initiate that conversation before the chaplaincy team on the ship takes over,” she says. “That was the most challenging thing about my job—having those ‘no’ conversations was never an easy thing to do. Most of the patients we see come with the hope of being helped, but when we have to say no to them, it almost feels like that hope crumbles before their very eyes.”
Greatest Reward
She also, though, had many rewards—the greatest of which was forming relationships with the ship’s community. “The relationships I built during that time, [ones] that become an integral part of my life. The community is really special. Now, I have friends all over the world,” says Echu, who now lives in Minnesota. “I do not have family here in the United States, but I know friends with whom I worked with on the ship, [and they] are my family while I am here.”
Echu says she will never forget “the amazing patients I got to work with and their families and the joy they always had on their faces even without having much.”
If you’re a nurse thinking about volunteering with Mercy Ships, she says, “Do it! Go and see for yourself. Have an open mind and be ready to learn and receive as well,” she says. “Most volunteers go on the ship with the mindset of giving and serving which is good, but also go with the mindset of receiving. Receiving could be anything—like being welcome in the house of a local, or being encouraged by a patient who doesn`t have much, but they still have a big smile on their faces. It’s an experience that would change your life completely for good.”
In nursing school, you may have learned that health care provider bias can literally endanger a patient, but when an instructor explains this, a least a few classmates will probably imagine their parents scoffing. Even if you can’t imagine your parents saying “hogwash!” to healthcare bias studies, as barely 0.6% of our population is transgender or genderqueer, if you feel uncomfortable or confused about what to say and do the first time you meet a trans patient, there’s no shame in admitting it. Better yet, a trans patient has some practical advice that might help you get started on the right foot.
“Treat the person with respect and caring, and leave whatever prejudices you have at the door.”
Wynne Nowland, CEO of Bradley & Parker, Inc., a New York insurance brokerage, made business news headlines when she came out as transgender last year. As a transgender patient, Nowland has firsthand knowledge of what it is like to be a member of a small minority seeking treatment within our healthcare system, and she kindly took the time to answer questions from DailyNurse. What follows is our interview, edited for length and clarity.
DN: We want to help nurses communicate more effectively with transgender patients and better understand their needs—for example, helping them find gender-affirming care.
That said, what is the first thing that nurses should do when they meet a transgender patient? Ask what pronouns they prefer? Should they ask about gender identity and sexual orientation?
NOWLAND: People don’t really want any special treatment–we just want to be treated like everyone else.
Many times, either with the name they are using or their choice of dress, hairstyle, etc., it is clear what gender the trans person is presenting as. In those cases, you should simply use the pronouns that correspond with that gender, regardless of the fact that you may suspect the person is trans or even though the person is trans.
If they are truly presenting in an ambiguous manner, it is then perfectly OK to ask which pronouns they prefer. Unless there is something specific going on that requires inquiry on sexual orientation, I can’t see any reason for that.
Sometimes going overboard has a reverse effect… we just really want to be treated like everyone else.
DN: What can nurses do to make sure that the patient feels comfortable in their care?
NOWLAND: Aside from using the correct pronouns and just being generally respectful, I’m not sure what else is required. Sometimes going overboard has a reverse effect, and as I already mentioned, we just really want to be treated like everyone else.
Sometimes, because of medical issues, intimate topics need to be addressed and there is really no way around that. It just needs to be done with care and compassion.
DN: Is there any particular guiding principle to follow when treating a transgender patient?
NOWLAND: Treat the person with respect and care and leave whatever prejudices you have at the door. A simple formula, but one that will be effective.
DN: What are some of the biggest mistakes that nurses can make when treating or communicating with a transgender patient?
NOWLAND: Being disrespectful, judgmental, or insensitive. For some people, the temptation to let the trans person know that they know they are trans is strong and that should be avoided at all costs.
In reality, the vast majority of trans people have the same medical needs as anyone else.
DN: How can nurses help trans patients—in terms of helping them find resources for better trans care, advocating for them, or even stepping in if they see another health care provider doing something that’s not appropriate with trans patients?
NOWLAND: If a nurse sees another medical professional in some way treating a trans person in an inappropriate manner, almost anyone would appreciate the nurse taking any other professional aside and discreetly redirecting them. It’s not a great idea to have a blatant confrontation, as that can just put the trans person in an even more embarrassing position.
The same with any advocacy, while it’s appreciated, being present during a combative situation is not pleasant and is best avoided. The very phrase “trans care” is kind of nebulous. In reality, the vast majority of trans people have the same medical needs as anyone else. There are certainly some items regarding medical transition and supportive therapy that are specific to trans people. If someone is presenting in a general practice, for instance, that is not equipped to handle medical transition needs, then it certainly would be thoughtful to have referrals to those practices that can help.
DN: What do you think trans patients would most want nurses to know?
NOWLAND: A theme I have had running through my entire commentary on this topic—we just want the same care as everyone else. And sometimes we understand that specific trans care like the things I mentioned above may not be your specialty or in your practice. That’s OK. Just talk to us about it in a respectful manner and help us find those resources.
Unless there is a medical reason to know, asking what’s in somebody’s pants is just never appropriate!
DN: Is there anything else that you think our readers need to know?
NOWLAND: Sometimes people are naturally curious about trans people and some things about their lives.
Every trans person, like every other person, is different and takes this curiosity in various ways.
In my own case, I welcome respectful questions, but at the same time can see the ones that are asking for the wrong reasons from a mile away.
Finally, the one big thing most trans people feel very protective about is the status of any gender-conforming surgery. Unless there is a medical reason to know, asking what’s in somebody’s pants is just never appropriate!
While you may have heard about what it’s like to work as a travel nurse, have you ever thought about travel nurses who work in the ICU?
Daisy Award-winner Deji “DJ” Folami, RN is an ICU registered nurse from Oklahoma with Cross Country Healthcare, who specializes in critical care nursing and travel nursing. He told us what it’s like to work as a travel ICU nurse—and why he loves doing it. What follows is our interview, edited for length and clarity.
“I was just simply blown away by their [ICU travel nurses] level of confidence, their can-do and go-getter attitude, and their all-around knowledge, that the motivation to explore travel nursing came easily.
DailyNurse: How did you get interested in being a travel nurse—especially one working in ICU?
DJ Folani: I joined ICU nursing after one year of being a Med-Surg nurse because I was fascinated by the skills and organization of the code team. Same degree, just higher levels of training and knowledge. After one year in ICU, I met a few travel nurses. I was just simply blown away by their level of confidence, their can-do and go-getter attitude, and their all-around knowledge, that the motivation to explore travel nursing came easily. In 2016, I started my journey as a travel or contract nurse, and I have never looked back since.
Explain to me briefly what a travel nurse specializing in ICU does? How long do you tend to work in any one facility?
A travel nurse must be an experienced and adaptable person. However, a travel nurse who specializes in ICU is expected to be dynamic and ready to meet challenges when circumstances change.
For example, most ICU travel nurses specialize in medical-surgical ICU but may be asked to float to a cardiovascular or neuro ICU to take care of patients within their scope. Simply put—same skill set, different unit or different protocols.
Typically, a travel nurse works as a contract employee at a facility. Each contract can be a period of 8 to 26 weeks, renewable up to one year. After that one year is up, a break is required up to 30 days, depending on state laws. If the facility wants to continue with the nurse, they will offer to renew the contract.
How and why did you get into becoming a travel nurse? Did you have to sign up with one specific business that places travel nurses? Are ICU travel nurses in high demand?
I was satisfied being an ICU nurse, but I was not content with the knowledge I had acquired. I wanted to impact the world beyond my residential city. I love meeting people. Therefore, I pushed myself to follow up on a referral made by another experienced travel nurse I had spoken with. The recruiter asked questions about my interests, specialty, etc. While awaiting offers, I called and spoke with other travel agencies to compare my preferred assignment, convenience, and of course salary rates.
Yes! Travel nurses are in high demand. An ICU travel nurse with experience in complex critical interventions such as continuous renal replacement therapy (CRRT), hypothermia protocol (Arctic Sun), and certifications such as critical care registered nurse (CCRN), etc., are in high demand.
What do you like most about working as a travel nurse?
Every facility has its own unique way of carrying out nursing processes. I love learning new ways of doing the same thing. These new experiences add to my wealth of knowledge.
What are the biggest challenges you face in travel nursing?
Finding a suitable accommodation. A comfortable and affordable place to live while on a travel assignment is vital to my overall well-being. I love to find a place that is close to a gym, a grocery store, and at closest proximity to the hospital.
What are your greatest rewards as one?
New friendships and networking.
Is there anything else that is important for our readers to know?
The key here is to add value to their team and strive to make an impact such that you become an asset and not a liability. I always ask the nurse manager or leaders what ways I could be more useful to their team. Have a positive attitude, rid yourself of trivial complaints. Be a part of the solution you are there to be and have fun while doing it. Blend in quickly and be an important team player. Do this, and you’ll be surprised at how fast the facility will ask you to stay longer with them.
Patients lean on them every day, and Certified Nursing Assistants (CNAs) contribute so much to the nursing field—yet they rarely seem to receive the credit they truly deserve. Even when writing this story, autocorrect kept changing CNA to CAN [Microsoft Spelling Checker, are you listening? –editor], and this seems an ironic reminder of the way CNAs can be overlooked.
Two years ago, the Evangelical Lutheran Good Samaritan Society started a CNA Training Program. Rochelle Rindels, MSN, RN, QCP, vice president of nursing and clinical services for the Good Samaritan Society, headquartered in Sioux Falls, South Dakota, took time to answer our questions about the program.
What follows is our interview, edited for length and clarity.
When did Good Samaritan start its CNA Training Program? How many students are enrolled currently?
Since its inception in May of 2020, we’ve enrolled more than 600 students into the Good Samaritan Society CNA Training Program with a 91% success rate for students that sit for the certification exam.
Investing in our own team members is extremely important to us. I started as a CNA and progressed through different nursing licenses and degrees and am grateful for the support I received from my employers. We have experts who contributed to the curriculum build for the CNA program, and we recognized the value in training our CNAs in our buildings, familiarizing them with the residents they will care for throughout their employment.
The health care system has experienced a shortage of trained caregivers for critical roles for some time; nurses and nurse aides are among the fastest growing occupations, but supply is not keeping pace.
Building and strengthening the worker pipeline is essential to support current staffing patterns, paramount to any future staffing enhancements and foundational to drive further improvements in delivery of care and services to residents.
We do not want to lose the heroes who answered the call to serve and continue to step up to care for our nation’s seniors in a time of crisis. We need to retain these caregivers, so they are not facing job loss, and residents in nursing homes are not facing the loss of caregivers who know them and love them.
We have proactive strategies in place to ensure we have the positions we need to continue to provide care as close to home by investing in growing our own frontline nurses, one being our CNA Program.
How does the program work? Do students attend in-person, online, or a combination of both? Do they attend full or part-time? How long does it last?
Our CNA program is a hybrid program. The curriculum consists of online coursework and in-person skills lab and clinicals, which allows the student to apply skills and knowledge in a care setting. Full-time and part-time options are available for employees to complete the 80-hour program.
Students receive training in our locations while they are working for us and earning a paycheck. They are trained in person by preceptors and nursing team members who are also their coworkers. The students also get to know the residents who they will continue serving after they graduate and pass certification.
What does a CNA do in health care, and why is it important for aspiring nurses to train as one?
A CNA is more than the title alludes to–nurse assistant. CNAs are absolutely the eyes and ears of our nurses and assist in completing nursing interventions. They are intimately involved with residents’ day-to-day care and needs, and they build lasting relationships with residents and their families. They complete daily activities of living with residents, perform dressing, bathing, and meal assistance. CNAs assist with restorative interventions to help residents maintain function and document important needs and data points related to the resident’s overall condition. They are a valued and essential part of the care team.
Why is this program important? What does it offer that makes it different from others?
The nurses who work for the Good Samaritan Society tell us they find their jobs incredibly rewarding. It’s hard work, but they believe they are called to do their roles. They build special relationships and friendships with their coworkers, and their residents become family. It’s the experiences like celebrating birthdays and anniversaries as well as the wisdom they gain from their residents that makes being a nurse such a rewarding career.
If someone wanted to get into the program, what would they need to do? What steps would you tell them to take?
Applying to the program is easy! Anyone interested can apply to a nurse aid position and upon hire will automatically be enrolled in the CNA training program. We offer the internal program in six of our states, including South Dakota, North Dakota, Iowa, Minnesota, Florida, and Tennessee. We are currently in the application process in five more states.
Is there anything I haven’t asked you about that is important for our readers to know?
I personally grew up with the Good Samaritan Society. My mother spent nearly 40 years as a nurse at Good Samaritan Society–Luther Manor in Sioux Falls, South Dakota. I remember performing ballet recitals and Christmas programs for the residents and staff. My mother and I have just one of many Good Samaritan Society stories of family working together. It’s that sense of calling and the family-like connection to residents that makes our culture so unique.
We’ve supported our people with investments to maintain the stability of our workforce and new programs to support employee well-being. These investments have paid off–our turnover rate is below the industry average and we were a Forbes top midsize employer in 2021.
In 2021 alone, we invested $15 million in direct care wages, and we recently announced a $5 million investment in starting wages.
We’re focused on how we can create positions that allow for more work-life balance for our people who are carrying out our mission every day. As a large organization, we have opportunities to solve for some of these things. But at the end of the day, we still need meaningful policies and long-term solutions to support and address our workforce needs now and in the future.
I was satisfied being an ICU nurse, but I was not content with the knowledge I had acquired. I wanted to impact the world beyond my residential city. I love meeting people. Therefore, I pushed myself to follow up on a referral made by another experienced travel nurse I had spoken with. The recruiter asked questions about my interests, specialty, etc. While awaiting offers, I called and spoke with other travel agencies to compare my preferred assignment, convenience, and of course salary rates.
