The pandemic was in full swing as ICU nurse Ashlee Schwartz entered her tenth year as a nurse at Mercy Hospital in Fort Smith, Arkansas, but while critical care nurses may feel like they’re running on fumes these days, their profound sense of empathy and ability to care is still running at full steam. Like this Nurse of the Week, they continue to put the “C” in ICU as they go above and beyond to bring comfort to their charges.
When Schwartz – already a 2017 and 2018 Daisy Award winner – saw 23-year-old Eric Robison watching his 22-year-old wife Emily breathe with the aid of a ventilator, the sight went straight to the RN’s heart. Emily had recently given birth to a daughter, but the Covid-plagued young family was in no shape to celebrate. “The image will forever be inscribed in my head. He was just staring in a daze. It literally broke my heart to pieces,” Schwartz said. “Especially as an ICU nurse, the reality of life with this virus is any patient’s story could very well be our own story someday – and I just thought to myself, ‘What if this was me sitting in this chair staring into my husband’s room?'”
Due to Emily’s youth, her husband and clinicians had been hopeful even after she was placed on a ventilator, and Schwartz, a mother herself, stepped in for Emily as the unvaccinated new mom did battle with the relentless virus. Newborns require a LOT of equipment, so Schwartz started by announcing the birth of baby Carmen on Facebook and sent out a call for baby gear, as the beleaguered little family had not had the leisure to stock up on infant essentials. With a nurse’s thoroughness, she set up registries on Amazon, Go Fund Me, and other popular sites – and the response was astounding. The Go Fund Me raised $16,000, and over 200 people donated gifts.
“I remember all I could picture was if Emily was going to be able to overcome COVID, more than likely, Carmen would be home before Emily. Emily was going to be in the ICU for a handful of months and then go to intensive rehab and all I could picture after that was her coming home and walking into her house and having nothing for her new baby,” Schwartz said.
Tragically, Carmen’s 22-year-old mother succumbed to the virus even as caring strangers all over Arkansas and beyond donated gifts and cash for the baby girl.
“Never would I have imagined that gifts would start pouring in from all over Arkansas and the rest of the country,” Robison told CNN. “It’s bittersweet because I wish Emily was still alive to see it. But not having to worry about Carmen being taken care of is one less thing I have to worry about right now.”
“I called Eric and asked if he and Emily had a baby registry and he didn’t know what a registry was. He said all they had for Carmen were clothes. As Emily was fighting for her life, I just felt called and a sense of responsibility to make sure this baby had everything she needed,” Schwartz said.
“All I could picture was Emily coming home after being in the hospital for months and not having much of anything for Carmen and asking herself ‘Why did someone not help me?'”
After Emily’s death, Schwartz, with Eric’s blessing, made two pictures of the young mom’s handprints, so Carmen will “forever have a keepsake of her mama.” As she told Fox, “I love to see other people blessed, it makes my heart so happy, I’m so overwhelmed with happiness. If you can pay life forward to people it brings so much joy to your life, sometimes those acts of kindness, people will never forget.”
Robison now regards Schwartz as a family connection, and says, “Ashlee will be in Carmen’s life until she’s older and Ashlee’s sons and my daughter will probably be best friends.”
Republican legislators in more than half of U.S. states, spurred on by voters angry about lockdowns and mask mandates, are taking away the powers state and local officials use to protect the public against infectious diseases.
A KHN review of hundreds of pieces of legislation found that, in all 50 states, legislators have proposed bills to curb such public health powers since the covid-19 pandemic began. While some governors vetoed bills that passed, at least 26 states pushed through laws that permanently weaken government authority to protect public health. In three additional states, an executive order, ballot initiative or state Supreme Court ruling limited long-held public health powers. More bills are pending in a handful of states whose legislatures are still in session.
In Arkansas, legislators banned mask mandates except in private businesses or state-run health care settings, calling them “a burden on the public peace, health, and safety of the citizens of this state.” In Idaho, county commissioners, who typically have no public health expertise, can veto countywide public health orders. And in Kansas and Tennessee, school boards, rather than health officials, have the power to close schools.
President Joe Biden last Thursday announced sweeping vaccination mandates and other covid measures, saying he was forced to act partly because of such legislation: “My plan also takes on elected officials in states that are undermining you and these lifesaving actions.”
All told:
In at least 16 states, legislators have limited the power of public health officials to order mask mandates, or quarantines or isolation. In some cases, they gave themselves or local elected politicians the authority to prevent the spread of infectious disease.
At least 17 states passed laws banning covid vaccine mandates or passports, or made it easier to get around vaccine requirements.
At least nine states have new laws banning or limiting mask mandates. Executive orders or a court ruling limit mask requirements in five more.
Much of this legislation takes effect as covid hospitalizations in some areas are climbing to the highest numbers at any point in the pandemic, and children are back in school.
“We really could see more people sick, hurt, hospitalized or even die, depending on the extremity of the legislation and curtailing of the authority,” said Lori Tremmel Freeman, head of the National Association of County and City Health Officials.
Public health academics and officials are frustrated that they, instead of the virus, have become the enemy. They argue this will have consequences that last long beyond this pandemic, diminishing their ability to fight the latest covid surge and future disease outbreaks, such as being able to quarantine people during a measles outbreak.
“It’s kind of like having your hands tied in the middle of a boxing match,” said Kelley Vollmar, executive director of the Jefferson County Health Department in Missouri.
But proponents of the new limits say they are a necessary check on executive powers and give lawmakers a voice in prolonged emergencies. Arkansas state Sen. Trent Garner, a Republican who co-sponsored his state’s successful bill to ban mask mandates, said he was trying to reflect the will of the people.
“What the people of Arkansas want is the decision to be left in their hands, to them and their family,” Garner said. “It’s time to take the power away from the so-called experts, whose ideas have been woefully inadequate.”
After initially signing the bill, Republican Gov. Asa Hutchinson expressed regret, calling a special legislative session in early August to ask lawmakers to carve out an exception for schools. They declined. The law is currently blocked by an Arkansas judge who deemed it unconstitutional. Legal battles are ongoing in other states as well.
Legislators there also passed limits on local officials: If jurisdictions add public health rules stronger than state public health measures, they could lose 20% of some grants.
Losing the ability to order quarantines has left Karen Sullivan, health officer for Montana’s Butte-Silver Bow department, terrified about what’s to come — not only during the covid pandemic but for future measles and whooping cough outbreaks.
“In the midst of delta and other variants that are out there, we’re quite frankly a nervous wreck about it,” Sullivan said. “Relying on morality and goodwill is not a good public health practice.”
While some public health officials tried to fight the national wave of legislation, the underfunded public health workforce was consumed by trying to implement the largest vaccination campaign in U.S. history and had little time for political action.
Freeman said her city and county health officials’ group has meager influence and resources, especially in comparison with the American Legislative Exchange Council, a corporate-backed conservative group that promoted a model bill to restrict the emergency powers of governors and other officials. The draft legislation appears to have inspired dozens of state-level bills, according to the KHN review. At least 15 states passed laws limiting emergency powers. In some states, governors can no longer institute mask mandates or close businesses, and their executive orders can be overturned by legislators.
When North Dakota’s legislative session began in January, a long slate of bills sought to rein in public health powers, including one with language similar to ALEC’s. The state didn’t have a health director to argue against the new limits because three had resigned in 2020.
Fighting the bills not only took time, but also seemed dangerous, said Renae Moch, public health director for Bismarck, who testified against a measure prohibiting mask mandates. She then received an onslaught of hate mail and demands for her to be fired.
The new laws are meant to reduce the power of governors and restore the balance of power between states’ executive branches and legislatures, said Jonathon Hauenschild, director of the ALEC task force on communications and technology. “Governors are elected, but they were delegating a lot of authority to the public health official, often that they had appointed,” Hauenschild said.
‘Like Turning Off a Light Switch’
When the Indiana legislature overrode the governor’s veto to pass a bill that gave county commissioners the power to review public health orders, it was devastating for Dr. David Welsh, the public health officer in rural Ripley County.
People immediately stopped calling him to report covid violations, because they knew the county commissioners could overturn his authority. It was “like turning off a light switch,” Welsh said.
Another county in Indiana has already seen its health department’s mask mandate overridden by the local commissioners, Welsh said.
He’s considering stepping down after more than a quarter century in the role. If he does, he’ll join at least 303 public health leaders who have retired, resigned or been fired since the pandemic began, according to an ongoing KHN and AP analysis. That means 1 in 5 Americans have lost a local health leader during the pandemic.
“This is a deathblow,” said Brian Castrucci, CEO of the de Beaumont Foundation, which advocates for public health. He called the legislative assault the last straw for many seasoned public health officials who have battled the pandemic without sufficient resources, while also being vilified.
Public health groups expect further combative legislation. ALEC’s Hauenschild said the group is looking into a Michigan law that allowed the legislature to limit the governor’s emergency powers without Democratic Gov. Gretchen Whitmer’s signature.
Curbing the authority of public health officials has also become campaign fodder, particularly among Republican candidates running further on the right. While Republican Idaho Gov. Brad Little was traveling out of state, Lt. Gov. Janice McGeachin signed a surprise executive order banning mask mandates that she later promoted for her upcoming campaign against him. He later reversed the ban, tweeting, “I do not like petty politics. I do not like political stunts over the rule of law.”
Fawbush was a sponsor of 1989 legislation during the AIDS crisis. It banned employers from requiring health care workers, as a condition of employment, to get an HIV vaccine, if one became available.
But 32 years later, that means Oregon cannot require health care workers to be vaccinated against covid. Calling lawmaking a “messy business,” Fawbush said he certainly wouldn’t have pushed the bill through if he had known then what he does now.
“Legislators need to obviously deal with immediate situations,” Fawbush said. “But we have to look over the horizon. It’s part of the job responsibility to look at consequences.”
Nurses tend to be top-notch communicators, but with families of Covid patients not even able to visit their relatives, misunderstandings can arise all too easily. Nurse of the Week Kandace Williams has—well, not an app for that, exactly, but the University of Arkansas DNP student is creating a guide for families with a loved one in a Covid ICU.
Williams, who is also an ICU nurse at the University of Texas Southwest Medical Center in Dallas, has had first-hand experience as the relative of a Covid patient. Her mother was admitted to a New York hospital for Covid-related issues last year. “It was extremely frustrating when my mom was admitted,” Williams told KUAF, a Texas public broadcast station. Her healthcare knowledge didn’t seem to amount to much when she could not even visit her mother and hold her hand. Being unable to support her mom in person was “frustrating, and gave me a [constant] anxious feeling.”
While worrying about her mother, Williams thought about the enforced separation of families from their hospitalized loved ones, and realized that bad as her anxieties were, it must be far worse for people lacking her training. Thus was born her latest DNP project: a guide that helps make sense of the things families see and hear when paying virtual visits. It glosses the barrage of medical lingo, instruments, and procedures so they can better comprehend what they see and hear during a video visit.
In addition to covering the terminology, Williams’ guide explains what the imposing array of medical equipment is for, and includes a section to record notes on the patient’s status and to jot down questions for the nurse or physician. She told KUAF, “Normally [before the pandemic] they could ask ‘what is this?’ or ‘what does that machine do?’ But they can’t do that now.” The guide, says Williams, “is essentially their way of looking into the ICU without actually being there.” Recalling her own sense of helplessness when her mother was hospitalized, she has tried to demystify the workings of an ICU and its staff so families can better understand what they see and hear during their virtual visits.
Williams’ guide is going to be adopted by her employers, the University of Texas SW Medical Center.
To listen to the KUAF podcast interview with Kandace Williams, click here.
Our Nurse
of the Week is Seth Cobb, a nursing student at the University
of Arkansas (U of A) who is using his position on campus to encourage a
sense of community among fellow veterans.
Cobb’s calling to become a nurse began when he was an Army
medic with the 82nd Airborne Division. After four years in the Army, Cobb
decided to move home to Arkansas and pursue his passion. He says his military service
taught him that building a bright future requires initiative. Cobb still remains
part of the military, serving in the Individual Ready Reserves.
Cobb tells news.uark.edu, “My service as a medic cemented that dream and showed me that I had found what I wanted to do with my life. I have never gotten as much fulfillment from life as I did when helping my fellow soldiers through medicine.”
In his second semester of nursing school, Cobb faced
unexpected circumstances that nearly forced him to drop out. In 2019, a family
member facing an urgent financial hardship forced Cobb to start working full
time to help. But then he was awarded the Mike and Cindy Bonds Advance Arkansas
Scholarship that same month, allowing him to refocus on schoolwork and his
dream of becoming a nurse.
Now, Cobb is helping others on the U of A campus. He’s the
president of the Razorback Student Veterans organization, which helps student
veterans transition to civilian life. Cobb is especially focused on connectivity
and service, inspired by the high suicide rate among veterans. He is committed to
growing a rich community among the veterans at U of A and in their local
community, to ensure a support system for his fellow veterans.
According to news.uark.edu, Cobb stated in a press release: “We aim to alleviate some of their challenges by providing a peer group they can relate to, while also giving them an outlet to continue the service they built their lives on in the military though volunteering and service projects here at home.”
To learn more about Seth Cobb, a nursing student at U of A
who is using his position on campus to encourage a sense of community among
fellow veterans, visit here.
Hart
received the grant money as part of her final doctoral project where she worked
with a dozen local patients at Northwest Medical Center’s Heart
Care center in Springdale, AR. The equipment Hart purchased for her study
included weight scales and blood pressure cuffs for each of the patients who participated.
Hart has
been a registered nurse at Northwest Medical Center for 13 years, with a
primary focus on cardiovascular disease. She’s currently an emergency
department registered nurse. Hart continued to work while earning her DNP at U
of A and graduated with her fellow College of Education and Health
Professions students on May 11.
Her final
DNP project focused on implementing a quality improvement project in the
healthcare field of her choice. She worked with Dr. Michael Green at Northwest
Medical Center.
Hart tells news.uark.edu, “I have always been passionate about patients in the heart failure population. The goal of this project was to improve self-care management and decrease unnecessary hospital readmissions. Heart failure patients require a lot of management and continuous communication with a provider to assure that they are maintaining their baseline well-being.”
The main
objectives for maintaining overall well-being include daily
weight, fluid and salt management, and early recognition of
worsening symptoms. Hart recognized that access to the right equipment was a
major barrier for her participants and she wanted to assure that each patient was
given the best chance for success. She reached out to the American Heart Association
local branch to see if they would assist her, which led to the grant that
allowed her to purchase 12 bathroom scales and 10 blood pressure cuffs.
To learn
more about Wendy Hart, a recent DNP graduate from the University
of Arkansas, who used a $500 grant to purchase equipment for patients with
heart failure issues, visit here.
The University of Arkansas (U of A) Eleanor Mann School of Nursing is launching a new online program for licensed practical nurses (LPNs) to complete their bachelor’s degrees in nursing (BSN). The program will begin in the fall but students can apply now.
U of A’s new online LPN to BSN program will help meet the Institute of Medicine’s recommendation from 2015 that 80 percent of nurses in the United States hold a bachelor’s degree by 2020. The program will also benefit graduates who will become more competitive in the nursing job market and increase their earning potential.
Susan Patton, director of the U of A School of Nursing, tells news.uark.edu, “In order to face the challenges of an aging population, a dynamic health care environment and a pending nursing shortage, the BSN degree is becoming the new standard for registered nurses. Our BSN programs are comprehensive and offer knowledge that can be applied in all health care settings such as critical care, primary care, public health and mental health.”
The new LPN to BSN program was created to meet the needs of working licensed practical nurses who require a flexible option to finish their degrees. The required clinical hours can be completed in the student’s local area to avoid travel to campus. Courses are offered in 8-week sessions each fall and spring.
To be eligible for the program, students must be a licensed practical nurse with at least 2,000 hours of work experience at the LPN level in the last 12-24 months. Applicants must also have 48 hours of prerequisite courses completed with a minimum 2.8 GPA. The program is accredited by the Commission on Collegiate Nursing Education.
To learn more about the University of Arkansas Nursing’s new LPN to BSN program, visit here.
