Nurse of the Week Michael King has been dedicated to both nursing and the law for 15 years. His latest challenge—as Commander of the New York City Police Department’s Special Victims Division—calls for him to draw upon both of his professions.
The Jamaican-born officer/RN emigrated to New York at the age of 16, and enrolled in an emergency medical technician program after he entered college. After four years of training paramedics, King joined the NYPD as a beat cop in 2000. As a rookie policeman, he attended nursing school and worked in city hospitals during his off hours. By 2005 he was a licensed RN. King eventually became a forensic nurse, and spent his off-duty time as a coordinator at the Wyckoff Heights Medical Center’s sexual assault response team. Meanwhile, he pursued his NYPD career as an investigator, a crime scene commander, and later as the executive officer of the Joint Terrorism Task Force.
John Miller, the NYPD’s Deputy Commissioner of Intelligence and Counterterrorism, who recommended King for the Special Victims command, says “If we didn’t have Mike King, I am not sure we could have invented him. At SVU he can combine his experiences of helping people in trauma, his knowledge of science, forensics and investigation and his sense of justice in a way no one else — at least no one else I know — could.”
King’s understanding of the close relationship between forensic nurses and police sex crime units makes him keenly aware of both the wide picture and the details behind the operation of an SVU. He also has first-hand experience with rape kits from his stints as a nurse at hospitals in Long Island and Brooklyn. King says his team uses a “science-based technique that encompasses compassion, sensitivity, and the knowledge of psychological trauma.” He wants to extend training in this area toi patrol officers as well, as “they are usually the first ones at a scene to interview a survivor of sexual assault.”
For an interview with Michael King, see this video at PIX11. More details on King’s background and career are available in this story from AM New York.
In addition to Dr. Grant’s keynote address, the conference (which is being hosted online by SpringerPassport) will feature poster presentations, a live NCLEX-RN Review, networking opportunities with prospective employers and schools in the Exhibit Hall/Career Development Center, special discounts at publisher and NCLEX vendor exhibit booths, a virtual yoga session, and more. Live interaction in the Exhibit Hall begins at 7pm EDT on October 29; visit the schedule for details on all live event times. Attendees can also take advantage of the virtual format to access video recordings of programs and exhibits at their convenience (recordings will be available for three months post-conference).
Poster presentations featuring school and state projects by NSNA Chapters and individual members will be available through the online Project Showcase. Presenters can apply here. The application deadline is October 25, 5:00pm EDT.
Registration for the NSNA’s 38th MidYear Conference is open through October 31, 11.30pm EDT. Members who register by or before October 13will receive a $15 Early-Bird Registration Discount. Prior to registering you will need to have your membership number and/or credit card handy. NSNA members and sustaining members must provide their membership number when they pre-register for verification purposes.
The NSNA fosters the professional development of undergraduate nursing students and provides them with opportunities to develop their leadership skills and prepare for lifelong involvement and continuing education in the nursing profession. The association currently has over 60,000 members in 1,500 nursing programs across the US. Visit NSNA.org for information on membership, scholarships, the NSNA Career Center, and association activities.
“Uncertainty, stress, and worry was at a peak, with everyone concerned about how COVID-19 would affect their work and families and home lives. Directives were changing, seemingly hourly,” recalls Fritze. “It was clear that we needed a place for our staff to feel safe, grounded, and centered in the middle of this crisis.”
The Center’s Foundation team came together with the Posner Wellness & Support Center team to brainstorm how they could create a restorative space to make employees feel better. Fritze says that within three days, the Zen Den was born.
“We transformed a community health classroom—not in use because of pandemic safety restrictions—to a sanctuary,” says Fritze. “With the financial support of our wonderful Foundation and community donors, we rented room dividers and green plants, purchased mp3 players, wireless headphones, and Himalayan salt lamps. We also included a CD player, essential oil diffusers, antigravity lounge chairs, and a massage table, borrowed from our Posner Wellness & Support Center.”
Fritze describes the room: “It was partitioned into four separate private spaces with lovely wooden screen dividers. Three stations—or individual relaxation nooks—were set up, each with its own relaxation chair, salt lamp, mp3 player, and headphones. The music players were preloaded with six differently themed 15-minute guided visualizations, narrated by male or female voices, per the guest’s choice. Between uses, for the health and safety of our staff members, all of the equipment was thoroughly sanitized.”
The last section of the room was a designated Healing Therapy space. On a massage table, health care workers at the Center could get a 15-minute personal Healing Touch session. “This is a powerful yet subtle bio-field therapy to support the body/mind/spirit in achieving a relaxed state of being. To enhance the experience, we combined aromatherapy with the Healing Touch sessions,” explains Fritze. “All employees were able to schedule these free sessions in advance using a dedicated online program accessible to all staff via the intranet, website, and mobile phone.”
The Zen Den, says Fritze, “was purposefully designed to be a respite, an oasis, in the eye of the storm. The overarching service we provided was TLC, an opportunity for caregivers to be cared for in a deep and meaningful way. We provided the opportunity, the time and the space for team members to take a break from the physical, emotional, and mental chaos, and go within to a place of peace and safety.”
When some of the safety restrictions were lifted and patients were returning to the hospital, the Zen Den had to be moved. Fritze and others are currently searching for a more permanent space option so that the Zen Den can be reopened again.
Other staff members were inspired by the Zen Den to create their own wellness spaces. “Several units within the hospital have created their own Zen Den meditation and quiet spaces—great options for busy team members who can’t leave the units during their shifts, due to PPE and safety requirements,” explains Fritze. “These units are using relaxation chairs with salt lamps and essential oil diffusers. The great thing about this is that it shows that these staff members, these care teams, are making their holistic health a priority. Each space has its own personality. Some have beautifully decorated scarves adorning the walls. Some have little fountains. Some have seashell displays on the table. Each unit is owning their health and well-being in their own way, so we can continue to be here for our patients, our colleagues and our community.”
Fritze believes that all people need to take time for self-care—to quiet the mind and to stay centered and healthy. “I am very happy to see my colleagues taking an interest in self-care and mindfulness practice. It is so very important to take the time to quiet the mind from the constant stress we are exposed to on a daily basis. Health care workers will always put their patients’ needs first, even, at times, to their own detriment,” she says. “I believe we can and should take a few moments to care for ourselves so that we can take the very best care of our patients. We all think and process information better when we are centered. It’s gratifying to be an active part of a work culture that actively encourages that we lovingly care for one another, particularly now, when health care workers need it the most.”
Herd immunity, also called community or population immunity, refers to the point at which enough people are sufficiently resistant to a disease that an infectious agent is unlikely to spread from person to person. As a result, the whole community — including those who don’t have immunity — becomes protected.
People generally gain immunity in one of two ways: vaccination or infection. For most diseases in recent history — from smallpox and polio to diphtheria and rubella —vaccines have been the route to herd immunity. For the most highly contagious diseases, like measles, about 94% of the population needs to be immunized to achieve that level of protection. For COVID-19, scientists estimate the percentage falls between 50% to 70%.
Before the COVID pandemic, experts can’t recall examples in which governments intentionally turned to natural infection to achieve herd immunity. Generally, such a strategy could lead to widespread illness and death, said Dr. Carlos del Rio, an expert in infectious disease and vaccines at the Emory University School of Medicine.
“It’s a terrible idea,” del Rio said. “It’s basically giving up on public health.”
A new, large study found fewer than 1 in 10 Americans have antibodies to SARS-CoV-2, the virus that causes COVID-19. Even in the hardest-hit areas, like New York City, estimates of immunity among residents are about 25%.
To reach 50% to 70% immunity would mean about four times as many people getting infected and an “incredible number of deaths,” said Josh Michaud, associate director of global health policy at Kaiser Family Foundation. Even those who survive could suffer severe consequences to their heart, brain and other organs, potentially leaving them with lifelong disabilities. (KHN is an editorially independent program of KFF.)
“It’s not a strategy to pursue unless your goal is to pursue suffering and death,” Michaud said.
What’s more, some scientists say natural immunity may not even be feasible for COVID-19. While most people presumably achieve some degree of protection after being infected once, cases of people who recovered from the disease and were reinfected have raised questions about how long natural immunity lasts and whether someone with immunity could still spread the virus.
Even the method scientists are using to measure immunity — blood tests that detect antibodies to the coronavirus — may not be an accurate indicator of who is protected against COVID-19, said Dr. Stuart Ray, an infectious disease expert at the Johns Hopkins University School of Medicine.
With so many unanswered questions, he concluded: “We can’t count on natural herd immunity as a way to control this epidemic.”
Vaccines, on the other hand, can be made to trigger stronger immunity than natural infection, Ray said. That’s why people who acquire a natural tetanus infection, for example, are still advised to get the tetanus vaccine. The hope is that vaccines being developed for COVID-19 will provide the same higher level of immunity.
But What About Sweden?
In the political debate around COVID-19, proponents of a natural herd immunity strategy often point to Sweden as a model. Although the Scandinavian country imposed fewer economic shutdown measures, its death rate is less than that in the U.S., Paul said at Wednesday’s Senate hearing.
But health experts — including Fauci during the same hearing — argue that’s a flawed comparison. The U.S. has a much more diverse population, with vulnerable groups like Black and Hispanic Americans being disproportionately affected by the coronavirus, said Dr. Jon Andrus, an epidemiology expert at the George Washington University Milken Institute School of Public Health. The U.S. also has greater population density, especially on the coasts, he said.
When compared with other Scandinavian countries, Sweden’s death toll is much higher. It has had 5,880 deaths linked to COVID-19 so far, according to data from Johns Hopkins University. That’s nearly 58 deaths per 100,000 residents — several times higher than the death rates of 5 or 6 per 100,000 in Norway and Finland. In fact, as a result of COVID-19, Sweden has recorded its highest death toll since a famine swept the country 150 years ago. And cases are on the rise.
Despite that level of loss, it’s still unclear if Sweden has reached the threshold for herd immunity. A study by the country’s public health agency found that by late April only 7% of residents in Stockholm had antibodies for COVID-19. In other Swedish cities, the percentage was even lower.
Those findings mirror other studies around the globe. Researchers reported that in several cities across Spain, Switzerland and the U.S. — with the exception of New York City — less than 10% of the population had COVID-19 antibodies by June, despite months of exposure and high infection rates. The results led commentators in the medical research journal The Lancet to write, “In light of these findings, any proposed approach to achieve herd immunity through natural infection is not only highly unethical, but also unachievable.”
Herd Immunity Is Still Far Off
The bottom line, medical experts say, is that natural herd immunity is an uncertain strategy, and attempts to pursue it could result in a slew of unnecessary deaths. A vaccine, whenever one becomes available, would offer a safer route to community-wide protection.
Until then, they emphasize there is still plenty to do to counter the pandemic. Wearing masks, practicing social distancing, hand-washing and ramping up testing and contact tracing have all proven to help curb the virus’s spread.
“As we wait for new tools to be added to the toolbox,” Andrus said, “we have to keep reminding ourselves that there are measures in this very moment that we could be using to save lives.”
KHN reporter Victoria Knight contributed to this article.
Published courtesy of KHN (Kaiser Health News), a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
Claiming that it will “effectively reverse decades of progress in combating racial inequality,” the American Nursing Association (ANA), the American Medical Association (AMA), and the American Hospital Association (AHA) have called upon the White House to rescind Executive Order 13950, “Combating Race and Sex Stereotyping.”
Scheduled to take full effect in November, the September 22 EO directs that federal funds be denied to federal agencies, companies with federal contracts, and recipients of federal grants that sponsor any program that “promotes race or sex-stereotyping or scapegoating.” Any company found to be defying the order is threatened with cancellation of all federal contracts or funding. Non-exempt contractors are expected to start complying by November 21, but federal agencies were immediately affected by the order. The Justice Department has already suspended its diversity and inclusion training, and the prohibition has provoked a tumult at colleges, hospitals, government offices, non-profit organizations, and other institutions dependent on federal monies.
Citing “the pernicious and false belief that America is an irredeemably racist and sexist country; that some people, simply on account of their race or sex, are oppressors; and that racial and sexual identities are more important than our common status as human beings and Americans,” the EO is a widespread condemnation of the standards underlying most mainstream diversity initiatives. The order describes the concepts espoused in recent federal training programs as a “malign ideology” and claims that “research… suggests that blame-focused diversity training reinforces biases and decreases opportunities for minorities.”
The October 14 ANA/AMA/AHA letter states that “as providers of care to diverse communities throughout the country, we urge the Administration to immediately rescind EO 13950 and allow for our continued work on inclusion and equity.” The three signatories warn that Executive Order 13950 will “stifle attempts at open, honest discussion of these issues [e.g., sexism, systemic racism] in the public and private sectors” and argue that “prohibiting federal agencies from conducting and funding trainings that promote racial reconciliation is counterproductive to addressing racism.” Noting the disproportionate impact of the pandemic upon Black and Brown Americans, the letter argues that “vital research conducted at the National Institutes of Health and academic centers to comprehend the effects of structural racism and implicit bias on health care and health outcomes is needed right now more than ever before.”
The Association of American Medical Colleges also spoke out against the order, and in a September 24 letter, stated that “The AAMC, and the academic medical institutions that comprise our membership, are committed to being diverse, inclusive, equitable, and anti-racist organizations. We believe this training is needed now more than ever. The AAMC intends to continue our trajectory of pursuing and even increasing such training. We urge our member institutions and other affected organizations to do so as well.”
While the academic world is largely seeking to challenge the order, two colleges, the University of Iowa and John A. Logan College, have already announced that they are shuttering their diversity programs, at least on a temporary basis.
In normal times, transition-to-practice programs help new nurses gain confidence, skill, and proficiency as they move into their careers. But during the days of COVID-19, those programs can gain even more significance.
Recently, a panel discussion held at the ANCC Virtual Summit outlined how four transition-to-practice programs adapted during the pandemic. At least one program, the OhioHealth Acute Care Advanced Practice Provider (APP) Fellowship, provided staff to help care for COVID patients at the height of the pandemic.
The program, which runs roughly 10 months, prepares NPs and PAs to provide acute, critical care, and trauma services. The five-year-old program enrolls 10 APPs per year, according to Todd Fuller, MSN, ACNP, program director, based at OhioHealth Riverside Methodist Hospital in Columbus, Ohio.
The program has two parts. The first provides broad experience in critical care, while the second is reserved for the fellows to focus on a specialty once they secure a position in the system.
In March, “the two ICUs that are the main ICUs for our system at Riverside were ground zero for COVID at the time,” he notes. Facing a shortage of staff to care for COVID patients, the system called on three of the ten APP fellows to provide help in critical care. “These APP fellows are more trained than anybody to be able to best take care of these patients,” he notes. They were able to take a more independent role while also receiving supervision from their preceptors.
At the time, the staff was down three full-time employees. The APPs helped save overtime and minimize fatigue on team members. They were able to help split up extra night shifts and extra weekends and “take a lot of the burden off of the rest of the team that they were already going to be working with.”
The curriculum offers such features as a large number of CMEs, a high-tech high-fidelity simulation facility, procedure training, and an ultrasound curriculum.
Beside the OhioHealth program, the ANCC session provided information about transition-to practice programs from Huntington Hospital (Pasadena, CA), Mayo Clinic, and NewYork-Presbyterian Hospital. The ANCC Virtual Summit was held this year in lieu of the ANCC National Magnet Conference.