Many people, including nurses, have daily mantras or affirmations they use to set their intentions and motivate themselves throughout the day. Mantras can help you get through a tough time, but the ones you’ve always used before might not be enough to get you through the pandemic. If you’re looking for new mantras or affirmations, or you want to get started with them, here are 10 phrases tailored to COVID-19:
1.I will care for my patients to the best of my ability.
Nursing is also about patient care, so leading with a patient-centered affirmation is very fitting. Notice that the words focus on what’s possible—“care for my patients to the best of my ability”—instead of focusing on unrealistic expectations (i.e., “I will cure all my patients”). All mantras and affirmations should be equally realistic and within your abilities; otherwise, they will put unneeded pressure on you and stress you out.
2. This will not break me.
Caring for patients during the pandemic, especially patients who are severely sick with COVID-19, can be absolutely overwhelming. Tell yourself that you may bend under the pressure, but you are strong enough not to break. You will get through this in one piece, and you will live to fight another day (or rather, live to help your patients fight another day).
3. I have survived hard times before.
This relates to the previous mantra, and the two work well in tandem. As proof that this experience will not break you, consider all the times you thought you couldn’t overcome a challenge—and then did it anyway. Look to the past for evidence of how strong you are and how your resiliency will enable you to persevere in the midst of these incredibly tough times. Even when the last thing you wanted to do was put on your cotton scrubs and go to work, you still did it, and you can do it again.
4.Stay in the present.
With no real end to the pandemic in sight, it’s easy to get caught in a spiral, wondering about all the disasters the future might hold. This is an understandable impulse, but try not to give in to it. Instead, focus on the present moment and helping the patients right in front of you (or making the most of your day off, when you’re not on shift). Concentrate on what you can do this week, this day, this hour, this minute.
5.I can make a difference.
Within the scheme of the pandemic, it may not seem like the actions of a single nurse can make a difference either way. However, your actions matter to your patients, which in turn impacts their loved ones and their entire network. Maybe you can’t make a difference to the whole world, but you can (and will) make a difference to your patients. Your work is not futile.
6.This is temporary, and it will pass.
As the pandemic drags on, the hypothetical end point seems further and further away. Some days it feels like there has always been a pandemic, and will always be a pandemic. But even the worst situations eventually come to an end. Even though it may feel endless, COVID-19 will end and vaccines will become available. We don’t know how far away the light at the end of the tunnel is, but there is a light.
7. I cannot control everything.
This can be a tough one for nurses, who often joined the profession partly because they like to be in charge and have a lot of autonomy. But many things are still out of your control, and this is especially true in the healthcare field where you can do your best and still not achieve the patient outcomes you so desperately wanted. Rather than blame yourself, remind yourself that you cannot control everything and sometimes things happen.
8. I will focus on things that I can change.
Another mantra duo, “I will focus on things that I can change” is a good follow-up to “I cannot control everything.” Thinking about how you can’t control everything can sometimes lead to feelings of helplessness and powerlessness. But just because not everything is in your control doesn’t mean that nothing is. Concentrate on what you can do, even if it’s just taking the time to listen closely to a patient.
9.I have things to be grateful for.
In hard situations like coronavirus, it’s very easy to fixate on the negatives because there are so many bad things happening at once. While it can be difficult, try to find some small things to be grateful for–even if it’s as simple as a call with your loved ones or a nice soothing cup of tea. It sounds silly, but looking for the small things will help you find tiny sparks of positivity.
10. I am allowed to have negative feelings…but they won’t overwhelm me.
You are probably having a lot of emotions right now, many of them negative. You might be scared, sad, angry, confused or all of the above at once. Tell yourself that it’s okay not to be okay and that you are allowed to feel all your feelings, however negative they may be. Avoid “toxic positivity” which insists on projecting happiness and productivity at all times. However, you should also remind yourself that these feelings will pass. You don’t want to wallow in them so much that you tip into despair.
The right mantras and affirmations can help you center yourself, clear your head and reaffirm your priorities. If you’re in need of some mantras during the pandemic, try reciting these 10 phrases to yourself before donning your scrubs and heading to work. Thank you for all that you do!
Who was Biddy Mason? After her portrait was found in a group of Works Project Administration (WPA)-era murals slated for destruction, a flurry of media reports has fostered a growing curiosity about Mason’s place in the pages of Black history and the history of nursing.
Biddy Mason is among the figures depicted in the “History of Medicine in California,” a 10-mural series completed by Bernard Zakheim in 1938. The murals, which have long been on display at the University of California, San Francisco, are housed in a building that is going to be demolished in 2022 to make way for a new medical center. The family of the artist was told that they would need to furnish the funds required for the preservation of the murals. As UCSF and the Zakheim family battled over the cost of preserving the murals, the conflict gathered a varied group of interested parties, including Mason’s descendants Cheryl and Robynn Cox. In June, the General Services Administration entered the fray. The GSA countered UCSF’s ownership claim, insisted that the paintings be preserved and stated that “ownership of the murals resides with G.S.A., on behalf of the United States.”
The debate over the fate of the murals continues, but one happy result is that Biddy Mason’s story has emerged from obscurity. And her story is a classic American journey. Mason began life as a slave in the Deep South. She toiled in slavery on the pioneer trail before gaining her freedom. Finally, after working as a free nurse and midwife, she became a wealthy (and charitable) community leader who improved the lives of her contemporaries and later generations as well.
Born enslaved in Mississippi, Mason ultimately became the property of a Mormon convert. As she traveled west in a caravan with her owner, his family, and their enslaved laborers, she performed midwife duties, herded cattle, and cooked. The caravan ultimately made its way to California. In 1856, five years after her arrival, Nelson successfully petitioned for freedom for herself and 13 members of her family. She then moved to Los Angeles, where she worked for $2.50 a day as a midwife and nurse for Dr. John Strother Griffin, one of the first formally trained doctors in Southern California. Eventually, she set up her own business.
She never learned to read, but Mason was canny with money. She invested her earnings in property in various locations around Los Angeles and became a wealthy woman. By the time she died in 1891, Mason was a prominent philanthropist, and left her heirs an estate worth 3 million dollars. In addition to donating time and money to relieve prisoners and the impoverished, Nelson founded LA’s oldest Black church, the First African Methodist Episcopal Church, a daycare for the children of poor working mothers, and a Traveler’s Aid center. She lived until 1891.
Visit here to see a more detailed history of Biddy Mason and her place in history. For an account of the debate over the UCSF WPA murals, see this article in the New York Times.
Before COVID-19 hit New York City, Mount Sinai Morningside Hospital had a flexible, 24-hour visitor policy for patients in the intensive care unit (ICU).
People would visit their loved ones at any hour of the day, coming and going as they pleased. Doctors and nurses said the constant support of family members was beneficial to these gravely ill patients.
Now, per New York State Department of Health guidelines that apply to all areas of the hospital, visitors are limited to one 4-hour session per day, and only one person is allowed at the bedside at a time. At Morningside, that has to be done between the hours of 10 a.m. and 6 p.m. so visitors can undergo temperature and symptom checks before being permitted on the floors.
Morningside ICU physicians and nurses told MedPage Today those visitation policies are too restrictive, especially as staff have become more adept at managing COVID-19 transmission risk.
“It’s particularly challenging for this community because these families have a lot of restrictions,” said Mirna Mohanraj, MD, an ICU physician at Morningside (formerly St. Luke’s Hospital), which predominantly serves minority patients from Harlem and the Bronx. “Not everyone has a flexible job they can leave for 4 hours. They don’t have the financial resources to hire childcare.”
In an emailed statement, the New York State Department of Health said that hospitals “can authorize visits longer than four hours depending on a patient’s status and condition” and noted that labor & delivery patients, pediatric patients, and those with intellectual or developmental disabilities can have a support person at all times.
“This policy remains in place to safeguard and maintain the health and wellbeing of patients, staff and visitors while the need to contain the spread of COVID-19 continues,” the statement read.
The new visitation rules are a vast improvement from the disease peak, when visitors were barred from hospitals altogether and patients died alone. But while the policy may be sufficient for patients elsewhere in the hospital, it poses particular challenges for the ICU, Mohanraj said.
“The ICU is such a dynamic place, things change frequently and unexpectedly,” she said. “It’s traumatic for a family member not to be present when things are changing rapidly.”
Morningside ICU charge nurse Jessica Montanaro, MSN, RN, said while the visitation rules “make sense on regular floors, you have more grave situations [in the ICU]. You’re dealing with death and difficult decisions. In truly grave situations, people need more support. It should be a different situation for the ICU.”
Mohanraj said the literature “shows that having family at the bedside can be beneficial to patients” in the ICU, which is why many ICUs have adopted flexible visitor policies in recent years.
“Family members can provide emotional and psychological support,” she said. “Often, they’re the ones re-orienting patients, moving their legs, alerting the nurses to issues like pain control or a bedpan.”
“They’re also the constant reminder of the full lives that patients had before they got to the ICU,” she added. “And it helps the family develop trust in us as their healthcare team.”
Hospital administrators have allowed exceptions on a case-by-case basis, as called for by the state guidelines. But that means more time spent trying to cut through red tape, and the possibility of request denials.
Eric Gottesman, MD, medical director of the ICU at North Shore University Hospital in Manhasset, New York, which was also hit hard during the COVID-19 peak, said administrators there typically make exceptions to the visitor rule for end-of-life discussions.
“We follow the guidelines but if there’s an emergent issue, we do stray a little,” Gottesman told MedPage Today. “We try to bend, not break.”
Gottesman was similarly accustomed to a liberal visitation policy before COVID-19 hit. The new policy “puts more pressure on us by having to tell patients about the limitations,” he said. “Also, if we’re on rounds and no family member is present to take in the info, we have to come back and do it over.”
So what changes would ICU doctors and nurses like to see?
Family members should be able to stay for longer than 4 hours, Mohanraj said, especially if that person is the patient’s only visitor. That visitor should also be allowed to return to the bedside after they’ve left (right now, once a visitor leaves a hospital floor, they’re not allowed to return).
Finally, Mohanraj said nighttime visits would be especially helpful because ICU patients who experience delirium typically get worse at night, so the additional family support might alleviate related issues.
Safety is the first priority, she said, and thus far preventing transmission among visitors “has been perfectly manageable,” especially as very few patients with COVID-19 remain in the hospital, she said.
ICU providers in New York hospitals say the trauma of seeing families separated during the peak of the crisis has stuck with them, and makes their current push to have family members around more urgent.
In the beginning of the crisis, visitors weren’t allowed unless a patient was imminently dying — but that’s not always easy to call, Montanaro said.
“We had difficult cases where we would allow one family member to come up and stand in the patient’s doorway, say their goodbyes, and then the patient didn’t pass,” Montanaro said.
As policies eased over time, and patients could have two visitors, she recalled a case of a dying mother with three family members who wanted to say goodbye — her husband and two sons.
“That family had to choose which son would say goodbye to their mother,” she said. “So many things about that experience will haunt us for the rest of our lives.”
Data from National Nurses United (NNU) suggests that while only 4% of US nurses are Filipinos, some 30% of the nearly 200 RNs who have died from COVID-19 are Filipino Americans. NNU believes that overall, nurses are primarily endangered by PPE shortages and restrictive guidelines limiting access to tests, but Filipino nurses tend to face additional risks.
The odds of being exposed to the virus tend to be higher for Filipino nurses and healthcare workers. One reason for their vulnerability is based on sheer numbers, particularly in California and New York. One fifth of California nurses are Filipino, and according to a ProPublica analysis of 2017 US Census data, 25% of the Filipinos living in New York work in the health care industry. The types of jobs they take also increase the likelihood of exposure. A 2018 Philippine Nurses Association of America survey (cited by ProPublica) found a large proportion of respondents working in bedside and critical care, and a StatNews report noted that “because they are most likely to work in acute care, medical/surgical, and ICU nursing, many ‘FilAms’ are on the front lines of care for Covid-19 patients.” The StatNews story added that Filipino frontliners often “work extra shifts to support their families and send money back to relatives in the Philippines. Those extra hours, and extra exposure to patients, mean higher risk.”
Roy Taggueg, of the Bulosan Center for Filipino Studies at University of California, Davis recently told NBC News that in addition to the low rates of testing in their communities, Filipino nurses are also more likely to reside in multi-generational households, which makes them and their families more vulnerable to the virus. He explained, “One person might be going out, but they definitely are bringing everything back with them when they come home from work, because they’re forced to work out there on the front line. We’re talking about their parents, their kids, all of that. It’s a very particular position to be in, and it’s one that I think is unique to the Filipino and Filipino American community.”
While many nurses have been speaking out about the lack of tests and inadequate PPE, Filipino nurses usually find it more comfortable to remain silent. Cris Escarrilla at the San Diego chapter of the Philippine Nurses Association of America remarked, “We don’t really complain that much. We are able to adapt and we just want to get things done.” Zenei Cortez, president of National Nurses United and the California Nurses Association acknowledged this, saying “Culturally, we don’t complain. We do not question authority. We are so passionate about our profession and what we do, sometimes to the point of forgetting about our own welfare.” However, Cortez thinks that the younger generation of Filipino nurses seem to be finding their voices: “What I am seeing now is that my colleagues who are of Filipino descent are starting to speak out. We love our jobs, but we love our families too.”
Immigrant women receive dubious hysterectomies and staffers openly neglect even basic COVID precautions at Georgia’s Irwin County Detention Center, says LPN Dawn Wooten in a complaint filed by four non-governmental organizations.
According to Wooten, the private immigrant detention facility has refused to test symptomatic inmates, has not been isolating those suspected of having the virus, and is disregarding mandatory CDC social distancing practices. Wooten’s complaint also notes that she and other nurses have been alarmed by the inordinate number of hysterectomy operations performed at the Center. In reference to the frequent and questionable hysterectomies one detainee described the detention center as “an experimental concentration camp.”
COVID-19 safety and treatment are given short shrift at the center, and Wooten says that even before the pandemic the facility was often dilatory in providing medical care for detained immigrants. Since the pandemic, the complaint alleges, the center has made almost no use of its two rapid-response COVID testing machines, and has instead sent swabs to be tested at a local hospital. Wooten was told she should not be “wasting tests” on people she suspected of being infected, and when she inquired about testing one detainee, a co-worker responded, “He ain’t got no damn corona, Wooten.”
In addition to failing to provide PPE for staff working directly with confirmed cases of COVID-19, Wooten’s complaint states that the facility forced symptomatic staff to continue to work in the facility and threatened them with discipline if they refused to work in dangerous conditions. Because she spoke out against such practices, Wooten says that she was transferred from her full-time position to a part-time job in which her shifts consisted of a few hours a month.
On Tuesday, September 15, House Speaker Nancy Pelosi called for an investigation. Regarding the alleged misuse of hysterectomies on immigrant women detainees, Pelosi said “The DHS Inspector General must immediately investigate the allegations detailed in this complaint. Congress and the American people need to know why and under what conditions so many women, reportedly without their informed consent, were pushed to undergo this extremely invasive and life-altering procedure.” She also called attention to the neglect of COVID safety measures and proper treatment, and referred to “ICE’s egregious handling of the coronavirus pandemic, in light of reports of their refusal to test detainees including those who are symptomatic, the destruction of medical requests submitted by immigrants and the fabrication of medical records.”
Project South, one of the organizations filing the complaint, states that “ICDC (Irwin County Detention Center) has a long track record of human rights violations.”
For more details on this story and quotes from Dawn Wooten, see the article in The Intecept.
This is Nephrology Nurses Week, and our latest Nurse of the Week is RN Sandy Nichols, who treats acute dialysis patients in hospitals in Albuquerque. When there was a call for nurses willing to volunteer in COVID hotspots, Sandy stepped forward and flew out to Chicago. The need for nephrology nurses was urgent: AKI is a complication that affects about 15% of all hospitalized coronavirus patients—even those with no previous history of kidney problems—and 20% of the COVID patients in ICU suffer from kidney failure.
After parting from her husband and 20-year old daughter in New Mexico, for nearly a month Sandy devoted 12-18 hours a day to caring for Chicago’s COVID patients—and she says she’s ready to go back if she’s needed. Sandy told DailyNurse about her background as a nephrology nurse and shared her reflections on the pandemic and her frontline experience.
DailyNurse: How long have you been a nephrology nurse, and how did you decide on this field?
Sandy Nichols: “I have been a nephrology nurse for eight and a half years and have worked in every form of renal replacement therapy available except for kidney transplantation. I first learned about nephrology nursing during my third semester of nursing school when I was one of two nursing students chosen to go for a week of clinicals in a chronic hemodialysis clinic. I hadn’t decided on the field of nursing I wanted to go into yet so I went in with an open mind. From that first day, I was fascinated by the mechanics of the dialysis machines, the concepts of renal replacement therapies, the dedication and involvement in the patients’ health, and the knowledge that I could be giving my patients life because of the care I was providing with every treatment.”
DN: What were your first thoughts about COVID—and what are your current views on the pandemic?
SN: “When I first heard about COVID-19, I thought, “Wow! That is going to spread quickly through China because of the sheer number of people living so close together there.” I could’ve never imagined what we’ve now seen here. This pandemic has impacted every human being in some way.
“I needed to do this. I felt like it was my calling because both our patients and my colleagues in those cities needed help.”
When Fresenius Kidney Care asked for nurses to volunteer in hospitals because of the rise in acute kidney injury caused by COVID-19, I just knew I needed to do this. I felt like it was my calling because both our patients and my colleagues in those cities needed help. Having seen the effects of this virus firsthand, and helping patients fighting it, the most important message I share with people is to take this seriously. Help us slow the spread of COVID-19 by social distancing, wearing masks, and washing your hands.”
DN: What prompted you to start working on the front lines?
SN: “When I started to hear about all of the different places being hit so hard by COVID-19 and the nursing shortages, I knew I wanted to help in some way. I always had the desire to volunteer when natural disasters would happen but I was never in a position to do so, until now. As soon as Fresenius put out the call for volunteers, I signed up. I knew that I was drawn into nursing to help people and I couldn’t think of a better way to do that then to go and give my fellow nurses support when they so desperately needed it.”
DN: What were the most striking aspects of your experience?
SN: “Going into Chicago, which was known as a hot zone at the time, I was anticipating staffing and supply shortages, long grueling hours, and constant chaos. What was most striking in my time there was the camaraderie that I witnessed and felt every day. The staff was exhausted and overwhelmed working 18 to 24-hour shifts to maintain patient care, but they were all so supportive and helpful of each other. It was so obvious that they were all bound together as one big family. They welcomed me in as one of their own and even invited me to one of their rare potlucks.”
“The staff was exhausted and overwhelmed working 18 to 24-hour shifts to maintain patient care, but they were all so supportive and helpful of each other.”
“I got to see success stories of patients with COVID-19 who survived being on a ventilator and walk out of the hospital. They would announce a “Code Joy” over the intercom and everyone would stop and cheer. I also saw devastating outcomes that broke my heart. Going through those experiences, which I will never forget, gave me a whole new perspective and I truly believe it made me a better person and a better nurse.”
DN: What are you doing now?
SN: “I am currently working in an acute setting at Fresenius Kidney Care in Albuquerque, NM. The camaraderie that I experienced in Chicago has followed me back to Albuquerque because my coworkers are closer to me than ever before. We are there together, going through the same thing, every workday. I am so thankful for my career and the knowledge I continue to gain every day. I wouldn’t be the nurse I am today without the support of my work family and my home family as well as my community in New Mexico and my company, Fresenius Kidney Care.”