Dealing with COVID has been difficult for everyone. However, patients who have cancer face a more complex battle.
Gabriella Magarelli MSN, ACNP-BC, AOCNP, is the Director of Nursing, RCCA at Hackensack Meridian Health John Theurer Cancer Center at Hackensack University Medical Center in New Jersey and a Lymphoma Research Advanced Practice Nurse. Magarelli has been with the cancer center since 2004. She was a staff nurse from 2004-2010, then joined the Lymphoma Team, where she currently works.
“At the John Theurer Cancer Center, our patients are always our top priority,” says Magarelli. “During the pandemic, we remained involved in their care even when diagnosed with COVID.”
While oncology dedicated treatment needs to pause to treat COVID, Magarelli and her team are still active members of the care team, working closely with the primary medicine and infectious disease teams to safely and swiftly return the patient to their cancer treatment.
If a cancer patient was diagnosed with COVID, their immune system must not be further compromised through cancer treatment.
Gabriella Magarelli MSN, ACNP-BC, AOCNP
Factors to Consider for Cancer Patients with COVID
Magarelli notes that “there are lots of factors to consider. COVID symptoms, disease status, and types of therapy needed are often considered before continuing or holding cancer-directed therapy.” However, every patient is different, and every situation calls for further treatment, withheld or not. In some patients, pausing chemotherapies or other treatments that cause severe immune system suppression is not an option.
To safely continue care to patients in the inpatient and outpatient setting who also tested positive for COVID, Magarelli and her team protected the immunocompromised in many ways. Including screening patients before visits to assess for signs and symptoms, limiting visitors, and creating dedicated elevators and pathways for COVID-positive patients to travel in. In some cases, the team would use telemedicine check-ups instead of in-person visits.
Cancer patients are encouraged to get COVID vaccinated and boosted. Magarelli and her team are constantly educating their cancer patients to avoid large crowds, wear a mask in public, and alert the team immediately with any signs or symptoms of infections.
Any type of infection on top of a patient already who has cancer is difficult. However, Magarelli and her team faced new, more complex challenges when COVID began infecting her patients.
“COVID and cancer is a complicated combination and is ever evolving as we learn more about COVID and have new therapies to treat it,” she shares. “While general guidelines are in place, the multidisciplinary team looks at each patient’s care independently to determine whether to proceed with or hold cancer-directed therapy.”
There is More to Cancer Care Than Just Physical Treatment
Magarelli and her team emphasize communication with the patient, as having cancer and COVID can be a terrifying experience. Patients have strong relationships with their oncology team and lean on them for advice and support throughout the process.
The care team needs to remain actively involved with their patient, as open communication is, in Magarelli’s opinion, the best thing she can do for them throughout treatment.
Overcoming COVID while suffering from cancer is a difficult obstacle for the patient. Still, these new challenges have also taken a toll on the John Theurer Cancer Center oncology team.
“While I have experienced lots of healthcare challenges in my 17 years as an oncology nurse, nothing has compared to this,” she admits, “At the beginning of the pandemic, I remember feeling helpless, which goes against the very essence of what people go into nursing to do: ‘help people.’”
Pandemic Builds Strong Unity
However, in these trying times, Magarelli has felt a strong unity among healthcare workers.
They have all worked tirelessly to care for their patients, develop standard operating procedures and workflows, and develop testing and vaccines to combat the virus. “As the pandemic evolved and we learned more about COVID, it reignited my passion for medicine and research,” she adds.
From the moment she became a nurse in 2004 and started her career in oncology, Magarelli has always been proud to call herself a nurse. More now than ever, nurses and healthcare professionals acknowledge the selflessness, compassion, and hardworking nature of their colleagues. With COVID-19, the world’s eyes have also been open to this determination.
Thanks to Magarelliand her oncology team at the John Theurer Cancer Center, cancer patients diagnosed with COVID can continue their treatment with undivided support and attention.
“I could not be more proud of this profession and how everyone pulled together during the pandemic. As a result, 2020 was labeled the year of the nurse, and it could not have been more fitting.”
Nurse of the Week May Parsons – who delivered the world’s first Covid jab on December 8, 2020 – was among the recipients of the George Cross Award at Windsor Castle (a setting also calculated to cast the White House in the shade) on Tuesday. The award, created by King George VI to recognize brave civilians in WWII Britain, was bestowed in honor of UK health care providers’ “courage, compassion, and dedication in circumstances of extreme danger.” In addition to Parsons, the award was also presented to her sister and fellow nurse Joanna Hogg, the first person in Northern Ireland to receive the vaccine and one of the first nurses to administer the life-saving shots.
Parsons recently earned an MSc in Global Healthcare Management at the Coventry University School of Nursing Midwifery and Health and is a Modern Matron for Respiratory at University Hospitals Coventry and Warwickshire Trust. She moved to the UK from the Philippines in the early 00s and has been a nurse in the UK Midlands district for about 18 years.
A shot seen round the world
When her turn in the spotlight arrived in late 2020, the Coventry nurse found out just a day before her big moment. And initially, she said, “I assumed it [the shot] was going to be the first in the West Midlands. I didn’t realize until afterward that it was the first in the country, never mind the world!”
The choice of Parsons was apropos. As a committed participant in her hospital’s flu Peer Vaccinator program, she held a three consecutive year record for having administered more flu jabs than any other person on the staff, with a personal best in which she vaccinated 140 patients in a single day.
Parsons put her one-day warning about the history-making shot to good use. The person scheduled to receive the world’s first Covid jab was 90-year-old Margaret Keenan, so Matron Parsons visited her patient and tried to put her at ease before she bared her arm to the needle for the world to see. She told a Royal College of Nursing reporter, “I went to see Margaret to build a rapport with her, making sure that she was aware the vaccine was new, and that there’d be a lot of press there.” Parsons added little comforting touches the next day as well, encouraging Keenan to wear her favorite color and helping her get her hair right before meeting the cameras. She recalled, “She [Keenan] was keen to have it – she wanted to get back to normal, see her grandchildren and the rest of her family.”
“It’s all about integrity”
After the momentous public jab, Parsons dove into the Midlands rollout of the Covid-19 vaccine, “managing the vaccination hub – the flow, mixing the vaccine,” as well as “staffing – recruiting people, training them, making sure they’re assessed properly and have the right information to give to patients.”
As a nurse, her role in encouraging vaccination seems obvious to her. “As a nursing profession, we have a relationship with patients where they trust us. It’s important for the rollout because we want them to be able to say, ‘Tell me straight, what will this do to me?’ I say to my family: I’m not going to tell you to have it if I wouldn’t have it myself. It’s all about integrity.”
Like New York’s Sandra Lindsay, who received the first US Covid jab six days after her, Margaret Keenan has persistently failed to experience frightening or bizarre side effects from her historic jab. She has apparently not been surveilled via a sinister 5G network courtesy of Bill Gates, and her grandchildren must have been dismayed to learn that magnetic toys did not adhere to her skin. Instead, when she got her booster last September, Keenan, now 91 years old, enjoyed her moment of fame and expressed immense relief to see the efficacy of the vaccines.
After she and her famous nurse reunited for their booster shots and enjoyed their first hug, Keenan remarked, “I’m happy now that I can be free, it’s like the good old times. It was great to have May here, we have become a double act! It was such big news all around the world.” Then, with a lack of sympathy one might expect from a woman who never feared that forks and spoons might suddenly start sticking to her arms, she added, “Go and get the jab, it will save lives. I don’t really know what stops people from having it because it’s so quick. Do go and get your vaccination!”
Berg shot, edited and produced the video, but he credits its power to the ICU nurses who opened up to him about the toll the surge was taking on them and their community. He went to the ICU that day expecting the focus of his story to be an unvaccinated patient whose experience with COVID-19 left him wishing he had chosen vaccination. As he began speaking to nurses Chani Marcoux, RN, Britney Meunier, RN, Danielle Poulin, NP, and Kimberly Matheson, RN, he knew their stories were just as important because they not only were speaking for themselves, but for the patients they lost.
“The truth is I showed up for one day with a camera and the nurses and the front line care teams have been doing this for two years, putting their lives on the line,” Berg said. “It was important to them that people see the needless pain and suffering that patients, families and care teams were going through when effective vaccines were available. It was important to me that that story be told.”
When the Regional Emmy® was announced, Marcoux, Meunier, Poulin and Matheson took the stage with Berg to receive the award. Berg introduced the nurses, who received a standing ovation.
“Charlie really was able to portray and capture the message of what it’s like to be an ICU nurse during the pandemic and the importance of vaccination,” Meunier said. “Inviting us to be part of the Emmy ceremony was so special.”
“Just being acknowledged, not only that night but also with the number of times that video has been seen was emotional for us,” Marcoux said. “To us, this award is for the patients we lost, those who passed away without their families with only us there. They’re always on our minds.”
Since March 2020, community health workers (CHWs) have taken on an expansive role as essential workers to help on the frontlines of the COVID-19 pandemic. Now, CHWs in the state of Utah can receive hope and comfort in COVID-19 support sessions through the University of Utah College of Nursing.
The sessions are offered by Caring Connections, the College of Nursing’s not-for-profit bereavement care program, through a unique partnership with the Utah Department of Human Services. Originally funded by CARES Act funds, Caring Connections was asked to develop and implement peer-support groups for CHWs.
“The community health workers are an amazing resource for Utahns, particularly those in underrepresented communities of color,” says Kathie Supiano, Ph.D., director of Caring Connections. “They have themselves been disproportionately impacted by the pandemic. It has been gratifying to encourage their good work.”
COVID-19 support sessions for CHWs through Caring Connections are offered monthly, either virtually or in person, to CHWs across the state of Utah. Caring Connections works in collaboration with Latino Behavioral Health to provide the program in both Spanish and English.
Caring Connections also provides other COVID-19 support groups, including:
COVID-19 Grief Support
This group includes members of the community who may have lost a family member or friend to the coronavirus or who are grieving a death that was disrupted due to the pandemic.
COVID-19 Recovery Support
This group is for individuals who are still dealing with emotional struggles relating to long COVID symptoms. Members of the group can find support from others with similar experiences related to their illness.
All Caring Connections support groups are currently being held virtually. The groups meet once a week and are led by licensed health care professionals. There is no cost for Caring Connections COVID-19 Support groups, though registration is limited. If you are a CHW in Utah, you can register by phone at 801-585-9522.
“Since I was in, I think, about 4th or 5th grade I knew I wanted to be a nurse,” says Brittany Wilborn, RN. It took the mother of five nearly a decade, but Wilborn, our Nurse of the Week, knows how to persevere and how to pace herself. She has cleared the many obstacles in her path, developed an arsenal of leadership skills, and is steadily amassing a collection of nursing credentials. Over the past 10 years, she progressed from a CNA to an LPN, then an ADN RN. Before the ink had dried on her RN, she had gone on to enroll in a BSN program. And after that? She plans to become an FNP.
Wilborn’s nursing aspirations were born early in life. As a child in Galesburg, Illinois, when Brittany went to see her pediatrician, it was not the doctor, but the nurse who attracted the little girl’s rapt admiration. The APRN-to-be recalls, “I thought she was so pretty, and she was professional. The way she approached me and treated me, made me feel better about myself and the situation. That’s when I knew that I wanted to be a nurse.”
But she had a lot of living to experience first. After Wilborn graduated from high school in 2010, she enrolled at Carl Sandberg College to begin her studies and earn her CNA credentials. However, life had other plans for her. Brittany became pregnant and soon dropped out to give birth to twin boys. (Twin boys have a talent for stopping all sorts of things). For the next few years, she focused on mothering the boys through their Terrible Twos and had two more children. Looking back, Wilborn thinks she needed to do some growing up herself first. “Now I feel like it [dropping out of college] was an excuse that I was making,” she said, and added, “And I think it’s one that a lot of us, as parents, make. ‘Oh, the kids, oh the kids!” After giving birth to child number four, though, she decided it was time to move fully into independent adulthood and pursue that nursing career: “2014 is when my journey really began to take off. I became a CNA, started working, got an apartment, and moved out of my mom’s house….”
After earning her CNA, Brittany went on to complete Sandburg’s Licensed Practical Nursing program in 2018. However, as a woman of color she had been subject to so many non-criminal law enforcement encounters that the NCLEX-PN criminal background check was deeply intimidating. Anxious and overwhelmed, she went no further until Covid and an insightful instructor pushed her forward. While Wilborn was working as a CNA at the height of the pandemic, the nurse she was assisting told her, “I don’t know why you won’t be a nurse. Why won’t you take your boards?’ Then, Stacy Bainter, MSN, a Sandburg nursing faculty member, also urged her to go ahead. “I realized that [your history] doesn’t define who you are and what you’re capable of,” Wilborn says. And, with a conscientiousness typical of good nurses, she thought, “If (Bainter) believed in me and Sandburg believed in me to give me this degree, I owe it to them to at least apply for my nursing license and put it to use.” She also began to flex her leadership skills (valuable not only for nurses but to any mother of twin boys). Brittany joined Sandburg’s Black Student Association, became a student trustee for Sandburg’s Board of Trustees, and was selected as chairperson for the Illinois Community College Board’s Student Advisory Committee.
Today, Wilborn has five kids and a growing collection of degrees and certifications. She is now an RN with an associate’s degree (ADN), but that is just the beginning. Wilborn is pursuing her BSN now at a joint Sandburg/Chamberlain College program, and after that plans to enroll in the FNP program at Chamberlain College. If there are more obstacles ahead, Wilborn will find her way around them: “It’s necessary for me to keep going because I know that I can. It’s necessary because I feel like I shouldn’t limit myself. For some people, the ceiling, that’s their limit. And for others, the ceiling is your bottom.”
For more on Brittany Wilborn, RN, see her interview with local TV station KWQC.
Nurse researcher and educator Kasey Jordan, RN, PhD knows the stereotypical image of a school nurse – overworked, underpaid and, over the past two years, often on the front lines of controversial COVID policies.
And while those things are true, they aren’t the complete picture, says this Nurse of the Week.
“We don’t always present them as these strong, capable expert professionals that they are,” she said.
The same could be said for nursing in general – or for any traditionally “female” job. But Jordan sees the power in the interpersonal connections that nurses build with their patients and, from that, their capacity to create community change.
“If we’re serious about having better patient outcomes for society, then it’s areas in which the traditional nursing role can lead that really, I think, have a lot of potential to make a big difference. Things from communication to health promotion to what happens outside of that time when people are sick,” she said.
School nurses as “change-makers”
The possibilities inherent in nursing have inspired Jordan ever since she accidentally ended up in a nursing class in high school in rural Georgia.
“In high school, there were vocational classes that we took with all the other classes, and I wanted home ec, but I got stuck in health occupations against my will. Well, it stuck, and it really resonated with me,” Jordan said. “I ended up including those classes as part of my program of study, and I did an apprenticeship program with a local family practice and just never looked back.”
Even with the limited work that a high school apprentice could take on, she felt a meaningful engagement with patients and saw the role that the nurses played in their patients’ health journeys.
Jordan went on to study nursing with the expectation that she would be a bedside nurse, but by the time she finished her program, she knew she wanted to be in public health. Her first nursing job was in the cardiothoracic unit at Duke University Hospital to gain experience. Then she worked at the health department for a time before taking a job in the emergency department so she could complete an internship while earning her master’s degree.
Through the public health department, she spent a year and a half as a school nurse in Durham, North Carolina, at five alternative schools, each geared toward a different student population that needed extra attention.
“Every school had its own flavor,” she recalled.
Yet she also started to see constraints in the system.
One small example: The alternative schools were well-connected to mental health and behavioral resources for the students. But Jordan saw that some students weren’t having truly basic needs met, like good nutrition, decent sleep and adequate physical movement. Jordan approached an administrator about this, and the answer was, “Well, there’s no grant funding for that.”
“It was like, there’s all these high-level treatments that are so valuable. But then there’s also these basic processes that are so impactful on our outcomes. And it was sometimes harder to work on those things,” she said.
In both public health and school nursing, Jordan found herself surrounded by “incredibly smart people with great ideas” who faced numerous obstacles in bringing those ideas to fruition.
“That core challenge is really what led me to go back for my Ph.D. and what, in different ways, I’ve tried to explore since then,” she said.
Now an assistant professor in the College of Nursing at MUSC, Jordan focuses on innovation management. She especially values how school nurses and other health care providers find ways to develop resilience in communities and address disaster risk.
“What I’m most excited about is nurses and health professionals finding ways to make our communities more resilient to disaster. School nurses are incredible change-makers, and so are our students,” she said.
For instance, students in the accelerated Bachelor of Science in Nursing classes are learning the change-making skills that school nurses often learn, by necessity, on the job, Jordan explained.
Innovative projects the ABSN students have tackled recently included a podcast geared toward mental health challenges during the pandemic and support for educators to understand how COVID-related changes could affect student health.
School nurses play key role in community resilience
Jordan noted, too, that local disaster response requires flexibility to adapt to specific circumstances, and that’s where she’s interested in seeing who’s doing what.
“If you consider disaster response, there’s this piece of improvisation that is in it. It’s such a fascinating area, and school nurses have been on the ground improvising to meet these needs,” she said. “It’s really inspiring – and important to understand.”
“So much of responding to disaster is locally driven,” she continued. “So understanding what professionals in community spaces need is important.”
Jordan said she loves seeing school nurses who understand how comprehensive the role can be and are pushing expectations of what they’re there to do.
“One of the amazing gifts of school nursing practice, because you are outside the traditional system, is there is so much freedom and independence,” she said.
On the other hand, that requires skills that nurses don’t necessarily come equipped with. Unlike nurses in a health care setting, school nurses may need to be more entrepreneurial to “sell” innovations related to health.
“School nurses really have to build their teams and raise whatever kind of capital is needed – social or financial – to see their changes move forward,” Jordan explained.
While there’s general agreement that addressing health and physical needs will ultimately help with academic outcomes, Jordan said, the rub is the school nurses actually have to negotiate to get what’s necessary to address that health. That’s where those skills of teambuilding in a multidisciplinary environment come into play.
“There’s good evidence that school nurses are a great return on community investment, but I think there is more to tell about the community resilience they are building that is outside the traditional expectations of what school nurses have done,” she said.
In follow-up to a previous study she conducted, Jordan is currently looking at how school nurses are leading resilience-promoting change in school settings.
Since coming to South Carolina, Jordan has been working with the South Carolina Association of School Nurses to determine what subject areas need more research to help nurses in schools. That’s how she came to do an analysis of continuing education needs for school nurses, which led to her examining how school nurses are leading resilience-promoting change in school settings.
Throughout her journey, one fascinating thing that she has discovered is that innovation can come from anywhere.
“There’s not a single profile of an innovator,” she said. “It’s something that happens in all parts of an organization. But definitely there are skills we can learn to make it more effective.”