With the spread of the COVID-19 pandemic, Jennifer Scott, CNM, realized that she needed to take additional steps to keep her patients safe. As the pandemic rose in severity, Jennifer, whose primary patient base is a local Mennonite community in the Finger Lakes region of central New York, temporarily closed her clinic and began seeing patients in their homes.
The home visits were necessary, according to Scott, who had to rule out telehealth visits because her Mennonite patients don’t have computers or cell phones.
“We provided home visits because it is easier to isolate and wipe down our equipment between homes. This also prevented our clients from congregating in the waiting room. Many women will make appointments on the same day and share a ride. We are also only visited clients who were higher risk or near term. For example, we’ve spaced our four-week visits out to five weeks and are doing more phone calls.”
Jennifer is from the Finger Lakes region and, after working as a full-scope midwife in a community hospital for seven years, she joined other colleagues to open Community Midwives in 2019. She has retained admitting privileges at the hospital, though the Mennonite community prefers home births.
“The reasons are multifaceted,” Jennifer said, noting that she and her fellow nurse-midwife at Community Midwives attend six to 10 births per month in the community of approximately 600 families.
“Many are farmers, have large families and don’t drive cars. In order to have a hospital birth they would need someone to take care of the farm, watch the children and would have to hire a driver to take them to the hospital in labor, possibly in the middle of the night. The closest maternity hospital is 30 to 45 minutes by car. Some are put off by hospital costs and length of stay. Others like the comfort of their own home. They feel safer emotionally to give birth in their own surroundings.”
Making her patients feel safe became an additional challenge amid the COVID-19 pandemic. While the pandemic impacted this somewhat isolated community differently than other parts of the country, the fears were the same. The closing of schools and churches limited primary sources of socialization, entertainment, and information. Because the Mennonite community does not watch TV or listen to music, Jennifer shared news about the pandemic with the families she serves, printing off the latest information from the county and state health departments.
“Like everyone, they were worried for their families, stressed by the social restrictions and having to homeschool their children,” Jennifer said.
“The Mennonite community is very self reliant. They have stocks of canned and frozen produce from their own gardens and bake their own bread. They have fresh eggs and milk also. They may only go once a month to Walmart for other supplies so they are not as exposed to as many crowds.”
Jennifer, whose husband also battled the COVID-19 pandemic as a physician in a local hospital, said she hopes the pandemic inspires others to choose nursing and medicine, just as she was inspired by her experiences as a Frontier Nursing University (FNU) student.
“FNU taught me to grab my saddlebag, get on my horse and ride up that mountain,” Jennifer said.
“It taught me that my calling is to care for the underserved, the vulnerable families, without hesitation. I’ve always believed the education at FNU has prepared me for anything I encounter in the workplace. I remember Kitty Ernst giving a talk at Frontier Bound that I paraphrased as ‘We only educate the strongest, most resilient nurses’.”
Nursing organizations have joined individual nurses in speaking out. American Nurses Association President Ernest J. Grant, PhD, RN, FAAN issued a moving statement, in which he remarked, “As a black man and registered nurse, I am appalled by senseless acts of violence, injustice, and systemic racism and discrimination. Even I have not been exempt from negative experiences with racism and discrimination. The Code of Ethics obligates nurses to be allies and to advocate and speak up against racism, discrimination and injustice. This is non-negotiable…. At this critical time in our nation, nurses have a responsibility to use our voices to call for change. To remain silent is to be complicit.”
“You clapped for us. We kneel for you.”
A mingling of professional training and empathy moved nurses such as Miami RN Rochelle Bradley to take a knee in remembrance of Floyd’s death. Bradley told CNN that “Kneeling here today for nine minutes and knowing that that’s how long George Floyd was on the ground with his airway compromised really bothered me as a nurse.”
For healthcare workers, the protests also reinforced their sense of unity in the era of COVID-19. In Boston, nurses who gathered to kneel in front of Brigham and Women’s Hospital carried a sign reading, “You clapped for us. We kneel for you.” One nurse interviewed, Roberta Biens, said, “I just want everybody to know they’re not alone, we’re with them and we’ll stand in front of them or behind them, wherever we need to be to support them.”
Minneapolis nurses appeared in force at the protests. One local ER nurse told the Insider, “COVID is a temporary and critical health crisis. Racism, through violence and disease, has been killing our patients since the hospital was built and will continue killing them long after COVID is gone.” And in an official statement, the Minnesota Nurses Association said, “Nurses continue to see the devastating effects of systematic racism and oppression targeting people of color in our communities. We demand justice for George Floyd and a stop to the unnecessary death of black men at the hands of those who should protect them.”
Hospitals in New York City united to stand behind the protests. The Gothamist scanned official Twitter posts and noted, “The six major hospital systems in the city–NYU Langone Health, Mount Sinai Health System, New York-Presbyterian, NYC Health + Hospitals, Northwell Health, and Montefiore Health System–have all posted publicly in support of the demonstrations…”
Weighing the Call to Civic Action Against Public Health Concerns
Medical practitioners are understandably divided about engaging in public assemblies while the coronavirus is still at large, but many believe the risk is worth taking. On June 8, World Health Organization (WHO) director-general Tedros Adhanom Ghebreyesus said, “WHO fully supports equality and the global movement against racism,” but added, “As much as possible, keep at least 1 meter from others, clean your hands, cover your cough and wear a mask if you attend a protest.”
Asked by Health.com about the danger of public protests, Natalie DiCenzo, an Ob-Gyn resident in New Jersey, responded that “the risk of remaining silent and complacent in the face of racism and police violence is also deadly. I believe that with the proper precautions, these protests can be done relatively safely when it comes to COVID-19.”
Nearly 2,000 US “public health professionals, infectious diseases professionals, and community stakeholders” also expressed direct support for the national protests in a widely circulated June 4 letter (initiated by faculty from the University of Washington School of Medicine). Following a statement that “White supremacy is a lethal public health issue that predates and contributes to COVID-19,” the letter recommended a series of safety measures to protect protestors from the virus. Among other issues it urged “that protesters not be arrested or held in confined spaces, including jails or police vans, which are some of the highest-risk areas for COVID-19 transmission, “ and that no use be made of “tear gas, smoke, or other respiratory irritants, which could increase risk for COVID-19 by making the respiratory tract more susceptible to infection…”
On Twitter, nurses participating in the protests offered their own practical suggestions. A DC pediatric nurse told attendees to bring gloves, sunglasses or goggles for eye protection, and “an extra mask. Yours will get hot and sweaty so switching it out halfway through is smart. If you have a cloth mask throw a bandana on top too…” Following participation in protests, some nurses have also taken the step of self-quarantining for two weeks.
Amanda Stuart postponed her wedding with her long-term fiancee and resigned from her job at an ER in Midland, Texas to care for COVID-19 patients in New York. Since her arrival, she has been working steady 12-hour shifts, taking an hour-long bus trip each day from her Manhattan hotel to a hospital in Coney Island. The shared experience of working on the front lines of the pandemic created a tight bond among the nurses on her bus, and as they exchanged personal details during the commute, Amanda says, “Many of them heard I had to cancel my wedding and began joking about having [my fiancee] Ronnie fly out here and just walk to Times Square to get married.”
The idea of a wedding in the COVID-stricken city might have sounded like a joke at first, but perhaps a life-affirming act like marriage could be a welcome counter to the stress and emotional turmoil of the pandemic. When Amanda’s fiancee decided to visit her in New York, the joking notion gave birth to a plan: “I felt deep inside me not only did I want to get married but I felt all the frontline heroes needed something positive to look forward to at this point in our journey,” and a widespread group agreed.
As in a Cinderella story for the COVID-19 era, aid came from all sorts of unexpected sources. The Times Square stairs, normally prohibited for private use—and now denuded of the usual crowd of tourists—was made available for the ceremony. There were also mysterious gifts that appeared as if by magic: “I had complete strangers provide a cake, a wedding dress, shoes, jewelry, music, and flowers for my wedding, [and] the NYPD & FDNY blocked off the ‘red stairs’ where the wedding would be held,” Amanda relates.
The festivities were a combination of the fanciful and the practical. “They made me a wedding dress out of PPE, lingerie out of scrubs, and my leg garter for my something borrowed. Something new and something blue [were made] out of a piece of scrubs detailed with a one of a kind Coney Island face patch from the Coney Island fire department crew.” Masked fire-fighters, NYPD members, nurses, friends, and family looked on as the couple (also wearing masks) exchanged vows, and nurses and other front line workers practiced social distancing as they danced in the streets following the wedding.
The bride will always treasure that special night. “We realized how much we ALL needed that moment… My dream come true was something I never, ever could have imagined! A small town girl from Arkansas with the wedding of a lifetime!”
For the full story on Amanda’s NYC wedding, see the story on WBTV.
For Nurse of the Week Emily Fawcett, working at Lenox Hill Hospital in New York City during COVID-19 is the culmination of a series of nursing stints in stricken areas. She went to Puerto Rico in 2017 to help in the wake of Hurricane Maria, attended to patients on the USNS Comfort in Venezuela in 2019, and makes regular trips to work in free community clinics in Kenya.
Such experiences have left the 30-year-old RN with first-hand knowledge of how important it is for caregivers to forge strong support networks, especially in times of crisis. Dealing with a flood of desperately ill and dying patients—on a daily basis, for weeks and even months—exacts a high toll on the nurses who are working the frontlines of COVID-19. Burnout has long been an occupational hazard in nursing; now, in the unprecedented circumstances of the pandemic, clinicians can find themselves engaged in a constant battle against mental and physical fatigue and trauma.
Of working at Lenox during the pandemic, Fawcett says, “We’re truly in a war zone here. These are nurses that are tough as nails. … But I was on this text thread with them, and they were saying how horrible it’s been [in the ER], how upset they are. One of them said it was the first time that they had ever in their life cried at work. And they’re just so completely overwhelmed and upset and overcome with emotion.”
Concerned by the evidence of flagging morale, Fawcett looked for a way to help beleaguered ICU staff prepare for the onslaught of each new shift. As a float nurse, she encounters patients on every floor, and this gives her the opportunity to witness the “success stories” of those who recovered from the virus. Armed with these more positive experiences, Fawcett introduced a new ritual to the Lenox ICU: the “hope huddle.” Now, prior to beginning a new shift, staff share good-news stories about patients’ progress, exchange uplifting and humorous anecdotes, and bond in preparation for the challenges they will face in the hours to come. An assistant nurse manager in the ED explained the uplifting effect of a huddle: “Hearing five people [were] getting extubated and 13 people [in the ICU were] stepping down to lower levels of care, meaning… they’re starting to improve and they don’t need to be in an ICU anymore, just hearing those overall numbers is super inspiring.”
Hope huddles are now held on every floor of Lenox Hill. Fawcett told the New York Post, “It really just came about to spread positivity, good patient outcomes, how we’re really saving lives here at Lenox Hill and to kind of increase the morale and give us a little pep in our step. The hope huddles are bringing hope to our hospital, and they’re bringing a little light.”
Nurse of the Week Kirsten Flanary has an abundance of the compassionate nature that is a defining characteristic among nurses. This week, she serves as an example of the many nurses around the country who are venturing out of their comfort zones to join the fight against COVID-19. Flanary, a 25-year-old ED and travel nurse who has worked at Holston Valley Medical Center in Kingsport, Tennessee, and Vanderbilt University Medical Center, was stricken by the news about the devastating impact of COVID-19 on New York City. Kirsten couldn’t seem to stop thinking about the overwhelmed city and soon found herself ready to join the fight.
As she listened to the reports that came flooding in, Kirsten thought, “All these big cities are just drowning in this virus. Nurses are exhausted, they’re working long hours, they’re not having days off. Everybody is getting sick…” When the pandemic spread and legislators removed restrictions preventing nurses from using their licenses to practice out of state, Kirsten was ready to do what she could to help ease New York’s plight. She had never even been on an airplane, but that now seemed like a small consideration in the overall scheme of things.
Kirsten’s mother—who is a nurse as well—was initially flabbergasted. “Her response was, are you insane? But she has been my biggest support in all of this.” An undaunted Kirsten packed her bags, flew into the Big Apple on Sunday, April 5, and joined the thousands of nurses working on the front lines of New York’s COVID-19 pandemic. Kirsten arrived in a desolated city, but since her arrival, she has been inspired and gratified by the appreciation of those who remain:
Now, Kirsten, too,
is braving the virus while caring for a seemingly endless flow of
patients, but she feels committed: “When you start nursing you take
an oath. We put our patients first and typically put ourselves last.
I felt like I needed to do something.”
New York City makes its comeback as a notoriously high-decibel town every evening at 7.00PM. Before the advent of COVID-19, New York was America’s noisiest city. The standard volume of Manhattan streets was always at 11, day and night. On the crowded sidewalks, pedestrians provided a constant soundtrack that combined shouted, fast-walking verbal exchanges and New Year’s Eve Party-levels of laughter with intensely personal conversations bellowed into mobile phones. The natural loudness of New York talk would gamely rise to compete with construction workers’ jack-hammers and machine tools, honking horns, sirens, and car stereos blasting pop and hip-hop through open windows.
Since it became the hotspot of the pandemic, the city has taken on an eerie quietness, but NYC hasn’t forgotten how to be noisy. Starting with the initiation of the #ClapBecauseWeCare movement on March 27, the city now erupts every evening when the clock strikes 7.00PM. At that time—every day of the week—New York City comes together to generate exuberant, rolling waves of sound to celebrate the courageous efforts of healthcare providers, first responders, and other essential workers who are making it possible for NYC to survive the pandemic.
It might be possible
to set one’s watch by this new evening ritual, as New Yorkers mark
the hour by drawing upon their innate ability to be transcendentally
loud and express their gratitude by filling the air with several
minutes of boisterous cheers, claps, shouts, whoops, and car horns.
The enthusiastic show of support has been a moving experience for
those on the frontlines. As the Independent
reports, ICU nurse Kelley Bradshaw told ABC News, “Oh my gosh, you
guys, this makes me cry almost every dang time. That gives me such a
boost and such hope that we’re going to unite and we’re going to
fight this bad boy because this virus is vicious.” New York City is
indeed united, and every night the city gathers—at a safe distance,
of course–to say “thanks.”
Below are a couple
of short videos of 7.00PM cheers in NYC: