Nurse of the Week Andrea Dalzell was just 5 years old when she was diagnosed with transverse myelitis, a neurological disorder caused by inflammation in the spinal cord. Before long, she needed a wheelchair to get around, but that simply meant she would move forward on wheels instead of on her feet—and she hasn’t stopped moving since.
As she grew up, Dalzell became deeply involved in advocacy for the disabled and received a number of awards in recognition for her work, including the Cindy Loo Disability Rights Advocate Award in 2015. In 2018, the Brooklynite became New York City’s only wheelchair-bound RN and attained her bachelor’s degree. In a special interview on the September 10 broadcast of Good Morning America (GMA), Dalzell made it clear that her mission is to bring more disabled people into nursing and other healthcare professions. She told GMA, “You have to have people with these disabilities, these diagnoses, being in healthcare.”
Easily navigating hospital corridors in her wheelchair, Dalzell became a dedicated nurse, and threw herself into work on the NYC frontline when the city was stricken by the pandemic in Spring 2020. Now, she’s a nurse and department head at the Manhattan Quad school for gifted children with disabilities, where “the kids absolutely love her,” according to school founder Kim Busi.
Sitting in her wheelchair on the GMA stage, Dalzell said that she is trying to spread a message of hope and aspiration: “People with disabilities aren’t living a death sentence. They’re living life, and I get to prove every day that I’m going to do that. I need to be able to change that narrative for others so if they know that they’re diagnosed with something… that life doesn’t stop there. Life still happens, and it’s up to them to decide if they want to live it.”
At the conclusion of her interview, GMA host TJ Holmes awarded a teary-eyed Dalzell a $1 million dollar Visionary Prize from the Craig H. Neilsen Foundation in honor of the “extraordinary determination, inexhaustible passion, and ability to inspire” the wheelchair-bound RN has displayed in her advocacy for the disabled.
Dalzell wants to put some of the money toward advancing her education, but she is devoting most of the award to advocacy: “I want to start a whole program for people with disabilities to get into health care. They should be given a chance,” she told GMA.
Visit this page to see the full Good Morning America feature on Andrea Dalzell.
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.”
In March, when New York City staggered under the weight of the COVID-19 outbreak, the images of refrigerator trucks, overwhelmed hospitals, and outdoor triage centers set Amy Kinder’s caregiving instincts afire. On April 5, 2020, the ER nurse left her home in Kokomo, Indiana and joined the thousands of dedicated nurses who came to work on the city’s frontlines. During her 21 days at Coney Island Hospital in Brooklyn, Kinder formed a tight bond with eight colleagues. Now, the nine nurses have described their experience in a new book, COVID-19 Frontliners.
“I remember my first night in the emergency department I was stopped abruptly in my tracks as I was racing down the hallway. My eyes caught movement in one of my rooms. I stopped to ensure what I was seeing. I had a patient actively dying and the patient next to her reached through the rails of the cot and held her hand trying to comfort her. I felt anguish for these patients. They did not know each other, but they were all alone. They had no one but the stranger beside them.” –Amy Kinder, COVID-19 Frontliners
In an interview with the Kokomo Perspective, Kinder said, “We felt like it was important to get the truth out there because you see on the news so many conflicting stories of what’s really happening or what was going on. So we just felt like it was important to get our frontline experience out there so other people really could see and understand what it really was like—because when I was out in New York, [it seemed] like the news sugarcoated what was really going on.”
As they attempted to communicate with non-English speaking patients, Kinder and the other nurses tried to find their footing amid scenes of chaos: “There were patients everywhere, double and triple stacked in rooms, lining the hallways, right up to the nurses’ station.” She added, “I could not believe what I was seeing. How could this be possible? Where did all of these patients come from? I thought to myself, ‘Damn, this is way worse than what I saw on the news.’”
In addition to dealing with the overcrowding and insufficient PPE supplies, Kinder and her colleagues struggled with a shocking volume of mortalities that sometimes included co-workers: “During the hardest time, we learned how to cope in ways we never had before. Not only were we seeing death in our patients but within our own healthcare family. We lost an agency nurse one night at shift change. She was found down in the bathroom. My heart still hurts for this individual’s family.”
When Kinder returned to Kokomo, she found that the experience had left marks on her psyche. Back on duty at the Ascension St. Vincent ER, “Alarms go off, and I flash back to the horror in NYC. I begin to hyperventilate worrying that we are running out of oxygen again or that a patient is in crisis. I have to talk myself down and remind myself of where I am and that I’m no longer in NYC.”
Her 21 days in New York also left Kinder with a sobering awareness of the realities of COVID. “I knew that it was a big deal, but at the same time I wasn’t really sure how big of a deal it was. There’s so much unknown about this dang virus, so I even was on the fence. But then I come home and people are mouthing, and until you’ve been out there and lived it, it hurts to hear people talk like that…”
Jimmy Kimmel had a very special surprise for Metallica fan Tracy Bednar, a Long Island pediatric nurse who has been treating children afflicted by COVID-19. Kimmel, who interviewed Bednar in one of his Healthcare Heroes segments, discussed the stressful nature of her job and asked what she does to relax. Bednar mentioned golf and yoga, but admitted that after her shift ends, “the best thing I do [to unwind] is… I play my radio really, really loud” during the 45-minute commute back home from the hospital. What does she like to listen to? Her favorite band is Metallica, and the song she loves most is “Enter Sandman.”
Her Metallica fandom, Kimmel responded, was known to him, because “we’ve been spying on you.” As it transpired, Kimmel’s “spies” are well-connected, and the late-night host managed to treat Bednar to a virtual meet’n’greet with Lars Ulrich. Ulrich remarked, “When I heard the words ‘golf’ and ‘yoga,’ obviously the third word in that [series]—the third basic food group would be Metallica…. And as a father of three, I can’t thank you enough for what you do…”
Expect more nurses to take on leadership and public policy positions, says Dr. Stephen Ferrara, DNP, FNP-BC, FAANP, editor of the Journal of Doctoral Nursing Practice and Associate Dean of Clinical Affairs at Columbia University Medical Center. Speaking to DailyNurse, Dr. Ferrara described his work managing the treatment of non-COVID patients during the New York outbreak and shared his views on the impact of COVID on the nursing profession.
Stephen Ferrara: In my role as Associate Dean, Clinical Affairs at Columbia University Medical Center, my team and I develop systems and practices to ensure world-class patient care within our clinical locations—most recently that has included managing systems for screening and safety for our non-COVID patients. At Columbia, I serve as associate professor and manage the Columbia Doctors Nurse Practitioner Group, one of the country’s best nurse-run primary care services. I also teach health policy to the Doctor of Nursing Practice (DNP) students, and as Interim Executive Director of Jonas Nursing & Veterans Healthcare, I oversee our nursing scholars program, a group of exceptional nurses pursuing higher education in order to serve vulnerable communities in unique ways.
What have been the challenges of treating non-COVID patients during the height of the NYC outbreak?
SF: It is always our first priority to keep patients safe while providing the most comprehensive care possible. During the height of the outbreak in New York, the greatest challenge was supporting non-COVID patients in first assessing the need for in-person care and then managing the risk of infection against the potential consequences of their condition if gone untreated for a period of time. Education for patients and potential patients on telemedicine and other low-risk care options was also priority for us during this time. Since bringing patients into the office was no longer an option, we quickly transitioned to video visits to triage patient concerns, diagnose and treat minor acute issues and provide continuity of care for existing patients of the practice.
What sorts of adjustments have had to be made in caring for non-COVID health issues?
SF: The first step we had to take was ruling out COVID in patients with similar symptoms and ensuring we were keeping non-COVID patients out of the emergency room to begin with. We stood up a cold, cough and fever clinic which allowed streamlined patient flow, testing and procedures. We were able to rule out infections such as influenza and strep throat. While virtual visits had been part of our offering before the pandemic, they became standard procedure during the outbreak. Critically, we had to adjust staffing procedures and evaluate our supply of appropriate protective resources so that enough would be available for fellow healthcare personnel on the front lines.
What are your views on the impact of telemedicine?
SF: Telemedicine is making the way we administer care safer, more efficient, and potentially more accessible to all our patients. By conducting appointments virtually, we cut down the risk of spreading infection between patients in healthcare offices, and allow individuals who are mobility impaired to receive the help they need faster, from the comfort of their own homes. For the first time, we have the ability to assess patients’ home environment for safety which can help guide us in our treatment recommendations. Of course, in certain cases telemedicine cannot replace in-person examination or care, but with a decrease of patients coming into the office, these cases can often be given more focused attention than before. Additionally, not all patients have access to a smartphone or computer thus a significant barrier to care potentially exists.
In what ways do you expect the nursing profession will be changed by the US experience? What changes in healthcare do you think should/will remain in the long term?
SF: I think the critical role nurses play in our healthcare system, not only with hospitals, but in labs, clinics, offices, and from home, will become more apparent. Their insights and perspective on how we prevent, prepare, and treat situations like these will have lasting effects on the future of care. I believe we will see more nurses rise to leadership positions in our country’s healthcare institutions because of the value of their input, and look forward to the innovations and efficiencies that will follow. We will also see more nurses become increasingly involved in health policy based on their experience and recommendations.
Nurses make up the largest component of the healthcare workforce & have been rated as the most trusted profession per Gallup polling for the last 18 years in a row. As a result, we will see more nurses in elected positions throughout our local, state and federal governments. In terms of the changes brought on by this pandemic which should remain, I have seen this crisis open our eyes to the vulnerabilities of underserved communities and hope our attention remains focused on improving outcomes for these groups.
Journal of Doctoral Nursing Practice
This triannual journal focuses on clinical excellence in the application of evidence-based practice of doctoral nursing. Articles cover issues such as clinical practice and patient care; case studies; practice issues, including management, scope of practice, and reimbursement; ethical dilemmas, legal issues, and business practices; innovative methods of teaching and evaluating advanced practice, and more.