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Bethany Macchi, BSN, RN-CCRN has worked in a pediatrics cardiac ICU unit for nearly five years, and also worked as a travel nurse earlier this year. As a follow-up to last week’s interview with NurseFly about the current career outlook for pediatric travel RNs, DailyNurse asked Bethany for a first-hand account of her experience as a PICU nurse during the pandemic.

DailyNurse: What are you doing right now, and what has been happening in your unit this past year?

Bethany Macchi: “[In my pediatrics cardiac unit] we treat newborn babies all the way to young adults in their earlier 20s, so we’ve seen and treated cardiac and medical illnesses across the spectrum.

I had my first travel nurse experience from January to March this year, when I moved from Colorado to Phoenix to stay with my parents and save money ahead of starting school in August. I was meant to be on a six-month contract, but COVID completely up-ended my plans.

“There’s a huge need for pediatric RNs in general, not just in my hospital, but across the country.”

There’s a huge need for pediatric RNs in general, not just in my hospital, but across the country. The beginning of the pandemic was quite scary because we had a huge dropoff in the number of kids in the unit, having canceled all elective surgeries. As a result, we also had fewer nurses scheduled for shifts. Once elective surgeries picked up again, our schedule loads doubled as there were not enough nurses available to take on the shifts. We typically have high patient acuity, so a lack of nurses makes ensuring each patient gets the attention they deserve all the more difficult — but we make it happen.”

DN: How has the experience of working as a pediatric RN changed during the pandemic?

Macchi: “Everything we do requires a few more steps now, from signing in for the day to prepping kids for surgery. We conduct a ton of testing to make sure kids remain healthy.

“Similar to other hospitals, we have a major lack of PPE.”

We’re still given one mask for our entire shift, whereas a year ago, we’d have used one mask and one gown for each patient we see. Now, we get one of each for our entire shift.

In April, we created a new role for one nurse per shift who knows how much PPE we have, and can sign more out than what’s regularly allotted if another nurse gets fluids from a patient on their mask, for example. Every time we enter a room, we have to wear a face mask and shield, whether that patient is positive or negative for COVID.

We’ve also had to get creative with a shortage of gowns. Instead of disposable gowns we’d dispose of each time we leave a patient’s room, we’re throwing linen gowns into hampers so that we can wash and reuse them. We started that in July, and we go through thousands of washable gowns at a given time. On average, I might use up to 12 in a given day.”

DN: What safety procedures are in place for nurses at your hospital?

Macchi: “Most hospitals, including mine, are very diligent about screening and testing every person who walks through who walks through the door. We treat every person as if they are a positive COVID case until they test negative. We take all the precautions we can, and have a lot of new policies in place to ensure they are followed.

For example, even walking into work we’re required to complete a form on our cell phones, get our temperatures checked, receive our mask for the day. Many of us come in early so we aren’t stuck in a line just getting inside the building. Anyone who needs a COVID test gets one, so we all feel safe coming to work.”

DN: What is the experience of pediatric ICU nurses like right now, and what have you been seeing since the public school reopenings?

Macchi: “Each year, my unit is busier than the last. This influx of patients year over year is largely because of the technology-enabled services we’re now able to provide. Some of the cardiac services we’re doing now hadn’t even been invented 15 or 20 years ago. As a result, we have a ton of new options for patients, and they are living longer and coming back to us if they have complications down the road because they know we’re equipped to handle whatever issues arise.

Since back-to-school started, we are seeing more respiratory and flu-like illnesses, and we’ve also seen a decent amount of COVID cases. We’ve been really busy since COVID hit, and we’re seeing a surplus of patients that overflow into other units. In the cardiac pediatric ICU unit that I work in, we’ve seen a lot of kids coming in with heart failure. In the medical pediatric ICU unit, we’re seeing an increase in both non-accidental and accidental traumas.”

DN: Since you’ve worked as a travel nurse, do you have any tips for traveling pediatric RNs?

Macchi: “Nurses are at a higher risk of burnout during the pandemic. We’re getting SOS texts to cover shifts from nurse charges saying acuity is really high and they need help — but it’s OK to say no, especially after putting full-time work in that week. It’s crucial to self care in whatever ways you need to. I’ll exercise, go on a hike in the mountains, or spend time with my family. Maintaining your physical and mental wellbeing outside of work is core to protecting yourself against burn out.

“I expect health systems to provide COVID testing whenever it’s asked for, and provide proper PPE to every hospital staffer.”

COVID-19 guidelines change daily, so when you’re at work, make sure you’re following any new policies or procedures in place. Health systems are good about disseminating that information quickly. I expect health systems to provide COVID testing whenever it’s asked for, and provide proper PPE to every hospital staffer to ensure we aren’t exposing ourselves, friends, and loved ones to any viruses after we leave the hospital.

We (nurses) understand there are mask and gown shortages, for example, and that’s why we only get one — but our basic expectation is that we are at least getting one at the start of each shift.”

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