What to do if you are a patient or have a loved one in the Emergency Room

This post is dedicated to all the other nurse family members and friends out there.

As the emergency nurse in my family and friend circle, I am almost always one of the first calls or texts by people when they wind up in the ER or have a loved one that is an emergency patient.

First and foremost - I always tell the person on the other end of my call or text that I am so sorry that this is happening but please know that if you or your loved one is being taken to the emergency department, you most likely need to be seen by a medical provider and that the hospital is THE PLACE to be evaluated for all things medical. This often helps calm the person or at least put some of their concerns in perspective.

Next - I always validate whatever feelings they are having. It is normal to freak out when going to the ED or hearing that your loved one is going there. We do not have to be rational in a moment of crisis. Give people space to be emotional. Validate those feelings, then try to guide them back to the practical. I feel that is the greatest gift a nurse friend or family member can do - direct a person in crisis to something practical and addressing the scary unknown.

Now, if you’re reading this and you are not a nurse or medical person, WELCOME to the organized chaos that is emergency medicine! I am hoping this blog post will help clarify some of the confusion that you may be feeling and give support by answering some of the most common questions that I get as an emergency nurse friend and family member.

Clarification on the method to the madness that is emergency medicine:

• Is it the ER or ED? Emergency Room vs. Emergency Department

  • Funny thing, it’s both. - The Emergency Department (ED) is the same thing as the Emergency Room (ER). You see, the specialty of emergency medicine was born in a room and originally, seemed confined to those original four walls. As the specialty became more advanced and comprehensive, we took up more than a room, and the ER went through a re-branding to become the emergency department. In common nomenclature and thanks to Hollywood, ER will always be more widely used. ED also stands for ‘erectile dysfunction’ in medicalese, so there is that challenge too.

• What happens when I or my loved one arrives to the ED?

  • The short answer: lots of things. - Being a patient in the ED is like being a Nascar car that just arrived in the pit and is getting a quick turnover by the pit crew. Upon arrival, a patient will be quickly registered in the computer system - this means that their name, DOB, and other personal data will be put in the computer to create a digital chart that medical providers will use to document their care. This is not when they ask for your health insurance.

  • At the same time as registration, the patient will be taken one of two ways into the ED (assuming no one is ahead of them) >> to the triage room/area or directly to an ED exam room. In either case, the patient’s vital signs (i.e. heart rate, blood pressure, oxygen saturation, respiratory rate, temperature) will be taken and documented, lots of questions asked about their health history (things that have happened to them in the past medically), about their current issues that have brought them to the ED today (AKA “Why are you here today?”), current medications, and screening questions that they ask everyone related to domestic violence (“Do you feel safe where you live?) and suicidal thoughts (“Have you thought about ending your life, harming yourself, or others?”). Do not take these screening questions personally. They are often mandated by a regulatory body to be asked to everyone who can answer them.

    • In the time of COVID-19, ED’s are incredibly full of patients 24/7 so more realistically, you will be waiting in the waiting room for a very long period of time (think many hours) if you come by private vehicle (AKA your car) or a very long time on an EMS gurney if you come by ambulance. There is also the chance that if you come by ambulance, you will be re-directed to the waiting room too to wait. I am sorry. This is just the reality of emergency care at this time.

  • As these questions are being asked, orders may be placed for an EKG, blood labs, medications, IV placement, or imaging like X-rays, ultrasounds, or in some cases, CTs ( AKA Cat Scans - no cats involved). If this is the situation, you may be quickly poked or transported somewhere to have pictures taken of various body parts. This is good. You want answers and to get answers, tests need to be done. However the results of these tests may take anywhere from 45 minutes to hours to come back. A medical provider will review any abnormal results with you at a later time.

  • To complete many of these tests, you will need to be undressed to your birthday suit and placed in a hospital gown and socks with those rubber skids on the bottom. Please do not fight medical staff as they try to undress you. It is for medical reasons and not our entertainment that we need to get you naked. if you have cultural needs that need to be addressed like needing a specific gendered medical staff to assist you while undressing or religious garments that need to be maintained in a certain way, please let your medical staff know, and they will do their very best to make those accommodations while also meeting your medical needs as quickly as possible.

  • All of these events can happen concurrently which is often why the patient feels like the car getting handled by a pit crew. Lots of stickers may suddenly be attached to you with cords going all over the place. There may be pokes with needles or probes in various orifices. You may be asked to produce body fluid samples like urine or sputum while all this is happening. None of this is ideal or often comfortable, but know that we are asking you to do each task with the goal of getting you the care that you need rapidly and efficiently.

• After the initial triage or intake process is completed for my loved one, does that mean I saw a MD/doctor/provider such as an NP or PA?

  • Maybe! But probably not. - Sometimes a physician or advanced care provider (NP/PA) will see you as soon as you arrive to the ED. Most often, it will take anywhere from a few minutes to several hours to see a physician during your visit. Average ED visits in the United States take anywhere from 4-8 hours, often longer in our current pandemic world.

  • If I am not immediately seen by a MD/provider as soon as I arrive, are things even happening those first few minutes to hours?? - Fear not! Lots of things will happen before the MD/provider physically sees you. Thanks to collaborative care and technology, many things will be ordered on you based on your “complaint” or reason why you are in the emergency department. Labs, scans/x-rays, medications, IVs, fluids and more are ordered “per protocol” or through “standing orders” and will be started as soon as you are seen (when applicable).

  • What if I get there and nothing happens? - This may happen too. If that is the case and you are waiting for an extended period of time in the waiting room, there is a reason. There is always a reason. However nothing is perfect and if you feel that you are there for a very big reason, check back in with the front desk. However if they say there are lots of sicker people who are waiting ahead of you, get comfortable and try to be patient as you wait your turn.

• Why aren’t I being seen faster?

  • Who gets seen first in the ED - The order of who gets seen first is not based on when people get there. It is based on a combination of complaint or illness/injury severity, timing, and who shows up next. Remember that the ED has two entrances - the front entrance where triage and the waiting room is + the ambulance entrance which you cannot see from the waiting room. The waiting room may be empty but ambulances might not stop coming, so it may appear that the ED is not busy from the waiting room while all the rooms are actually full of patients with a line out the ambulance door in the back. Please be patient as we work to get you and your loved one taken care of.

• Who can come into the ED to visit or accompany me or my loved one?

  • It all depends. - This is a hard one. During high COVID-19 surges, there are often NO VISITORS allowed in the ED. The only exceptions are an adult guardian for minors, possibly a care giver or guardian for memory (EX: dementia) or cognitively impaired or delayed patients, and end-of-life patients. When it is not a COVID-19 surge, the ED usually will limit visitors to one per patient. Please keep all minors home who don’t need to be there - siblings of a kiddo being seen for example. Encourage worried family members not to come to the ED in times of crisis. I always recommend making a point person for communication for the family or friends so that all info is filtered through one person. It can be a great tool to keep communication clear and concise.

• What should I bring to the ED if I am going as a visitor or as a patient?

  • If you are the patient and not going by ambulance (AKA - you have time to think about what to bring and collect it all.) - Things to bring - A LIST OF YOUR CURRENT HOME MEDICATIONS or your actual pill bottles of current meds, your POLST or advance directive if you have a copy, ID card, health insurance card, credit card, your cell phone, CELL PHONE CHARGER (the longer the cord the better) with wall plug, a change of clothes, a book or something to read, a computer or tablet if you need it. We usually encourage people not to bring valuables unless they absolutely need it because things can go missing in the ED. I wish that wasn’t the case, but just know it happens. DO NOT BRING FOOD OR DRINK TO CONSUME unless you can wait until after you see the provider and are told by the nursing staff that you can eat.

    • Free advice - DO NOT EAT OR DRINK ONCE YOU ARE IN THE ED.

  • If you are the patient and are brought in an ambulance - You bring exactly what EMS or the firemen say you can bring. Do not hold up anything if medics are trying to get you in an ambulance. If you do have a minute, grab A LIST OF YOUR CURRENT HOME MEDICATIONS or your actual pill bottles of current meds, your POLST or advance directive if you have a copy, ID card, health insurance card, credit card, your cell phone, CELL PHONE CHARGER (the longer the cord the better) with wall plug.

  • If you are a visitor to someone who came by ambulance as a patient - Often the patient will not have time to grab anything at all, so you can try to collect things for them.

    • In this case, I recommend bringing the following for a loved one in the ED who is a patient: A LIST OF THEIR CURRENT HOME MEDICATIONS or their actual pill bottles of current meds, their POLST or advance directive if they have a copy, ID card, health insurance card, credit card, their cell phone, CELL PHONE CHARGER (the longer the cord the better) with wall plug, a change of clothes, a book or something to read, a computer or tablet if they need it. We usually encourage people not to bring valuables unless they absolutely need it because things can go missing in the ED. I wish that wasn’t the case, but just know it happens. DO NOT BRING FOOD OR DRINK TO CONSUME for them. Just don’t. No patient in the ED should eat until instructed to do so by their ED nurse.

  • As a visitor of a patient in the ED, you really just need stuff to occupy yourself, keep your devices charged (the longer the cords the better + the wall plug), and $$$ to buy stuff to feed YOURSELF (NOT THE PATIENT until the ED nurse says so), and a way to get home. If it is a COVID-19 surge, ED staff will most likely not let you in the building, and you will have the option of waiting in your car in the parking lot or somewhere near by.

  • If you are a visitor who is not let in the ED and has to wait outside for updates, make sure the ED staff has your correct phone number. And make sure that you have a correct phone number that you can call for updates. We really mean well in the ED and try to call with updates when we can, but you may want to call and get updates at regular intervals. Ask the ED staff what those regular intervals are. Results come back at expected times, so staff should be able to tell you when the next update in information will be. If they say don’t call back for an hour, listen to them. If you call back too often, you will not get any updates and further stress the already stressed out ED staff.

• What will happen to me or my loved one in the ED?

  • In the majority of situations, you will either stay overnight in the hospital or get discharged home. - There are only two final options as a patient - you will stay or go.

    • Staying overnight in the hospital is called “being admitted to the hospital”. For an admission to occur, you will need to be seen by an “admitting doctor” which can be a hospitalist (think your main doctor for your hospital stay) or a specialist depending on your injury or illness. This doctor is different from the ED provider/MD. The admission doctor will see you after your initial ED work-up (all the tests done in the ED to determine if you need to stay overnight in the hospital or not) is completed. Whoever the admitting doctor is, they will have to evaluate you or the patient (your loved one) and write admission orders. This is done still in the emergency department. At that time, they will request an inpatient/admission bed for you. That bed will then need to be assigned. This bed is a bed NOT in the emergency department, but in a different part of the hospital where you will stay for the duration of your hospital stay. It can take hours to days at times (sorry - blame COVID-19) but usually hours to get this bed assigned. Then you will be transported to that assigned room via a ride in an ED gurney (bed with wheels) or a wheelchair. Then you will be assigned a new nurse and settled into your room for your continued hospital care!

    • Being discharged home from the ED means that you are not sick or injured badly enough to need to stay overnight in the hospital. Congratulations! You get to go home! What will happen next - the ED MD will come tell you about all your test results, give you verbal discharge instructions, and tell you to go home. But WAIT! You still have to wait for the PRINTED discharge instructions and the official discharge talk from your ED nurse before you actually physically go home. If you don’t get printed discharge instructions and any paper copies of prescriptions (or instructions that your prescriptions have been sent to your pharmacy), you are not ready to go home yet. The ED nurse does this with you. You usually hear about your follow-up care plan, recommended follow-up appointments (as applicable), and a review of any medications you need to continue at home + where to get them. Listen to all of this. It may be a very quick talk with the nurse. You will probably be in a rush and trying to figure out how to get home + a million other things, but this talk with the MD and the ED nurse are often your best chance to get your initial questions answered.

    • If you get discharged home, you should ask for a copy of all your test results and a disc with all your imaging on it. - Depending on the facility, they will be able to get this to you in the ED at the time of your visit. In some facilities, they will tell you to go online and find this information via an online patient portal. At other facilities, you will be instructed to make a request via the Medical Records department. Whatever the answer, fine, but make sure you ASK FOR A COPY BEFORE YOU GO. If you forget, it’s fine. It’s just often easiest to get this info at the time of discharge.

    • If you get discharged home, do not forget to ask for any valuables that may have been locked up during your stay. - You will know if this is applicable. In some cases as an ED patient, you will be stripped down to your birthday suit, all your belongings placed in a bag, and locked up in a locker. At the end of your visit, make sure to claim your valuables. This is often at Security or Registration (front desk).

• Getting home from the Emergency Department - You will need to get home if you are discharged from the ED. There are a few options.

  • If you are able to walk and talk, you get to figure out how to get home. If you arrived by ambulance, an ambulance will not take you home. You should consider calling a friend or family member, use a ride share service (EX: Uber, Lyft), or have the ED call you a taxi (Note: you will have to pay for this).

  • If you cannot walk or need O2 or other assistance due to chronic health conditions or new illness/injury, a non-emergency ambulance can be arranged to get you home. However this is done under very specific situations for insurance to cover this. Please ask your nurse about this if you think you or your loved one qualifies.

  • If you are a visitor for a loved one in the ED who is being discharged, feel free to drive them home (if appropriate). One of the best things you can do for a patient in the ED is provide a ride home. Make sure that they get all their belongings and have their discharge instructions (paper copy) before you leave. It is usually best to drive up to the entrance for the shortest walk/wheelchair ride to the car. if you or your loved one needs assistance to the car, let the ED staff know. If someone is available, they will be happy to help! It may just take a little while as most ED’s are very, very busy at the moment.

I hope that helps! That definitely does not cover it all, but I think it hits the basics on how to navigate the confusing world that is the emergency department as a patient or visitor. Please know that every emergency department staff is doing their best every day, every shift, but we are under unprecedented (and I HATE that word) stress right now. It is feast or famine in the ED, meaning that it is either the busiest day of the millennia or it is deathly chill. You never know when that will change, so make sure you bring your PATIENCE when visiting us.

— Sarah @ New Thing Nurse

PS. A few additional tips for anyone coming to the emergency department that will make the ED staff much more likely to be in a better mood with you:

1. DO NOT yell, insult, harass, or even consider being violent with ED staff.

2. NEVER say that it is “qui*t” in the ED. - If there are not a lot of people in the ED, please never say that it is the “q-word”. It is bad luck. Just don’t say it. Also avoid using the word “sl+w”.

3. DO NOT EAT OR DRINK ONCE YOU ARE IN THE ED IF YOU ARE A PATIENT. Don’t eat on the way to the ED. Just don’t do it. And do not eat again until your ED NURSE says that it is ok. Not the ED MD, the ED Nurse. Just trust me on this.

4. If you are a visitor, do not ask the ED staff for food or beverages beyond water for yourself. There is usually a cafeteria. Or if you are allowed to leave and come back, feel free to go hit up vending machines or a close by drive-thru. We are here to care for your loved one, not you. No offense. And NEVER feed or give something to drink to the patient. See #2 again.

5. If we ask you for a urine specimen, please get it to us as quickly as possible. We need it. We really do.

6. If there are other kids in your family that do not need to be at the ED if you are there, please try to find someone to come get them or take care of them before you come. You do not want your kid in the ED unless they are being seen as a patient. I understand extenuating circumstances happen, but this will make everything easier for everyone if extra kids aren’t there.

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About the Author - Sarah K. Wells, MSN, RN, CEN, CNL is an educator, speaker, blogger and owner of New Thing Nurse, a professional and academic coaching company for the nursing world. New Thing Nurse is organized to provide support and guidance to aspiring nurses, newly graduated nurses, and veteran RNs looking to make a change in their life. 

Whether it’s a new school, new job or new idea,

New Thing Nurse wants to help with your new thing!

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2021: The Year of New Thing Baby

My Pandemic Pregnancy

2021 was one long pause due to the production and arrival of #newthingbaby.

A quick summary of my pandemic pregnancy:

• Diagnosis of Hyperemesis Gravidarum - It sucked. I swear I didn't eat for the first 5 months. I ultimately got a Zofran subq pump. Zofran is magic. The Zofran constipation is not. Take stool softeners if you ever take lots of Zofran in pregnancy.

• Mostly just stayed home - I couldn't work. I was on the couch watching marathons of Call the Midwife. It was pretty miserable. This is why I've been offline for so long.

• I got the COVID-19 vaccine during my pregnancy. - The data was vague in January r/t the COVID-19 vaccine in pregnant people, but I knew I was going to be in the ED/Rad Dept. working and that my risk for exposure was high. I made the decision to get vaccinated early in my pregnancy. It was the right decision for me. Since then, the data has shown an overwhelming benefit of getting vaccinated while pregnant or lactating. Here is the CDC public health advisory r/t COVID-19 vaccinations in pregnancy.

• Late diagnosis of Cholestasis - My liver decided I didn't have enough going on in the pregnancy. I got to do lots of bloodwork and baby monitoring. The symptom that sent me to the MD for the diagnosis - ITCHY FEET. If you are ever pregnant and get insanely itchy feet, especially at night, message or call your OB immediately. Learn from my experience.

• #newthingbaby came early! - My baby bundle arrived two weeks early without the need for a discussed induction! All my awful NV stopped and the Cholestasis resolved as soon as baby was out. The mysteries of pregnancy! I was fine. Baby was fine. We went home and have been cuddling ever since.

That is the explanation for the radio silence of 2021 from the New Thing Nurse Blog!

I am getting back up to speed now - so get ready for exciting things from New Thing Nurse in 2022 😃

- Sarah @ New Thing Nurse

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About the Author - Sarah K. Wells, MSN, RN, CEN, CNL is an educator, speaker, blogger and owner of New Thing Nurse, a professional and academic coaching company for the nursing world. New Thing Nurse is organized to provide support and guidance to aspiring nurses, newly graduated nurses, and veteran RNs looking to make a change in their life. 

Whether it’s a new school, new job or new idea,

New Thing Nurse wants to help with your new thing!

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The light in the dark of 2020

I have failed so many times this year.

I have failed to get out of bed on days where my body wouldn’t listen to me.

I have failed to be open with my family, friends, colleagues, and clients when the despair was too great to function.

I have failed to be as present as I could have been during this most unprecedented time – historical mostly due to failures in leadership, process, and procedure that have cost our country 289,000 deaths and counting as of the writing of this post.

But most of the time, I am able to do so much – get up, work, smile, speak, write, advocate, care, support, listen, live, be – and each action is a success that must be celebrated.  

These are the days that will define my life.

I was a high school student during 9/11, graduated college in 2008 during the Great Recession, and worked as an emergency and radiology nurse during disasters, epidemics, and the worst days in the lives of so many of my patients. But this pandemic, this year, these moments – these will be what I tell future generations about.

And while I will speak to them about working through PPE and supply shortages, not knowing what to do when others needed it most, shouting reassurances to patients through masks and goggles, managing the public misinformation, and drowning in cleaning supplies at work yet not being able to find basic hygiene products at home, there are other more important moments that I will share first and most frequently.

I will tell the future generations of nurses and other healthcare workers about the fear of others, fear of an unknown, and a fear of bringing an evil home that could harm or kill my loved ones. I will tell them about the loneliness – missing my family, my friends, and not knowing when it will be safe to be around them again. I will tell them about the isolation – not just the feeling of being alone but also the physical distance between people – eating lunches outside, not in the break room with my coworkers. About edging away from others because of the unease of being around people without a mask. And the feeling of fear that was not always of others, but of myself, not knowing if I was unwittingly passing on a novel evil to others.

I will tell them about the crushing weight of shame when I called out of work as an essential frontliner, not for COVID-19, but for anxiety and sadness that I could not get under control, no matter how much mindfulness, self-care, and therapy I sought out. I will tell them about the days when I couldn’t move without my husband physically hauling me out of bed and into clothes to get even the most basic things done.

I will tell them that even in the darkest, loneliest moments that I was still me.

I was still a nurse. And I was no less of a nurse because of my struggles. Every time I took a stronger dose of my SSRI - I was a nurse.  Every call to my therapist, appointment with a psychiatrist, and day I stayed in bed and streamed 12 hours of TV in an attempt at harm reduction – I was a nurse. I was nursing myself. I was nursing my mind and my brain chemistry. I was nursing chronic conditions called anxiety and depression that were exacerbated by the most unprecedented year in medical history.

And I never did it alone. I had my husband, my amazing partner in all things, who cared for me every day. I had my family and friends, IRL and online, who helped support me during my best and worst moments. I had my incredible nurse community – because we are a community that can withstand all things – who checked in, sent me packages, emails, texts, DMs, messages, and the most hilariously inappropriate memes to make me smile on days when I thought the world was ending. I will tell them that my nursing and healthcare people came together to support me because that’s what we do when the shit hits the fan – we roll up our sleeves and figure out how to fix it.

I want to tell everyone going into healthcare in the future that you are never alone.

You have generations of us - nurses, doctors, nursing assistants, techs, phlebotomists, imaging technologists, respiratory therapists, social workers, therapists of all varieties, and all the other medical roles that make up our incredible healthcare team – who have had those dark days, been in those paralyzing moments, and gotten through to the other side. We are here for you to lean on, get guidance, and receive all the wealth of our collective experiences. We are also here to represent those who have not made it. We know how impossible the work is, yet we continue to do it. Through the hardest moments, we are there to care for others, keeping them alive and comforted, making them better. 

But know that you will have dark, challenging moments too. And often those moments will be in your car, on the way home, or at 0400 when you are unsuccessfully trying to sleep. You will be replaying things in your mind, wondering what you could have done differently, or thinking about how all of it doesn’t matter anyways. You may despair. You may want to give up. And it’s OK. I want you to know that I have despaired. I have wanted to give up.

But I haven’t, and you shouldn’t either.

I have seen the dark, and yet I eventually got up out of bed again. I showered, grabbed coffee, and put my scrubs back on. I got my PPE. I grabbed food and my nurse bag and went to work. I put on my mask and goggles. I cared for others because that’s what I do because I am a nurse.

 When I tell others about 2020, I want to make sure they know all the parts.

And I want to make sure that no matter what year it is, the dark moments have happened and will happen again, but despite the darkness, there is so much light to be had. I show up every shift for the light. I am here to help you see it too.

Sarah @ New Thing Nurse

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About the Author - Sarah K. Wells, MSN, RN, CEN, CNL is an educator, speaker, blogger and owner of New Thing Nurse, a professional and academic coaching company for the nursing world. New Thing Nurse is organized to provide support and guidance to aspiring nurses, newly graduated nurses, and veteran RNs looking to make a change in their life. 

Whether it’s a new school, new job or new idea,

New Thing Nurse wants to help with your new thing!

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To gather or not to gather, that is the question.

Thinking about getting a small group together for Thanksgiving this year?

Many are, but is it worth the risk? And what is the risk?

COVID-19 is raging across America.

The United States is facing another huge surge in COVID-19 cases across the country. As a nation, we have hit new highs of cases per day, hospitalizations and have now surpassed 250,000 deaths from COVID-19.

What does this mean for me?

COVID-19 is basically everywhere. People have been testing positive at a progressively higher rate across the country since September. When more people have the virus, it spreads faster and faster because more people have it to give to others.

And when more people have it, more people wind up in the hospital. In many states, hospitals are FULL meaning they have no beds or no staff to take care of you if you have a medical emergency.

Read that again - MANY HOSPITALS DO NOT HAVE SPACE OR STAFF TO TAKE CARE OF YOU.

That means medical staff have to start making choices about who gets care and who does not. This happened in some states already this year, but this round may be worse. Earlier this year, hospitals were at max capacity in some states but other states were able to help out by taking patient transfers or sending medical workers to help ease staffing shortages. Now, everyone is facing a mounting surge of COVID-19 patients. There are fewer and fewer hospitals with beds available to take any transfers. And no one has staff to send. No help may be coming.

What does this have to do with Thanksgiving?

Thanksgiving is a holiday where families and friends traditionally gather together to eat and visit. This is an especially enticing idea as so many of us have been isolated from our loved ones, and everyone is desperate for a feeling of normalcy in this most not-normal year.

And what I hear from healthcare workers is an even greater desire for something normal. We are carrying huge burdens in our professional and personal lives. That burden is now threatening days that are so special to our family and friends. We are used to working on the holidays but not having our work cancel the holidays for everyone.

However, gathering this year is riskier than you may think. With the rates of COVID-19 so high across the country, the possibility of being able to safely get together, even in small numbers, without someone in that group having COVID-19 is small.

Now you may be asking how I know that. That’s a great question! I know that thanks to the good people at Georgia Tech who have created a website called the “COVID-19 Event Risk Assessment Planning Tool” where you can assess the risk level of attending an event, given the event size and location.

I don’t care what Georgia Tech says. I WANT TO GATHER!

As a University of Georgia alumna, I completely understand where you’re coming from (sorry GT). However Georgia Tech isn’t the only group trying to show the risk of gathering for Thanksgiving and other upcoming holidays.

The Centers for the Disease Control and Prevention (CDC) has on their website - “…the safest way to celebrate Thanksgiving is to celebrate at home with the people you live with.”

The CDC goes on to break down the risk of holiday activities:

Lower Risk Activities

• Having a small dinner with only people who live in your household

• Preparing traditional family recipes for family and neighbors, especially those at higher risk of severe illness from COVID-19, and delivering them in a way that doesn’t involve contact with others

• Having a virtual dinner and sharing recipes with friends and family

• Shopping online rather than in person on the day after Thanksgiving or the next Monday

• Watching sports events, parades, and movies from home

Moderate Risk Activities

• Having a small outdoor dinner with family and friends who live in your community (Lower your risk by following CDC’s recommendations on hosting gatherings or cook-outs.)

• Visiting pumpkin patches or orchards where people use hand sanitizer before touching pumpkins or picking apples, wearing masks is encouraged or enforced, and people are able to maintain social distancing

• Attending a small outdoor sports events with safety precautions in place

Higher Risk Activities

Avoid these higher risk activities to help prevent the spread of the virus that causes COVID-19:

• Going shopping in crowded stores just before, on, or after Thanksgiving

• Participating or being a spectator at a crowded race

• Attending crowded parades

• Attending large indoor gatherings with people from outside of your household

• Using alcohol or drugs that may alter judgment and make it more difficult to practice COVID-19 safety measures.

Try to get creative!

This year won’t be like the past, but there is an opportunity to make it memorable for fun reasons. Try to get creative with how you are going to connect with the family and friends that you may not be able to see IRL. The National Institutes of Health (NIH) has a great blog (who knew?) that put out a recent post with some fun ways to celebrate Thanksgiving remotely this year:

Send Gifts. Although COVID-19 has changed our lives in many ways, sending cards or gifts remains a relatively easy way to let loved ones know that you’re thinking of them. Who wouldn’t want to receive some home-baked goodies, a basket of fresh fruit, or a festive wreath? If you enjoy knitting, candle making, or other ways of crafting gifts for the holidays, now’s the time to start planning for Thanksgiving through the New Year.

Make Videos. When I’m visiting family, there is often music involved—with guitar, piano, and maybe some singing. But, this year, I’ll have to be content with video recording a few songs and sending them to others by text or email. Come to think of it, the kids and the grandkids might enjoy these songs just as much—or even more—if they can watch them at a time and place that works best for them. (On the other hand, some of them might roll their eyes and decide not to open that video file!) If you don’t play a guitar or like to sing, you can still make your own holiday-themed videos. Maybe share a dance routine, a demonstration of athletic skill, or even some stand-up comedy. The key is to have fun and let your imagination run free.

Share a Meal Remotely. Most of our end-of-the-year holidays involve the family sitting around a table overflowing with delicious food. With all of the videoconferencing platforms now available, it is easy to set aside a block of time to share a meal and good conversation remotely with friends and family members, whether they live nearby or across the country. Rather than one cook slaving over a hot stove or a certain person monopolizing the dinner table conversation, everyone gets a chance to cook and share their stories via their smartphone, tablet, or laptop. You can compare your culinary creations, swap recipes, and try to remember to leave room for dessert. If you have a tradition of playing games or giving thanks for your many blessings, you can still do many of these activities remotely.

Take an After-Dinner Walk. Due to the physical demands and psychological impacts of the COVID-19 pandemic, it’s been difficult for many of us to stay physically active. The key is making exercise a daily priority, and the holidays are no different. After your holiday meal, go on a virtual group walk through your respective neighborhoods to work off the food. Thanks to your smartphone’s camera, you can share your time outdoors and all of the interesting sights along the way. (Yes, the new playground in the local park looks fantastic, and the neighbors really did just paint their house purple!)

If you do gather, be safe.

I know some of you will read this and then gather with your loved ones anyways. If you do, please be safe and follow the CDC guidelines and consider these recommendations from the NIH Blog for safe gatherings:

Stay Safe. If you plan to go ahead and join a holiday gathering in person, it’s important to remain vigilant, even when interacting with dear friends and loved ones. The greatest risk for spread of COVID-19 right now is these family gatherings. Remember there are risks associated with travel and with interacting with people who’ve not been tested for the coronavirus prior to the event, especially if they reside in a COVID hot spot—which is almost everywhere these days. Try to keep any family gatherings brief and relatively small, about five people or less. If the weather permits, hold the get-together outdoors.

To protect yourself and your loved ones, both now and over the holidays, please follow these 3 W’s:

• Wear a mask when you are out in public and when you are indoors with people who are not part of your immediate household. The only exception is while eating or drinking!

• Watch your distance, staying at least 6 feet away from people who are not part of your immediate household.

• Wash your hands thoroughly and frequently.

I don’t have all the answers, but as a nurse I would say do not gather. As a person, I understand if you do but please do it safely.

As an Emergency Department nurse for 10 years, I want you not to gather this holiday season. I will be spending Thanksgiving with my favorite non-family people - my ED co-workers at work in the emergency department. We want to be able to help you if you need it, so please consider not gathering if you can so that we can gather safely next year without the risk of COVID-19.

As a person, I have not seen my family in a year. They live in the Southeast while I live in California. I am a nurse during a pandemic. It has not been in the cards to travel safely this year to see them.

For the holidays, I am going to be flying home to see family. However I am taking a huge amount of time off to do so as safely as possible. I will be flying to Georgia and quarantining for 2 weeks with planned COVID-19 testing for me and the husband, then seeing family in small groups outside with masks on and at least six feet apart when possible with so much hand washing and sanitizing that my skin is already raw thinking about it. I am staying in a separate space, a rental that we have for the entire time we are there plus a rented car. Then upon the return, I will be quarantining for 2 weeks at home.

(I am incredibly lucky to have the flexibility and resources to be able to make this complicated trek. I know that this is not realistic for most.)

This is an impossible time, and we are having to make impossible decisions. Please just know that every decision you make will have repercussions that you must be ready to face if and when they come.

Be well and be safe.

Sarah @ New Thing Nurse

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About the Author - Sarah K. Wells, MSN, RN, CEN, CNL is an educator, speaker, blogger and owner of New Thing Nurse, a professional and academic coaching company for the nursing world. New Thing Nurse is organized to provide support and guidance to aspiring nurses, newly graduated nurses, and veteran RNs looking to make a change in their life. 

Whether it’s a new school, new job or new idea,

New Thing Nurse wants to help with your new thing!

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Have PPE Shortage Stories? Congress wants to hear them!

Have a story about challenges with PPE while working in healthcare during COVID19? Congress wants to hear from you!

Senate Finance Committee Ranking Member Ron Wyden, D-Ore., is asking for health care workers to submit their experiences trying to obtain personal protective equipment (PPE) during the COVID-19 pandemic.

“I want to hear the stories of the people being affected by these shortages—nurses, EMTs, doctors and health care providers struggling to get PPE. Lifting up these stories in the coming weeks will be crucial to Congress’ understanding of the work ahead.”

Stories can be emailed to PPEshortages@finance.senate.gov. The deadline for submissions is August 31st. All personal information will be redacted unless requested otherwise

This is your chance to have your stories, your stress, and your frustrations heard. I shared my story. I would love to have our collective stories shared to see if we can make a difference in the availability of PPE for all frontliners in the United States. 

- Sarah @ New Thing Nurse

Here is the testimony I sent to Senator Ron Wyden via my emergency nurse colleague, Penelope Blake:

“My name is Sarah K. Wells, MSN, RN, CEN, CNL. I am a Registered Nurse who has worked in emergency and radiology medicine since 2010. I live in Oakland, California and work at two hospitals in the Bay Area.

I am writing to you today to share my experiences with the Personal Protective Equipment (PPE) shortages that are facing the frontline healthcare workforce in the United States. For nearly 10 years, I have worked in the hospital setting. As a nurse, I come to work each shift to care for those in need. In the emergency department, I see patients from newborns to the elderly and am responsible for being able to care for minor to the most complex medical conditions in collaboration with interdisciplinary care teams. I am trained to respond to disasters in often hazardous conditions and have learned to utilize a wide variety of PPE to prevent exposure to infectious diseases and hazardous materials. From being trained to care for patients with Ebola to those suffering from chemical burns, I know that I must protect myself so that I can care for others.

The majority of the PPE that I am trained to use is single-use, single-patient items. This means that I would wear PPE for use with one patient encounter and then dispose of it. Imagine a patient with tuberculosis, an infectious disease spread through airborne transmission. Historically, I would have that patient in a private, isolation room in the emergency department. To enter the room safely and care for the patient, I would put on a N95 respirator mask, a specialized mask that filters out approximately 95% of airborne particles, along with other appropriate, single-use PPE per my facility's policy, enter the room, complete my patient care, exit the room, and throw that N95 respirator mask and other PPE away in the trash. I would then perform the appropriate hand hygiene and move on with my work day. Whenever I needed to re-enter that patient's room, I would then put on a fresh N95 respirator mask and PPE, complete the necessary care, and dispose of PPE upon every exit from the patient's room. In this way, I never put on "dirty" masks or other equipment, meaning masks that have been exposed to germs from previous encounters in the tuberculosis patient's room. I never risk exposing myself to that patient's germs by putting on the "dirty" PPE, and I would never wear "dirty" PPE into another patient's room. I have gone through dozens of masks per shift in the past without thinking twice because it was the standard of safety and best care for my patient and the policy of my employer.

All of that changed this year when COVID-19 came to the United States. In March, early rumors of N95 respirator mask shortages started to circulate. Then there was discussion that we may need to start extending the use of our single-use N95 masks. This seemed impossible. How could we re-use a single-use item? It went against our infection prevention policies and put us at risk for exposure to infectious germs. I assumed this was just talk until my emergency nurse colleagues from across the United States started to tell me that it was true and happening. And soon, it was not just re-using the N95 masks for a few hours, but the whole shift, and then multiple days. By the end of March, I had colleagues telling me that they were using the same N95 masks for weeks at a time. And then, I was told by many friends and acquaintances that nurses and other medical staff were caring for COVID-19 patients with no N95 masks at all because there were none to be had. This would have been an unacceptable situation in January and now, it was becoming the norm.

At my facility in California, we did not face this reality until sometime in April. We have thankfully never completely run out of N95s. However we have been encouraged to extend the use of our single-use N95s for multiple shifts, being given cardboard containers that you would normally use in our cafeteria to get a hamburger to-go, to store our masks in between uses. Our emergency department, like most in the United States, also has a limited amount of Power Air Purifying Respirators (PAPRs) units, battery powered machines that are attached to plastic hoods, that can be used for working safely with COVID-19 patients. However these units are expensive and most emergency departments only have a hand full. These are sufficient for caring for small numbers of patients, but not for managing large quantities of COVID-19 patients all at once. And then there are emergent situations, for example where a person's heart stops and a team of people are needed in the room to perform life-saving measures, you may need 3 to 5 PAPRs at the same time for just one patient. That can easily be the department's entire supply of PAPRs. If a department is out of N95 masks and all the PAPRs are in use in one room, there is no way to safely care for the dozens to hundreds of other COVID-19 patients that you may have at the moment in your emergency department.

Furthermore, there is the rest of the hospital to consider. While the emergency department is specially trained to handle disasters headon with advanced PPE and a supply of PAPRs at the ready, most inpatient units have even less training and PPE supplies available. When COVID-19 initially hit, the majority of hospitals quickly depleted their PPE reserves and were scrambling to train all their staff to safely take care of our high-risk patients. And then the supply chain for PPE was broken, and facilities could not refill their supplies of PPE or procure more PAPRs. The inpatient units were caring for patients with not just re-used PPE, but insufficient PPE which put themselves and their patients at risk. Caring for a COVID-19 patient with a surgical mask is not safe because the surgical mask does not protect the person from COVID-19 exposure. Surgical masks only prevent my germs from spreading to others. And while many facilities are requiring all staff and patients to wear surgical masks, which in theory will greatly limit the spreading of germs, most of our hospital patients cannot keep a mask on due to their oxygen support needs, feeding tubes, anxiety, or confusion. Nurses and medical staff must have a N95 respirator at minimum to ensure they are not exposed to COVID-19 germs. This lack of PPE has had deadly consequences. Since this pandemic has started, there have been nearly 115,000 COVID-19 cases and nearly 600 deaths due to COVID-19 among healthcare workers in the United States. 

In addition to being a practicing nurse in the hospital setting, I also am the Founder of New Thing Nurse, a company committed to supporting the nursing community through a variety of services and platforms. Through New Thing Nurse and my nursing professional organizations, I have contacts with nurses across the United States. When I started getting reports of the limited PPE in the United States, I started making calls and inquiries to see if I could find PPE sources for those in need. I quickly found that the normal sources for N95 respirator masks available to the public, such as hardware and paint stores, were completely out of inventory. I made contacts with hospital buyers, the staff in charge of stocking PPE for healthcare facilities, to see if there was a way that I could purchase N95 masks in bulk. I was quickly told that no sources were to be found.

I started reaching out to the community. I started receiving donations of PPE from individual citizens. People who had a few masks here and there for emergencies or painting projects. I started fundraising and putting small PPE orders together where I could find small sources online on the secondary market, from sources like Ebay and Craigslist, paying outrageous prices but getting small quantities of masks and other PPE items that were also becoming short supply.

To date, I have sent out and coordinated nearly 5,000 PPE items donations to frontline healthcare workers to 14 states with an estimated cost of $9,000+. I am just one small example of such an effort to keep friends, colleagues, and other medical workers in the appropriate PPE that they need to care for COVID-19 patients safely. Huge organizations like GetUsPPE.org and A Million Masks have emerged to raise hundreds of thousands of dollars and distribute millions of masks. These are projects created by private citizens to close a basic supply gap that employers and the government have failed to remedy. This failure has caused the illness and death of care providers across the United States, dedicated citizens who have devoted their lives to caring for others. While they were caring for us, we failed to care for them.

Here is one email that I received from a mobile x-ray technician in Texas who requested PPE from New Thing Nurse: 

“Hello Sarah! I heard about you in the ... group on Facebook. It’s funny the timing as today after my shift I sat in my car and broke down crying.

I’m a mobile X-ray tech for ... in Texas. We service facilities, homes, long term care and jails all over Texas. Every single facility we service has Covid patients. Nursing homes and jails are especially rampant with it.

In the past three weeks there has not been one day I have done several x-rays on a positive patient. The majority of the facilities expect us as an outside contract to provide our own PPE. We are a very small company so finding them is scarce, I have been reusing the same gear several times over. My neighbor got me an N95 from her husbands laboratory. That’s how serious it is. Working at a small company we worry about publicly reaching out for PPE for fear of getting reprimanded. I don’t have anything negative to say about my employers, I honestly believe they are trying to get us PPE. But each day I literally go to work trembling worrying that it’s not going to be enough and I’m going to expose my family by not being adequately protected. I’m typing this in tears.

Today was an especially hard day as staff at one of the jails I was servicing were fighting over who was to receive a single mask. This is the same jail apart of a very large corporation that told me I needed to bring my own PPE but calls me everyday to image their Covid patients. Tensions were high and I reminded them we have to protect ourselves and our patients. There is a nurse who sneaks me PPE when she can, it is a very humbling experience to have to beg for that every shift. This is one of the most stressful times of my life. I will send my company info in the next email I’m typing on my phone.’’

The PPE shortage in the United States is a completely inexcusable failure. There is no reason that in a country as rich and powerful as ours that our medical workers should ever be without the appropriate equipment needed to provide the best and safest care to our patients. In the year 2020, healthcare workers have begged for PPE by going door-to-door in their communities, for PPE that should be provided as a standard workplace safety item by their employers. I implore you to take the necessary steps to finding a solution and keeping our frontline healthcare workers safe by providing appropriate PPE for all.’’

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The Beauty of Masks

Masks can be such a simple thing.

From a just a piece of cloth across your lower face (always covering your nose and mouth) to high-end pieces of technology with valves, filters, full eye protection, and many more bells and whistles, the mask has recently become a major part of everyone’s lives.

As COVID-19 cases continue to skyrocket across the United States, the wearing of a simple cloth mask (along with washing your hands, staying at least 6 feet from others, and staying home when possible) has been hearalded as one of the best infection prevention measures that any member of the public can take to slow the spread of the novel coronavirus.

On Monday, the American Hospital Association (AHA), the American Medical Association (AMA), and the American Nurses Association (ANA) even joined forces to issue a joint letter to the public urging them to wear masks to help prevent the transmission of COVID-19:

July 6, 2020

An open letter to the American public,

Since the beginning of the COVID-19 pandemic, we have urged the American people to protect themselves, their neighbors and their loved ones amidst the worst global health crisis in generations. After months of physical distancing and staying at home, infections and deaths began to decline.

But in the weeks since states began reopening, some of the steps that were critical to the progress we made were too quickly abandoned. And we are now watching in real-time as a dramatic uptick in COVID-19 cases is erasing our hard-won gains. Hospitals in some states are at or nearing their ICU capacity. Shortages of personal protective equipment and testing supplies continue to pose a dire threat to health care workers and patients alike. And last week, Dr. Anthony Fauci told Congress that the U.S could see 100,000 new coronavirus cases each day if we do not take more precautions.

This is why as physicians, nurses, hospital and health system leaders, researchers and public health experts, we are urging the American public to take the simple steps we know will help stop the spread of the virus: wearing a face mask, maintaining physical distancing, and washing hands. We are not powerless in this public health crisis, and we can defeat it in the same way we defeated previous threats to public health—by allowing science and evidence to shape our decisions and inform our actions.

The toll of this pandemic is already staggering, and it will take many more months, perhaps years, to truly understand its impact on our country and our way of life. But what is certain – and what the science and evidence are telling us – is that COVID-19 is not behind us and we must resist confusing re-opening with returning to normalcy. Doing so will escalate this crisis and result in more suffering and death.

To those of you who are doing your part in helping turn the tide of this pandemic – thank you. Your actions are critical to stopping the spread of COVID-19. Moving forward, we must all remain vigilant and continue taking steps to mitigate the spread of the virus to protect each other and our loved ones. There is only one way we will get through this – together.

Your continued partners in health,

American Hospital Association
American Medical Association
American Nurses Association

Masks are here to help. They will help keep our communities healthy. Masks are simple and accessible to everyone. And they can be ever so cute!

I am personally loving the many styles of masks that I am seeing being made available for donation and sale. Here are a few of my favorites from free to high-end (click any of the images to go to the company websites):

Dhvani Mask from Dhvani - Free

Black Floral Face Mask from LAFaceMasks.com - $6.50

Reversible Non Surgical Fashion Mask and Head Wrap Set from SonSon.com - $45.00

It’s a simple thing, the cloth mask. And how easy it is to wear, style, and use to prevent the spread of illness is a true thing of beauty.

- Sarah @ New Thing Nurse

*None of the companies featured in this post are affiliates of New Thing Nurse. I just truly love their stuff.*

Resources:

AHA, AMA, ANA Joint Letter to the Public Supporting Masks

Centers for Disease Control & Prevention (CDC): Use Cloth Face Covers to Slow the Spread of COVID-19

World Health Organization (WHO): When & How to Use Masks

And if you have any Hamilton lovers, this is for you:

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Hate is a public health issue.

Hate for others.

Hate for yourself.

Hate due to misinformation.

Hate that leads to violence.

Hate that results in isolation.

Hate that creates poverty.

Hate that leads to fear.

Hate that causes inequality.

Hate that prevents people from getting what they need - including appropriate healthcare.

Hate causes illness, pain, injury, mental health problems, trauma, and death.

Hate is a public health issue.

- Sarah @ New Thing Nurse

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Corona Conversations Vol. 3: Living with the Trauma from COVID19 for Nurses with Lauren Funiestas

Being a nurse during the COVID-19 pandemic is not just hard, it’s traumatic.

Did you ever think of that?

I was lucky enough to sit down with my dear friend and favorite human, Lauren Funiestas, an experienced mental health provider who is passionate about providing multicultural, trauma informed care, for an insightful conversation about the stress and trauma that working during COVID19 has caused for the mental health fo frontline healthcare workers. We talked about how best to manage that stress and what you can do to be mentally and emotionally well during this challenging time.

And like any good conversation, we recorded it on Zoom! Enjoy the latest edition of Corona Conversations over on the New Thing Nurse YouTube channel. Cheers!

Bio: Lauren Funiestas is an Associate Marriage and Family Therapist who has worked exclusively in the forensic/community mental health field since 2007. She is currently preparing to take the California BBS license exam. She’s provided multicultural, trauma informed and mindfulness based individual/group therapy, case management and psycho education services within residential treatment facilities, school-based children’s mental health programs, public health clinics and detention facilities. Lauren received her Bachelor of Arts in Criminal Justice from San Francisco State University and her Master of Arts from John F Kennedy University’s Holistic Counseling / Transpersonal Psychology program. Lauren self identifies as a Transnational feminist, Filipina/Island girl and a champion for the advancement of communities of color within the mental health field. She believes strongly in decolonization, honoring the spirit and using all of your paid time off for self care. Lauren is a former body builder, white belt jiu jitsu champion (that counts) and her favorite TV character is Olivia Benson from Law & Order SVU.

Resources for Mental Health Support:

• National Suicide Prevention Lifeline - 1-800-273-8255

• Crisis Text Line - Text HOME to 741741 from anywhere in the USA

• National Alliance on Mental Illness (NAMI) - https://www.nami.org

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Corona Conversations Vol. 2: Working a COVID-19 Relief Travel Assignment in NYC, Being a New Nurse during the Pandemic, & more with Mica David of @registerednoire

Remember how hard it was being a new nurse? No imagine that you are a new nurse during a pandemic.

COVID-19 has been a challenge for everyone in the medical field but for our new nurses, it has been a real shift show. No one taught them to be prepared for a pandemic in nursing school. This year has been a real baptism by fire for us all, and one new nurse has jumped in head first into the chaos.

I want to introduce you to Mica David of @registerednoire. Mica and I met through the Emergency Nurses Association this year, and I have been following her ever since. Mica is a young nurse from Georgia (my home state!) who started her career at a busy Level II trauma center emergency department last year and has recently transitioned to travel nursing. Mica is currently working NYC on a COVID-19 relief contract as her first assignment!

I got to sit down with Mica on one of her days off to discuss what it is like working in NYC on a disaster relief assignment, being a new nurse during COVID-19, and what she is doing to cope with the stress of it all. Mica has some great tips for newer nurses considering travel nursing and shares her post-shift COVID-19 decon process for her apartment (this was fascinating to me - i’m a mega-nerd). Happy watching!

- Sarah @ New Thing Nurse

Follow Mica’s adventures on social media:

Instagram - @registerednoire

YouTube - @registerednoire

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Corona Conversations Vol 1: Nursing, Stress, Mental Health, PPE, & more with Sarah of New Thing Nurse & Anna of The Burnout Book

Is this pandemic over yet?

We’ve officially been sheltered in place for over a month here in Oakland, California, and I am feeling it. The stress of everything related to the novel corona virus/COVID-19 is making life in and out of the hospital hard. I have had up’s and down’s with my mental health. I feel that I am now on an upswing, but that definitely can change day-to-day. Some shifts at work are awful - I had a total meltdown this week in the ED. Other shifts are just fine.

On Monday, 4/13, I had the chance to sit down and chat with Anna Rodriguez of The Burnout Book via the almighty Zoom and discuss everything that is going on with nursing in the time of COVID-19. We decided to record the conversation and share it with you all. I hope you enjoy!

Without further ado, I present to you Corona Conversations Vol 1 on the brand new New Thing Nurse YouTube channel:

Description: Sarah from New Thing Nurse and Anna Rodriguez from The Burnout Book have a Corona Conversation about the status of their nurse mental health and wellness as of 4/13/2020 during the COVID-19 pandemic. Sarah and Anna also have a robust discussion on COVID-19 stress and the PPE shortage, how that affects our ability to provide compassionate patient care, and tools on how to reconnect with our patients and nursing community. Plus get Anna and Sarah's Top 3 Tips of the Week on how to make it work as a nurse during the novel corona virus crisis. Enjoy!

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COVID-19 & My Nurse Mental Health - I feel like shit that has been trampled by elephants.

I literally can’t get out of bed some days. 

Everything makes me cry. 

Going through the day feels like walking through waist-deep mud.

I am tired of talking to people who are not my nurse or healthcare friends. No one else understands.

This is what COVID-19 has done to me. I have not caught it. I am physically well but mentally, I feel like shit that has been trampled by elephants over and over again.

If you are in the healthcare field, you may know what I’m talking about. There is a constant dread during every waking moment. It is a heaviness that for me, is often on my chest, making it hard to breathe. I have heard others describe a giant pit in their stomach that will not go away. 

And your dread is valid. This effing novel corona virus is a REAL bitch, and it’s killing healthcare workers around the world. 

Plus, we are often being expected to work without the equipment we need to stay safe and keep our patients safe. It’s a time when we are being called “heroes” but are being treated like trash. 

Yet there are people out there who care. I see social media posts, public displays of appreciation, and huge philanthropic efforts to support us. Everyone I know texts, calls, or emails. They all want to know the same thing - “How are you?” 

I don’t know how to answer.

I want to say - “I am awful. I am afraid. I am worried about every one of my friends and loved ones getting sick or dying. I can’t see my family or best friends. I’m terrified that I am going to bring this wretched virus home to my husband. I am so lonely that I can’t move. Every shift gives me a panic attack before and after and sometimes during… but otherwise, I’m good. Have you watched Tiger King yet?”

I don’t think that’s what people are hoping for…

Thankfully, I have amazing friends.

A brilliant nurse friend and colleague of mine posted the most eloquent response to this question, which I have now borrowed with her permission and will use as the response for me, and I think, most nurses right now: 

“People keep asking how I'm doing. I wanted to be very honest, so here it is. Strap in - this is long.

We are struggling.

The burden of this pandemic weighs so heavily on us. We are bearing the weight of the world on our shoulders and we aren’t sure that we are strong enough.

We carry a rock in our stomachs and a lump in our throats which have taken up permanent residence and from which we cannot be released.

We put on a brave face, but we are taking enough antacids to medicate an elephant. If we are already on antidepressants, we’ve increased them. If we aren’t on them, we are considering starting them.

We’ve stopped worrying that we’ll bring this home to our families anymore. We’ve taken that as a given. We worry that our family members could be the vectors who unknowingly spread the virus to somebody else. We need to protect the world from US.

For that reason, we take social distancing extremely seriously. Guess what? That social distancing, though? It’s killing us. We are empaths. It is both our nature and our job and now we can’t give our love to anyone. Do you know how much we could all use a hug right now? We can’t have one. Our children miss their relatives and are begging for real in-person hugs and we can’t let them. Our hearts ache.

We worry.

We worry about all of the same things that you do. We worry about our families, but we don’t get to dwell on that because we’re worried about your families, too. We worry that you will be the patient we have to tell, “I’m so sorry, but due to the isolation precautions we will all be trying our best not to enter your room after I leave. Here is your call bell. Let us know if you need anything!” We worry that you will feel alone. We worry that it will be the last words you hear from another human before you are gasping for air and we have to intubate you with no family present and nobody to hold your hand.

We worry that our kids will internalize our grief, anxiety and depression due to what we face each day.

We worry that you call us heroes. We don’t feel like heroes at all. We are just as frightened as you are.

We feel guilty to be gainfully employed when so many are not. However, we worry what the ultimate price will be for continuing to do the job we love so much.

We feel sorrow for the lives lost and for the many more that we are bound to lose due to poor planning and preparation.

We feel disposable. Under a president who refuses to acknowledge the severity of this pandemic, the CDC making subpar recommendations for PPE, a national administration that has been unable to equip its frontline staff appropriately to protect themselves so that we can SAVE FUCKING LIVES – WE FEEL DISPOSABLE.

Despite all of this, we will still SHOW UP. Because when you are a nurse, it is more than a job. It’s a calling. It’s what we do. We SHOW UP.

To all of our colleagues – from EVS to RT to MD and everyone in between – THANK YOU for showing up.

To all other essential employees of the world – THANK YOU – for feeding us, delivering our mail, picking up our trash, keeping the streets safe. THANK YOU.

And to those who are forced and/or able to stay home, THANK YOU for doing your part to flatten the curve. We know that it is not without great sacrifices for many.

To those who are donating, volunteering, sewing masks and caps, lifting us up in prayer, helping your neighbors, and spreading kindness and love – THANK YOU.

This is a battle that we are all fighting together and everyone plays their respective part, so THANK YOU.”

 - Ginelle Rasch, Emergency Department Nurse

I know. Ginelle is THE BEST.

Things are so hard. If things seem impossible for you too, know that you are not alone. I feel the same. Ginelle feels that same. But somehow, together, we are going to get through this. 

And if you need a little extra help to push through, that’s totally ok too. In the past few weeks, I have switched my SSRIs, increased my talk therapy appointments (via telephone), and have had to be very open with friends and colleagues about my mental health needs. 

Your mental health is important, just as important as your physical health. Take time to care for yourself. And know that you are definitely not alone. 

- Sarah @ New Thing Nurse

Here are a few resources that I am using to help me get through the days. Maybe they will help you too:

Crisis Text Line - Mental Health Support via Text

National Alliance on Mental Illness (NAMI) COVID-19 Resources & Information Guide

Podcast: Kate Bowler - Everything Happens, “The Emergency Button”.

Podcast: The Hilarious World of Depression - Call a Friend, Find Out How They’re Doing.

I tried yoga once so far. It was nice. This yoga is free! - Down Dog

Connecting with friends:

Art of Emergency Nursing Podcast Episode with Me, Kristen Cline, & Kevin McFarlane

FB Live Fill Your Cup Virtual Meetup with Anna Rodriguez of The Burnout Book

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Crafts for Healthcare Workers: Make Headbands with Buttons to Save Our Ears with Mary Olp of The Irish Thread Creations

If you’re a nurse, doctor, respiratory therapist, CNA, PCA, or any other healthcare worker right now, I bet your ears hurt from wearing a surgical mask 24/7. Pain, skin breakdown, and more are happening to our ears as we work to care for COVID9 patients.

Well like all of today’s problems, the internet has given us a remedy for our surgical mask induced ear discomfort! Headbands with buttons sewn to them which allows healthcare workers to place ear loops over the buttons instead of their ears! #happyears

There are a lot of photos circulating on social media, and all of them look great! But my friend Mary Olp, a former emergency nurse, sewing guru, and the brain behind the Facebook page The Irish Thread, has created a pattern for all you crafty nurses and nurse supporters out there!!!

Note - These headbands SHOULD NOT be used with N95 masks as it may affect the seal. 

Ear Saver Headbands for Healthcare Workers

Wearing Surgical Masks Pattern & Instructions

by Mary Olp of The Irish Thread Creations

Once done, consider distributing to your nursing department, local hospital, and beyond! Make sure to take photos and send them to New Thing Nurse - newthingnurse@newthingnurse.com and The Irish Thread Creations.

Thanks to Mary and all the crafty folks out there who will be saving our ears!! 🧵💛 

To learn more about Mary Olp and The Irish Thread Creations:

The Irish Thread Creations Facebook Page

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COVID19 at the Border: How Nurses are Caring for At-Risk Patients & How You Can Help Too

I met Helen Perry through the Emergency Nurses Association grapevine and the almighty Facebook. Helen is a Nurse Practitioner and veteran of the United States Army as well as an Emergency Nurse sister, and I could not be happier that our paths collided as she is a most inspiring nurse leader and humanitarian.

Let me tell you about Helen Perry…

After serving five years as a nurse in the military, Helen went to Georgetown University and received her Nurse Practitioner (NP) degree. While on break during her NP program, Helen went to Mosul, Iraq with a humanitarian organization called Global Response Management (GRM) and helped run Trauma Stabilization Points for civilians who were injured in the fighting. She was hooked! Helen loved how GRM applied military medical philosophies to civilian situations and managed healthcare challenges with an outside-the-box approach. 

Today, Helen heads the day-to-day operations of GRM and founded a program and clinic in Matamoros, Mexico that has provided medical care for over 3,000 asylum seekers and refugees since opening in September 2019. The GRM teams of highly trained medical volunteers work in the camp seven days a week to help families facing acute and chronic medical conditions to get the care they need. 

Find out more about Global Response Management

Global Response Management’s Mobile Medical Unit and Better Shelter tent structures, currently sit in the middle of the camp allowing residents full access to medical care every day of the week.

A view of the tents housing thousands of refugees at the border between Texas and Mexico.

A Global Response Management staff member plays with a young patient through the fence at the border.

COVID19 & Border Health 

Now that COVID19 has arrived, the needs of the patients in Matamoros are rapidly changing. The GRM clinic is the main medical resource for the area and is planning to increase their level of operations in preparation for higher acuity patient care needs as COVID19 continues to spread. 

Give to Global Response Management

Helen and the Global Response Management team need our help! To get the GRM Matamoros clinic ready for the potential COVID19 patient surge, Global Response Management needs funding. If you are a nurse, know a nurse, involved in emergency nursing, management, or have a passion for supporting at-risk patient populations, consider donating to the Global Response Management program in Matamoros. They are urgently in need of financial support to care for those who have no where else to go. 

Donate to the Global Response Management Matamoros Program

A Global Response Management clinic offering medical attention to asylum seekers and refugees.

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About the Author - Sarah K. Wells, MSN, RN, CEN, CNL is an educator, speaker, blogger and owner of New Thing Nurse, a professional and academic coaching company for the nursing world. New Thing Nurse is organized to provide support and guidance to aspiring nurses, newly graduated nurses, and veteran RNs looking to make a change in their life. 

Whether it’s a new school, new job or new idea,

New Thing Nurse wants to help with your new thing!

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Guest Blog Post: Finding My People as a New Grad Nurse with Ted Rossini, BSN, RN, PHN

Hello New Thing Nurse Tribe! 

My name is Ted, and I am a new nurse who graduated in June 2019. I found my first job working at the Student Health Unit for the California School for the Deaf (CSD) & California School for the Blind (CSB) in Fremont, CA. When I started my nursing journey, I couldn't have known that I would end up here, nor could I have foreseen what a good fit it would be for me.

Before nursing school, I worked as a preschool teacher, a barista, a planetarium presenter, a waiter, a resident assistant for foster youth, and a summer camp director. I lived in four states earning just enough to pay taxes and in another five states for short stints with AmeriCorps and AmeriCorps NCCC. I accidentally fell into healthcare when I became an EMT while earning a FireFighter-1 Certification. All this is to say, I knew I had a lot of experience but was unsure how I'd fit into the nursing world when I graduated.

Sarah from New Thing Nurse visited my school in Fall 2018 with a presentation on the importance of self-care and avoiding burnout. At that point I was already feeling burnt out from nursing school and really didn’t know what type of nursing I'd like to pursue upon graduation. I was also hearing healthcare professionals tell the world that turning 36 hour weeks with lots of overtime is bad for them and bad for patients’ health. One thing that really stood out from the New Thing Nurse presentation was a picture of Sarah with her shift mates doing a silly dance on a slide entitled - "Find Your People." 

From my experience in EMS and non-profits, I was already familiar with how much self-care outside of the job and taking breaks was key to avoiding burnout. But this concept of "finding your people" was a new idea for me. So often I was devoted to the work that whoever my coworkers were just happened to be who they were. It was a very strong tool I carried with me on each clinical rotation throughout nursing school and sure enough, the rotations that were the most fun and meaningful had less to do with where I was than who I was with. Put me with someone who liked their job and wanted to help people, and I was happy in all kinds of clinical settings from Pediatric Heme One, the Cardiac ICU, Med-Surg, NICU, to orthopedic rehab. 

And then there was my nursing school cohort. I love my cohort dearly and wouldn't trade them for anything, but so often in class, my views and values clashed with theirs. I would often hear my fellow nursing students say things like - "I'm going to be in a level 5 NICU" or "I'm going to be an ICU nurse" . In protest, I declared - "I'm going to be a school nurse."

After I calmed down and took some breaths, I remembered once working as an EMT at a Renaissance Fair. I had met someone who was studying American Sign Language (ASL) and had just been accepted to a graduate program. In my travels and previous jobs, I had actually learned a fair amount of ASL and interacted with a large deaf community in my early adulthood. That was when I remembered that the California School for the Deaf was near my nursing school, and I had a simple thought - “It's a boarding school, so they must need nurses.”

I looked, and there was a position open! I kept my eye on that post for four months while I finished school, recovered from my preceptorship, and finally studied for and passed the NCLEX. I wasn't sure what I'd find there, and I certainly had almost no experience with the blind community. But even before I was hired, school staff were so kind and welcoming. 

Ultimately, I applied and got the job! On my second day, there was a "True Colors" team building exercise where I got to really know my coworkers and felt immediately at home. I quickly discovered a friend, who is now one of my mentors, who loves theater (like me!) so I joined her and her husband for a play my very first weekend on the job. I quickly realized that I had found my people - we're huggers, we like to laugh, we like watching kids grow from children into adults, and we wear fun scrubs. A great moment came when my mentor and her husband joined my grandmother, aunt, mother, and myself for Hamilton. She wanted to get a picture with just her and me, and I quickly thought we should make a sign together as one. She immediately knew the best sign: Nurse!

- Ted, School Nurse

Photo: Ted and mentor make the American Sign Language sign for “nurse”.

Photo: Ted and his colleagues are doing "serious” work at the California School for the Deaf (CSD) & California School for the Blind (CSB) in Fremont, CA.

Photo: Ted and colleagues in the fun scrubs on Crazy Hair/Punk Day during spirit week.

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About the Author - Ted Rossini, BSN, RN, PHN works at the Student Health Unit at the California School for the Deaf (CSD) & California School for the Blind (CSB) in Fremont, CA. When Ted is not at work, he enjoys attending the theater with family and friends.

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A Vacation from Nursing: I took one & you should too.

I love my job, but it was about to break me.

I have been an ER nurse for almost seven years. For some of you, that may seem like no time at all. I have met many a veteran nurse who has been grinding at the bedside for 20, 30 and 40+ years. I applaud you. You deserve to be knighted. Our healthcare system survives because of your perseverance and expertise. #careergoals

The rest of you might be thinking – “Dang! She’s been an ER nurse for SEVEN YEARS.” Seven years probably seems like a lifetime to those of you still in school or recently starting your nursing career. The truth is that seven years is kind of a long time to be an ER nurse. Emergency department nurses have one of the highest rates of turnover within all of the the nursing specialties – an impressive 21.1%.  Per a study completed by NSI Nursing Solutions, many emergency departments will turnover their ENTIRE RN staff within 5 years.

Why are nurses leaving so quickly?

• Low Salaries - Nurse salaries vary widely across the United States. However I started in rural Georgia at a whopping $20.13 per hour in 2011. Even after a whole lot of overtime, there was no way that I was going to pay off my student loans from nursing school in less than 10 years. While I loved my hospital and my job, I left and moved to California where I found myself making a much more competitive wage. This allowed me to pay off my student loans in less than 3 years and has already set me up better for retirement. While my story is just one example, it is one of many similar stories that I have heard where nurses cannot support their families on their full-time job's earnings. And the situation for LVN- & ADN-prepared nurses is even more difficult in many states. Lives literally depend on our work. It costs a lot to get our education. Nurses should get compensated accordingly.
• Staffing Issues - Unless you have been living under a rock, you know that there is a national shortage of nurses. Many facilities are trying to get creative with staffing, which sometimes leads to unsafe nurse-patient ratios. This increases stress on staff and increases potential for unsafe patient care. The U.S. Department of Health and Human Services states that "Hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes..". Good staffing is good for nurses and patients alike.
• Stress - Healthcare is becoming more and more concerned with time. Nurses now have to do everything faster, while still ensuring perfection with every task. Medicine does not look favorably on errors. The essence of nursing is fast, efficient care that people's lives depend on. If that's not stressful, what is?
• Abuse - Nurses experience all kinds of abuse. Period. Verbal, emotional and physical, there are few days on-shift where I personally don't get the joy of one of these. This has to stop to keep nurses. The American Nurses Association (ANA) has a campaign called #EndNurseAbuse that is working to decrease the amount of abuse that nurses encounter in the workplace. In addition to the loss of nurses, the ANA cites that the financial cost of workplace abuse of nurses is $4.3 billion annually or about $250,000 per incident. Healthcare has to address this problem if they want to end the nursing shortage and improve patient outcomes.
• Nurse Burnout - Burnout is physical, mental and emotional exhaustion caused by stress, often being suffered by "helping professions", such as nurses.  With all the abuse and stress that nurses are facing in the workplace, is it any wonder that they are experiencing burnout and leaving the bedside?

How my job almost broke me.

Like I said earlier, I love my job. Sometimes, I love it too much. I am a fixer – a person that wants to get in there and find a solution to all the problems. I want to fix my patients. I want to fix my colleagues' problems. I want to fix all the issues in our department. I want to fix all the challenges in healthcare. I want to take it all on and solve the problems, so that everyone can be happy and healthy.

A few years ago, all of that almost crushed me.

All of the things that I was trying to fix led to increased stress and major burnout. I didn't have wa healthy work-life balance. It was all work. All I could think about was work problems at home, when out with friends and family, or laying awake in bed at night. I wasn’t sleeping. My health was poor. Things were not going well for me.

I decided to take a vacation from nursing.

There was a point when my husband and I decided that I needed to take a break from bedside nursing. I needed to be away from patient care. I didn’t need to be going to any meetings. I needed to not be at the hospital. I had to take a big step away.

I made some changes. I started working on that vacation.

Over the course of a few months, I started slowly taking steps to get away from work. Every time the Charge Nurse asked if someone wanted to go home early, I volunteered. I started asking the PRN/Per Diem staff if they wanted to pick up my shifts. I took some personal days. I started looking for a part-time or Per Diem position. When a Per Diem spot finally posted at our other campus, I applied and took it. I started in a new emergency department, not on any councils or committees. Just as a bedside, Per Diem RN.

And then, I took some time off.

I traveled. I hung out with my friends. I took time to explore the world of nursing. I gained some perspective and a new appreciation for my profession. The idea for New Thing Nurse started to cook in my brain. I grew as a person and as a nurse. 

I got my nursing groove back.

This plan won’t work for everyone.

I know that it is not possible for everyone to say BUMP IT to your full-time job and suddenly go rogue as a Per Diem nurse. However if you are feeling the symptoms of burnout, you need to make a change. Untreated stress and burnout will lead to the end of not just your nursing career, but also can manifest as physical and mental health issues. I have talked about my mental health journey before. It is no joke. You should do regular self-assessments of how you are feeling. Take the time to take care of yourself if you want to be successful in all things.

Things that you can do to combat nurse burnout –

• Take a vacation. - This can be anything from a few days off to a several week adventure. The main thing is that you GET AWAY from the clinical environment. Don't check your email. Block the short-staffed text messages. Give your brain some time to forget about patient care and focus on self-care.
• Find some quiet. - Do you dream of alarms going off? Pumps beeping? Your zone phone ringing to deliver another critical lab? You need to get out of that mindset. Find some quiet. Engage in silence. Breathe. Meditate. Take a nap. Just find a place where there is no beeping or buzzing going on that will take your mind back to the bedside.
• Exercise. - The mind-body connection is real. Your brain needs to be well for your body to be well and vice-versa. Exercise helps you manage stress. It helps you feel physically better. It is good for you. I am not saying to jump into an Iron Man, just encouraging gentle exercise. Try to move a little, and see how it makes you feel.
• Eat well. - You body needs to good calories to have the energy to do all the things. Try to avoid processed foods and soda. One of my favorite dietary tips is - "If it wasn't in the kitchen when your great grandmother was cooking dinner, don't eat it." Try to stick to fresh things that look like real food.
• Get enough sleep. - Sleep is foundational to everything. If you are not getting enough, you will be testy and experience increased stress. Everyone has their own sufficient, minimal amount of sleep, but always try to get that amount every night. If things are getting in the way, triage your tasks and find time for rest. It is essential.
• Appreciate yourself and others. - It is time to remember how amazing you and your team are. Take a moment to appreciate yourself and others. My department recently started a Shining Star Award and are picking one person a quarter to give it to. The winner gets a pack of Starbursts and their picture up on the staff fridge. It's not a big deal, but everyone so far has thoroughly enjoyed knowing that their work is appreciated.  

My Current Vacation from Nursing

I am currently on another vacation from nursing. I have been calling it my August sabbatical. While I am still working on New Thing Nurse projects, I am only working three shifts in the ED this month to give myself some time to take care of the projects and myself. I continue to LOVE my job and think that I am a pretty awesome nurse. 

But - I have come to recognize that time away from the hospital is just as important as time at the bedside to ensure that I continue to be the best nurse that I can be.

- Sarah @ New Thing Nurse

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About the Author - Sarah K. Wells, MSN, RN, CEN, CNL is an educator, speaker, blogger and owner of New Thing Nurse, a professional and academic coaching company for the nursing world. New Thing Nurse is organized to provide support and guidance to aspiring nurses, newly graduated nurses, and veteran RNs looking to make a change in their life.

Whether it’s a new school, new job or new idea,

New Thing Nurse wants to help with your new thing!

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