I started keeping a journal on the pandemic story a few weeks ago. This is the first part of at least three. As I described it to our CEO a few weeks ago, “I feel like I’m standing in snow up past my knees, seeing the avalanche coming and not able to do anything about it.”
I’m not looking forward to what I expect will happen in the small mountain community where I live and the nearby slightly larger community where I am the nurse manager of a federally qualified health center (FQHC). For those of you who aren’t familiar with the acronym, FQHCs were created back in the 60s to serve the most vulnerable populations across the US. We have over 40% seniors in our population, many patients who have multiple medical problems and many others who have mental health issues as well. And Ma Nature is apparently not very happy with us because she just dumped over a foot of snow and we had to close the clinic for today and maybe tomorrow.
We’re trying to figure out how to help our elders shelter in place now that they are snowbound as well as homebound. We’re running longer hours at the food closet, but these people can’t get to us now. Transportation is always an issue in our area – we don’t have buses, taxis, trains or any sort of public system. We need to make sure our patients have meds, food, heat – the logistics boggle the mind. We have people who live in cabins without heat and even a few in tents – at 3,500 feet in elevation. At least one family I know hauls their water from a stream in buckets.
Luckily I have always been of the “be prepared” mindset and had been monitoring the situation as soon as China started talking about the coronavirus, so I was able to get the conversation going early (to the point, I’m sure, some folks wished I would shut up about it, already!). I got the triage nurses checking for possible COVID-19 symptoms early, we revised our triage tool to make sure we answered all the right questions and every morning – and now sometimes at noon – the whole clinic huddles for updates, changes and planning. We stocked up on extra medications for our dispensing closet and made sure the oxygen tanks are all full. Everybody is doing extra cleaning before, during and after the workday.
It’s a constant struggle. Do you insist staff wear masks all the time and use up valuable personal protective equipment (PPE)? If not, how do we protect ourselves and our patients? How can we do telehealth or phone calls instead of face-to-face visits and how do we get paid? Like most FQHCs, we run on a very tight budget. Like hospitals, we are closely regulated – if we don’t color within the lines, they can shut us down. But difficult as our situation is, I can just barely imagine what it’s like in acute care – it’s more than 15 years since I was a director of nursing.
People are a big part of this pandemic story. While I am extremely thankful not to be working in acute care any more, my heart goes out to the hundreds of nurses I’ve precepted and mentored in my 50+ years of nursing. There’s a pain in my heart to know we’re going to lose some of them. Every time I talk to a patient, I have a tiny voice in the back of my mind: “Some won’t survive – will it be you I mourn?” On the other hand, I’m one of the oldest staff members, so maybe it’s me they’ll be mourning. It’s the hand we’re dealt – gotta play it with fingers crossed.