In their own words: COVID-19

As an emergency room nurse, it was scary to be in the hot zone of the emergency department during the initial shortage of PPE. Having the conversation with my family about advanced directives, should things go wrong, helped me empathize more with patients who need to have that difficult conversation. The most heart-breaking part of it all was not being able to have families by their loved ones’ sides during some of the worst days of their lives. As a nurse practitioner student, it was extremely hard to get my clinical rotation. I’m grateful to DeWana (Bailey, clinical site coordinator) who helped me find a preceptor in the middle of July, when I had the challenge of balancing work and clinicals as I tried to make up the hours I had missed. Now, I’m searching for a preceptor for pediatrics. If anyone’s looking for a student, I’ll bring coffee!

I graduated in the midst of quarantine, with my mom at my side, sitting at the dining room table watching a Facebook Live graduation ceremony. The tears I shed were both in celebration of my accomplishment and in grief: for the loss of traditional parts of my senior year and for the fear of what lay ahead in my nursing career. At the time, we were inundated with stories of nurses falling ill and dying, quarantining away from their loved ones and working until they dropped from exhaustion. It was difficult to be excited to enter the field while fighting the increasingly real worry that I might not survive my first year if the pandemic, or our response to it, did not change. Although I have been lucky to work as a nurse in a unit that very rarely cares for COVID-19-positive patients, I notice the effects of our (very necessary) new policies on our patients. Our population often stays with us for long periods, meaning extended periods of time away from family. The extensive post-hospital care that our patients need often requires lots of practice and in-person learning, which is harder to accomplish now. On the roughest side of this fight, there are the losses, which takes a lot of organizing to ensure families can say goodbye. One of the parts I treasure most about our job is providing emotional support, but it’s difficult to watch family members head home and wonder who is there for their loved ones when they aren’t. When I draw to mind every blow the pandemic has dealt to our lives, it is hard not to first think of the safety of myself and colleagues, but a close second is the burden it places on my patients and their families as they attempt to navigate not only a devastating life change, but a potential prolonged separation. For the families of my patients who are unable to be there in person, know that until we are able to come together again safely, nurses like me and my work family will continue to care for your loved ones like they are our own. We’ve got their back, and yours.

Both personally and professionally, COVID-19 has impacted me like many. One of the many lessons I have learned from COVID-19 is the true understanding that the joy of work comes from the energy received by working with colleagues, spontaneous conversation, interacting with excited students and catching up on the small details of people’s lives. The human connection is so important. I miss the people coming by my desk to take a candy and make a connection. We now try to connect utilizing technology. It helps to hear the voices and see the faces. We always try to connect about what is going on in our lives. At the college, we are exceptionally lucky as we have been delivering quality distance learning for many years, so our graduate students continued to receive the best education. I also work as a primary care nurse practitioner at a Federally Qualified Health Center in Lincolns Heights, Ohio, part of the Health-Care Connection. We have remained open and meeting our patients’ needs throughout this time. In the beginning, we shifted to virtual visits, unless it was a situation where the patient had to be seen in person. At first, I was concerned about the ability of meeting my patients’ needs virtually, but I soon realized that approaching every complaint as I have always done – with a detailed and solid history – you have most of the information you need to diagnose and set out a plan. Every advanced-practice student I have taught in my assessment class can remember how much I stress the importance of getting good history; it truly makes a difference. I’m also glad to be able to educate my patients on COVID-19, reinforcing the importance of getting information from legitimate sources.

I was set to begin my first clinical, in May, at a local pediatric clinic owned/operated by Nationwide Children’s Hospital but, in March, the clinic suspended all student activity to reduce exposure and conserve PPE. Providers were split into groups that rotated one week on/one week off. Half of the providers saw patients that needed to be seen in person, while the others did telehealth visits. As my precepting NP was pregnant with her first child, management decided that she would only do telehealth visits, which meant I had to restructure the semester so I could continue to take courses and delay my clinical. Although I’ll finish my program a semester later than planned, I am grateful that I didn’t have to take a semester off. I hope that my clinical rotations will proceed as planned.

In early June, I received the announcement I was waiting for: clinical trials to do final evaluations of the COVID-19 vaccine were coming to the greater Cincinnati area. I immediately called the office where the trials would take place and had my name placed on the volunteer list. Not everyone understands my determination to participate in the vaccine study, but those who know me well won’t be surprised. As an advanced practice RN in HIV care and prevention, I have consistently emphasized the importance of immunizations to those who were living with HIV infection or were at risk for acquiring it. For four and a half years, I worked as a principle research assistant in the Infectious Disease Clinical Trials Unit at the University of Cincinnati where I saw firsthand the impact of new medications on the health and survival of persons living with AIDS. I admired the courage of those who volunteered for those studies, donating their time for extra study visits and blood samples to help us understand how the study drugs worked. On the morning of April 28, I received a call from the long-term care center where my 92-year old mother lived, informing me that she had died of respiratory complications of COVID-19. Knowing the vaccine studies were coming, I decided that day that I would follow the example of those I cared for in the clinical trials unit and volunteer to participate.

The COVID-19 pandemic certainly threw my summer for a loop, as I was super excited to get a job as a PCA at a Cincinnati hospital. I applied to jobs in February and was patiently waiting to hear about what this next chapter in my life would look like, but March rolled around and the pandemic hit—hard. My classes and clinical got moved online and I had to go home, which is about three hours away, because the dorms had shut down. Picking up my life to move back home with no idea about when I’d be returning or, if I did, what my life would look like was pretty stressful. This pandemic put a strain on me and the people I love. Trips to see ill family members were put on hold for the greater good of keeping everyone safe. There was definitely a lot of growth happening, despite being confined to our homes. In June, I finally heard back about an interview for a PCA position. I was so excited! After two interviews and a trip back to Cincinnati, I was offered a position on my dream floor to begin a whole new educational journey. I have learned so much and have seen my skills and confidence transfer over into to my clinicals this semester. Moving back down to Cincinnati, in the middle of a pandemic while trying to navigate the meaningful relationships I have down here, has been no easy feat. Adding a full-time load of classes and schoolwork has been probably the greatest challenge of them all, and I have seen myself grow in a greater capacity than I thought possible.

For me, and for the discipline of psychiatry in general, COVID-19 has pressed mental health providers to innovatively leapfrog at least 10-15 years in the advancement of treatment modalities and approach. My clinic, as well as the hospital I serve, have been constrained to adapt or be left behind – or more egregiously, leave our patients behind. From this hopeful vantage, I would gingerly contend that this pandemic has in a sense been good for the progression of mental health. It has also spawned a desire within most advanced practice nurses to be even better clinicians, tapping into one of our foremost qualities, adaptability. Despite the many setbacks, we are better because of this crisis. COVID-19 has also demonstrated that the management of mental illness is as critical to preserve during a public health crisis as those for conditions such as heart disease and cancer. We are mindful that if radiation or dialysis treatments are not accessible for an extended period, life-threatening repercussions are likely. Yet there is analogous pathology in psychiatry where, when psychotropics and other treatments are suddenly eliminated, worsening illness or even death are possible. This has all helped to publicly amplify the importance of mental wellness and access to care. And, for this, I am grateful.