The American Association of Nurse Practitioners® (AANP) History Committee is tasked with not only locating and preserving past NP history but also with documenting the accomplishments of NPs today. In 2020, the AANP History Committee announced an annual contest for members to submit their firsthand accounts and stories for future generations to reflect upon.
The defining health care event of 2020 was undoubtedly the COVID-19 pandemic. Therefore, the theme for the 2020 NP History Writing Contest was: NP Reflections on the COVID-19 Pandemic.
To all AANP members who made a submission: thank you. Your stories, experiences and perspectives have provided an unprecedented level of insight into a year filled with challenges, sacrifices and tremendous courage. AANP is now pleased to share the winners of the 2020 NP History Writing Contest.
I’ve sat down multiple times to compile my thoughts and experiences into a concise essay, but I have gotten overwhelmed reliving these experiences. My story begins in March 2020. I was offered my first NP job, working in long-term care. I had a long history working in long-term care, first as a dietitian, and then after I completed my registered nurse (RN) degree, I stayed in long term for six more years, eventually becoming an assistant director of nursing (ADON). After completing two weeks of training in this new position, I was furloughed for eight weeks. When I came back in June, I continued with my training and eventually began working at my assigned facility.
Living and working in Western Pennsylvania, we were mostly spared from the first round of the COVID-19 surge that other cities had experienced in the spring. I had only watched or read stories of nursing homes being ravaged by the virus; you questioned the integrity of these facilities when you heard of the most unthinkable things, but I knew it was different from the average flu season. In August, the facility experienced a small outbreak with a handful of staff and residents testing positive, all of whom recovered without long-term effects. It was also at this time that I was asked to join the Regional Response Health Collaboratives (RRHC), an initiative through the Pennsylvania Department of Human Services, to assist long-term care facilities with COVID-19 readiness and preparedness.
As the region’s positivity rate increased, I knew it was only a matter of time before COVID-19 would be at our building, but I had never imaged how fast it would spread, as many patients and staff were asymptomatic at the time of diagnosis and found during surveillance. Despite one of the most stringent universal surveillance policies, COVID-19 still entered the facility.
As a practice, the game plan was to transition to telemedicine if any of our facilities had active COVID-19. Due to technical issues, it was not prudent to complete telemedicine visits, and as a member of the RRHC team, I was going to the facility on a daily basis to assist with infection control and employee education. Although what I have experienced has been hard, I would have felt guilty staying at home while my nurses, who had become friends, were caring for our patients without my support.
When COVID-19 enters a facility as fast as it did, the best analogy is describing it as a war zone. The patients’ conditions are unpredictable, and they decline rapidly. As a nurse or NP, you question your skills. Every patient I have sent to the hospital for more intensive treatment has succumbed to the virus. I have had to contact countless families and recommend hospice care. I have mourned the death of my patients. I have felt guilt for the patients’ families who have had limited visitations since March and had to say their goodbyes via teleconferences. Although we allow compassionate visits at the end of life, many families have expressed their own fears about contracting the virus and forgo the visits. During my time as ADON, I worked through a flu outbreak four years ago, and we did not have a single death, hospitalization or long-term complications as I have seen with COVID-19. It is a demonizing force in our elderly population.
Although I have experienced many hard days, I try to find the little moments. In one particular situation, I had a patient who rapidly deteriorated due to COVID-19, and I recommended hospice. I asked her what was one thing she would want, and she requested a beer. I’ll be honest, I didn’t expect her to make it through the night, but I brought a beer the next day, and she devoured it. I brought her in a beer every day she could safely drink it, and by the third day, she had improved just enough that her family and the staff noticed a difference and jokingly remarked that a can of beer was her miracle drug for COVID-19 — or at least for the time being. It will be these little moments that I will carry with me, particularly her face lighting up when I popped open a cold one!
Through this entire experience, I have had the best support system imaginable. My collaborating physician has been there for me every step of the way, answering calls, talking me through high-stress situations and supporting my clinical decisions. My fellow NPs in the practice have offered their assistance with my other duties and allowed me to focus on my patients and their families. My family has also supported me in little ways — watching my dog when I worked long hours, cooking me meals and helping with laundry when I was too tired. To the management, nurses, aides and other ancillary staff at the nursing home: I commend them for their hard work and dedication and for the amazing care they provided patients. Working in long-term care is a selfless job. Add a global pandemic to the mix, and they definitely don’t get the recognition they deserve.
Haruki Murakami wrote the following:
“And once the storm is over, you won’t remember how you made it through, how you managed to survive. You won’t even be sure whether the storm is really over. But one thing is certain. When you come out of the storm, you won’t be the same person who walked in. That’s what this storm’s all about.”
Although I am still navigating my COVID-19 storm, it is definitely making me a stronger person and an even stronger CRNP for my current and future patients. The patients I have lost during this time will never be a statistic to me, but rather I will continue their legacy through my work.
Today I held a hand.
I held a cold hand that was covered in dried blood and dressings from an arterial line that was mottled with purple webbing from artificial blood pressure support.
Today I held a hand to help bring comfort to a patient in an intensive care unit bed.
I held your hand as I wiped your face as blood was coming out of your nose, around the nasogastric tube we placed to decompress your stomach. I wiped your cheeks as blood came down your nose and saturated the pads in place meant to hold your breathing tube that connected your ventilator as the machine breathed for you as you could not. I wiped your mouth that required more oral suction as frank blood continued to seep out.
I held your hand as the other nurses and doctors came to your bed as the extensive artificial life support with medications, a breathing machine, continuous renal replacement therapy and a balloon pump were not enough to keep your weary body going.
I held your hand as we called your family.
I held your hand as I told your family that your earthly time is coming to an end soon and that we have an opportunity to make sure your last moments are more comfortable and provide you a more dignified death as you transition to heaven.
I held your hand as your family said to make sure you were comfortable and did not suffer anymore.
I held your hand as the chaplain came by.
I held your hand as your pulses came and went with the alarms in concert.
I held your hand as I had the other nurses go call back the doctors as your time on earth was done.
I held your hand as the doctor did the “official pronouncement,” even though we all knew you had left moments earlier.
I held your hand as we began to peel back the medical technology layers that had attempted to keep your body going.
I held your hand as we changed your gown soaked in blood and changed your bed.
I held your hand as I cleaned every nail bed and the rest of your hands and arms and placed pressure dressings over where the IV sites were.
I held your hand as they cleaned your feet and legs.
I held your hands as I asked for the lavender lotion. I began to let go of your hand as I gently massaged the lavender lotion on your hands, arms and legs.
I held your hand as we replaced a crisp white sheet and comforter across your cleaned body and gown.
I held your hand one last time as I said a silent prayer for you and your family.
I let your hand go as I replaced and positioned your hands and arms on clean bedding and replaced the side rails so the bed was neat. You look so much better the other staff said. You look at peace now.
I touched your hand then walked and paused a moment and touched your tip toes as I was done holding your hand.
Today nurses of all backgrounds and training will hold a hand.
For families that cannot be here due to this COVID-19 pandemic: Know that I and my nursing colleagues will be there to hold their hand if your loved one’s time on earth is complete.
Nurses are here to hold your hands in good times and bad.
May you know how very honored nurses are to be able to hold the hands in these sacred times of great joy, sorrow and need.
May God give you peace and grace as we all walk this journey of life ahead, hand in hand — Together We Can!
In honor of Dr. Loretta Ford, co-founder of the NP role in 1965, AANP has launched a special scholarship program to empower NPs of the future. This program will provide support to AANP members who are RNs as they pursue advanced education to earn their Doctor of Nursing Practice (DNP) degree. Applicants will follow in the footsteps of Dr. Ford, epitomizing the qualities of courage, determination, perseverance, dedication and introspection. The deadline to apply is February 5, 2021. See all the eligibility requirements now and, if you are not eligible, share the news with your nursing colleagues — plus, stay tuned for the 2021 AANP Grants and Scholarships program, launching February 10.