Marking the Moment…and Continuing Forward Together

From the 5/6/2021 newsletter

Perspective/Opinion

Marking the Moment…and Continuing Forward Together

Jennifer Popies, MS, RN, ACNS-BC, CCRN-K; CVICU Clinical Nurse Specialist

Ms. Popies, a Clinical Nurse Specialist in the Cardiovascular ICU, writes about what it has been like to be part of the team caring for desperately ill patients with COVID-19 over the past year. Recently, the caregivers in the unit paused to reflect on the one-year anniversary of the pandemic and to bear witness to what the year has meant …

It is overwhelming, humbling, and simultaneously a source of pride - as well as pain - to think of all the precious nursing moments with patients and families that I have borne witness to or been entrusted with in heartfelt conversation over the past year.  Gestures that may seem like the smallest details of a patient’s care became some of the largest measures of bringing humanity to the bedside.  

Nurses staying in sweltering layers of PPE, including re-used N95 masks for a time, to hold the hand of patients who were scared, alone, and gasping for air. Serving as champions and cheerleaders for patients to encourage them to keep moving, to keep eating, to simply keep trying. Reading letters and cards sent by family members even though the patients were intubated and sedated so they could still have a chance to hear the words of their loved ones. Bathing and washing the hair of dying patients so they would look recognizable for a family’s last goodbye over an iPad. Making handprints of their patients to give to their families to have as tangible memories of their loved one when that is all we could leave them with.  

All roles deserve to be celebrated for their unique contributions to the wellbeing of those we collectively serve, but this Nurses Week, it is a special privilege to try to capture in some small way what it has meant - and continues to mean - to be a nurse in this pandemic.  Never before has the public, and perhaps even some of our healthcare colleagues, really understood so clearly that “Nursing is both a Science and an Art.”  

Deciding to mark our “anniversary” …

Before Nurses Week was approaching, a different date loomed:  March 18, 2021 – the date that marked the one-year “anniversary” of our CVICU accepting our first COVID-19 patient on Extracorporeal Membrane Oxygenation (ECMO).  Our nursing leadership team, along with our ECMO RN Coordinators, talked about how best to honor this. How should we acknowledge the losses our team suffered over the year and the triumphs we celebrated? Most of all, how do we truly recognize and express thanks for the talent, skill, dedication, and compassion of our staff?  

]We gathered feedback from our nurses and settled on brief “marking the moment” sessions - one during night shift at 0300 and another on day shift at 1100 - with a special message read from our leadership team, followed by an even more special compilation of video messages from prior COVID-19 ECMO patients who were successfully discharged from our care.  Then we set about getting the word out about these sessions and inviting all members of our interprofessional team to join in because, as nurses, we coordinate care and our care is not just for our patients, families, and each other, but for everyone on our team.

Hitting the mark …

The date came and, as happens in nursing, we had to adapt our plan slightly from 0300 to 0330 to accommodate a new ECMO patient just rolling in when we initially planned to start. We had to do “repeat” sessions throughout the morning and early afternoon so that we could ensure that all team members working that day could take the time to listen to our message and see the video.  It was worth everything, though, to be able to stand together and pause, to remember together, to tear up and laugh at the video messages together, and to feel the solidarity in our team to keep going, to keep persevering, to keep caring since we all recognize that our work is not over.  

The unprecedented times are not yet done, and we know that our work to share this gratitude for the care that all nurses have given - and continue to give - in every unit, not just ours, is not done.  Indeed, our work to let all our healthcare team members in all departments   no matter their role   know they are appreciated for what they have contributed and continue to give, is not done.  It is in that spirit that I share below a slightly modified version of the message we wrote for and read to our nurses and our team, in the hopes that it will also hold reflection and meaning for you who are reading this.  It is truly meant for each of you, too.

To our nurses and our teams:

In March 2020, when we learned that we would be receiving our first COVID patient at Froedtert, none of us could have fathomed what this past year would bring.  We hear the numbers all around us of what the pandemic has done in America – millions infected, more than 540,000 lives lost - and yet they still somehow fall short of capturing the enormity of what we have personally experienced as a team in just one hospital, in one city, in one state, in one country.

The challenges and changes that we have seen in just this one year are startling to list.  We donned and doffed according to rapidly changing guidelines, we implemented reusing PPE and sending it for UV light disinfecting to try to protect ourselves and each other, and then learned to use other PPE that we had never had to learn before like PAPRs and CAPRs and Elastomeric masks.  We implemented airway teams, proning teams, AGP guidelines, and the use of extension tubing to run IV pumps outside of rooms.  We cross-trained floor nurses and uptrained Resource Pool nurses.  We developed and implemented guidelines for putting patients onto ECMO and other treatments for COVID and adapted them as we learned more with every passing month.  We tried different therapies - hydroxychloroquine, convalescent plasma, remdesivir, and Cytosorb to name a few - all while learning to tolerate O2 sat levels and lab levels we could never previously have imagined.  We adapted different ways to try to help patients handle the symptom burden and isolation of this virus – medication regimens at doses we weren’t used to, partnering with trauma psych despite not being trauma units, learning to use iPads with WebEx for everything from routine family connection time to family conferences to harps of comfort music sessions to end of life moments.

Specific to COVID-19, we have collectively cared for hundreds of patients.  We have lost some of these patients, despite our best efforts, despite exceptional care, despite our deepest hopes to give them back to their loved ones...but these efforts were not in vain simply because they died.  Their families noticed, their communities noticed the care they received, and we will remember them; caring for them changed us.  Please join me in a moment of silent remembrance for them now...

We have also been able to celebrate incredible triumphs, moments of seeing our patients stand for the first time in many weeks, be freed from their tether to an ECMO machine or a ventilator, roll out of our ICUs to other floors or facilities or home with us cheering them on.  None of that would have been possible without each of you, without each member of our team, whether your role was directly caring for COVID patients or caring for our other acutely ill patients who required our specialized care.  One shining, crystal clear truth that has never changed over the past year is this:  When we stand together, we stand stronger - for our patients and for each other.  

As a leadership team, we have marveled at what has been accomplished this year and are incredibly proud of the care you have delivered and continue to deliver despite personal struggles and the professional challenges that have been faced.  There are simply not enough words to express our gratitude, our deepest thanks for everything that you have done and who you have shown yourselves to be as the Froedtert team in caring for all the patients and families that we have served over this past year.  Please know that you are seen, you are valued, you are our Froedtert Family!  Thank you from the bottom of our hearts!

Jennifer Popies, MS, RN, ACNS-BC, CCRN-K is a Clinical Nurse Specialist in the Cardiovascular Intensive Care Unit at Froedtert & the Medical College of Wisconsin.