Surviving the Storm: COVID-19, Nurses, and PPE

Hindsight is always 20:20, right? Knowing what we know now, I would have done things differently in mid-January. I would have picked up that extra pack of toilet paper and bought a whole lot of stock in Zoom conferencing systems. 
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But What Actually Happened? Let's Look at PPE

PPE? Yes, I definitely would have ensured that my organization had an ample supply of surgical masks, disposable gowns, face shields, and a variety of N95 respirators. Oh, and I would have pressed harder to ensure all the medical staff was fit-tested for the respirators.

For those non-clinical folks, you might be asking, “What does PPE stand for?” Personal Protective Equipment, or PPE, is defined by the Center for Disease Control & Prevention (CDC), “Gloves, protect the hands, gowns or aprons protect the skin and/or clothing, masks and respirators protect the mouth and nose, goggles protect the eyes, and face shields protect the entire face.”

It’s easy for me to look back and say what I should have done, just as it is for most healthcare organizations. It’s easy to place blame around a conference room table, and there’s plenty of it to go around during these times. 

Yet, here we are in the (hopefully) middle of a pandemic, and some organizations are more prepared than others. To get a more comprehensive view than just my own, I interviewed a CNO, an Infection Prevention Nurse, and an ICU staff nurse from large organizations. And, because PPE is such a hot topic right now, I am keeping their names anonymous for their peace of mind.  
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PPE and Nurses - Where Do We Stand?

If we could go back, I believe some organizations would focus less on reducing costs by keeping a low-level of supplies on hand, assuming we could easily order more each day, blissfully unaware of the pending devastation in the supply chain. The theory of a light ship being maneuverable enough to stay on top of the surging tide seemed like a good idea at the time.

Given another chance, we might have put more effort into our required Surge and Emergency Contingency Policies, our navigation tools, and made sure that we had a stockpile of provisions necessary to get us through several weeks. We would have made sure that we had a solid communication plan to get vital information to our precious staff promptly and over many venues and platforms.  

I know that many infection-prevention nurses would have insisted, as early as mid-January, to begin screening incoming patients and limiting visitors to our hospitals. I’m sure they and the clinical educators would have taught their crew how to be better stewards of PPE in general. This is all to say, had we known about what we’d be facing today.
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But we didn’t know. Did we?

True, we knew it was theoretically possible, but we didn’t believe it would be in our career’s lifetime. We saw the movies of the zombie-apocalypse and contagions, and we heard the TED Talks about super-infections. But most of us didn't believe it would happen.
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Should we have believed? Should we have assumed?

As I say to our adult children about our parenting: We did the best we could with the information we had at the time. Most organizations had a hard time wrapping their brains around the concept that a novel flu, surfaced halfway around the world, would ever touch their towns or cities.

Organizations didn’t intend to reduce supply levels so low that their staff is now providing care to COVID-19 patients without proper protection. I'm confident that not one hospital administrator had "Put organization, staff, patients, and our communities at risk by failing to respond to a droplet-transmitted pandemic” on their 2020 goals. 

Yet, some saw the storm coming, reacted quickly (and were accused of overreacting at the time), initiated measures to reduce patient contact, and requested supplies from the National Stockpiles. Some chose to get in front of the surge and created education around PPE use and even published the number of PPE supplies on their website. Many leaders across the country allowed themselves to show vulnerability with their staff and continue to provide as much transparency as possible. I find some respite in knowing that at least some leaders got the memo.

Another favorite family saying: There’s no such thing as bad weather, only bad gear. 

Some saw the gale and put on their best gear. Their ships are getting battered just like all the others, and their crews are tired... but they’re safe and dry. Other organizations saw the storm and hoped that it would turn before it reached them. The crews of these ships are exhausted, tattered, and worn to their core.

Knowing what we know today, of course, there are things we all should have done differently. Hindsight has perfect vision. The more important question: ‍

What are we learning from this pandemic to better prepare for the next squall?‍

If you're looking for up-to-date information on COVID-19, particularly as it relates to nursing, you can check out the COVID-19 Nurse Resource Center.