#OrthoNowOther - Hannah Miller, RN, BSN

I’m an ortho nurse at Good Samaritan Hospital in San Jose, CA. The Ortho unit at my hospital shut down in March. Ever since, I have been floating to other Med/Surg units and have spent quite a bit of time on the COVID unit.

This is a story from my very first day on the COVID floor.

05:30 Wake up, get ready, put on scrubs

06:15 Drive to work

06:45 Arrive at work, only to find I’ve been floated to the 5th floor (I usually work on the 6th floor). I later learn that my home unit, which specializes in Ortho, has cancelled all elective surgeries, which means they will be getting overflow medical patients.

07:00 Shift begins. I realize the 5th floor has been turned into the COVID-19 unit. All patients are either confirmed or rule-out (awaiting test results) cases. I spend the next 30 minutes being briefed on how to care for these patients, including how to don & doff Personal Protective Equipment (PPE) correctly.

07:30 Time to prepare. I get organized. I throw all my usual supplies (jacket, stethoscope, pens, gauze pads, alcohol swabs, flushes, etc.) into my locker to avoid getting them contaminated. Just me and my scrubs. I look up my patients in the EMR. I write down their orders & meds. I read about their medical history.

08:00 Time to go in. Call lights are starting to go off. Patients are asking for their breakfast trays, meds, to go to the bathroom, etc. I suit up: First, hand hygiene. Then gown, N95 mask, goggles, and gloves. I have a “spotter” watching me to make sure I put everything on correctly. I make sure I have everything I need: supplies, meds, breakfast tray, linens, tissues, ice water... anything I can think of that my patient might need. I enter my patient’s room, and my spotter quickly closes the door behind me.

08:15 I do my assessment: listen to my patient’s lungs, ask about their symptoms, etc. I help them get their breakfast tray set up. I take their vital signs. I pass their meds. I organize and clean up their room. I empty their bedside commode. I even draw their labs and take out their trash (not typical for the RN to do at my hospital). I make sure they have everything they need.

08:30 I’ve finished everything I need to do in this patients room, and I’m ready to leave. I ask if there’s anything else I can do. My patient is scared, lonely and locked in a room by themselves, with no visitors allowed. They want to talk to me, hear about my life, share stories from their’s. I listen.

08:45 Time to get out. I have 2 other patients waiting for me. I carefully remove my gown & gloves and knock on the inside of the door. My spotter opens the door to let me out. She watches as I perform hand hygiene, remove my goggles, mask, and do hand hygiene again. Another nurse rushes up to me to tell me one of my other patients has been calling for the last 30 minutes asking to see me. My spotter helps me quickly get gowned, goggled, masked, and gloved up to go into the next room. I make sure to grab everything I need to go in.

09:00 I enter my second patient’s room. He is angry that he’s been waiting for me for 30 minutes, because his IV alarm has been blaring this whole time. I explain how sorry I am for the delay, and turn off the alarm. I explain that the alarm was going off because his arm was slightly bent, causing the IV to get occluded. I show him how to keep his elbow straight so it doesn’t happen again. I do my assessment. I take his vitals. I pass his meds. I make sure he puts his oxygen back on, knowing he needs it. I make sure he has everything he needs. I listen. I apologize again. He thanks me.

09:30 I’m ready to go see my last patient. I knock on my door, and my spotter lets me out. She watches me doff my PPE and wash my hands. I take a breath.

09:45 Time to see my last patient. I don my PPE, I get my supplies together. I go in. Assessment, vitals, meds. This patient is probably the sickest of the three, and I’m now late with her meds, yet she is the kindest. She never once complained, but instead thanked me again and again and tried to make my job as easy as possible. Patients like this sometimes need to be reminded that we are taking care of them, not the other way around. I thank her for her kindness. I listen. I make sure she has what she needs.

10:00 After doffing my PPE, and washing my hands again, I sit down to chart. After about 5 minutes, the call light starts going off again. Patients requesting more meds, needing their commodes emptied, requesting help ordering lunch, asking for a warm blanket or more ice water. I spend the next couple hours tending to those various needs. And each time, donning & doffing my PPE to protect myself and other patients.

12:00 Another round of vitals & more med passes.

12:30 Time for my 30min lunch break. I tell the break nurse about my patients so she can take care of them while I’m eating.

13:00 Lunch break is over. I grab a cup of coffee and finish my charting.

15:00 The charge nurse tells me that I’ll be a spotter for the rest of my shift, since we have more nurses coming in at 3pm. I give another nurse report, and they take over caring for my patients.

15:30 I become a spotter. I spend the rest of my shift making sure the nurses, doctors, and other staff are all donning & doffing PPE correctly, opening & closing doors for them, wiping down used equipment with bleach wipes, and grabbing things for them while they are stuck in isolation rooms. I don’t sit down for 4 hours.

19:00 My shift is almost over. My manager comes to do a huddle. She thanks everyone for their hard work and dedication. A doctor compares this pandemic to a war zone. She shares how proud she is of our bravery and hard work. She explains that this will probably be what work looks like for the next couple months as we battle this virus.

19:30 I lecture the next shift on everything I learned during my shift so they can pass the information along. I clock out.

20:45 I get home. I’m greeted with proud, beaming faces and flowers. My boyfriend makes me dinner while I strip and shower before touching anything or anyone. I eat, watch a show, and pass out after a long day of work.

A lot has changed since that first day. Our ratio is now 4:1 and we no longer have spotters. As our testing capabilities improved, we are now able to discharge the stable patients more quickly. As a result, the remaining COVID patients are of a much sicker population. Many of them spent weeks on a ventilator in the ICU.

While this has been a really challenging experience, I am so thankful for my family, friends, and amazing coworkers who have been supporting me through it all. I can’t wait to get back to my ortho floor, but in the meantime I’m happy to be caring for these very sick and fragile patients. Nothing makes me happier than getting to discharge them home.

#RNStrong #OrthoNowOther #COVID19

- Hannah Miller, RN, BSN

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