When you look up “hero” in the dictionary, there should be a photo of a nurse, especially during the COVID-19 pandemic. They know the extreme risks they are taking just to do their jobs and they realize when they go home they could be carrying that risk to their own families.
Nurses care very deeply about their patients’ medical and personal difficulties, including being there for them at end-of-life when needed. Some days the work is nearly unbearable, but they still show up for work every day. That seems to be a good definition of “hero.”
Mass media, social media and politicians can’t stop talking about the pandemic, but those comments frequently send mixed messages. The public hears, “You must wear a mask and social distance.” Then, they hear, “If you want to wear a dang mask, wear a dang mask.” And they hear, “The COVID-19 virus is no worse than the flu.” They also hear advice to “shelter-in-place,” and to “patronize your local businesses.” People shout, “Open the schools!” Then, others say, “Opening schools is dangerous.”
Regardless of who hears what from whom, nurses bear the brunt of those mixed message results and pay the price when COVID-19 strikes.
How is all of this affecting nurses on the frontlines of the COVID-19 pandemic?
Mid Rivers Newsmagazine spoke with two of the many heroes at SSM Health St. Joseph Hospital – St. Charles: Samantha “Sam” Shelton, critical care nurse and Jessica Smith, nurse manager of critical care.
Shelton described herself and her coworkers as “tired and stressed, but trying to be resilient.” She said her work hours are long and tiring, but she and other nurses “still find ways to fill in and help on various shifts.”
“It’s hard, but everybody adjusts to different situations and cases every day,” she said. “We plan ahead to ensure we have coverage on every shift, considering the COVID cases and the non-COVID cases as well. As this pandemic progresses, we want to be sure no one lacks care.”
Smith, who has spent her entire career at SSM Health St. Joseph-St. Charles, described the nursing staff there as “a kind of a family.”
“We watch out for each other, help each other as much as we can, and take care of each other,” Smith said. “Many even check in on their days off. And I always make it a point at end of shift to check in with them, to make sure everyone is OK, and ask them if they need to vent.”
The standard shift is 12 hours per day, three days each week, plus small amounts of overtime when the nurses choose.
Smith said her team is “stressed, tired and trying to find the ‘new normal.’”
“When the pandemic started it was really scary for us. It still is, but we’re getting used to it. All of us are moms, daughters, sisters, spouses, and we know we’re putting our families at risk, too. That’s really scary,” said Smith, who has a 5-year-old and a 3-year-old.
Across the region, guidelines and regulations change from county to county – and everyone has an opinion on what is right.
“Social media’s effect is both positive and negative, depending on whom the person chooses to follow,” Shelton said. “We all did well at the beginning, especially in St. Charles County, with schools, stores, restaurants and other businesses shut down or restricted. But now, ‘pandemic fatigue’ is causing some people to (do) what is easiest to do, not necessarily the correct thing to do. People seem to be ignoring the reality of rapid increases in COVID cases and deaths.”
One of the hardest scenarios is in caring for a critically ill patient whose family is not permitted to visit.
“We try to be flexible and work with families to provide compassionate care during circumstances including end-of-life. But we primarily rely on tools like Zoom or Facetime to communicate with them while they’re in our hospital,” Shelton said.
She said it’s wonderful when families can at least lay eyes on their loved ones, even if they can’t be there in person. Sometimes, not even that is possible.
She described a case where a COVID patient was dying and did not have any close family left. “We did not want him to be alone, so when his time came, another nurse and I suited up with protective gear. We went into the room, and each of us held one of his hands until he passed. No one should be alone at a time like that.”
When asked if she has gotten over that and other similar cases, she said, “Yes and no. All ICU nurses do the best we can. We all have to deal with that type of stress with non-COVID patients as well, so this is not new. COVID cases just add to the number of times.”
Smith explained that in caring for patients, nurses often rely on families, because they know the patient’s cues, especially for older patients.
“When the family is not there or can’t communicate at an ICU patient’s end-of-life, that’s a whole new world where we handle the personal touch and contact,” she said. “We have taken on that burden and stress, too.”
The toll of COVID-19 cases on the rise
It’s also emotional seeing COVID-19 cases on the rise. Shelton predicted that would not happen if the general public followed precautions similar to those that the nurses do every day.
“Wear your mask when around other people, keep your distance, wash your hands, and be aware of where you are,” Shelton advised. “Everyone is suffering ‘pandemic fatigue,’ but if nurses can keep up these precautions full time, so can everyone else part-time.
“It’s frustrating,” she said. “It would seem to be a common courtesy to wear a mask to not just protect yourself, but also to protect other members of your family and other people’s families.”
She described the challenge of taking extra time when she is tired at the end of her shift to sanitize things, change clothes and wipe herself down before leaving. Then, going home and taking a shower before her children can come near her.
“I have three children at home,” Shelton said. “My 6- and 8-year-olds are not having too much of a problem waiting, but my 3-year-old does. She doesn’t understand why she can’t be by mommy as soon as I come home. All nurses face this with family members.”
Shelton’s advice for flu season is simple and familiar: “Get a flu shot. You can get them at SSM Health Express Clinics at Walgreens, through your primary care provider, and many other places. Pay attention to where you are and who is around you. Not just at work, but everywhere. Wash your hands. Wear a mask.”
The COVID-19 pandemic is real, Smith said. “It’s really happening. It’s really out there. Hospitals are filling up. People are dying alone.”
According to Dr. Shephali Wulff, an infectious disease specialist at St. Joseph Hospital – St. Charles, “As new cases rise, there will certainly be more people who need hospital-level care … We look at the positivity rate, which tells us how many tests are coming back positive related to how many tests are conducted overall. We want that number to be less than 5% and we’re currently around 20%. We haven’t seen a number like that since the beginning of April.”
With cases on the rise, she cautions against giving up.
“I think it’s important for people to feel like we haven’t lost and to avoid taking a fatalistic view of the virus,” Wulff said. “It would be dangerous to think that nothing we can do will matter. That’s not the right message.
“Yes, the numbers are higher than we’d like, but we can still be responsible and make choices that can affect those numbers. We can choose not to gather in large numbers, and we can choose to wear a mask in public. Those things work.”
A recent press release from The St. Louis Metropolitan Pandemic Task Force provides a collective look at the St. Louis regional hospitals from all major health systems. It shows that, at the time of its release in the third week of October, area hospitals were at 85% overall capacity and growing; ICUs were at 75% capacity and growing. Some hospitals were operating near or over capacity. The 72 hospital admissions recorded on Oct. 28 was the greatest total in a single day since tracking began in early April.