In the US we used to live in just a few years ago, the public health reporting of communicable diseases both bacterial and viral was such a very different picture from what we’re seeing on the news today. We need to factor in the vast number of people who aren’t being tested and realize how very many more people are actually sick with the coronavirus COVID19 or are positive carriers spreading the disease faster than we can keep up. That number is one we can only estimate in our minds. But the point is, the real picture of this disease is much grimmer than we know – and than we will ever know.

These tremendously deflated numbers are being used to support the so-called preparation for what they tried to call a hoax. The numbers tell a story of why we received far fewer tests than we need as well as the ridiculous amount of PPE and ventilators. It’s propaganda being used to try to convince us we’re almost ready to ramp us business again and go about our lives as usual by April 12.

Medical experts and doctors and nurses on the front lines paint a very different picture and are clamoring for PPE to protect themselves and help prevent the spread of this deadly virus. There is a huge unfilled demand for ventilators needed to save the most critical patients. Sane minds in government are pressing for stricter guidelines and more cooperation from the public to stay home and stop shedding virus all over.

Testing is not everything

In the reality of the US today, testing is far less important. We have all been taught to assume everyone is infected and to take necessary precautions and act accordingly. We learned these lessons many years ago starting with the Aids and then the Ebola epidemics.  It’s not rocket science, it’s nursing science! Use your critical thinking skills!!! It’s time to calm the nerves and press on and work to eradicate this enemy. There is NO treatment except a ventilator for those in dire condition. We can only treat the symptoms of cough and fever and possible GI disturbances. And even then we perhaps run the risk of masking worsening symptoms. Comfort care is essential. Sanitary conditions are absolutely necessary. Quarantining or isolating is common sense! PREVENTION is key to containing this virus and gaining control.

Much of the care can and should be done in the patient’s own home in lieu of hospitalization when possible by isolating the patient in one room and minimizing all other contact. Using specific utensils and linens for the infirmed only. Washing them separately in hot water and soap. Maintain their hydration, nutrition and make sure they sleep as much as their body requires. Oxygen and nebulizers may be used in the home and a home health nurse should be assigned to make visits to assess and supervise the care. If we can keep the hospitalizations only for the sickest patients we can better manage the crisis.

Chloroquine phosphate

There is NO miracle cure! Unfortunately, people have listened to Donald Trump prescribing (without any medical knowledge, education or license) chloroquine phosphate as a cure. This is a snake-oil presentation and people have tried self-medicating without prescription or medical care. However, one couple, in particular, bought a form of the chemical substance that is used to clean algae from aquariums and is NOT FIT for human consumption. Now a man is DEAD and his wife in critical condition because, in their own words, they believed Trump. Perhaps her anger at this betrayal will help her pull through. There have been many more deaths worldwide from the use of this drug even under medical care.

Chloroquine phosphate (aka Plaquenil or Resochin) was originally used to treat malaria. Today it’s used primarily for lupus and RA and other inflammatory chronic diseases and now it’s on backorder for the people who truly need this medication. It requires a prescription and close medical monitoring for a wealth of serious side effects including blindness.   The FDA has NOT approved it for use in the US for COVUD19! And it’s probably not likely to do so unless Trump holds a gun to their heads.

Common sense questions the safety of this in the first place. Researchers have said that people with inflammatory diseases are more prone to COVID19 and using anti-inflammatory drugs such as ibuprofen and Aleve can make their response to the virus even worse. So why in the world would another drug which reduces inflammatory responses be advised?! Perhaps, like the manufacturer of the only tests used until recently, this drug manufacturer is connected to the Trump/Kuschner family as well? Or are they practicing insider trading with our lives? Follow the money…?

Workarounds are essential

Regardless of your political views, (illness is non-political) the medical community has got to work TOGETHER to find and create workarounds to provide the excellent medical care we know how to despite whatever DJT throws out there as a wild hope to jump-start the economy in the midst of the worst pandemic in a century! We as medical minds need to spread TRUTH, HONESTY, and INTEGRITY in order to manage this crisis and find our way out of the hell hole together! That is NOT going to happen by April 12! People need to practice safe living and PREVENT the spread of this deadly virus. The curve must be flattened if we’re going to have a chance and the longer people disobey the rules, the longer and more deadly it will be!  We are ALL in this together so do your part to participate and educate others:

• Stay home if you’re sick – it will save lives!
• Social distancing means staying 6 feet away from the next human being. The reason for that is because should one of you cough or sneeze, even into an elbow, the droplet spray will not reach the other person. Five feet is not a safe zone! Six feet!!!! (You cannot play basketball or volleyball with friends and be social distancing! There’s a reason the NBA canceled games, even if they had no audience!!! )
• Your pets aren’t going to spread the virus so love them and DO NOT dump them at shelters! If it’s a money matter, call your vet for resources.
• Protect yourself! If your employer wants to fire you for using a mask, there’s another employer nearby who’ll be happy to have you!
• Wash your hands more than you thought you would in your entire lifetime!
• Replenish yourself. Get sleep, eat right, and HYDRATE!!!
• EDUCATE your loved ones and friends to listen to trained medical professionals and contact their physician for advice!

Don’t make another human being die alone in a hospital room (no visitor allowed) on a ventilator because you or a friend or loved one decided a party was more important than being socially responsible and staying home!

This issue with COVID-19 has been a struggle for nurses and healthcare workers everywhere, and there isn’t any real light at the end of the tunnel. There are a few glimmers of hope for a vaccine for the novel Corona virus by the the end of the year, more likely early 2021. In order to help improve healthcare in general, nurses are going to need to stand up and be heard!

Not unlike many others, I have not escaped direct impact. A close family member was just released last Friday from 50 days in the hospital and followed up with rehab in a SNF. I have also seen other extended family members lose their battles with this viscous disease! Looking in from the outside it has been a terrible roller coaster ride. Some of the care has been questionable at best which makes me very sad. I understand the impact on staffing and care giving, but there is NO EXCUSE for terrible nursing care that puts the patient at even greater risk! Being lied to and given misinformation has made the ordeal even more difficult. As the nurse in the family, I have made my voice heard by administrative staff.

I’m quite sure there has been an even greater burden placed on the nursing staff because family members haven’t been there to relieve some of the burden of the patient care. I also know how loved ones can be an annoyance, but without them, who is there to advocate for their loved one? In our case, obviously very few!!

The truth about misuse of clustering care

Clustering care to conserve PPE which is already in short supply is one thing. Protecting staff from over exposure is another. BUT, leaving a patient in 8/10 pain, on a soaking wet chux, and scrunched down in the bed unable to move for another hour until the insulin is due and the nurse doesn’t want to DON and DOFF the PPE twice constitutes Immediate Jeopardy and is NOT a consideration for clustering care under any circumstances! This is NOT the nursing care any patient deserves! (There were a variety of other reported offenses to be sure.)

CEOs who are increasing the burden on nursing staff to save some money (to put into their own pockets) is deplorable. The shortages of adequate PPE to protect our most valued workers is unconscionable and the government officials who continue to minimize the impact of this deadly virus should pay at the polls in November. Change must come to protect all of us as nurses and as citizens of this planet. This virus is not going away any time soon and we have not yet seen the affects it may have over time.

Nursing workforce is largest in nation

Nurses in the U.S. are 4 million strong and growing. Nurses have been selected as the most ethical and honest profession for 18 years in a row by the Gallop Poll. Nurses make up a large majority of the entire workforce in the U.S. and they comprise the largest portion of the healthcare workforce. As such nurses have a strong collective voice, and one that needs to be heard from! The COVID-19 virus thrust nurses into the limelight and they have been heralded as angels and heroes and leaders in helping us all get through this pandemic together. Understandably, nurses are being kept busy keeping patients alive, but the time will come when they need to stand shoulder to shoulder to right the many wrongs in the handling of this pandemic as well as improving health care delivery as a whole.

Nurses need to stand up and be heard

A very grateful public will have to be be informed and warned about the perils healthcare and the need to take away the power of a few corporations and their greedy CEOs. The truth needs to be told about what has really gone on behind the scenes while family have been silenced. And the real struggles to defeat this illness and prevent complications.  Nurses will need to be seated at the table in board rooms and elevated to positions of power, influence and importance to create a health care system that works for all and provides for quality care for all. Through legislation and the election of candidates interested in humanity and and healthcare, we can abolish policies that continue to make a few people rich on the backs of the majority. Nurses collectively have a strong voice and need to be heard!

We need a National Nurse

A grassroots effort with the goal “to elevate and enhance the position of the Chief Nurse Officer of the USPHS to bring more visibility to the critical role nursing occupies in promoting, protecting, and advancing the nation’s health” is in current legislation before the House (HR 1597) and the Senate (S696). The National Nurse for Public Health has the highest amount of bi-partisan support during this pandemic year than it has had since it’s inception as an op-ed in the NY Times in 2005. Now is the time for nurses to stand up for national leadership to further the nursing profession and in support of prevention and promotion of health and wellness especially in these challenging times. Please take the time to read about these bills and send off an email in support to your Senators and Congressional representative today!

When it comes to pressure ulcer prevention and treatment, traditional risk assessment tools don’t always tell the whole story. As nurses, we know how pressure ulcers can negatively affect patients’ lives. This serious skin condition can not only lead to further complications and higher costs, but also can inhibit a patient’s ability to participate in rehabilitation and ultimately lead an active role in his community.

It’s important to note that the more nurses can do to properly assess pressure ulcers from the very beginning, the better they can do to help promote healing, reduce hospital stays and accelerate recovery time. Obviously, this involves the use of valuable tools, such as the Braden Scale. But we should also implement a good dose of clinical judgment once pressure ulcer risk is determined. Here’s how:

It’s more than just a risk score

The 2014 International Guidelines on the Prevention and Treatment of Pressure Ulcers stress the importance of looking at other factors and not just the risk score when establishing risk levels and interventions for your patients. As mentioned earlier, to accurately determine your patient’s risk, the use of traditional tools alone (like the Braden Scale) is no longer considered to be enough.

Since the current condition of the skin is a key factor to consider when determining risk levels and interventions, the guidelines recommend both risk and skin assessments be completed within eight hours of admission. Anytime a risk assessment is completed, a skin assessment must be done and it should be documented right along with it. This applies throughout the patient’s stay within your care setting.

What else should you do?

When examining your patient’s chances for developing a pressure ulcer, taking note of the current skin condition is crucial. Are there reddened areas that barely blanch, and are they frequently recurring over the same bony prominence? Answering questions like these is important.

We always must look at the bigger picture of risk and then factor in additional information such as psychosocial status, patient size, care setting, support surface, lab data and other sources. Refer to the National Pressure Ulcer Advisory Panel’s Prevention and Treatment of Pressure Ulcers: Quick Reference Guide for risk factor assessment recommendations. In addition, our infographic includes specific recommendations when conducting skin and tissue assessments.

Are you on board?

Using your clinical judgment, along with traditional assessment tools and the tools from the guidelines, is a must when it comes to skin and risk assessment for pressure ulcers.

Graduating from nursing school is one of my most valued accomplishments, as I’m sure it is for most of us. Four years of blood, sweat and tears finally paid off.

As I have heard from new grads, the transition from nursing student to RN is not an easy one. As excited as I am to have accomplished my goal, I’m also fearful. I have learned from talking to my peers that I am not alone in my anxiety about being a new RN. Thanks to my mentors and teachers, I have come up with reminders that can help allay these fears. Hopefully, they will help you, as well.

Fear of making a medication error

Medication errors can be avoided. Technology has come a long way and many hospitals now require us to scan patients and medications before we administer them to make sure they are a match, which helps prevent errors. We can also avoid errors by not taking shortcuts and researching our patients’ medications when necessary. As new grads, we will not know every medication’s prescribed usage, so look it up if you are not sure why the medication is being prescribed or if you are unsure of the side effects. If you are uncomfortable administering a medication, because you feel you need more training on the technique, ask for help.

Fear of saying the wrong thing to a patient

If you worked on developing a good bedside manner throughout your journey in nursing school, this fear will probably dissipate as you gain experience. But sometimes it’s not about saying the right thing — it’s about listening. Never lie to or mislead your patients. If you are unsure of how to respond to a question, tell the patient you will get back to him or her. The relationship between a nurse and a patient should be built on trust; you never want to lose that trust once you earn it. The same thing applies to a patient’s family.

Fear of working with an interprofessional team

Before I started my preceptorship and got the chance to work with an interprofessional team, I was intimidated by the idea of it. But I quickly learned that I had something in common with the team — the patient’s best interests are the No. 1 priority. As long as you are giving the patients the proper care as part of the team, you will be fine. It also is important to respect the people with whom you work. Being a waitress for the last five years has taught me that you do not have to like everyone you work with, but you must respect them. And we must all be open to learning from and listening to our supervisors and peers.

It is never easy to start a new job. We have been preparing for this for four years, and we’re very capable of doing the job well. When a fear creeps up, devise a plan to eliminate it. Then move on to the next challenge.

Now is the time for nursing students to start researching and applying for summer internships. Peers and classmates who have participated in internships may tell you they offer experiences and knowledge you may not get in your clinicals or through classroom lectures, and they’re right. In school, you probably will not witness a patient’s progression of care, while during an internship, you’re likely to observe a more holistic picture of patients as you work alongside a practicing nurse.

For 10 weeks last summer, I had the opportunity to work as a student nurse intern at Roswell Park Cancer Institute on a medical ICU and medical oncology unit. I thought I had an idea of what nursing entailed through my clinical experiences, but my internship helped me understand the depth and breadth of what nursing has to offer. I found that it was one of the best ways to prepare me for my senior year, as well as for my career as a professional nurse, and here’s why:

Benefits of internships

You get to work one on one with a nurse – Nurses usually volunteer to be preceptors, and they gladly share their know-how, while promoting a safe space for learning. Anytime there is a learning experience on the unit, preceptors will try to get you involved in some way or allow you to observe. At the end of your internship, if you have done well, the nurse preceptor could end up being a great reference for your future job pursuits.

You will gain confidence in the clinical setting – You will have the opportunity to practice and perfect clinical skills. During my internship, I learned how to use an infusion pump and stayed on the unit until I mastered the skill. Nurse preceptors may even allow you to perform certain procedures that you practiced only in the skills lab.

You will practice interprofessional collaboration skills – During my internship, I had the opportunity to give report, join huddles, and work with physical and occupational therapists and pharmacists. Working with a broader healthcare team has helped me to understand each profession’s roles and responsibilities.

It may result in your first nursing job – An internship will, at the very least, allow you to familiarize yourself with the acute care environment. The experience also may help you home in on what specialties and settings interest you.

My internship was called a long-term, 357-hour interview. During your internship, your managers, supervisors and staff will notice your talents and perseverance. They might ask you to come back as soon as you graduate or even work as a nurse’s aide during the school year.

Tips for a standout internship application

Given the benefits of an internship, you’ll want to make sure you have plenty to write and brag about on your applications. Here are some tips:

•  In your clinicals, go above and beyond what is expected of you as a student. Inquire if staff needs assistance or if you can observe during special procedures or patient care. A recommendation from a clinical instructor or nurse preceptor is usually required with an internship application, so make sure your faculty and preceptor are familiar with you and what you’re capable of.
•  Know your strengths and weaknesses in the clinical setting. Be ready to explain the details of your clinical experiences on an application and to answer questions about how your patient care has benefited others or how you overcame difficult situations in the clinical setting.
•  Teamwork in healthcare is essential. When you are being interviewed, you should talk about your clinical experiences as a member of the healthcare team.
•  As a nursing student, it is important that you get involved in your school organization. Participate in community service activities, school improvement committees, school program initiatives or volunteer abroad. And make sure your resume and internship application reflects what you have learned.

I highly recommend you start looking for summer internships right now. Apply to as many as possible to expand your choices. If you are already gainfully employed for the summer, I encourage you to apply for nursing residency programs that are offered upon your graduation.