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International Nurses Day is observed on 12 May every year, on Florence Nightingale’s birth anniversary. The contribution of nurses to healthcare is, of course, unparalleled. This year, the global outbreak of COVID-19 has brought it into even sharper focus.
myUpchar spoke to nurses at two big hospitals in the Capital about how this extended battle against COVID-19 has tested them, their working conditions as well as the challenges they have faced in the last few months, especially while dealing with COVID-19 patients. Edited excerpts from the interviews:
Linda Rose Simmy, 24
Staff nurse, Fortis Shalimar Bagh
Work experience: 1 year
How long have you been working in the COVID-19 ward?
Since 26 March 2020. Before this, I was working in the medical ICU (intensive care unit).
What safety precautions are you taking?
I have been staying in the hospital since we started working in the COVID-19 ward. The hospital provides the food, accommodation, PPE kits - everything. We are also following all the infection control practices in a separate area. (Read more: Personal Protective Equipment for different areas in the hospital)
We have also been assigned new shifts: we work in 6-hour shifts. Even though PPE suits help, it becomes difficult to wear them at all times. We work for seven days at a stretch, and then are off for the next seven. That is how the shifts are being managed right now. We are a team of 12 nurses in the COVID-19 facility.
What is your role in the COVID-19 ward?
The hospital created a COVID-19 ward and separate ICU on 26 March. When the first patient came in on 27 March, I was assigned to look after this patient.
What happens as soon as a patient comes into the hospital?
Patients come to the Emergency department. They are asked about their medical and travel history, what kind of symptoms they have been noticing, if they have had fever, sore throat or other symptoms, or if they reside in an area which is considered to be a COVID-19 hotspot.
Next, if the patient tests positive for COVID-19, he or she is moved to the COVID-19 ward.
When does your work begin?
Once the information is passed onto us, we are ready with our PPEs and the emergency staff shifts the patients. One staff is usually able to manage a patient per shift. The doctors are in constant touch with the medical staff and medications are arranged immediately. There are four time-slots for sample collection - 8.30 am, 11.30 am, 1.30 pm and 5.30 pm. We inform the labs and results are sent to the respective hospitals thereafter.
We are doing symptomatic management; if a patient has a fever, we try to reduce the fever with medication and antibiotics, and similarly for other symptoms as well.
How many patients do you look after in a day?
The ratio of patients to nurses is assigned depending on the severity of the cases. The ratio is 1:1 (one nurse per patient) if the patient is on a ventilator or critical care. There is one nurse for two patients in the ICU (1:2), and one nurse for six patients with mild symptoms, who are stable but tested COVID-19 positive. (Read more: Intensive care for severely ill COVID-19 patients)
In the case of a patient admitted in the medical ICU or HDU (high-dependency unit), there is a ratio of three patients per nurse.
Have you noticed anything different in how things are managed now?
There is no limitation for entry of medical staff looking after patients in critical care usually, but there is limited access to COVID-19 positive patients.
Do you see fear or even panic among the patients?
There is panic and fear among the patients, and they constantly ask about their condition: “Will I be ok?” We just try to tell them to trust us and assure them that they are in safe hands.
There isn’t a specific line of treatment available yet, but they are given symptomatic treatment, and our support seems to make them feel safer and stronger.
It is our calling to help these people. There will be fear, but I keep telling them not to panic, keep having lots of water, and to listen to the doctors and nurses. We keep giving them assurances that it will get better.
Read more: How to deal with the anxiety of living through a pandemic
Tell us more about your patients.
Most patients are between the ages of 40 and 50, but 18- to 20-year-olds have also been admitted. There were elderly patients as well.
Last month, two patients turned out to be positive. Both of them were stable, performing activities of daily living without any support. They had a fever but they didn't require oxygenation. They had a history of sore throat and red rashes on their hands, faces and reddening of the eyes. (Read more: What is oxygen therapy?)
They are very cooperative and will recover very soon. They are very courageous, they will fight this disease and recover. They have symptoms but they are stable. They are being managed through symptomatic treatment, doses of antibiotics, checking their TLC count (total leucocyte count) on a daily basis.
In patients who take time to respond to treatment, medicines are given through injection and their food and water intake are increased. If they can’t drink water, IV (intravenous) fluids are administered along with regular doses of vitamins to build immunity. (Read more: What is fluid therapy)
Do you feel your training as a nurse - in college and at the hospital - prepared you adequately for this?
I completed my graduation in nursing from the Government Medical College in Kannur. Teachers tell us to be ready for anything and to be on the frontline during a pandemic. As a fresher, I came here and was posted in the ICU. I had studied the role of support for critical patients and was asked to join the COVID-19 division. I am doing the best I can. In fact, everybody is. We are also praying to the Almighty for this to get over soon and that we are successful.
Is there anything you wish could be done differently?
People are obeying the rules and regulations, this is a worldwide thing. In Kerala, conditions have improved, but in Delhi and Maharashtra, things are getting worse. Kerala took the steps and controlled it by strictly following rules. People need to follow the correct rules and regulations for this to be reduced. This pandemic spread is in our hands, if we fight against this properly we can defeat it.
How does it feel to be a healthcare worker in these times?
I am proud to be a frontline worker and happy that people are recognising our contribution. My family is a great support for me - they have a lot of fear, but they keep telling us that this is our time, and to do a good job. It is because of their support we are able to keep going during this time.
Dr Dhirja Sharma, VP Head Nursing & COE ER Services
Sunita Uppal, AGM Nursing, NQET
Ms Prabhjot Kaur, Assistant Manager, NQET
Max Healthcare
How long have you been operating COVID-19 wards at the hospital?
Dr Dhirja: It has been about a month since we started dedicated COVID-19 wards. While I cannot say how many people are under our care, I will say that we are getting new admissions every day.
What is the experience of working in COVID-19 wards?
Dr Dhirja: COVID-19 wards are very different from regular wards. The procedures involved are different and nurses and personnel must be trained before they can work in one.
One major difference is working in PPE: one must learn the correct way to put on the protective suit (PPE) and get used to working in it. It is heavy and constrictive and can be quite uncomfortable.
We’ve also had to develop new ways to communicate with each other; speech is muffled and even facial expressions are obscured by the protective screen, so we have to use body language to communicate different situations and scenarios.
A shift is 6 hours long here, but it is not really possible to rest during this time. Nurses can’t leave the ward to unwind because they can’t take off their PPE unless the shift is over. Of course, this means that it gets tiring, but that is the nature of the job right now.
On average, how many patients are nurses responsible for?
Dr Dhirja: Depending on the situation, one nurse will look after up to three patients or two nurses could be involved with the care of a single patient. It depends on the condition of the patient.
Do nurses have a choice about working in these special wards?
Dr Dhirja: Once you have been trained as a nurse, it is immaterial what condition is circulating; you have a duty to look after patients and you will carry it out come what may. It has been heartening to see that not a single member of the staff has dithered from their duty and everyone has said that they want to help and do their part combating this pandemic.
What kind of training is given to nurses for COVID-19 wards?
Ms Uppal: More than 30 working instructions have been issued by the hospital that we must follow at all times. We have adapted the guidelines from the CDC (US Centers for Disease Control and Prevention) and the MoHFW (Indian Ministry of Health and Family Welfare) and they involve procedures such as how to correctly disinfect equipment and taking patient readings without putting ourselves at risk. For example, we have been taught how to use thermal thermometers to minimize unnecessary contact. (Read more: Government guidelines for COVID-19 isolation wards)
All nurses must undergo special training before they can work in COVID-19 wards. There is an online training module that educates nurses on the disease and the various safety procedures they must undertake to keep themselves safe. It also discusses crucial interventions that can save the life of patients.
There is a questionnaire and quiz at the end of the modules that the nurses must pass before they work in the special wards. If they don’t make it the first time, they can try again.
Can those in the special wards work in the general wards currently?
Ms Uppal: No, as per government requirements, staff deployed in COVID-19 wards cannot be assigned to work in general wards, and without clearance and training, those from the general wards cannot work in COVID-19 wards.
How has your family and residential society reacted to your job on the front line?
Ms Kaur: My family understands what I have to do, and no one is unnecessarily afraid. I have a young daughter and she keeps telling everyone that Mumma is going to work—she is proud and does not worry that her friends will avoid her. The same is true for those in my society as well—there have been no negative comments so far. There is a sense of worry in the air, but it is not so extreme that it is making people act out.
In fact, there was a nurse who was quarantined for 14 days. After she was released, everyone in her colony came out and applauded her. It was a good gesture.
How do you feel? How have you been handling the anxiety?
Ms Kaur: It is difficult to put into words, it is always a mixture of emotions. Of course, I’m more worried and anxious than usual, but there are also times when I feel totally okay. As a nurse, we have dealt with infectious diseases before—cholera, typhoid, tuberculosis—lots of nasty stuff. It is different this time because it is a new disease and so much is unknown. But in other ways, we are taking care of ourselves as we would have before and our training has equipped us to feel more confident.
What would you like the public to know about the current pandemic?
Dr Dhirja: People shouldn’t be so scared of coming to the hospital. It feels like people are avoiding seeing doctors for fear of catching an infection. We’ve noticed that the regular ward is seeing fewer patients. Unfortunately, this means that sometimes they come late; it is always better to get checked early on if you think that something is amiss. Delaying meeting doctors can really make situations worse.
So, for the public’s sake, we would like the disease to be demystified. For example, people think that if you get COVID-19, you will forcibly be taken from your families and kept in isolation or locked away in an ICU. This is not what happens… Most cases are mild and people make full recoveries at home by resting and looking after themselves. Taking caution is prudent and necessary, but don’t let it come in the way of seeking care when it is needed.
(This year is also the 200th birth anniversary of Florence Nightingale, who is widely regarded as the founder of modern nursing.)
