Jackie:
The applauding and the clapping…that’s great. It serves a purpose, but it comes to a point where it’s patronizing and it’s borderline disrespectful. You know, it’s great when I’m walking into work and someone’s clapping and I go up to the floor and half the floor is crying, you know, the floor is on fire! So why is everyone outside clapping? We need help.
Nacole:
I’ve been working on COVID units these past few months also, and the phrase the floor is on fire, well, that’s pretty spot on. There are definitely shifts that make me feel like that. Whether you’re an experienced critical care nurse, like myself or a nurse who just floated to the ICU, like Jackie, COVID creates complete and total chaos. And when doctors and administrators do not collaborate with nurses, it gets even worse. It can be hard to speak up, but Jackie did it. And her story really inspired me. And I hope it inspires you as well.
Nacole:
My name is Nacole Riccaboni. I’m a critical care nurse working in Florida and your host for SHIFT Talk. This podcast is brought to you by SHIFT, a new community for nurses ready to make a change. SHIFT is sponsored by the Robert Wood Johnson Foundation. Follow us on Instagram at shiftnursing and for more awesome stories and real talk about nursing, head over to our website at shiftnursing.com. One final note, this episode was recorded in mid-July and things with COVID might have changed between now and then. Let’s dig in…
Nacole:
So, Jackie, what types of systemic challenges did you face as a nurse before COVID began?
Jackie:
I mean, I think the things that I saw in my 10 years being at my facility, and I started as a nursing assistant and probably like a year, year and a half in, I passed my boards and I got a job as a nurse. And even just watching the nurses while I was nursing assistant, you know, I kind of started picking up on things, staffing being one of them. I feel like that’s kind of like the crux of healthcare is staffing is kind of always an issue. And then I think another thing I would say is kind of like the nurse relationship with physicians, and I’m not saying all physicians. What I’ve noticed in my facility is I feel like there’s definitely kind of like a culture of whatever the doctor says goes.
Nacole:
Now you consider this to be a systemic issue. Why wouldn’t you consider it to be specific to that particular hospital? Or have you worked at other ones that you’ve seen these same issues?
Jackie:
I think just like hearing other people’s stories. And I think it’s, it’s more of a culture problem. And like I said, definitely like a generational thing where like older doctors might feel this way, and younger doctors are more inclined to include the nurses and have that conversation.
Nacole:
I’ve had providers even telling me as a nurse practitioner that, you know, you don’t quite understand what’s going on. Like, I’m glad you thought that you could talk to me and that’s cute and I’m glad you feel this way, but I don’t think that’s what this is. So whatever I say goes, and you’re like, okay, well next time I might not say anything.
Jackie:
Exactly. And it’s really mean we’re only speaking out to do…We want to do the best for the patient. And I would say, oftentimes we’re right. And we’re spot on. And the direction that the patients are heading. I mean, there’s countless times that I’ve had a bad feeling and it’s like, oh yeah, that’s cute. Oh, you have a bad feeling? And the patient ends up doing poorly. And that’s not something we can quantify. And I think that’s the problem.
Nacole:
Cause I had a nurse last week say, can you come over here? And I was like, I just started eating. So I put my food away and I go to see the patient. I’m like, she looks terrible. And she’s like, I know, I don’t know what’s wrong, but just come over here…something’s wrong. And I don’t think most like, like you said, it’s a generational thing. They don’t take it seriously. But like you said, 99% of the time you’re accurate in what you’re looking at.
Jackie:
Right. And I think part of it is just because it’s not quantifiable and doctors want those like hard facts, those numbers, and the nurse being like, yeah, this patient just doesn’t look right. Like I have a bad feeling. They’re like, yeah, okay.
Nacole:
Because you know in nursing school we’re taught to treat the patient, not the numbers, not everyone does that apparently.
Jackie:
For sure. For sure. And we definitely have like a more holistic outlook of the patient.
Nacole:
For sure. So tell me about your experiences treating COVID patients.
Jackie:
So the floor that I worked on was kept clean, so to speak. I mean, obviously we would get patients that would come in through the ED and a couple of days later show symptoms. They did have several units that were completely COVID like med-surge areas and then completely COVID positive ICUs. So because my floor has a PCU or a step down unit, the PCU trained staff were sent to the COVID ICUs. Now, a lot of us didn’t have, we weren’t given any ICU experience, we just have PCU experience, which is vastly different from, you know, critical care. So we were floated to these areas. It was super overwhelming. I would say just from like a critical care standpoint. I mean, COVID aside, that’s obviously in the back of your mind and the PPE and all of that, but it was just having to float to critical care areas and not really knowing the layout and not really having any of the training. So that was really the scariest part.
Nacole:
Now, how did you get assigned to the COVID unit?
Jackie:
We were really just floated.
Nacole:
Oh, really?
Jackie:
Well, the staffing office kind of decided that.
Nacole:
It was a mandatory thing?
Jackie:
Yeah. We didn’t, there was no choice in it. There was no choice. It was like, oh, this is what you guys are gonna do. So that was right. So that was, that was super frustrating because it’s like, you go into work. You don’t, you have no idea. You’re not going to be on your floor. You’re not going to be with your, you know, your friends and you have no idea where you’re going.
Nacole:
Floating gives me so much anxiety. Even now, when I go on a new floor, you have to get acclimated and it takes you hours to get acclimated. I couldn’t imagine…
Jackie:
I’ve been doing this for almost 10 years and I still get nervous floating to another med surg floor, another tele floor. It’s nerve wracking.
Nacole:
And on top of that, their COVID patients so that, that whole level of like stress and anxiety is already there.
Jackie:
It’s just another layer that just adds, you know, fear and anxiety when you’re already walking into work. And it’s already stressful. I mean, it’s stressful on a normal day.
Nacole:
I bet. Now, how are you prepared to take care of these patients? Did you get like a week of training or a day or an hour?
Jackie:
You’re funny. Um, so we got, we got like a little crash course. It was probably five minutes and then we were instructed to, Oh, if you have any questions, there are videos and modules online you can go. So yeah, it was, it was, I wouldn’t even say it was a crash course. It was a pep talk. It was a pep talk.
Nacole:
For sure you can do this, be a hero, go ahead and do this…
Jackie:
Yes, exactly.
Nacole:
Now, how was your first shift once you got there? What was your kind of reality?
Jackie:
So I got floated to the medical ICU. I think that was like the first time I got floated and, you know, they were so trying to figure out the role of the PCU nurses that were being kind of redeployed to these areas. So I kind of didn’t know what to do, but I mostly just helped the nurses who, you know, obviously were like scared and overwhelmed as well. I would say I was, I was like super overwhelmed and we were, a lot of the patients were prone, so we had to supinate them. And that in itself is, I mean, that’s super overwhelming. I mean, a lot of these patients are unstable, you know, supinating them is difficult. It’s challenging. And then to see these patients that have been lying prone for, you know, 12-16 hours, you flip them over and you know, they don’t even look, they don’t even look like themselves. You know, they’re just bloated. They don’t look human. And it’s, it was that like, I don’t think I will ever forget that. And I’m not like a frail, delicate nurse over here. But it was like, definitely it was just so overwhelming. I will never forget like just their eyes, their lips, everything is so swollen. And I don’t think anyone has any idea of what we’re doing to their patients and for sure. Yeah. It’s just, it’s scary.
Nacole:
I mean proning a patient, there’s so many complications that people don’t even think about. Like my husband sleeps on his face for like all of 30 minutes and his whole face is swollen. These people are lying on their stomach for 16 hours.
Jackie:
Right. And they’re maxed on pressers and they’re on all these drips.
Nacole:
Very sick. And then sometimes they’re so sick, you can’t even supine them at all. They’re that sick? Oh yeah. I mean, I’ve been in critical care for about six years, so I’m pretty kind of used to it. But even like you said, even then with the whole COVID thing, they’re just so sick, you never forget what they look like.
Jackie:
Yeah, no…I’m never going to forget.
Nacole:
Now what were some of the missing pieces? I know you said that you felt unprepared, but what were the missing pieces as far as you wanting to feel prepared or what you thought prepared look like?
Jackie:
Definitely more training. I mean, prior to us getting like an influx or, you know, the surge of COVID positive patients, um, our census was super low. We weren’t really working at, you know, our mass capacity. So I think that would have been an excellent time to, you know, send us to the ICUs, you know, get acclimated with the units, with the staff so we know someone, um, so that we can really be useful, you know, when we get floated to these units. Cause that was kind of another issue is, you know, when you have these seasoned ICU nurses and you throw a PCU nurse into the mix and they’re like, what are you doing? No, don’t touch my patient. Like you don’t know what you’re doing.
Nacole:
I know. They’re so territorial.
Jackie:
I don’t blame them at all. Like I don’t want…I don’t want to touch your patient, like I don’t know what’s going on.
Nacole:
That’s true.
Jackie:
So, I mean just kind of working those kinks out. And I also think that there’s plenty of, you know, PCU nurses that have aspirations of going to the ICU. I’m not one of them. And I have full transparency with me saying that it’s just not of interest to me.
Nacole:
Now, your cup of tea, I understand.
Jackie:
Not my cup of tea. And there’s plenty of nurses that that’s what they want to do. So I think that asking who would have been interested would have been like polite. And I also, I understand what they were up against. You know, it’s kind of like an all hands on deck attitude, which, you know, in the moment sure, I will rise to the occasion, but I’m not going to float somewhere and stand there and like feel useless. You know, I want to be helpful. So either give me the training or send me back to my floor where I know that I can be useful.
Nacole:
Now, why did you write the article in STAT, speaking out against hospital leadership during COVID?
Jackie:
I was frustrated and I was going into work, you know, day after, day for weeks and I was looking at my peers around me and every single shift someone was crying. Someone was crying on the way in, someone was crying on the way out. You know, I would float to different floors and I would see the same thing, people crying. And I had been vocal and several of us had been vocal and we kind of got the same kind of dismissive attitude, you know, from our leaders and from management of, you know, Oh, I know this is hard, you know, stay in there, hang in there. You know, it was like a pat on the back like, Oh, it’s going to get better…
Nacole:
And here’s a pizza party.
Jackie:
Right. You know, we just have to do what we have to do, which…it felt a little patronizing, to be honest. Yeah and the applauding and the clapping…that’s great. It serves a purpose, but it comes to a point where it’s patronizing and it’s borderline disrespectful. You know, it’s great when I’m walking into work and someone’s clapping and I go up to the floor and half the floor is crying, you know, the floor is on fire! So why is everyone outside clapping? We need help.
Nacole:
Now did you get fired? Or were you reprimanded from you writing this kind of article?
Jackie:
No. So I still work. I’m still employed at my facility. No, I definitely wasn’t reprimanded, you know, I had a conversation with some members of nursing leadership and management and it was an open conversation. It was not authoritative, adversarial at all. It was just a conversation, you know, why did you feel this way? And I guess the most startling part of the conversation was, you know, they were completely kind of unaware of what was going on.
Nacole:
Oh really?
Jackie:
Oh, completely. You know, like we didn’t know. And I had been super vocal for weeks and kept saying, you know, these are problems. This is an issue, you know, that is an issue. How are we fixing this? And every single time I was brushed off. So it wasn’t like, I just, you know, one day went home and just like wrote this article bashing administration, which was not my intent. I just wanted to ignite a conversation of like, how can we make things more efficient and how can we make frontline staff feel appreciated and feel supported? So, I mean, I think I kind of met my goal with that
Nacole:
You did, for sure. Yeah.
Jackie:
I mean the outcome…I’m very happy with the outcome. Nothing happened. I still have my job. I’m very thankful for that.
Nacole:
Now, how did you find the courage to speak out? Like what made you think like, I need to say something?
Jackie:
So it was really just watching my peers, looking at my colleagues and some of them, you know, couldn’t speak out for fear of retribution, what have you. And I was coming home and, you know, I was talking with my family and my fiance and I have a great support system and they kept saying, you know, you need to do what’s right for you. And so I just felt like okay, I’m going to do this. And I kind of like wrote this article. I don’t even, I like almost like blacked out. I just like purged all of it.
Nacole:
It probably felt so good though.
Jackie:
It did. And I wrote it and I was like, all right, well, whatever happens happens. But I definitely could not have written it if I didn’t have, you know, a solid support system and kind of a safety net to catch me. And I know there’s a lot of nurses out there that don’t have that. You know, there are single moms or single dads what have you, they have families, they have bills…Not to say that I don’t have any of that, but I have this safety net that’s going to have my back. So I wrote it for kind of all those people that feel scared or nervous or don’t want to speak out. They’re scared to speak out. So I really wrote it for all of them.
Nacole:
Now, what advice would you give other nurses who are trying to find their own voices in this whole situation?
Jackie:
So I guess the biggest thing with speaking out is you’re always scared that fear and uncertainty of, you know, am I going to get reprimanded? Am I going to lose my job? And I think there’s some facilities where, you know, nurses have been fired for speaking out. Obviously my situation that didn’t happen, and I’m very grateful and thankful for that. But I think that you need to kind of stand up for what’s in your heart. And if you don’t feel comfortable doing something, if you don’t feel comfortable with the situation, you know, we’re taking care of patients and we owe them, you know, that justice. We have to be comfortable and safe in our jobs because then how can we, how can we provide adequate care for them? And that’s really what it came down to for me was I just felt that I wasn’t working to the best of my ability and neither were my peers. And I got in this for the patient at the end of the day, you know, I wanted to do my best to take care of sick and ill patients. And that was kind of echoed throughout the facility was nurses feeling like they weren’t doing the best by their patients.
Nacole:
Because you guys care so much, you spoke up. I feel like if someone didn’t care about their job, they wouldn’t be worried about speaking up. But you guys care so much that you spoke up.
Jackie:
Right. And I think that administration can kind of like use that to their advantage a little bit. They know that we’re never going to leave the bedside. We’re never going to leave our patients because this is why we got into it. And I feel like that part is, you know, I feel like nurses are exploited a little bit in that regard just because, you know, we got into this to take care of patients. We’re never going to leave them. And so they can throw more at us. They can add more things to our plate. And we’re probably just going to sit there and say, yeah, sure. Because at the end of the day, we’re there to take care of people.
Nacole:
Now in terms of the code floor, uh, how did you feel the doctors kind of worked with these patients? Were they in the room with you assessing them or kind of how did that dynamic take place? Was it kind of telemedicine?
Jackie:
It was definitely telemedicine. I mean, so my floor was kept clean and you know, my floor was not like dirty, but hearing from, you know…I got patients from the COVID positive floor that had tested negative, what have you, and even, you know, hearing story from the other nurses, you know, they were calling into the rooms. And I remember I had a patient and my heart just broke for him. He had been there for two or three days and he’d been transferred to me and he said, I haven’t seen a doctor. And yet he had had like a major heart attack. And he was like, I haven’t seen a doctor like I don’t, I just want to see a doctor. They called me on the phone. And I was like, just so infuriated because, you know, I’m sure the nurses on the COVID floor where he was, are gowned up, they’re stressed out, they’re kind of task oriented. They’re going in there. They’re trying to get their job done. And this guy really needed, you know, some like emotional support. He needed someone in there just to sit there and explain things to him.
Nacole:
It’s so scary too.
Jackie:
Exactly. And that, that was kind of like, you know, reiterated, you know, that was kind of like the narrative that was reiterated from, you know, leadership and admin was, you know, Oh, we’re all in this together. like, you know, this collaborative teamwork approach…And, you know, you float to the units, the doctors aren’t going in the room and, you know, it’s falling all on the nurses.
Nacole:
So you felt that it wasn’t a collaborative effort?
Jackie:
I would say, no, not really. I mean, I don’t want to, again, like, I’m not trying to sit here…There were plenty of doctors that were, you know, were gowned up in the room saying to the nurses, Hey, can I hang something for you? You know, can I cycle a pressure? You know, can I empty a foley? I mean, that means the world to…
Nacole:
Oh, I bet.
Jackie:
Yeah. So I think we need to see more of that and you know, less of peaking over the curtain, trying to see the vents…
Nacole:
Yeah. Were you guys able to have patients communicate with their family members via like phone or monitor or iPad?
Jackie:
Yeah, so we, at some point all of the units got their own iPads so families are able to FaceTime. But I mean, in the beginning, when we first didn’t allow any visitors and, you know, I was using my personal phone, you know, before we got the iPads and the iPads were super helpful.
Nacole:
I’ve seen so many nurses do that. I was like, is that your personal phone? And she’s like, yeah, but he wants to talk to his wife. And I was like, you are such a good person. You did not have to do that.
Jackie:
Yeah. Right. I mean, I did it with patients. I know my peers did it with patients. And it’s so funny because you know, sometimes the visitors come in and they’re overwhelming, you know, they can be a lot.
Nacole:
Yeah. They’re emotional.
Jackie:
Yeah. And it’s like, you have another patient, and then you kind of take the visitors away and you know, you have these patients that are so, so sick and they’ve been in the hospital, you know, for weeks, for months. And the family members in those situations would make the world of difference, you know, just motivating them. So I didn’t care about, you know, using my personal phone and I never had an issue with that and I was happy to do it because I saw how much it meant to the family. And I saw how much it meant to the patient.
Nacole:
But it just goes to show you how much nurses care. You didn’t have to do that, but you were like, this is what my patient needs right now. And I’m okay with extending my personal device for you to communicate with your family. I care so much about your wellbeing and your mental health, I want you to communicate with them regardless of what, you know, it takes to get there. Now, how did other nurses treat you when you came onto the COVID unit? Did you feel like, you know, they were kind of open arms, come help us or was it like slightly adversarial?
Jackie:
So I mean, it really, it really depended. The experiences I had were pretty positive, but I’ve had peers that, you know, were floated places and the nurses were like, okay, you can do all the work.
Nacole:
Yeah you can do all the grunt work for us.
Jackie:
We weren’t trained, and we were scared. But I did have some experiences where the nurses were like super willing to like teach me and okay, let’s go into the room together. And, you know, I can do, you know, empty foleys. I can push meds down a Dobhoff, stuff like that. I mean, for me, I had a relatively good experience, but I don’t think everyone had. And it was really just across the board. And like the ICU nurses were super overwhelmed. They’re taking care of these super sick COVID patients. They don’t want to teach us. And it’s, I don’t think it’s a, it’s a really appropriate time. We were just another set of hands is what we were supposed to be. And I think they tried to frame it as like, Oh, this is going to be a wonderful learning experience. And like, no, these patients were sick. They needed experienced nurse taking care of them.
Nacole:
As if you both have all this free time to conversate and look around, like you both have this free time to do these online modules and do this and do that. That’s very impractical.
Jackie:
As if the ICU nurse has time to like, teach me about the vent settings.
Nacole:
For sure. What can other nurses do to address systemic issues kind of within their own organization? What advice would you give them?
Jackie:
You have to be vocal. And I know that’s scary. You have to stand up. I mean, you need to be professional. You know, speaking out can be a bit of a double edged sword because you can come off as, Oh, you’re too emotional, then your message doesn’t get across. So I think you need to go through the appropriate channels and speak your concerns and go up your chain of command, go to your, you know, your charge nurse, your assistant manager, your manager…You have to kind of escalate things. But I mean, my advice would be you can’t be scared because at the end of the day, it’s you, it’s your license. And you’ve got to stand up for what’s right. And you have to do right by the patient, period, end of story. That’s why we got into this.
Nacole:
Now what is your vision for the future of nursing look like?
Jackie:
I would really love nurses to be brought to the table more. And, you know, with physicians, even with administration. We’re the frontline staff, we’re in the trenches and, you know, we need to be brought to the table, we need to be heard. So I think from a physician standpoint, you know, our perspectives need to be valued. We have the knowledge, we have the experience and a lot of times we know what is going to work for our patients and what isn’t. So I would hope that, you know, as time goes on that physicians value us more as a whole. And I do see that getting better. And then as far as administration goes, just bring us to the table. I find that, and I don’t think that this is unique to healthcare, but there’s people at the top and then there’s people at the bottom and they’re the ones on the front lines, and they’re doing all the dirty work. And the people at the top are making all the decisions and they affect the people on the bottom. So we can help, you know, we can, we can help streamline care and policies and make sure things are run more effectively, but we need a voice. We need an outlet. We need to be brought to the table.
Nacole:
Jackie, thank you so much for spending this time with me and sharing your story. It’s going to be a great story to tell all the nurses out there. Your experience is definitely gonna hit home for a lot of them.
Nacole:
Thank you so much. Thank you for having me. I mean, I’m glad I’ve been able to use my voice and I hope I inspire anyone else who’s feeling this way to speak out. So thank you for offering me this opportunity.
Nacole:
Thanks for listening to SHIFT Talk. This podcast is brought to you by SHIFT, a new community for nurses ready to make a change. SHIFT is sponsored by the Robert Wood Johnson Foundation. The views expressed in this podcast are of the guests and host only, and do not reflect the views of the Robert Wood Johnson Foundation. To learn more about our guest and hear more nurses talk about the important issues we’re all facing right now, visit our website shiftnursing.com. And please subscribe, rate and review SHIFT Talk wherever you get your audio content from. Until next time, stay safe and keep being awesome!
