Chief Nursing Officer, Washington County Memorial Hospital
Changing face of healthcare and COVID reporting
I’ve been a nurse for 25 years, and this fall, I’ll have been at this hospital for 11 years. We’re a small hospital, so we all wear multiple hats. Things are always changing in healthcare, especially since the pandemic. The reporting of COVID-type statistics has increased and we do a seven-day a week reporting cycle. The first year, I did my reporting every day: Christmas Eve, Christmas Day, Labor Day. And any random day off during the week, I still logged in at home and did my reporting.
The federal government system is standardized across the nation. We’re looking at bed availability, how many people are on ventilators, how many we saw in our emergency department the day before, how many of those were COVID-related visits, how many inpatients tested positive, how many we have who we’re testing for COVID, and how many we give certain medications to. Then once a week, we report on our PPE supply: the number of N-95 masks, surgical gowns, gloves, and regular masks we have. Since the vaccine has become available, we also report on how many of our employees are vaccinated each week. And it’s not just a cut and dry ‘how many are vaccinated?’ number. It includes how many got their first dose last week, how many have completed the series.
I worked at Missouri Baptist Hospital on the med surg floor right after I graduated nursing school. In the late ’90s, I transferred to another hospital in our community and worked in the operating room and recovery room for about nine years. Then when I had my kids, I was a school nurse for five and a half years. When this hospital did some restructuring of positions, I heard about a job opening, and applied. I worked in employee health and infection control, then became the Director of Quality and Risk Management. I’ve been in this Chief Nursing Officer role since February of 2019.
Healthcare and public health partnership
Some people went into public health because it was more of a Monday to Friday job. You didn’t usually work holidays or weekends, but COVID changed everything, especially at the beginning. Whenever we were all trying to figure out what contact tracing looked like, the urgency of it meant those public health nurses were working so many extra hours and days.
While the Washington County Health Department has always been a partner of our hospital system, I’ve never worked this closely with them, and they offer so many great programs and services. But as far as the public’s opinion of them goes, unless you utilize their services on a regular basis, the health department might seem like background players. People don’t realize the impact they have on our community and what they do until COVID came and there was a public health crisis.
The health department brought in people who had recently retired and got nurses and other staff to help. They had to learn as much as they could as quickly as they could. And just like the rest of us, their guidance was changing all the time and they had to stay on top of things. Plus, they’re dealing with a scared public and having to answer those calls, and we still have to have our normal services running. We still have to take care of patients who don’t have COVID. They still have to give kids shots and worry about lead levels and their WIC program and all of the other things they do.
COVID vaccination rates and vaccine hesitancy
Washington County is one of the lower counties in the State of Missouri as far as vaccination rates go. The last I looked, we were hovering around mid-30% for the general public. For our hospital staff members, it was at about 40%. There is a lot of vaccine hesitancy and it’s for a variety of reasons. Some people still feel like the vaccine approval process was hurried through to get approval. Even though Pfizer is now fully FDA approved, we don’t have it at our facility. I believe our local health department does have
some available now. But initially, they did not because Pfizer has different storage requirements. You have to have an ultra-cold freezer, and there wasn’t one of those in our county. By the time we found that out, there was such a delay in being able to get one, they went strictly with Moderna because it’s a little easier to store.
Some people are concerned about what the long-term side effects will be, which goes hand in hand with people feeling like it was rushed to be approved. Some are concerned about not really knowing what the vaccine is going to mean 10 years down the road. Some think because COVID does have a high survival percentage that it’s worth it to risk contracting it rather than getting the vaccine. And some think since they already had COVID, they should already have some immunity, even though we don’t know how long that lasts. There are so many unknowns. And that’s what’s made it so hard, especially at the beginning when the guidance we as healthcare leaders were receiving kept changing. Whenever we had to change and adapt, depending on the guidelines and recommendations we’re given, it’s hard because we’re all creatures of habit.
Some people felt distrustful, like, "Last week you told me this, and now you’re telling me that. How do I know that in two weeks, you’re not going to say you shouldn’t have gotten the vaccine?" Personally, I got my first dose the second it was available to me and my family. It’s a personal choice, and I definitely believe in people being able to make their own decisions. But, I struggle with people who say they don’t know what’s in it and use that as an excuse. You don’t know what’s in other shots you’ve had and have been giving your children either. Because I live it and see the struggles we face every day as healthcare workers, that’s why I’m so pro-vaccine.
COVID's impact on hospital staff
A staff member at our hospital passed away due to COVID. She was not a direct patient care employee, and the vaccine was not available at the time. But she was a young, healthy woman, and a very positive person. She was so friendly. She worked here longer than me, so more than 10 years. We cared for her at our hospital. And then she was transferred out and didn’t make it. Her family, along with some of her coworkers, purchased a bench in her memory that was placed by the walking track in front of our hospital. It was a way to honor her memory and it's available for anyone in the community to use.
We’ve had multiple staff members who have been admitted and received care here because they had COVID. And it’s hard. I see both sides of it. Some people say it’s harder to care for someone you know because you’re used to seeing them as a healthy coworker. Others feel like, "Because I know you and know what you’re like, that makes it easier to be supportive. It makes me want to give you that extra TLC, maybe sit longer with you, and hold your hand." Still, it’s hard seeing anyone struggle.
And we have to limit our visitors. If you’ve got COVID, or you’re a person we’re testing for COVID, you don’t get to have a visitor. It’s too risky. We all wear our appropriate PPE and know how to protect ourselves, but a layperson doesn’t. They haven’t been fitted to have an N-95 and they don’t have the face shield or how to put on a gown and gloves. So unless someone has had a significant change or we think someone is at end of life, we can’t let people have visitors. One thing we do have that we like to take advantage of is our windows. We’re a one-story facility, so all of our patient rooms have a window, and we’ll do window visits for people. Then at least you can lay eyes on your loved one and maybe talk to each other over the phone.
We try to do everything we can. Whenever I talk with staff, I always say, "What if that was your grandma? What if that was your dad? What if that was your child? What would you want us to be doing for you?" So we try to always put ourselves in their shoes and do what we need to make the situation as positive as we can. Sometimes that takes more time. And when you’re already rushed and have twelve other things you need to be doing, it’s not that anyone doesn’t want to do it, it’s just a struggle sometimes.
Random acts of kindness
Random Acts of Kindness Day was started in 2016 after a young lady in our community committed suicide. Her mom wanted something positive to come out of what happened, so she encouraged businesses to commit to doing random acts of kindness on August 31st. We’ve taken that to heart, and are committed to doing that every year. Typically, we order cookies and then have a list of businesses and other community groups that we want to do a random act of kindness for.
As healthcare workers, food is the way to our hearts. We divide that list up and leaders take the treats and deliver them to people just to thank them for being our partners, to brighten their day, and to show some love. I’ve also seen classrooms that will send a note of appreciation and thanks to their principal or something like that. It seems like the past couple of years that’s been even more meaningful because it’s been a really tough time for everyone.
Supporting healthcare workers' mental health and morale
We have licensed clinical social workers at our facility. They’re available if someone wants to call and talk. Sometimes just talking helps. We’ve done other things for our staff members for no reason at all too. We may go buy a bunch of little mini candy bars and somebody will walk around and give them out. Or, if a department is overwhelmed, we’ll buy them lunch and try to make sure they get a break. Providing food is what we do because, when you’re busy, you don’t have time to run to the cafeteria and get anything. A couple of people from Admin got
some totes and filled them up with little travel-sized pretzels and snacks. We just try to show, "Hey, we’re thinking about you. Thanks for all the hard work. Keep it up!"
And we’ve had fun days too. We had the hospital Olympics on the day of the opening ceremonies. We had a pie-eating contest, a sack race, and different things like that set up on the top of each hour so we could try and get as many people involved as possible. Last week, we had our annual fish fry run by the guys in our maintenance department. It’s available that day for all employees, and they come back and do it during the overnight shift too. We try to always take it to the team at the ambulance district, the Sheriff’s department, and the police station too, just to thank them for being our partners in all of this.
Continuing challenges with the COVID pandemic
The pandemic is so not over. We’re in worse shape now than we were at this time last year. In healthcare, the winter months are always our busier months, but we’re seeing record-breaking numbers in our emergency room. The percentage of patients we’re testing for COVID or are COVID positive are breaking records for our facility. It’s scary knowing we’re going into our busiest time already. And we’re going to get agency staff nurses here because we have nurses leaving and can’t replace them. I know we’re struggling with keeping lab techs also. And then consider if we have a nurse who calls out because they have to get tested or have COVID or have to care for their child who has COVID. That puts us in even more of a dire need to get help.
Our hospital workers are tired. Our patients are sick. And the putting on and taking off PPE every time is draining. Staff is good about it because they know how important it is, but it’s exhausting. You can’t skip it one time because when you do, you’re putting not only yourself at risk, but your coworkers, your other patients, your parents, and your children who you’re going home to. It’s too risky. I want people to know our healthcare workers are doing the absolute best they can, but they’re tired. They’re scared and worried too. And it’s not just in Washington County. It’s every hospital in Missouri. It’s hospitals across the Nation. It’s frustrating because while we’ve had people admitted who were COVID positive and were vaccinated, the majority of them are not.
I know people who are wavering about the vaccine, or against it when they hear those kinds of statistics, and they’re thinking, ‘Why should I get the vaccine when I could still get admitted to the hospital?’ Well, hopefully, you won’t. Hopefully, it will prevent you from being sick enough to get admitted. But if not, hopefully, it will keep you off of the ventilator and you’ll have a less severe case. Because our healthcare workers are caring for people at our facility who, if COVID wasn’t around, would be transferred to a hospital in St. Louis with an ICU. But we don’t have that option right now.
Rural communities' struggles with COVID
Rural communities are held to the same standards with fewer resources. Here in our hospital, we don’t have a large float pool of nurses to pull from if somebody’s sick. We know a lot of our community people aren’t going to go to St. Louis. If they can’t receive the care here, they’re not going to go elsewhere. And that can be for a variety of reasons. Maybe they’re not comfortable driving to St. Louis because they don’t have a reliable vehicle. We’ve got a lot of farmers in our community, and farming is a 24/7, 365 job. Or they don’t have anybody to take care of their animals. We hear that a lot: ‘Who’s going to feed my dog?’ We’ve even had staff members take care of pets for people. So there are challenges, but we’re not afraid to work hard. We’re just tired and we’re trying to do the best we can.
Chief Nursing Officer
NOTE: Jenifer shared her story in fall 2021. Some information about COVID and the hospital response has changed since that time.