I have joked for years that I wanted to work in a hospital so I could wear scrubs every day. My time has come. I bought my first scrubs today.
In thinking about sharing experiences of working in a hospital during this time, I tried to imagine my private practice days and what information would be helpful as a provider who was seeing patients on the front lines of this pandemic. This is unprecedented. We use our best judgement about the way forward -- but the reality is, we are winging it. We put all of the contingency plans we have created in place and hope that we got it right. We hope we have learned from the countries and states who are ahead of us and who are experience the surge that we know is coming. Additionally, we all need grace. Our patients need grace. Our coworkers need grace. We need to give ourselves that same grace.
As PRN staff, my shifts at the hospital can have gaps of one or two weeks depending on my availability because the need is always there for me to pick up additional shifts. March brought a much needed break from CDP-related travel after a busy first two months of the year, so I had signed up for more shifts at the hospital. I first noticed subtle changes at the hospital in mid-March. There were new directional signs on the elevators. One COVID-19 unit had been created and patients shifted. Our crisis stabilization unit began discussing personal protective equipment (PPE) and what that would look like for us versus other medical units. Staff began discussing anxiety about what was to come. Questions arose about whether we would all have the necessary equipment to keep everyone safe. The emergency room seemed less busy and several shifts passed without me being asked to do a consult.
When I arrived for a scheduled shift the third week in March, things were markedly different. I could no longer use the same entrance, which meant the Starbucks at that entrance likely closed. What happened to those staff members? Temperatures had to be taken before we started our shift. More staff were wearing masks. Visitors were limited (and soon, not permitted at all).
My first task was a consultation on a medical floor, our COVID-19 unit. As I read the chart, it was a patient who had a traumatic intubation. She was also one of us, a staff member. I was not prepared for my first COVID-19 consult to be a co-worker. When I arrived on the unit, and the patient’s nurses showed this Mental Health Counselor how to don all the necessary gear, several comments were made about “Take care of our girl” and “Tell her I’ll come see her when things slow down”. Going in, I was a bit anxious. How was I going to take care of her?
My anxiety dissolved as I listened. Listening is what was needed. She needed someone to be present when she recounted her traumatic experience and reassurance that it wouldn’t always be this raw and scary. She needed to be able to put her experience in context of her job and how her experience might affect how she does her job in the future. I normalized her feelings. I applauded her bravery for asking for help when needed.
I left the consult feeling relieved. Relieved that while this pandemic is unprecedented, what I needed to do to help had not changed. I had the skills I needed to help. I was grateful for this experience, grateful I could help alleviate her fears and grateful that I still had the skills to work with patients with recent trauma. I was also grateful that I had agreed to work a random week-day shift that I typically didn’t cover.
Since that day in March, every shift brings changes in SOPs. Masks went from “recommended” to “required.” Temperatures are taken. Patients access our Emergency Department differently. COVID-19 drive-up testing signs appear. A temporary building appears where I used to park.
Yet, we wait. We wait for our surge. We spend shifts wondering if today is the day. We complete computer based trainings (CBT) to educate us about the pandemic. We spend shifts catching up on CBTs that are overdue. Because our surge isn’t here yet. We wait and watch what is happening on each coast and hope that our surge doesn’t have the dire impact on our communities that the coasts have experienced. We hope that we have necessary PPE. We ask for community members to make and donate cotton masks. We share anxieties about what is to come.
For me, I make the decision about how many shifts to sign up for. How many times am I willing to put myself (and my family) at risk? How many shifts can I cover for an immunocompromised co-worker who can’t work? The answer is: more than usual. I request to be able to wear scrubs instead of my typical dress clothes, so that I can wash them in scalding water after every shift. The reality is that if the social work department is not staffed, nurses take on those duties. Nurses fill out Emergency Detention Order paperwork. Nurses call judges for verbal orders. Nurses and doctors make decisions about whether a patient is safe to go home or needs additional treatment. I, like many of us in the helping field, experience guilt about not being able to do “enough.”
While the pandemic is unprecedented, we can anticipate what health care workers will need based on our work with others who have experienced trauma. There will be survivor’s guilt. There will be acute stress reactions. There will be second-guessing of actions and decisions made in times of crisis. There will be burnout. There will be sadness and grief. There will be intimate partner violence and child abuse. There will be an increase in substance use disorders. There will be insomnia. Sometimes these will occur in the patients we care for. Sometimes they will happen amongst ourselves and our families.
We know how to help these front line workers. Many of you reading this have been through CDP training are trained in EBPs that we know will help these heroes. In order to use these skills we have to give ourselves the same grace and understanding we will give them.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Christy Collette, MA, LHMC, is a Program Associate with the Center for Deployment Psychology at the Uniformed Services University for the Health Sciences in Bethesda, MD.