As a labor and delivery nurse, I see patients at their most vulnerable and am there for them during an incredibly intimate time. After thirteen years, I am still awed and amazed at each birth I am lucky enough to be present for.
But in March of 2020, everything I knew as a nurse changed when COVID-19 reached my small community hospital.
Our struggles were two-fold — making our patients feel safe and making our staff feel safe.
Protecting Patients
During the pandemic, many patients in labor and delivery were scared — scared of COVID-19 and scared of health care providers.
Women didn’t want to come to a hospital full of germs — and risk exposure to COVID-19 — to bring their baby into the world. Patients in some hospitals were told their partner or support person would not be allowed in the delivery room to support them through labor and birth. Some hospitals separated patients from their babies if the patient had, or was suspected to have, COVID-19.
This all led to an increase in home births across the country. Although a 2015 Cohort study shows the vast majority of low-risk pregnancies will have a positive outcome at home, as a labor and delivery nurse, I have seen the devastation that can arise when the appropriate health care professionals are not present during an emergency.
It is crucial that we do everything possible to make the hospital a viable option for birthing patients during the pandemic. Families do not want to be separated during childbirth and the postpartum period. They should be allowed to remain together and bond. Several studies show separation does not prevent or decrease infection from the mother to the newborn. And the World Health Organization and Academy of Pediatrics recommend that families remain together.
Hospitals and nurses should support our birthing mothers and encourage both them and their support person to come to the hospital for the labor and birth of their baby. We must ensure they feel safe and taken care of while they are with us.
Protecting Nurses
In addition to the new challenges in protecting patients, we faced new challenges in protecting our nursing staff during the COVID-19 pandemic.
At the beginning of the pandemic, we struggled to acquire enough personal protective equipment (PPE) to protect our staff. While some physicians came to work with PPE provided to them by their secondary private practices, many nurses had none. Although nurses spend the most time with patients, we lacked adequate PPE.
To ensure there was enough PPE to go around, nurses needed to unlearn everything they had learned in nursing school regarding infection prevention. For example, N95 masks are meant to be single-use. These masks are intended to be used only for the brief period of time the provider is in a patient’s room, and then thrown away to prevent patient cross-contamination.
During the height of the pandemic, we asked staff to keep a single N95 mask on for a whole 12-hour shift, and to re-use it for at least four 12-hour shifts before sterilization. Never before was PPE sterilized and reused, and potential associated risks remain unknown. Nurses were asked to trust this process to prevent them from getting sick and bringing COVID-19 home to their families. Everyone was nervous for their health and safety, and yet nurses and other health care professionals showed up to work each day to care for patients.
Reuse of PPE can affect its efficacy. Nevertheless, during the pandemic, many health care workers are required to wear full PPE when entering a room, even when it might not fully protect us. Moreover, this can have detrimental consequences for patients: In an emergency such as fetal distress or a maternal cardiac arrest, we cannot rush to a patient’s bedside. Instead, we must remain outside until full PPE is in place. This can take minutes, and minutes matter in life-threatening situations.
Ways Forward
The COVID-19 pandemic has underscored the need to rethink and reeducate our nurses on how best to protect their patients and themselves during emergencies. Nurse educators play an important role in preparing staff to respond to a range of potential medical circumstances; now is the time to develop policies and procedures for these now-lived public health emergency scenarios. Above all, this has become clear: we need to find better ways to take care of the people who take care of us.
This blog post was written by a Master’s prepared nurse who specializes in maternal-child health in the northeastern U.S. The author was granted anonymity to protect from reprisal.
This post is part of our digital symposium, In Their Own Words: COVID-19 and the Future of the Health Care Workforce.
