Frontline

Frontline

I recently volunteered to exclusively work in our main adult COVID ICU (on my old general care peds unit). There are multiple COVID-19 ICUs and moderate care floors throughout the health system. It is terrifying to see two critically ill adults in each room when there used to be one isolette or crib for relatively healthy children. Every night I learn how to do more and more ICU care to help the primary nurses as much as I can. My first night I helped get a bagged body ready for the morgue. My second night I saw family come to the bedside of a man in his 30s to be with him before he passed. Most patients are intubated and several are on continuous renal replacement therapy (CRRT). None of this is fair. None of it seems real. It is very surreal to see room after room with patients maxed out on ventilator settings, sedation, pressors, and barely surviving. In some rooms you can hardly move with all of the IV pumps, machines, supplies, and equipment. I cried the first time I walked the RICU halls, but now feel somewhat immune to the trauma we see at work or watch on TV every day. Then, I find out patients I helped bathe, turn, or draw labs for died that next day and I break down again. My emotions, probably like yours, are all over the place. I can’t always label them but I do know a lot of what I’m feeling is grief. Grief from what our lives were supposed to be like this spring, grief from cancelled events or missed trips, grief from not seeing friends/family, grief from actual death around us, and grief from our old way of life as we transition to a ‘new normal.’

I am thankful however, to have all of the PPE I need to safely enter patient rooms. The entire unit is negative pressure too. This is NOT the reality for many nurses across the US and now some are even getting fired for refusing to work without N95s. While we did sign up for this job to help others, we did NOT sign up to do it without the equipment needed to protect ourselves. Our country was completely unprepared for this pandemic and its essential workers are feeling its detrimental effects the most. The good news is that the curve is flattening thanks to successful mitigation. Please continue to do your part by STAYING HOME until it is deemed safe to leave. You are helping save the world by doing so and the frontline can’t thank you enough. The next time you venture out don’t forget to thank our other crucial frontline staff ~ grocery store employees, postal carriers, truck drivers, bus drivers, chefs, janitors/EVS, and more! Stay strong, we will get through this.

#HAILtotheFrontline

“Just going to hold his hand for a bit, I don’t think he has long.”

FYI

“We know from history that when citizens become restless and protest to their leaders about lifting these sanctions too early, another rise in cases invariably occurs. In some places it was worse than the first peak.” -Howard Markel MD

African Americans represent 40% of COVID-19 deaths in MI but only represent 14% of our state’s population. The reasons for this can be attributed to multiple social determinants of health such as having a job that doesn’t allow ‘work from home’, lower income, fewer community resources, comorbidities etc. (this is Nursing 101)!

Proud of our Governor for creating a task force to help understand why these racial disparities are occurring and how we can remedy them.

Please remember you don’t have to be productive during quarantine. We are experiencing a trauma and your only job is to stay home and take care of yourself. Mental health is as much of a priority as physical health so don’t feel pressured into doing anything you aren’t comfortable doing right now. Two articles helped me understand this: A Trauma Psychologist Weighs In & Don’t Feel Like ‘Getting Things Done’?

*Jaanuu is selling cute reusable, antimicrobial masks for when we all have to wear them 🙂
*Love Your Melon also has a face mask/headband collection and FIGS has a mask waitlist
*What I use to sterilize my phone & watch (PhoneSoap) after work, also sold on Amazon

Coronavirus (COVID-19)

Flattening the Curve

The best way to prevent illness is to avoid being exposed to this virus.

  1. Clean your hands often (for 20 sec) or use hand sanitizer (at least 60% alcohol).
  2. Social distance (at least 6 ft). Stay away from those who are sick.
  3. Stay home if you are sick (for at least 14 days). If not sick, only leave the house for essentials.
  4. Ensure you are reading/sharing credible information via CDC & WHO.

John Hopkins Global Interactive Map

Encouragement

Free lunches for Michigan children found here

Distillers making hand sanitizer found here

Starbucks offering free coffee found here

Crocs donating free shoes found here

Be thankful for your thoughtful professors/teachers who are working hard to make sure you can still learn during this time.
undefined

Friendly Reminders

*There is an extreme blood shortage. You can save a life by donating today via the Red Cross*

Protect your mental health during quarantine

Don’t just “look for helpers.” Be a helper by doing your part to combat COVID-19.

Taylor BSN, RN

Although racial/ethnic minorities make up ~34% of the US population, they only represent ~25% (11.5% Black, 6.1% Latino, 7.3% Asian) of the nursing workforce, as of 2016. 👩🏽‍⚕️👩🏾‍⚕️👩🏿‍⚕️

Diversity among nurses is crucial for providing culturally competent care and in turn, improving health outcomes. We can also help ALL of our coworkers become more culturally aware. One of my goals is to inspire more minorities to choose nursing in order to have a workforce more representative of the US. Having someone take care of you who looks like you, has a similar culture, may speak your language, and understands you can save lives. Every few weeks I’ll feature a fellow minority to share our unique stories.

“When I began at the University of Michigan, I was undecided on what I really wanted to do. I knew I wanted to be in the medical field but definitely not a physician. During freshman year, I was in a Health Science Scholars Program, where I researched multiple careers, listened to numerous speakers, and shadowed physicians but nothing sparked my interest. My grandmother, who is a nurse, told me to research the field and ironically my roommate was in the nursing program. I began doing my research and realized the endless possibilities in nursing. I immediately knew I wanted to be a nurse practitioner working as a midwife (that changed once I did my clinical lol). I decided to apply but was discouraged after listening to other applicants talk about the extra science pre-reqs they had while I only had the minimum. I was also discouraged by my counselor because she told me the nursing program rarely admits students of color. With everything against me, I took a leap and applied. I was admitted into the nursing program at the end of my sophomore year through their RN-BSN sophomore-transfer program. I was excited and a little upset because this meant I would have to do an extra year of undergrad (which means nothing now).

Going through nursing school was tough being 1 of the 7 African American females in a class of 180 students. I believe this increased my drive to exceed. I worked as a nurse tech in the PICU at St. John during my last year of nursing school. I graduated in April 2017 with a 3.7 and passed my NCLEX with 75 questions. Job searching fortunately was fairly easy. I got offered 4 pediatric nursing positions after graduation. These included: PICU at St. John, DMC Children’s ER, Mott Children’s as float nurse, and Beaumont Children’s. I decided to choose Beaumont Children’s because of location convenience and wanting to begin my career on a general pediatric floor, so I could become more familiar with common childhood illnesses and how they are treated.

My interest to specialize in pediatric nursing started while in nursing school. During my pediatric clinical rotation, I gained great insight into what it meant to care for children. I was very intrigued about how passionate the nurses were compared to those in adult nursing. They had to play a unique role in not only supporting their young patients, but also comforting families while explaining patient conditions and providing emotional support. Initially, I couldn’t imagine having the responsibility of facing the family of a seriously ill child and standing with strength enough to not only instruct them on how to best care for their child, but to also help build their faith in the face of, in some cases, a discouraging prognosis. The realization about the innate resilience of children solidified my decision to specialize in pediatric nursing.  It helped me not only feel more comfortable and confident working with the pediatric population compared to adults, it also affected the way I presented while caring for my patients. I became more confident in my ability to encourage families because I began to truly believe in the strength of children to promote healing.

After working for 2.5 years in pediatrics, I have gained so much insight into what it means to be a nurse. I have learned that it takes great responsibility, tenacity, and accountability to care for the life of another. After working for 1 year, I decided to go back to school to get my master’s as a Primary Care Pediatric Nurse Practitioner. This desire was matured through my previous and current work environment. I have passion to work in underserved communities to promote health and prevent/manage childhood illnesses. Working in the city of Detroit and surrounding suburbs has allowed me to see the difference in access to healthcare and health education. I understand that there is a lack of support and opportunity, which negatively affects the health of these communities. This drove my desire to do more and increased my inclination for continuing education among this patient demographic. Working as a CPNP-PC, I will be able to make choices that I believe will benefit the community and turn my advocacy into action. After completing my education, I plan to work in an underserved community providing outreach and educational programs either in clinics or school-based settings. Long term, I plan to participate in local legislative affairs relating to children’s health policy and reform.

Sadly, there is still a lack of minorities in the field. I see this every day at my job. I try to encourage young black girls to keep pursuing this career because although it can be challenging, having minorities in nursing allows for better health outcomes of underrepresented patient populations.”

~Taylor BSN, RN

To Weigh or Not to Weigh?

To Weigh or Not to Weigh?

Throughout my life I have been both overweight and underweight. I have loved how I looked and hated how I looked. If you’re like me, the holidays are an especially difficult time for body image and food guilt. You might be exercising a little more or plan to immediately start dieting in January. However, I just want to send a gentle reminder that food is not the enemy. What you eat fuels your body and mind. What you say to yourself about your body fuels your soul. You are not what you eat, not how you look in a bathing suit, and you are not defined by your clothes size.

To be completely honest, I never cared about my weight until college. I was a competitive swimmer since I was eight years old and on three swim teams during the year in high school. I grew up in a bathing suit and never gave my body shape too much thought. I didn’t grow up with an older sister telling me how I looked or what to wear. My parents never said anything about my weight. I also had practice five to six days each week so I felt like I could eat whatever I wanted. Every Sunday morning after practice I had McDonald’s for lunch as a treat. Whatever I ate was pretty much burned off the next day. Michael Phelps ate over 10,000 calories/day while Olympic training so whatever I ate didn’t compare in my mind haha. I still eat fast food at least weekly and don’t diet. However, I want to make it clear that I never struggled to be an average weight. According to 23andMe (which has been ~95% accurate), I am predisposed to weigh less. I point this out to say that it is not miraculous for me to be average or on the thinner side. I don’t have a great weight loss story and don’t intend to.

My body image journey began around the time I was applying for nursing school. I was struggling with some classes and began seeing a therapist for inattentiveness and OCD-like behaviors. Like Meghan Edmonds recently said, I too am a “stress non-eater.” In combination with a new med I started that had ‘loss of appetite’ as a side effect and drinking coffee for the first time in my life, I began losing weight quickly. I didn’t notice or care at first. However, I decided I was going to try out for the dance team, so I started wearing a leotard again. I would regularly look in the mirror and began enjoying seeing the ribs in my back show. My thighs were thinner than ever and I loved how my leggings looked. The following fall, a friend in my dorm had a scale in her doorway. I truly never tracked my weight until then. I began weighing myself several times a day and panicked if I was over 105. My dorm also had the calories listed for every meal and food item. While this a University initiative to be more transparent, it actually made it a lot easier for me to eat less. I tried to make sure I wasn’t eating more than 1,000 calories a day. This is about half of what someone in their twenties should consume. In addition, I was going to the gym every few days, something I previously hated to do. I tried to wear bigger clothes and hide it as much as possible. My friends and family would make comments about my slim figure, but I usually blamed it on the stress and the questions stopped.

Then, I started dating and began what would turn into a four-year relationship. I slowly put the weight back on. I was eating out a lot, snacking, drinking wine, and pretty much just enjoying life. I didn’t have time to go to the gym and didn’t want to. I started a nurse assistant (tech) job and had a bagel and an Iced Cap every morning before work. I didn’t have my calories listed in front of me anymore, so I lost track of how much I was eating. However, I did have access to a scale. One day at work I decided to look and see. At my highest that summer, I was up to 127. It was surprising, but not enough for me to do much about it. My self-esteem was probably better than at my thinnest. Yet, this weight was not a healthy one for my height. I had a few extra pounds than a “normal BMI” but I was happy. Interestingly, it was the end of this relationship that threw me back in the opposite direction again. I stopped eating, as many people experiencing a trauma do, and lost over 20 lbs. I did not have the intention to lose this amount of weight and I acknowledge that large weight shifts in a short period is not healthy. This is especially true for someone barely over five feet. However, I started to like how I looked in a bathing suit again. I was getting compliments and I felt my self-esteem come back after what was a truly traumatic summer.

As of today, my weight is somewhere in between. I still have my self-conscious days of course, but I am happy with how I look right now. I still occasionally weigh myself, only because I have such easy access to do so at work. I don’t own a scale and never plan to. I don’t think knowing your weight is a bad thing. What is bad, is fixating on the number and affiliating your self-worth with what it says. If weighing your self is good for your own personal goals, then go for it. We all know how to calculate a BMI, so I encourage you to diet or exercise if reaching a healthy BMI is your goal. I don’t belong to a gym but do go to yoga every few weeks. I also have a personal home exercise routine that I do every few days. I try to limit my sweets but treat myself whenever possible. I have been lucky to be able to eat whatever I like since I AM predisposed to weigh less. However, I still try to eat healthy and exercise because it makes me feel strong, healthy, and confident. That is my goal now.

In nursing school, we are taught basic nutrition. In grad school, we have honed in on specific nutritional needs for newborns through young adults. I could tell you all about different formulas, enteral/parenteral nutrition etc. What we have not been taught enough is how to respect your body’s own nutritional needs: how to love and care for yourself in a way that enables you to care for others. We must take care of ourselves before we can effectively take care of our patients. Nurses and other healthcare workers neglect our bodies the most. This has to change or our patients suffer. You have to eat because your brain needs food. Read that again. Your brain cannot survive without food. If you are thinking about skipping a meal because you don’t like what the scale says, don’t. Your body is your prized possession. You will only be hurting yourself, and ultimately your patients, in the long run. Enjoy your holiday potluck without guilt, it’s the best gift you can give yourself.

Night Shift

I’ve only ever worked night shift (7p-7a or 11p-7a) and have slowly gotten used to the lifestyle. I also don’t anticipate switching to days before I graduate. The most asked questions I get are “how do you sleep?” and “how do you stay awake?” I have to preface that I only work two 12-hr shifts per week now. I used to work 40 hours, then 28, and now 24. So naturally your routine will be different depending on how many nights you work. However, I never stayed on a night schedule. In other words, I always switched back to being awake during the day when I was off. My best advice for switching is going to bed right after work and waking up in the early afternoon if not back that night. That way, I’m usually still tired at a normal hour at night. In addition, try to cluster your days so you work several nights in a row to reduce having to switch back every few days. Obviously, this isn’t always up to you but try to request it if you can. I’m a pretty sleep-dependent person so I don’t even try staying awake the whole day after work. What probably makes me so tired is that I don’t sleep or nap before my first night on. I’m up early in the morning (sometimes even go to class all day, sadly) and then stay up all night. I can’t say this is safe or smart, but it’s what works best for me. I am then exhausted and could sleep all day. Thanks to my Fitbit, I know I get an average of about six hours of sleep in between shifts (~ 9a-3p).

Is night shift awful? No. I do miss out on a lot, especially working weekend nights. On my floor we are required to work every other weekend. Yet, it is when my friends work and sometimes gives me enough downtime to do schoolwork. There is a shift differential $$ for working nights which helps make it worth it. I also don’t miss class or meetings since I am never scheduled to work during the day. We do have more patients and a lot less resources though. I also can’t say I haven’t started to fall asleep on the way home. It is terrifying and always makes me say a prayer when I get there. The best way to stay awake in the car is to open your windows and call someone! Call your mom, a coworker, friend, or anyone who will talk to you to make sure you’re still awake. It is also nice for venting after a rough night. Loud music and snacking on something can help too.

How to stay awake at night?

  1. Drink a lot throughout your shift. A nice cold drink every few hours, I like ice water with a Pedialyte powder packet, will keep you hydrated and going to the bathroom. 😉 Coffee, pop, or an energy drink can also help but may give you a crash in a few hours. I always start my shift with a large coffee but switch to water/Gatorade later on!
  2. Walk around. I like to walk for the steps and sometimes (rarely) will do all twelve flights of stairs down and back up. Walking almost always leads me to other people on the floor who I can sit and chat with for a bit too.
  3. Brush your teeth. It keeps me feeling fresh and like I just woke up. It also helps me forget that I’ve been awake for over 20 hours.
  4. Do a quick mini workout. Whether it’s five push-ups or ten jumping jacks, do what you can to get your heart racing.
  5. Don’t study too much. When I’m already tired, reading or trying to focus on anything other than work will almost always make me close my eyes. Maybe online shop instead? Jk…😊
  6. Bring snacks. I am notorious for bringing a small breakfast-like meal (usually only oatmeal) to eat around 1-2 am. Working for 12 hours is like a marathon so bring enough fuel to get you to the end. Especially if you might end up working for 16, small protein-packed snacks are essential. Try cheese sticks, protein bars, almonds, or espresso beans.

How to sleep during the day?

  1. Blackout blinds! This was one of my first work purchases and one of the best things I could have done for my sleep schedule. I got mine here and thought they were super easy to set up and use right away. If these blinds don’t work for your bedroom aesthetic or you prefer natural light, get a sleepmask. They are cheap and often work equally as well.
  2. Melatonin and an antihistamine. I use Nature Made Melatonin (5 mg) and Zyrtec 10 mg when I really need to sleep. Some of my friends take up to 15 mg of Melatonin and others take Benadryl. I don’t use them every day, but they work when I do. Fun fact, Zyrtec will make you drowsy, so we give it to our kiddos at night and pilots aren’t allowed to take it for that reason. If it has “day” or “D” after the name then it is non-drowsy and will not have the same effect.
  3. Shower before bed. I can’t imagine a lot of people don’t, but I need to emphasize it. I use the best body wash from Bath and Body Works, “Stress Relief” (sage & cedarwood). They also have a “Sleep” aromatherapy collection with lotions and pillow sprays that I’ve heard work great. The new ones are Lavender Vanilla and Black Chamomile. Treat yourself to a relaxing, smell-good shower after a busy shift.
  4. Minimize noise if possible. I personally don’t like white noise or the sound of a fan but know there are several phone apps that create these sounds. I also keep my phone on Do Not Disturb until I wake up. Give your friends and family a heads up when you are on a stretch, so they don’t flip when you don’t answer their texts or calls all day. I can never get back to sleep if I’m up halfway through looking at my phone, so I try to minimize sleep disturbances at all costs. Unfortunately, this is easier said than done.