21 USA, Xihua Huang

Hello I am Xihua Huang an Nurse Practitioner at University of Michigan (U-M) Cardiovascular Centre.

Daily Activities Working with Families

At the height of Covid I was still an RN and I only had COVID patients, because other patients were moved to other units. I was in the Cardiac ICU so all the patients that needed ventilation were there. Every nurse had three patients when there was high patient volume, when usually Cardiac ICU nurses have just one patient. Daily activities included: supervising ventilation, sedation, administering norepinephrine, epinephrine and propofol because regular nurses weren’t trained to deal with these medications.

Shifting Family Nursing Practice

During covid a lot of nurses left the profession due to multiple stressors. One of them being the feeling that you can’t abandon your coworkers by taking time off because if you don’t show up they will bear the burden.  After covid it has been difficult find nurses because a lot left – some went to bedside, travel nursing, etc. In my workplace half of the nurses have left.

There was a lot of emotional stress, many nurses were scared of going home and despite preventative measures all the nurses on the unit got COVID at least once. Patients also had increased stressed levels. One contributing factor was because decreased family support. Only two family members could come for 1 hour if the patient was severely deteriorating, other than that specific case, visitors were not allowed on our unit. Visitors help the patients feel supported and family can improve care if they are with the patient in the hospital – for example visitors could question medications that were at the bedside.

To address this concern our hospital employed the use of iPads. Family education about meds, plans of care and more were communicated with an iPad. Other changes include zoom meetings that were used to discuss with the patient and family members. Family was pretty cooperative and adapted to the use of technology. 50% of patient did not know how to use the iPad so nurses completed patient education about iPad use and also held the iPad for patients who were unable to move. With the iPads, we would still stay with patients and explain to family as well as the patient themselves the treatment plan and answer questions. One positive with the use of iPads was that there is no time limit and patients and families could take for long periods of time. iPads were very key for our unit – every unit had 2-3 iPads. It definitely was a transition to communicating virtually, like communicating a death over zoom, the decision to stop treatment, but overall communication stayed the same.

A change that our unit adapted because of COVID was the use of technology. Before, if family was out of country and could not make it to see the hospital it seemed like a bigger deal compared to now. Furthermore, doctors can come into the hospital less now, we send electronic orders to pharmacy, and iPads are still a mainstay in our patient care.

Lessons learned

The main lesson I learned during the height of COVID was the resilience of nurses. During the height of the pandemic all nurses came to work, the work spirit of nurses was commendable. Despite the numbers of nurses that left the profession after COVID, without their contributions we as a healthcare team would never be able to manage and control COVID.