Inside the ICU: A look at COVID-19 on the front line
Kaelee Stone, an ICU nurse in Lincoln, Neb., offers a look at the impact COVID-19 is having on a personal level and on the hospital and the community at large.
Kaelee Stone, a member of our Blue Cottage of CannonDesign healthcare consultancy team, spends three days a week working 12-hour shifts as an ICU nurse at St. Elizabeth Regional Medical Center in Lincoln, Neb., and the rest of her workweek consulting health leaders on how best to plan and operate their facilities for the future. For her, the fight against COVID-19 is personal and professional, with numerous realities in between. Kaelee recently took time from her busy schedule to share insight, inspiration and ideas from her experiences as an ICU nurse treating patients with COVID-19.
Question: Let’s start way pre-COVID. What inspired you to work in healthcare and how did you become an ICU nurse?
Answer: My grandma, Rosella. I distinctly remember when my grandmother was in the hospital for congestive heart failure. I was 14, and it was a scary moment. Each provider we saw seemed to tell her something different. Her care experience felt disconnected and lacked a clear path. From then on, I wanted to keep her and my grandpa out of the hospital as long as possible, or at least until I thought I could fix it.
That experience has always stayed with me and inspired me to work in healthcare. I originally went to school for health administration and worked more on the business and strategy side. But, after six years or so of that, I went back for an accelerated bachelor’s degree to be an ICU nurse. I’ve been doing this two years now. They say anything less than three years and you’re still new – all I know is I learn something every single day.
Q: How do you balance your two career paths of ICU nurse and strategic healthcare consultant?
A: Our leadership has been incredibly supportive of me doing both and I really enjoy having a space in each world to be honest. The nursing work is more scientific and engages a certain part of my brain. It’s personal and deeply human. The Blue Cottage work is more innovation-fueled and works another side of the brain. It’s about large teams coming together for broad-scale systems solutions.
Each informs the other, too. The patient bedside experience helps me understand why large initiatives shaped at the leadership level struggle during implementation. I can also explain to other nurses how capital investments will or won’t impact nurses. It’s a synergistic balance.
Q: What has been the hardest part about working on the front lines of the COVID-19 response?
A: This pandemic is hard for so many, whether you work in healthcare or not. As an ICU nurse, it’s a challenging moment, but it’s also a time when we’re able to help people, innovate and lead in ways we don’t always get to. There’s satisfaction that comes with working at our highest capacity if that makes sense.
One of the major challenges is worrying you’ll be an asymptomatic carrier of the virus. Healthcare staff have to be especially careful to protect ourselves, our colleagues and our communities. That amplifies the isolation so many of us are dealing with in the moment.
Isolation is also extremely amplified for patients right now. COVID or non-COVID, these patients can’t see their families or other visitors. And, nurses are wearing masks everywhere. This challenges us to use therapeutic care in new ways.
Rather than popping in and out of patient rooms for quick moments, I’ve been planning to go into patient rooms for 30 or 40 minutes at a time. I go in for a wound change, medications, etc. and really focus on grouping my cares. I talk with them, I touch their arm or shoulder, I try to get to eye level. I joke that I’ve gotten really good at winking because our eyes are really all the patients can see. I’ve even been able to take an iPad into an isolation room to connect a patient and their family. These aren’t things we always have extra time for as nurses but we’re getting creative and making time for them now because families can’t deliver that human interaction and therapy.
Q: How are you inspired by your colleagues during the pandemic?
A: There is inspiration everywhere. Globally, you see providers volunteering for 21-day shifts in different areas of the world. They’re offering to be away from their families during this crisis even when they don’t know if they’ll have the supplies they’ll need. They just want to help people they’ve never met.
In the hospital where I work, you just have a relentless team committed to doing what’s necessary. In the early days of the outbreak, we had policy changes coming through every couple hours, now they’re daily. We know what to do, we’re evolving, we will overcome – there’s this incredible spirit in the building that gets us through dark moments.
On the Blue Cottage of CannonDesign side, just seeing so many different efforts unfolding has been amazing. We’re offering services pro bono just to help. We’re making masks to protect people. We’re gathering for virtual happy hours. We are all finding our way through this moment together.
Q: What creative solutions have you seen care teams develop to deal with supply shortages?
A: There is limited PPE so we have to really be strategic about when we go in and out of rooms to limit use. So, how do you limit traffic? Here are a few efforts I’ve seen:
- We’ve pulled IV pumps out of patient rooms so we can titrate medications more closely without frequent PPE use. I’ve seen other organizations run their cords through pool noodles to keep them off the floor, limiting infection through the line and limiting personal exposure and PPE use.
- We’re practicing Telehealth in the building. We have virtual nurses and doctors that can talk to patients or assess them without ever stepping foot on the COVID floor. We’re using digital stethoscopes that help them hear patients’ hearts, lungs and more.
- We’re writing on patient room windows just like our architects write on walls in their offices. For example, one day I had a patient with 11 different IV medications. If certain drugs were to run out, it could require urgent action. Others don’t require that level of urgency. So, I wrote on the window which was which so if I was not nearby, other staff could determine if they needed to go in from outside the room. If we don’t have to go in immediately, that saves PPE.
Q: Five years from now, how do you think nursing will be different as a result of COVID-19?
A: I hope nurses continue to take more ownership of their own practice. Right now, with all the pressures on the system, we’re doing our own research, keeping up on the latest COVID-19 treatments and trends in lab values, and operating at the top of our licenses. I hope that continues and nurses continue to lead the way on education and research.
We’re also going to need more nurses. We’ve known that for a while and this pandemic is putting intense stress on current nurses. I hope administrators are thinking about wellness, recruitment, retention, education and training. We need to focus on the wins – how we were able to send Patient X home healthy to their five kids. Hopefully all the attention the medical community is receiving right now inspires even more people to pursue healthcare careers.
Q: How do you shift from work to home, both physically (taking off PPE, what are you bringing/not bringing back to your home, etc) and mentally?
A: As soon as I get to work I get new OR scrubs that can be laundered at work since I’ll be seeing COVID patients. I wear these, and at the end of the day, I take nothing home beyond my keys, phone, etc. I don’t bring my own stethoscope and I leave my shoes at work. Even with wearing different clothes, as soon as I’m home I throw my clothes in the wash, shower with hospital-grade soap and then I lysol the keys, doorknobs, everything I might have touched. I also just clean my apartment and wipe everything down every couple days.
Mentally, it just depends on the day, the week, the patients I’ve seen. It’s always with you. I’ve woken up twice in recent weeks with my hands in the air, dreaming that I’m washing them. I’ve also dreamt that I was a patient, intubated and proned. I just try to not focus on it by Facetiming with friends and family, exercising and keeping up with other hobbies. I try to not scroll social media and the news too much. I can’t change the death rate, but I can help the patients in front of me.
Q: What’s one thing you wish the general public understood better about healthcare’s fight against COVID-19?
A: Even though some communities may not be as affected by COVID-19 as others, it’s very real. And, you can’t discount how hard people are working in countless communities to help patients and address this crisis.
Seeing patients makes COVID very real and people are getting very, very sick. We can’t stop social distancing or ease up. If hospitals in your area aren’t overcrowded, that’s good. That means social distancing is working. Keep it up, keep washing your hands. You never know whose life you are saving.