Return to the Hospital Setting

This past week, I returned to the hospital setting with my cohort after nearly a month being off the floor, away from any direct patient care. We were at a hospital to volunteer and support various departments in whatever capacity they needed. Eagerly and without knowing much detail, we got assigned to various units that day, attended a brief orientation, and assigned ourselves to numerous 12-hour shifts through mid-May.

Wearing the hospital-provided surgical mask over my personal cloth mask and glasses for some eye protection.

To give some background, all my clinical rotations were indefinitely suspended on March, Friday the 13th, due to the global pandemic. I would have never imagined that the pandemic would cause life-altering changes here in the United States for so many. For me, I still wanted to be nurse, but without the patient-interaction provided by my clinicals, my ability to graduate from nursing school was threatened . (The California Board of Registered Nursing (BRN) requires at least 75% of clinical hours to be with patients). As news of the pandemic began to worsen, however, I was relieved to be able to stay safe at home and not have to be in the hospital setting.

Honestly, during the first couple weeks of “stay-at-home” orders, I couldn’t prioritize school or graduation requirements when I felt like I was scrambling to survive and keep my family safe. After the orders were announced, my daughter had come down with a high fever (105 degrees) and started vomiting on an evening my husband was asked to go into work. My husband was sent home, thankfully, and my daugher seemed to gradually improve. A couple afternoons later, however, my daughter’s fever spiked again to 104/105 and she began coughing in her sleep. I listened to her lung sounds with my stethoscope, and I was convinced I heard wheezing in her upper lobes. Her fever broke early that morning, before dawn. I was still worried, so I reached out to her pediatrician. We were able to conduct a tele-visit with her doctor’s office who wrote a prescription, and my daughter has been well the past three weeks. The week after my daughter got sick, I took my 77 year old father to urgent care (for completely separate symptoms). In those first couple weeks, I used my nursing skills and tools to take care of my family. I prioritized family over school or studying for my future career. I was happy to use my nursing knowledge to focus on my family because I did not want to jump back into clinicals with all the uncertainty and seemingly unsafe conditions.

There was so much unknown about the virus and what was required to keep people safe. Should droplet precautions or airborne precautions be used? Even if the type of protection needed was consistently defined, personal protective equipment (PPE) was not readily available. A month before my cohort was called off the floor, hospitals were already asking their staff (and nursing students) to reuse their N95 respirators when dealing with airborne precaution patients. I preferred not to work with these patients because it made me uncomfortable to see a piece of intended-for-single-use equipment used repeatedly. I didn’t want to have to re-use a mask and increase my chances of contamination. With the pandemic, it has unfortunately become normal practice to re-use a mask or have a single mask in a 12+ hour shift because of the PPE shortage.

With what I was witnessing, hearing from the news, and learning from personal accounts and advice of nurses, it seemed best to stay away from direct patient care. I was willing to accept that it might take me longer to get my BSN than I planned. The health and safety of my family is more important than graduating with a BSN on an earlier timeframe. I was okay with taking classes online and patiently waiting when we could safely return to the hospital.

Then, at the end of March, the governer of California called for student nurses to join the Health Corp. I felt compelled to join and signed up. While I’m not a licensed RN, I am a nursing student about to graduate this year. I recognize I have a special set of skills and training that can be useful in caring for patients compared to someone without healthcare experience or education. I signed up with the comfort of knowing I could turn down a deployment. I also signed up because my school (and the BRN) said the volunteer hours could count towards the required direct-patient care clinical hours. I reasoned, “They wouldn’t put student nurses in unsafe conditions, would they?” In reality, the BRN is not set up to protect nurses; The BRN exists to protect patients. Ultimately, I know I need to rely on myself to be protected and safe.

I want to keep my family safe and not expose them to this virus or other illness because of my chosen line of work. Being a nurse lends itself to some risk, however. Nurses and other healthcare professionals are exposed to patients with communicable diseases. Before, the level or risk was acceptable because we had proper PPE available, vaccinations for most things we could be exposed to were offered, and effective treatments known. With COVID-19, the safety measures that made the risk acceptable of working with contagiously ill patients were diminished. After serious thought, I determined I still wanted to be a nurse; I hope that once I’m an RN, conditions are greatly improved.

As a student nurse, I’m fortunate to have the choice to stay home and not go into the hospitals. Because I’m not yet an RN, I’m privileged: I can’t lose a license I don’t yet have, and I can’t lose a job by refusing to work with patients at this time. I figured, if I’m truly uncomfortable and feel compromised, I can walk away from a volunteer position. My school isn’t forcing us to return to the hospital but explained that if we do, we can have our hours count towards our missed clinical hours. They presented us an opportunity to return to the hospital setting, separate from the California Health Corp. We were told we would have PPE provided for us, and we would not be on the COVID units. With all of that under consideration, most of the students in my cohort (including myself) decided to return to the hospital setting last week.

I was conflicted; I cried and prayed over my decision to return to the hospital setting. I love my family and want to do what I can to protect them. I have a husband with diabetes and a preschooler. I have parents over 65 for whom I’ve become their personal shopper to enable them to stay in their home. People for whom I am responsible and love dearly are considered vulnerable populations for COVID-19. I also feel strongly that I am supposed to be a nurse, despite the risks involved. God put in my heart a desire to help people and this is the best way I know how at this point. I am not yet a nurse, but I’m asked to use my training and nursing skills I’ve learned to help others. I don’t want to do it foolishly, and I take this opportunity to serve very seriously. I pondered over this opportunity with my husband and parents. Nurses are short-staffed and could use help. My classmates and I can offer that.

I miss working with patients; I am simultaneously excited and scared. I am anxious about the chaos I might encounter, but also hopeful to help fight this pandemic and support healthcare workers and other patients. At times, I get a little panicked, but mostly, I’m at peace with the choice I made to return to the hospital setting and continue with my pursuit of becoming a nurse.

These are such extraordinary times. The news and what we know about the corona virus keeps changing. I have additional training this week and will start my first shift later this week. The opportunity to be in the hospital gives me more reason to focus on assignments and overall learning to be more prepared once I’m on the floor. Who knows if I will change my mind and want to leave the hospital setting as a volunteer student nurse? A fundamental part of the nursing process is asseessment, and I’m constantly assessing my situation. Either way, I will continue to proceed with caution, but also with the confidence that I have skills and training that can help other nurses and patients.

If you pray, I would appreciate prayers for me, my classmates, and my family’s continued protection and safety. Also pray for guidance for nursing students as we apply our training into practice to support the current workforce. Thank you, be safe, and please continue doing what you can to flatten the curve!

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