An Assisted Care Nurse: Help Us Be More Florence Nightingale, Less Typhoid Mary by Joy Amy

An open letter to the owners and shareholders of Nursing Homes, Skilled Rehab Facilities, Memory Care, and Assisted Living Facilities and Governor Ralph Northam TODAY March 20th 2020,

The purpose of this letter is not to cause fear or panic. The purpose of this letter is to present information. This is a call to increased action and preparation on behalf of our most vulnerable.

Long term care facilities in America are chronically understaffed for a multitude of reasons that are not up for debate in this message. That is a fact.

The average Nursing Home has 4 units.

Due to staffing issues Nurses and CNA's often float from unit to unit.

CNA'S come into direct physical contact with 15 to 20 seniors a day or more.

Nurses in these facilities will come in direct physical contact with anywhere from 15-20+ residents on a skilled unit, to 20-40+ residents in a long term care unit.

"What does this mean today with the COVID-19 pandemic?"

This means that if a CNA is positive for C19 but asymptomatic, and goes to work on Monday on A unit, Tuesday on B unit, Wednesday on C unit, and Thursday on D unit he or she will have come into direct physical contact with at least 80 vulnerable senior patients.

If they have a different assignment and is floated the same way the following week it is entirely possible for that CNA to have come into contact with 120 residents or more in a two week period.

Wow.

"Now what can we do about this?"

Start treating each individual unit like it's own island. Designate nurses and CNA's to assigned units as much as possible while we are in this crisis. Nurses and CNA's who work on A unit don't float unless it is an emergency.

"What would this do?"

If a CNA or Nurse is asymptomatic but still C19+ they will now have only come into contact with 15-30 people in a two week span vs 120.

"But we don't have enough staff to do permanent assignments!!!???"

Many facilities are staffing 3 shifts.

7-3 has 4-5 nurses and 9 CNA's
3-11 has 4-5 Nurses and 9 CNA's
11-7 has 4 Nurses and 8 CNA's

If staffing is a barrier to permanent assignments for your facility I am urging you to do whatever you can to go to staffing two 12 hour shifts NOW.

"How will this help staffing?"

You will now only need to staff two shifts
7A-7P
7P-7A

You can use your Nurses and CNA's from third shift to overstaff these two shifts in case of call outs, giving each shift an extra 2 nurses and 4 CNA's.

"Great idea but we aren't there yet."

On Monday 03/15/2020
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of the White House coronavirus task force, stated at White House press conference, "The thing that I want to reemphasize ... when you’re dealing with an emerging infectious diseases outbreak, you are always behind where you think you are if you think that today reflects where you really are.”

You are always behind where you think you are.

"What else can we do besides permanent assignments?"

If you have fire doors between units close them. If you don't have a barrier between units create one with a curtain or sheet.

"Will that really do anything?"

It will help remind people to stay on their units.

"What if we need supply's?"

Assign one person at the start of the shift to be the supply person. Have them wash their hands when they leave the unit. Have them wash their hands when they come back on the unit.

"But what about housekeeping and the kitchen?"

Housekeeping and kitchen staff should wash their hands at the start of their shifts and as often as needed. Surgical masks and gloves in hallways. Housekeeping NEEDS to change their gloves each room that they clean. NO WEARING THE SAME GLOVES ROOM TO ROOM.

"Why should facilities do this?"
"This is too extreme!"

Henry Ford said "Whether you think you can, or you think you can't--you're right."

We CAN do more for our most vulnerable residents. We CAN explore EVERY OPTION and come up with solutions BEFORE the CDC recommends them.

We can't preach "social isolation" on the street but let our nursing homes be a free for all where CNA's and nurses come into contact with 100+ senior residents a week.

"But we are using personal protective equipment?"

I'm not going to dignify this with a response because I KNOW that YOU KNOW what I KNOW.

Talk to your staff. See what they are willing to do shift wise to ensure permanent assignments. We love our patients and want to help. Do whatever you can do TODAY to get there. Our patients lives depend on limited contact with potential untested asymptomatic carriers of this virus.

Family members are no longer able to enter our doors Nationwide to visit. If families are willing to sacrifice time with their loved ones to keep us and our patients safe then we need to do everything we can to honor that and decrease the chances of them coming into contact with a constant rotation of changing caregivers whenever possible. Please.

We owe it to the Nurses and CNA's who work on the frontlines at the hospital to do every last thing we can and explore every last available option to slow the wave they are bracing for. Please. Act today. Let's leave no single stone unturned.

Respectfully and sincerely,

A nurse who would like to be a little more Florence Nightingale and a little less Typhoid Mary.

Joy McGee LPN

If you work in healthcare and agree with this message please add your name and title next to mine and share. Feel free to add your state Governor to the list.

*These thoughts and opinions are my own and not a reflection of the thoughts or opinions of my current or previous employers. This is a broad and general statement not directed towards any organization in particular.

We owe it to the Nurses and CNA's who work on the frontlines at the hospital to do every last thing we can and explore every last available option to slow the wave they are bracing for. Please. Act today. Let's leave no single stone unturned.

Respectfully and sincerely,

A nurse who would like to be a little more Florence Nightingale and a little less Typhoid Mary.

https://www.wsj.com/articles/coronavirus-outbreaks-spreading-in-nursing-homes-11584628291