Is This Procedure Essential? Rationing Care During the Coronavirus

With hospital beds, ventilators, healthcare providers, and personal protective equipment (PPE) in short supply across the country, many states have signed executive orders limiting all elective or non-essential medical procedures, so healthcare providers can focus their energy on treating those infected with the virus. As a result, thousands of patients are now having to postpone various procedures and appointments until the pandemic is under control.

However, determining which patients and procedures are essential isn’t always clear. In some cases, postponing a check-up or medical procedure can worsen patient outcomes. Healthcare providers in some of the worst-hit areas of the pandemic now find themselves having to make complex life-or-death decisions as they respond to both COVID-19 patients and those being treated for other reasons.

As a healthcare provider, if you are asked to ration care and medical services during the pandemic, learn more about this thorny issue and discover some resources to help limit non-essential care at your facility.

New Recommendations for Postponing Non-Essential Care

Several federal and medical organizations have recently issued recommendations regarding postponing elective procedures to help public and private facilities make sense of this trying time.

The Centers for Medicare & Medicaid Services (CMS) recently announced that all non-essential adult surgeries and procedures, including dental, must be postponed during the coronavirus pandemic. Sending these patients home or rescheduling these appointments and procedures will not only help preserve crucial supplies, but it will also limit their potential exposure to the virus.

Which Procedures are “Non-Essential”?

Click here to read the full CMS recommendations for sorting out what to postpone and what not to postpone during the pandemic. The included chart organizes patients according to the severity of their healthcare needs to help providers quickly make determinations.

As an example, the chart reveals that patients suffering from cataracts or those who need colonoscopies will likely have to wait, while those suffering from cancer, transplant patients, and highly symptomatic patients will likely need care right away.

Tips on Limiting Non-Essential Care

The Center for Disease Control and Prevention has released guidelines for reducing non-essential care during the pandemic. The organization has come out with several tips that should help you limit elective and non-urgent medical services during this time:

  • Instruct patients to call in advance of their appointments if they have symptoms of any illness for clinical advice.
  • Review rescheduling and/or cancellation policies to ensure they are aligned with CDC and CMS guidance.
  • Utilize a recorded message when possible advising patients how to self-screen.
  • Use the same recorded message to advise those who have recently traveled to self-quarantine as recommended by the CDC and/or their state or local department of health.
  • Discuss the need to reschedule a planned appointment or to be seen in a different setting, e.g. via telemedicine visit, with patients.
  • Define a common language for staff to use when speaking to patients; enforcing the CDC guidance is necessary, but should not arouse panic. Consider individual patient needs in the context of your practice’s and community’s capacity.
  • Expand prescription medication refills to a 90-day supply when appropriate and consistent with their clinical status. They should contact their pharmacy to ensure medications can be filled.
  • Encourage patients to contact their insurance plans if refills are not initially approved. Several insurance companies have pledged to waive prescription refill limits on maintenance medications.

Every staff member at your facility should be familiar with these guidelines as you and your team continue fielding requests and questions regarding non-essential care.

Blurred Lines 

As helpful as these guidelines might be, some patients are bound to blur the lines between essential and elective. We’ve heard from several nurses and care providers on the front lines of the pandemic who say that carrying out these new recommendations can be difficult and emotionally draining.

A surgeon at Columbia University in New York City recently spoke to CNN about his experiences with rationing care. His team has had to figure out what to do with dozens of other patients who still need his services, including “shunt-dependent infants, children with ventricular septal defects in heart failure, teenagers with bad valves.” In some cases, postponing care could lead to devastating patient outcomes, even if the procedure isn’t deemed “essential.” Providers should assess the risk factors associated with postponing care to avoid certain worst-case scenarios.

One patient started noticing her own irregular heartbeat, so she scheduled two appointments for April to have tests performed on her pacemaker. Shortly after, she received a call from her cardiologist saying the appointments have been rescheduled indefinitely. As she told CNN, “It’s scary, because it makes me realize how reliant I am on a functioning medical system. I took it for granted. I’ve always been around really good care. It’s terrifying to think if anything happened now, it would be completely out of my control.”

The pandemic may lead to feelings of anxiety and helplessness in your patients, especially if they regularly depend on a functioning healthcare system. Reach out to your patients and encourage them to utilize telehealth and other ways of accessing care. Keep them informed during the situation so they have an idea of when they may be able to reschedule non-essential appointments and procedures.

From Graduation to the Front Lines: How You Can Recruit the Next Generation of Nurses

It’s all hands on deck in the healthcare industry. Communities and hospitals across the country are urgently calling for more nurses and doctors to help treat the growing number of coronavirus cases. As April begins, many nursing and medical students are getting ready to graduate next month, which means they will soon be joining the many brave individuals currently serving on the front lines of the pandemic.

Several high-profile medical academic institutions, including New York University’s Grossman School of Medicine and the military’s Uniformed Services University of the Health Sciences, are giving their students the option to graduate early, so they can start practicing medicine as quickly as possible.

If you urgently need more nurses and doctors at your facility to help treat coronavirus patients, learn more about early graduation requirements for seniors, so you can start recruiting the best and brightest in your community now.

The Growing Need for Healthcare Providers

The U.S. is now considered the epicenter of the coronavirus pandemic as hospitals across New York, Michigan, Washington state, and California struggle to keep up with the growing number of patients. NY Gov. Andrew Cuomo recently asked for an additional one million healthcare providers to help contain the pandemic in New York City. Many states and facilities have also started calling on retired healthcare workers as a way of filling in the gaps.

To help bolster the NYC health system, New York University’s Grossman School of Medicine recently announced it is letting some of its students graduate early. One student, Gabrielle Mayer, recently spoke to National Public Radio about her decision to graduate early. Instead of starting her residency in June as planned, she’s now scheduled to start work at Bellevue Hospital on Monday.

Once she finishes a week of onboarding and training, she will start caring for coronavirus patients in a limited capacity. She will start testing patients for the coronavirus and helping the facility better coordinate with local families. Mayer and her fellow recent graduates will be working as interns, but they’ll be serving on less medically acute floors than interns who have already been working at the hospital for 10 months.

The military’s Uniformed Services University of the Health Sciences recently bestowed degrees on 200 newly licensed healthcare providers, including 150 M.D. students and 33 practicing nurses, including clinical nurse specialists, family health, women’s health and mental health nurse practitioners. Graduation for military care providers is still six weeks away, but these talented professionals want to hit the front lines as soon as possible.

According to the military, recent graduates will stay in the national capital region to help with the military’s coronavirus response before moving on to residency programs this summer. The school held its first ever virtual commencement ceremony in March, denying these students the opportunity to walk across the stage. However, the sacrifice is a necessary precaution amidst the pandemic.

LCME Announces Early Graduation Principles for Final-Year Medical Students

Many medical and nursing institutions are considering implementing similar early graduation programs to help get more healthcare providers in the system. The Liaison Committee on Medical Education (LCME), an accrediting body for educational programs at schools of medicine in the United States and Canada, recently unveiled its “Guiding Principles for Early Graduation of Final-Year Medical Students” to help institutions make sure their students are up to the task at hand. Institutions can use this information to determine which final-year students are eligible for early graduation.

If you are in need of additional nurses and doctors, reach out to local nursing and medical schools to see if they are interested in having their students graduate early. If their students meet specified requirements, they may be able to start working at your facility in just a few weeks.

The Decision to Graduate Early

Going from the last year of medical school to serving on the front lines of the coronavirus pandemic may be overwhelming for some students, for whom the decision to graduate early can be extremely personal. They may feel ill-equipped to deal with such a stressful situation once they get out of the classroom. As you go about recruiting final-year med students, remember that just because someone has met the education requirements doesn’t mean they are prepared to serve on the front lines.

Schedule plenty of time for onboarding and training when bringing on recent graduates during the pandemic. Help them serve in a limited capacity at your facility until they feel more comfortable taking on more responsibility.

Work with local academic institutions to learn more about their curriculum and how recent graduates may be able to help out at your facility. Some may have the skills to interact with virus patients directly, while others may need additional training.

A new generation of nurses and doctors is gearing up for what could be the defining moments of their careers. Use these early graduation guidelines to help final-year med students find a place at your facility.

What to Do If You’re Short on PPE During the Coronavirus Epidemic

As the coronavirus epidemic continues to overwhelm hospital systems across the country, many healthcare workers are being asked to reuse their personal protection equipment (PPE) when caring for patients. Others are being reprimanded for bringing in their own safety equipment, including face masks and shields, hazmat suits, and gloves.

With vital medical supplies becoming increasingly scarce around the country, many healthcare facilities have had to tighten, or loosen, their safety requirements. Some facilities are encouraging their workers to improvise on the job by bringing in their own PPE, while others have restricted the use of PPE to ration their dwindling supplies. However, dozens of different organizations and businesses are stepping up to help fill in the gaps, so nurses can find the gear they need to stay safe.

The healthcare pandemic is affecting everyone differently. If you’re in California or New York, you may have been stocking up on PPE for months, but other nurses may be just coming to terms with the reality of the pandemic. The situation will likely get worse in the weeks ahead, so nurses across the country should be preparing for potential PPE shortages just to be safe.

As a healthcare provider, if you are asked to remove or go without PPE while caring for patients, here’s what you need to know:

The Race for PPE Continues

While the need for equipment varies drastically around the country, some states have had to resort to extreme measures. For example, California currently projects it will need 50,000 additional beds and 10,000 ventilators in the weeks ahead. The governor is now asking citizens to donate used or broken ventilators, so manufacturers can get them working again. Other states have also started asking for medical supplies donations from the public. Multiple states have even entered a bidding war for supplies as retailers and manufacturers struggle to keep up with demand.

President Trump recently enacted the Defense Production Act to support the automotive manufacturer Ford in producing ventilators for those in need. The U.S. recently lifted tariffs on Chinese face masks and other PPE, but many have questioned the effectiveness of these masks even though some states and hospitals are purchasing them as a last resort.

If you do not have access to PPE, you may find yourself improvising on the job, but in the end, any means of protection may be better than nothing at all.

Why Some Providers Are Getting Called Out

When it comes to wearing PPE, healthcare workers should be at the top of the list. If they get infected, they might spread the virus to their patients, colleagues, or loved ones unknowingly, further overwhelming the healthcare system. Providers also need to stay healthy so they can continue caring for the growing number of virus patients. Older care providers or those with pre-existing health conditions should be even more concerned about their health, considering they tend to be most susceptible to COVID-19, the disease caused by the virus.

However, some providers are getting in trouble for wearing PPE.

In El Paso, Texas, a 60-year-old anesthesiologist with asthma brought in his own N95 face mask to work. However, hospital officials told him to take it off because he was scaring the patients. He refused to take off the mask, fearing the virus may severely affect his health, but the facility responded by taking him off the rotation schedule. He was eventually reinstated after an investigation by NPR.

Nurses have had to delay the start of their shifts as they scrounge the facility for anything they can use to protect themselves. Providers are also getting in trouble for wearing PPE outside of caring for patients, such as in break rooms, restrooms, hallways, and other high-traffic areas.

Lower-income hospital workers, such as cafeteria staff, janitors, and servers, as well as highly trained therapists and translators are also being denied PPE on the job, with officials telling them “they don’t need them.”

Finding Your Own PPE

If you do not have access to PPE at work or are asked to go without, you may have to find your own source of protection.

If you are just starting to look for PPE, find online retailers that sell face masks, gloves, sanitary wipes and hazmat suits, such as Amazon.com, Grainer, or even Walmart. If you order online, it may take a little longer for your equipment to arrive as retailers struggle to keep up with demand. Avoid hoarding PPE, so other healthcare providers can find the gear they need.

You can try looking for PPE at local hardware stores, such as the Home Depot or Ace. However, the Home Depot has just halted the sale of N95 face masks, citing limited supplies. You can also reach out to local construction crews, industrial supply companies, and maintenance workers. Construction workers need to wear face masks on the job, so they might have some gear they can spare. Try contacting these businesses even if they are closed during the pandemic. Someone might be able to help you find the gear you need, especially during a public health crisis.

Try reaching out to local vocational schools, nursing programs, medical spas, tattoo shops, dental offices, specialty clinics, plastic surgeons, veterinary clinics and other businesses and professionals that may have extra PPE on hand during the crisis.

Use social media, such as Facebook, Instagram and Twitter, to organize a PPE drive in your community. Connect with friends and family members online to ask them to donate whatever PPE they may have lying around the house. To avoid overcrowding and in-person contact, encourage donors to leave their PPE at the door or in another secure location.

Several companies have started collecting PPE donations to keep healthcare workers healthy during the crisis, such as Find the Masks, Mask Match, PPE Link, and Providence, a non-profit healthcare system with facilities across the country. Reach out to these organizations to see if they can help you get the gear you need.

You can also reach out to your local or state government to see if they have any spare PPE. Many states and governments have issued state-wide calls for PPE donations.

If you know of a local company that may be interested in producing and manufacturing PPE during the crisis, refer them to one of these national organizations, so they can start getting face masks out the door. Project N95, Operation Masks, and Open Source COVID Medical Supplies are all looking for local companies to partner with.

Many of you have probably already tried some of these methods for securing PPE. Share your ideas and recommendations for nurses that are having trouble finding safety gear in the comments below.

Making Your Own PPE

The CDC is currently weighing whether to change its face mask policy for the general public. Currently, the CDC only advises those who are sick, older, or those who have a pre-existing condition to wear face masks in public, but telling everyone to wear a face mask may help limit the spread of the virus. However, encouraging everyone to wear masks would only put added pressure on PPE manufacturers.

To help limit the spread, many healthcare workers and individuals are making their own PPE. The CDC has yet to issue clear guidelines for making homemade PPE, but the New York Times recently posted their own instructions for making a homemade face mask. Use this article to make your own face mask with cloth.

Some individuals are using old T-shirts, scarves and loose pieces of fabric as face masks, but this will not give you the same level of protection as constructing your own mask. The mask should fit tight over your face to prevent the spread of germs.

What to Do If You Are Asked to Remove Your PPE

If you are asked to remove your PPE at work, you always have the option of refusing. You may be punished or reprimanded, but you can always invoke the Occupational Safety and Health Administration’s Whistleblower Protection Program if you face retaliation for wearing PPE on the job. Refer to your state’s whistleblower protection laws for healthcare workers to learn more.

While it is your duty to help your patients, you shouldn’t have to put your own life at risk to do your job. Do your best to find and use PPE on the job, but your facility may not have enough to go around. If you do not have access to PPE, do anything you can to reduce your chances of infection; talk to your employer about bringing in your own or using homemade safety equipment. Help is on the way as more companies invest in PPE manufacturing, so don’t lose hope.

NYC Calls for One Million Healthcare Workers After Deadly 24 Hours

New York Governor Andrew Cuomo issued a clear message earlier this week when he addressed the nation: “I am asking health care professionals across the country – if you don’t have a health care crisis in your community, please come help us in New York now.”

The New York hospital system is quickly reaching a breaking point as nurses and doctors race to save as many patients as they can. The governor issued his plea after another 235 citizens died from COVID-19, bringing the state’s total death toll to 1,218, the deadliest 24 hours since the outbreak began.

If you work as a healthcare provider in an area that has not yet been affected by the virus, consider going to New York to help those in need. See how New York City is coping with the pandemic and how you can make a difference.

Checking in on the NYC Healthcare System

The state of New York continues to be the global epicenter of the virus with most of the cases in and around the NYC area. Of the state’s 41,771 confirmed coronavirus cases, 8,549 have been hospitalized and 1,218 have died.

But Gov. Cuomo insists the worst is still yet to come.

Hospitals across the city are quickly reaching capacity. The National Guard of Engineers has just turned the Jacob K. Javits Center, a major sports arena and convention center, into a makeshift hospital. They are now working on building four more emergency hospitals, one for each borough. Officials have also opened up a tent hospital in the middle of Central Park to help patients in Manhattan find the care they need. The USNS Comfort, a Navy hospital ship, also recently docked in the Hudson River. This massive 1,000-bed ship will be used to care for non-virus patients to ease the burden placed on local hospitals that are currently focused on the pandemic.

Hospital staff are also putting patients up in college dorm rooms, hotels, and other temporary treatment areas to help make room for the ongoing surge in coronavirus patients. Across the city, medical staff have been cancelling elective surgeries, relocating and discharging homeless people that have been staying onsite for months, and rearranging the layouts of various facilities.

Some hospitals have had to combine wards and departments to expand their ICU capacity. For example, Lincoln Medical Center in the Bronx had to combine pediatrics and obstetrics to clear up some extra space. Other facilities are trying to relocate psychiatric patients, but these individuals need special accommodations and additional safety measures in place first. The morgues and cemeteries are already overwhelmed with bodies, and the outbreak might not reach its peak for weeks.

Why New York and Why Now?

New York City has been at the forefront of the pandemic since the first cases of the coronavirus arrived from China earlier this year. The city is one of the most densely populated in the world. Germs quickly spread on public transportation, in apartment buildings, and other high-traffic areas, making the outbreak nearly impossible to control.

Gov. Cuomo has repeatedly referred to New York City as the “canary in the coalmine” when it comes to the coronavirus pandemic in the U.S. While NYC may be the epicenter of epidemic right now, the virus will eventually reach less populated areas and more inland cities and states in the weeks and months to come. New statistical modeling shows we’re looking at a staggered pandemic. Various regions will see the apex of the outbreak at different times. That means smaller, more rural cities and hospitals will likely face equipment and staff shortages further down the line, but right now all eyes are on New York City.

If you and your colleagues are watching the outbreak in New York wondering if the same situation could occur in your state or facility, the answer is likely yes.

Over 80,000 volunteer nurses and healthcare workers have already been relocated to the NYC area. However, the city is looking ahead to create what it’s calling a “reserve workforce.” The city desperately needs additional help if it’s going to contain the outbreak. If you’re thinking of helping out the NYC health system, visit the New York Department of Health website to fill out a survey to see if you qualify. The website will give you information on transportation and housing.

The state is also asking for much-needed ventilators and personal protection equipment (PPE). You can click on the link above to sell or donate equipment to New York State. The state is also offering incentives and state funds to companies to get them to manufacture PPE. If you know a company that may be interested, refer them to the link above.

Returning the Favor

The governor said the state of New York will return the favor to facilities and healthcare providers that are willing to make the trip. As the pandemic reaches more U.S. cities and communities, hospitals across the country will likely need additional assistance in the near future. By that time, the situation in New York will likely have been stabilized, which means New York City healthcare professionals and providers will likely travel across the country to help fill in the gaps in these newly hard-hit areas.

If you’re weary about coming to New York to help contain the outbreak, remember that your city will likely suffer the same fate in the weeks and months to come. The governor went on to say, “Today it’s New York, tomorrow it will be somewhere else. This is the time for us to help one another.” Instead of working as separate hospitals and facilities, he suggested, “there has to be a totally different operating paradigm where all those different hospitals are operating as one system.”

As healthcare providers, we may work in different cities and facilities, but we’re all on the same team. Consider helping out those in need before the virus shows up in your hometown.

5 Tips for Caring for the Elderly in Quarantine

Millions of Americans are currently sheltering in place as the country struggles to respond to the coronavirus pandemic. For many, sheltering in place means spending more time with loved ones, including kids that are home from school and elderly parents. Thousands of home healthcare aides have been asked to stay home as well, which means many individuals will have to fill in the gaps by caring for their elderly loved ones themselves. Older individuals may need help eating, bathing, dressing, and taking their medication throughout the day.

The coronavirus (COVID-19) tends to be more dangerous for elderly individuals and those with underlying health conditions. If you suddenly find yourself caring for an elderly loved one during the pandemic, learn more about at-home care, so you can protect your family from the virus.

Help Is a Phone Call Away

Just because you’re stuck at home doesn’t mean you need to go it alone.

Many states have recently increased their telehealth coverage. These services are also covered by Medicaid/Medicare, so you shouldn’t have to pay out-of-pocket. Use these digital tools to monitor and report back on the health of your loved ones. If they start to show symptoms of COVID-19 or their health changes for any reason, help is just a phone call away. Call their doctor and wait for instruction, or of course, make a trip to the ER. About 46% of home caregivers perform medical and nursing tasks. If you’ve never performed these tasks before, contact a professional for tips and assistance.

Keeping Your Home Safe

Your home may need a makeover if you plan on sheltering in place with an elderly loved one. To protect them from the virus, consider having them stay in a separate room or living area. The virus may be able to move through the air. Allocate separate supplies to the most vulnerable members of your household, including dishes, linens, and other household objects to limit the spread of germs.

Depending on the condition of your loved ones, you may need to install handrails, adjust the lighting, or use other elderly care items to keep your home safe. It’s important for an elderly relative or friend to be able to move through the space without hurting themselves. Use adaptive senior clothing, such as elastic waist pants, slip-resistant socks, and assisted or self-dressing clothing, to keep your loved ones safe and comfortable during their stay. Stock up on home healthcare supplies such as thermometers, incontinence products, band aids, sanitary wipes and other must-have essentials.

Managing Your Time

Between working from home, protecting and caring for your loved ones, and homeschooling, time is bound to get away from you as this quarantine stretches on. Set alarms and reminders to help you stay on top of important tasks, such as preparing meals, administering medication, and disinfecting commonly used items and surfaces. It’s reported that the virus can last up to 14 days on surfaces, so look for the extra attention to detail when disinfecting. Remember that bleach needs to sit for 30 seconds to eradicate most germs. Spraying and wiping immediately does not sanitize.

If you run short on time, you may find yourself rushing throughout the day, but don’t overlook the emotional aspects of caregiving. Close to 68% of adult caregivers say they occasionally provide emotional support to their loved ones, while a third say they do this frequently. Staying at home can take a toll on everyone’s mental health, so try to stay positive as much as possible. Focus on helping each other through this stressful time.

Make Time for Self-Care

Research shows an estimated 17-35% of family caregivers view their health as fair to poor. These statistics vary widely based on a number of factors, including the age of the patient, the burden of care, and the existence of preexisting health conditions. The older the patient and the more involved the care, the more your mental and physical health may start to suffer. Additionally, older caregivers tend to suffer more than younger caregivers. An average of 11% of family caregivers report that caregiving has caused their physical health to deteriorate.

Roughly 40% to 70% of family caregivers have clinically significant symptoms of depression. About a quarter to half of these caregivers meet the diagnostic criteria for major depression. Allocate the same time to go for a walk each day. I.e. 4pm for 30 minutes.

Call Before Going to the ER

As the pandemic continues, you may be worried about your loved one coming down with COVID-19 or some other health condition. If you believe your parent or loved one needs to go to the hospital or doctor’s office, you need to call ahead of time.

Contact the office to see if it’s safe to come into the facility or if they have any vacancies. They may direct you to another local facility or give you strict instructions for bringing your loved one into the facility. Depending on where you live, local health systems may be overwhelmed with virus patients. Your loved one will likely contact the virus if you bring them into the emergency room or hospital. Always call ahead before bringing your loved one in for in-person care.

Keep these tips in mind as you adjust to your new role as a caregiver. Having everyone at home may not be easy, but you can all get through if you work together.

How the Red Cross Is Responding to the Coronavirus (And How You Can Help)

March is Red Cross Month, and 2020 is unlike any other year in the history of the organization. Red Cross workers and volunteers are stepping up to help ordinary citizens and the healthcare community combat the spread of the coronavirus. However, the organization is currently suffering from a severe blood shortage. The Red Cross is responsible for around 40% of the country’s blood donations. Yet, news of the pandemic has led to the cancellation of about 4,500 blood drives across the country, resulting in over 150,000 fewer donations.

In light of the coronavirus outbreak, the Red Cross has had to reevaluate its requirements for blood donations. However, the organization remains committed to collecting and providing blood donations for those in need of blood transfusions. Find out how the Red Cross is coping with the outbreak and what you can do to make a difference.

Urgent Calls for Blood Donations

The Red Cross wants to remind the general public that it’s safe to donate blood during the coronavirus outbreak; in fact, it’s encouraged. The organization needs a sufficient blood supply to avoid further shortages. Some donors have expressed reservations regarding the donation process, fearing they may get infected with the virus, but there is no evidence to suggest that blood transfusions can lead to the spread of the coronavirus.

The organization is looking for donations from healthy, eligible individuals, however it is asking those who have recently traveled to China, Italy, Iran, and South Korea to delay their donations for at least 28 days following their trip. Those who have been diagnosed with COVID-19 or have been in direct contact with someone who has the virus should also avoid donating blood at this time. Those looking to donate blood to the Red Cross should schedule an appointment at Redcrossblood.org.

Amid the shortage of blood samples, several U.S. senators, including Sens. Tammy Baldwin, Elizabeth Warren, Bernie Sanders, Kamala Harris, Amy Klobuchar and Cory Booker recently sent a letter to the FDA asking them to reverse the policy that says men who have sex with men need to abstain for at least 12 months before donating the blood. The senators called the policy “discriminatory,” citing the fact that it prevents many healthy gay and bisexual men from donating blood. Thanks to advances in blood screening and pre-exposure prophylaxis (or PrEP), men that have sex with men have a much lower chance of spreading HIV to donor recipients than in the past.

How the Red Cross Is Adjusting to the Virus

New social distancing requirements have forced the Red Cross to change its approach to the donation process. Donors are now spread six feet apart to limit the spread of germs. Workers and volunteers are using proper safety equipment to protect themselves from the spread of the virus, but recent shortages in personal protective equipment, or PPE, have made some volunteers nervous.

With N95 face masks in short supply, many volunteers are using basic surgical masks that are not as effective at stopping the spread of the virus. The act of drawing blood is also an inherently personal process. Nurses and volunteers must get close to the patient in order to retrieve the donation, and some workers are worried about getting infected with the virus.

However, the Red Cross is doing everything it can to put donors’ cares at ease. Staff are cleaning donation tables and equipment after every donation. They are also taking the temperatures of those interested in donating blood. Staff regularly have their temperatures taken, and anyone with a temperature over 99.5 degrees F will be turned away. The organization is also urging donors to schedule an appointment ahead of time to reduce overcrowding. This helps local clinics control the flow of donors, so they don’t pass the virus from patient to patient.

How the Red Cross Is Making a Difference Internationally

The organization extends beyond the borders of the U.S. Red Cross workers and volunteers are helping less affluent communities, including those in third-world countries, prepare for the eventual spread of the virus. They are helping these communities put together quarantine and isolation protocols, so they can reduce the chances of an outbreak. They are also educating individuals about proper hygiene, and fighting rumors and false information, while promoting other community-based programs that can limit the spread of the virus.

The Red Cross is currently urging the U.S. and international organizations around the world to invest in humanitarian actions to prevent widespread “devastation” in the developing world. The organization said on Monday that it will be nearly impossible for countries like Syria, Yemen, South Sudan, Nigeria, and Afghanistan to fight off the virus without outside assistance. These war-torn regions do not have the resources they need to stop the spread of the virus, which could lead to widespread outbreaks across the Middle East and Africa.

Patients around the country need blood donations now more than ever. We can’t let the coronavirus lead to an ongoing shortage of blood donations. If you want to support your local community, consider donating to the Red Cross today. Celebrate the end of Red Cross Month by contributing to the nation’s blood supply.

NOBC Nurse Profile: Pamela Guthman

Pamela Guthman DNP, RN-BC

Wisconsin Center for Nursing, Forward Community Investment

Tell us about your journey to the boardroom. What inspired you to seek a leadership position?

I was nominated for a secretary position several years ago for the Wisconsin Public Health Association, and from there other opportunities have presented.

What are you doing to ensure you continue to grow and develop as a leader?

I try to stay current with the changing landscape in community, public, and population health nursing, especially as related to rural communities, poverty, and the social economic determinants of health. My focus is on primordial, primary, and secondary prevention initiatives intertwined with collaborative collective impact.

What impact have you had serving on a board? 

I provide a preventive, broad health perspective to address issues as related to the lack of living wages, unaffordable and unhealthy housing, and inequitable access to education, opportunities, and health care. This has influenced some alternative strategies related to funding priorities for some of the boards. I have also brought the reality of what rural, aging populations are experiencing in regard to the determinants of health.

What do you think is the most significant barrier to nurses serving on boards?

Lack of knowledge/skills in this area, lack of adequate salaries and reimbursement to support travel and board level engagement by very busy and overwhelmed nurses, and lack of awareness of the substantial education, knowledge, and skills professional nurses have.

Why do you feel it is important for nurses to serve on boards?

There have been too few nurses at the table to discuss health care and health care needs, especially in regard to understanding the difference between the focus of nurses and medicine. Our patients’ health care interests are being represented in tertiary (treatment) care vs. prevention and health promotion. As licensed nurses, we have failed our clients/patients because we are not fulfilling our professional legal responsibilities as leaders advocating for the needs of vulnerable populations.

What do you think is the most significant barrier to nurses serving on boards?

Lack of knowledge/skills in this area, lack of adequate salaries and reimbursement to support travel and board level engagement by very busy and overwhelmed nurses, and lack of awareness of the substantial education, knowledge, and skills professional nurses have.

This article is part of our ongoing partnership with the Nurses on Boards Coalition (NOBC), formed to improve the nation’s health through the service of nurses on boards, commissions, and other decision-making entities. NOBC wants to see nurses occupy at least 10,000 board seats in 2020. Scrubs Magazine is committed to helping NOBC reach this goal by informing, educating, and inspiring nurses and nursing students to take on leadership roles at all levels. Find out more at NursesOnBoardsCoalition.org.

ICU Nurse Takes Her Own Life After Caring for Coronavirus Patients

King’s College Hospital in the United Kingdom has just lost one of its ICU nurses to an apparent suicide. The facility has seen eight patients die of coronavirus since the outbreak began, bringing the country’s death toll up to 422.

The woman was in her 20s when she took her own life. Authorities have yet to release her name out of respect for the family’s privacy. Officials believe she was working in the same ICU where coronavirus patients were being treated. The facility was quickly running out of ICU beds at the time of her death, but it’s unclear whether the incident is related to the outbreak.

The U.K.’s National Health System is quickly ramping up capacity around the country to help providers care for the growing number of coronavirus patients. The Army is considering turning the country’s ExCel Conference Centre in the Docklands into a field hospital, which would accommodate up to 4,000 hospital beds.

As we react to this tragic death, we’re shining a spotlight on the mental health of care providers during this ongoing crisis. If you or someone you know is suffering from depression or experiencing thoughts of suicide, find help before it’s too late.

Mental Health in the Age of the Coronavirus

Why does a 20-year-old nurse at the beginning of her career take her own life? It’s possible that the stress of caring for coronavirus patients started to weigh on her. Without enough personal protection equipment to go around, many U.K. healthcare providers are putting their health and safety at risk as they care for virus patients. Providers are going without face masks, hazmat suits, and other essential safety gear. This also means providers could be spreading the virus to their loved ones without their knowledge, which only adds to the stress of caring for patients.

For some healthcare providers, particularly new nurses, responding to the outbreak may be more than they can handle. Some providers may feel traumatized or overwhelmed by what’s going on around them. After all, most nursing schools don’t teach their students how to prepare for a situation like the coronavirus outbreak. The global healthcare industry is truly in unknown territory, and some providers may have trouble going to work as normal.

Tips for Dealing with Stress, Anxiety, Depression, and Thoughts of Suicide During the Coronavirus Crisis

Studies show depression and other negative emotions tend to be more common among healthcare providers compared to the general public. Prevalence rates of depression, anxiety, and stress were found to be 32.4%, 41.2%, and 41.2% respectively. Depressive symptoms also tend to be more common among U.S. healthcare workers than those in other countries. For example, around 35-41% of nurses in the U.S. suffer from depression, while just 10% of Canadian nurses feel the same way. Poor mental health can affect patient outcomes as nurses struggle with the task at hand.

Use these tips to monitor the health of your team as you continue responding to the coronavirus outbreak:

  • Keep an eye on your fellow healthcare providers throughout the day, especially if one of your colleagues loses a patient to the coronavirus. Ask them how they’re feeling and encourage them to take a break, if possible.
  • Talk to your staff about managing their emotions during the outbreak. Make sure your team has access to mental health resources, including counselors and social workers. Do not ignore signs of depression, anxiety, and hopelessness even as you and your team work overtime to respond to the outbreak.
  • Make sure your team is up to the task at hand. If a nurse is having trouble working with coronavirus patients or in the ICU or ER, consider moving them to another department or ward where they could be more useful.
  • Encourage your team to stay healthy outside of work by eating a balanced diet and getting enough sleep. Tell them to avoid overusing alcohol and other substances that may worsen symptoms of depression and anxiety during this time.
  • Encourage your team to talk about their emotions with their loved ones. If their spouse or roommate notices unusual behavior, depressive symptoms or a sudden change in mood, they should bring it to their loved one’s attention.

The wellbeing of your fellow nurses can change on a dime during this crisis. Someone may appear fine one minute, only to lose their cool a minute later. We are all under a lot of pressure at the moment, but we can still be there for each other. Support one another and be respectful of each other’s emotions during this stressful time.

Why Some Doctors Are Prescribing Themselves Hydroxychloroquine (And Why It Needs to Stop)

When it comes to treating the coronavirus, we’ve heard a lot of enthusiasm for an existing drug known as hydroxychloroquine, or hydroxychloroquine sulfate, sold under the brand name Plaquenil. During a limited unblinded study, the drug was able to reduce flu-like symptoms in around 70% of coronavirus patients. President Trump praised the drug at a recent press conference, calling it a potential “game-changer”. However, Dr. Fauci of the National Institute of Health is urging caution. The drug has yet to be tested on a wide variety of patients.

Hydroxychloroquine has been used to treat malaria and rheumatoid arthritis for decades, but now some patients are having trouble filling their prescriptions at local pharmacies. The culprit?

Doctors, physicians, and nurse practitioners have been stockpiling the medication and prescribing it to themselves as a way of protecting themselves from the virus. Not only are these care providers putting themselves at risk by using an untested drug, but they’re also depriving non-virus patients from the drugs they need to survive. It’s time to put this trend to rest.

Rising Demand for Hydroxychloroquine  

As soon as President Trump finished his press conference on hydroxychloroquine, demand for the drug skyrocketed around the country. Todd Brown, executive director of the Massachusetts Independent Pharmacists Association, recently commented on the situation: “Our members are definitely seeing more demand for this medication and possibly some people trying to hoard the medication. Pharmacists are seeing an increase in requests and prescriptions for them, in instances where it’s not clear why the patient needs it at this time.”

Hospitals and doctor’s offices are gathering large quantities of the drug in case it becomes an effective treatment for COVID-19. Yet, several states, including Texas, Louisiana, Ohio, North Carolina, Nevada and Idaho, are trying to limit the number of inappropriate prescriptions and preserve supplies for patients who take the medicine as approved.

In many cases, healthcare providers seem to be prescribing themselves the drug in case they need a fast way to treat the virus as this pandemic continues. Across the country, thousands of healthcare providers are going without the protective personal gear they need to protect themselves from coronavirus. These providers are worried about putting their health at risk and passing the virus on to their loved ones. Stockpiling hydroxychloroquine may seem like a good insurance policy against the coronavirus, but this behavior is considered unethical, to say the least.

Even if hydroxychloroquine becomes the treatment of our dreams, officials say the drug needs to be preserved for those that need it most, including patients that have the best chances of recovery. Stockpiling hydroxychloroquine also deprives non-virus patients of their medication, including those recovering from malaria, lupus, and those with rheumatoid arthritis. These patients need to take hydroxychloroquine daily to reduce swelling and rashes.

Without an adequate supply of the drug, these patients will begin to swell up and flare. They may then need to go on immunosuppressants or be admitted to a local hospital, which would only increase demand for healthcare services at a time when many facilities are already at or reaching capacity.

The Potential Risks of Using Hydroxychloroquine to Treat COVID-19

Health officials from NIH and the CDC were sending out large quantities of hydroxychloroquine to care providers as part of the Compassionate Use Program, which allows the prescribing of unapproved medications during public health emergencies. However, they have since limited unapproved use of the drug to protect the health of the nation.

That’s because hydroxychloroquine comes with some serious side effects, including headache, dizziness, ringing in the ears, nausea, vomiting, stomach pain, loss of appetite, and weight loss; it can also lead to heart and liver problems when mixed with other medications. Some patients have even suffered heart attacks as a result of taking the drug. Other care providers may be allergic to the drug without their knowledge, thus inhibiting their ability to care for patients.

Putting This Trend to Rest

Pharmaceutical companies, including CVS, are currently monitoring the nation’s supply of hydroxychloroquine to make sure it ends up in the right hands. The FDA is still a long way away from approving it as an effective treatment for COVID-19, so health officials need to stop hoarding this medication immediately. They could endanger themselves or their patients without realizing it.

If you believe someone at your facility may be hoarding or prescribing themselves this medication, report it. Consider implementing strict guidelines for prescribing and using hydroxychloroquine at your facility to ensure it is used properly.

As difficult as it may be to care for coronavirus patients without the proper safety gear, don’t let your fears get the better of you. We still need to follow proper protocols and use medication according to FDA guidelines. If we all follow the rules, we will all get through this ongoing crisis together.

“This Is My Tribute” – A 5th Grader’s Letter to Healthcare Workers

Across the U.S. and abroad, individuals are staying at home to diminish the spread of the coronavirus. Sheltering in place isn’t just about protecting yourself from the virus; it’s also about protecting other individuals, thus easing the burden on the local healthcare system. For many of us, staying inside is our way of showing our support for the healthcare community and for each other, but some people can’t help but share their words of gratitude.

Simone Winter has been at home since California enacted the shelter-in-place order early last week, but she’s been learning a lot about the pandemic from afar and how it’s affecting healthcare providers. She decided to write a letter to the nurses in her area to show her appreciation:

We thank Simone for her message of gratitude during these troubling times and encourage her to pursue her dream of practicing medicine. Our heart goes out to all the nurses and healthcare providers out there helping their communities through this crisis.