key: cord-1021384-alnk7irx
authors: Resnick, Barbara
title: Reflecting on the impact of COVID-19 on nurses
date: 2020-12-05
journal: Geriatr Nurs
DOI: 10.1016/j.gerinurse.2020.12.001
sha: 7ba7f50b1bc52c59d7d71ee2824be153587453a6
doc_id: 1021384
cord_uid: alnk7irx

nan

Reflecting on the impact of COVID-19 on nurses As a geriatric nurse I am sure you are all aware of the impact of COVID-19 on older adults whether living in home settings, group homes, assisted living or nursing home settings of care or when hospitalized. I want to take a moment to reflect and acknowledge the impact that COVID-19 has had on our nursing community overall. A recent Morbidity and Mortality Weekly Report 1 based on data from health care personnel in Minnesota showed that higher risk exposures to COVID-19 were associated with direct patient care (66%) and non-patient care interactions such as interacting with coworkers (34%), both common activities performed by nurses. Within 14 days of high risk exposure approximately a third of these individuals had symptoms and 50% were positive for COVID-19. Of those exposed and working in residential and long term care settings 57% returned to work even while still symptomatic. Of those exposed to COVID-19, 40% were direct care workers and 30% were licensed nurses. Unfortunately we are not just exposed to COVID-19 from our residents but equally so from co-workers.

Based on a national report from another Morbidity and Mortality Weekly Report 2 it was noted that among health care providers with COVID-19, 30% were nurses and 67% of these individuals worked in residential and nursing care settings (i.e., nursing homes and assisted living). Among all health care providers those who were COVID-19 positive mostly were female (79%), 16 to 44 years of age (57%), and not hospitalized (92%). The death rate among health care providers was only 1% of cases and the deaths were more common among those who were older, male, Asian or Black. These statistics just address the physical impact and disease incidence among nurses. The psychological impact has taken a toll as well and includes depression, anxiety, insomnia, burnout, what has been referred to as Secondary Traumatic Stress 3 . Secondary traumatic stress can occur when a nurse is exposed to a survivor who has been traumatized or to traumatic descriptions of events by a survivor. As nurses we are continually exposed to patients, loss of patients and grief or acceptance of these losses among families, particularly during a death experience that excluded the family due to restrictions around COVID-19.

Bottom line as geriatric nurses we are directly and highly affected by COVID-19. After just getting back to allowing some family visiting and resuming some activities within facilities for residents we are now experiencing a daily increase in cases in the community as well as within our settings. Although it varies by state, rigid restrictions are being reinstituted for the safety of residents and the protection of staff. YES we must think about protection of nursing staff as well as other staff in long term care.

Going into this second round of battle with COVID-19 and waiting for the impact of flu with COVID-19 we need to remind ourselves and each other of ways to prevent disease spread. I won't go into the debates over the best mask to wear but encourage all of us to just keep the mask on not just when working with patients or residents but also when talking with and meeting with co-workers. Nurses stations and offices and break-rooms are often small and don't allow for sufficient distancing space to be mask free zones. Safe eating and drinking areas need to be provided or timing of meals and breaks done so that there is no risk of caregiver to caregiver exposure. Strict guidelines and adherence guidelines should be established to assure that no staff come into work with symptoms and that these individuals are rewarded for staying home! This is a very different perspective and approach that we have traditionally seen in these settings. Additionally wearing of face shields or goggles, gowns and head covering should also be done particularly for those working directly with COVID-19 positive residents. I encourage all of you working in these environments whether as direct caregivers or in administrative roles to serve as role models for use of personal protective equipment and remind your colleagues to do likewise. We have so few nurses with an interest and commitment to geriatrics we certainly can't afford to lose even 1%.

I have personally been experiencing COVID-19 as a nurse practitioner in a continuing care retirement community, as a faculty member with a focus on graduate students particularly adult/ gerontological nurse practitioners and in research projects across all health care systems. I, like many of you, deal with the impact for residents, for us in nursing and for families of residents. My own mother died during the pandemic in an assisted living facility, not due to COVID-19 but following a six month period in which we were unable to visit. These losses are hard on both staff and families as there is no good way to celebrate together the life of the individual we have lost. I also am dealing with the challenges of providing nursing students Barbara 

Geriatric Nursing 000 (2020) 1À2

Geriatric Nursing journal homepage: www.gnjournal.com with geriatric experiences in long term care settings that involve real time face-to-face interactions due to restrictions in visitation in these settings. I worry about the next generation of health care providers and their preparation in care of older adults. Lastly, I too have had to stop research initiatives in long term care settings and transition to what we were able to do online.

Are there some silver linings? Of course there are and we should reflect on these as well. A rapid transition into telehealth opportunities has been one such silver lining. It is not perfect but allows us to bill for services we may have been providing previously and increases our access to patients in all settings and their access to us. It has forced some older adults into use of technology and thus maybe opened their lives in ways previously unknown. There is a terrific service provided by Candootech (available at https://www.candootech.com/) that can help older adults with connections and visual or hearing challenges associated with telehealth and other types of internet based communications. Today working from home and doing meetings and joining meetings from home via online platforms is not only acceptable but encouraged and rewarded. Amazing! I used to ask for such options so that I could be in my clinical site but participate in a meeting on campus but generally told they were not available. Lastly, less travel whether to meetings for business or just routine driving back and forth to worksites, and being able to spend more time with family has been another blessing of COVID-19.

As we enter 2021, COVID-19 is not going away and we need to prepare for another year of quarantines, health care challenges, teaching challenges and research challenges. Lets help each other stay safe and healthy. Remind your co-workers to wear their personal protective equipment, to distance appropriately and to take care of themselves as they take care of their residents and patients. We can't afford to lose anyone of us engaged in caring for older adults.

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