ED nursing: In the Year 2030, Not another 2020

 

January 8, 2030- Into the Future

Nurse Jess entered the Emergency Department with her trademark walk, hopping with every other step, swinging her arms as she went straight to the Charge Nurse Station. As the Director of Nursing, she could have just looked at the dashboard on her Mango watch/minicomputer/phone to see the unit metrics. But she likes being in the middle of the action. Besides, her usually unflappable charge nurse Mae seemed a little bit frazzled as she answered her Comdevice, and mumbled something about “Remember 2020”.

Jess entered the ED where she had been a nurse for 20 years, the last two years as the much-respected nursing director.  Finally, they are in the new ED wing, a state-of-the-art facility. Thanks to the generosity of the family of a prominent New York trillionaire. The 78-year-old man came in with a broken femur after a nasty fall but was so impressed by the efficiency of the ED staff before he was whisked to the OR. He lingered on just in time to say his goodbyes to his family, but he made them promise to build a new ER. And the family donated billions of dollars to create an ED well-suited to meet the demands of a new Covid19-like crisis. No more hallway patients, every patient in their own private room with some amenities like a tv, electronic patient tracker, and a nurse-call device.

Jess outfitted in the hospital-mandated IRC (Infection Repellent Clothing) for this new disease outbreak from Texas. The Tyvek 3^rd edition suit is very light with its own breathing apparatus the size of her hand. Her face shield mask is clear and does not fog nor suffocate. The plastic material covers her entire face and connects to the Tyvek suit itself. Thankfully, this new disease is not anywhere as virulent and as overwhelming as COVID-19.  A shudder went through Jess’ body as she remembered the year 2020, the Year of the Nurse which nobody ever anticipated to turn out to be a nightmare year for every healthcare worker. In the year 2030, it looks like they’re in a repeat of 2020.

Last month, ten years ago was a distant memory, relegated to the hospital archives. Right after the nth ZoomstatCom meeting with the Infection Control Czar last week, the hospital leadership went into UltraPreparedness/Response Mode.  The Incident Commander declared in his authoritative voice, “We are now in ICS level 2 and we expect to be in Level 3 soon.”

After the meeting, she scrolled back on her personal online blog to look for her Covid Diaries. In 2020, the ED was declared an endemic area. Ground Zero or more accurately, the war zone, for the hospital as the patients came in gasping for breath and the ED staff rushed in to fight for the patients to survive. The staff heroically stepped up to the plate, buried their emotions, and proceeded to take care of the patients. It was a whole year unlike any other that no one in his right mind would ever want to go back to. In one of the Covid-19 memes, The “Back to the Future” Emmett Brown admonished Marty McFly not to ever go to 2020 with his time travel machine.

Jess did not have to peruse the blog to relive the memories. Her heart ached in remembrance. She thinks she had some form of PTSD from that event, just like some of her colleagues. Thankfully, she was able to draw strength from her family and friends, as well as from her ED work family. Going through Covid hell proved how resilient healthcare workers are.

“Thank God, you’re here!”, Mae uttered in relief. She was still in nursing school when Covid-19 exploded. She heard terror stories from all the senior nurses, but now, her wild-eyed look resembled what Jess' 2020 nurses looked like. There were still several of those bad-ass nurses around; their eyes are calmer now, their experience during the Covid war gave them steel of nerves, and today, they serve as inspiration to their younger colleagues.

Jess swallowed her fear and made sure her smile reached her eyes above her mask. As the nursing director, she had to be a tower of strength, a source of truth, a comforting presence, and a purveyor of hope. Even if she felt a little apprehension as she saw the electronic dashboard in the Nurses' station with the throughput metrics and unit statuses highlighted in Red. It has not changed through the years, we still use the Red Surge as a common language that the ED is in crisis.

Dr. Johnson sauntered to the Nurses’ station. Like Jess, Brad experienced Covid-19. He wore his veteran status with honor, which in a way, comforted his fellow doctors. Jess and Brad are ten years older now, wiser and toughened by their experience.  Jess consulted with Brad and they decided to call a unit huddle.

Mae’s voice crackled over the staff’s Communication devices that were clipped on their scrubs. Except for those currently involved in a patient’s care, most of the unit staff gathered in the 5-bedded Resuscitation room. Unable to maintain physical distancing, the nurses, doctors, techs, pharmacists, registrars, environmental services members, transporters, respiratory therapists, case managers, and even the paramedics attended the huddle.

Brad addressed the whole staff, “Ladies and gentlemen, we are at this point of declaring the ED as an endemic unit. Meaning, you will have to be in full PPE when you enter the ED door. Don’t give me this crap that you cannot breathe because our masks are a hundred times more comfortable than we have in 2020. We cannot afford to have some of you out sick. Use your PPE”.

Jess addressed the staff. Knowing that everyone is compliant with the Covid and flu vaccine, she proceeded to tell the staff that another similar mRNA vaccine is being tested by the scientists. There will be some protection from the Covid vaccine, but this new vaccine will be specifically targeting this new disease called Joslin30.

Jess reviewed the surge and escalation protocol. Although the NEDOCs score is high, all the patients are secured in their private rooms, most of which are with negative pressure. The patients have their own sophisticated TeleFam monitors to connect with their families remotely. Visiting hours were suspended except for special circumstances. The newly-reorganized CDC Fauci organization issued a much-vetted Joslin30 treatment algorithm which is immediately started in the ED. The point-of-care Joslin30 screening test is top-of-the-line accurate with a one-minute result time. Additional medical and nursing staff reinforcement from the National Medical Guard will be in the ED in two days. Supplies and equipment, and most importantly the ventilators are well-stocked. Three additional hospital units are being prepared for additional patients and will be available in a few hours.

As Jess relayed all the updates, she could see the staff visibly breathing in relief. They needed to hear the updates; needed to hear that no patients have died so far, and that patients are responding to the aggressive drug cocktail. Jess herself believed that the world is much better prepared for this new challenge. They clapped at the end of Jess’ summary of the ED status. She brought them hope and confidence that this crisis will soon pass.

“This is 2030, not a repeat of 2020. This time, we have an intelligent and responsible President who does not quarrel with her own Infection Control chief. This time, the science we trusted in 2020 is bringing us a new vaccine soon. This time, the government officials are on the same page. This time, our hospital is prepared for all eventualities. This time, we will get through this in just a month or so. Thank God, this is not 2020.”

 

 

ED Nursing Stories: Rising to the Covid-19 Challenge

This is the Virtual ED Nursing Photo journal in reflection of our Covid-19 journey at Mount Sinai Morningside Emergency Department. I am certain that the sentiments will resonate with everyone on the front lines. The fears of the unknown transcend disciplines, titles, and even geography.

The ED photo album started as a collection of pictures, some submitted by those very same nurses in the direct line of fire, the ones who are at the bedside, in the front lines. I assume that these pictures were made in defiance, as well as an assurance to ourselves, that this too will pass. We were optimistic that these pictures will someday be just the chronicle of that unforgettable moment in our nursing lives. Who knows, we might just end up in the archives.

Somehow, this became a journal of our collective experience during the pandemic. I collected some of my nurses' personal reflections; I understand their need to share, to relieve their hearts of the burden.

For me, Journaling is a coping mechanism, it puts things in perspective, and it slows things down to manageable parts. It is a therapeutic activity to drain the brain of stressful recollections. Maybe, when it's written on paper, the pain loses its intensity, and it would not be as horrible. Writing eases my heartache.

While recording our anxieties, we were able to reflect on the special opportunity we have to serve those who are vulnerable. We found our joy and purpose in being valuable members of the healthcare team. So, this is also a gratitude journal. In the darkness brought by this scourge, the nurses, and of course, the rest of the healthcare team, emerge triumphant.

This is one department's journey in pictures, reflections of individual and the ED team strengths. Moments of levity are captured in-between moments of heartbreak. This photo journal captures our resilience against adversity.

In this Covid-19 crisis, ER nurses put their fears aside and placed their patients front and center. We remain resilient despite the challenges of this pandemic. On this Year of the Nurse 2020, of a time that even Florence Nightingale on her 100th birthday would have given us her seal of approval. I am never more proud to be an ER nurse.

ED Nursing Stories

COVID-19 Diary: The Heartaches and the Small Victories

This is not just my story. This is also a snapshot of my department's journey through the horrors of a pandemic, with all the heartaches and the small victories. Nobody comes out of this war unscathed.

January 1, 2020

This will be a good year. This is the Year of the Nurse.

January 25-
China is far away; the danger of the coronavirus that devastated Wuhan is far away. (Or so, I thought). The hospital cautions us to prepare but there is a general sense that it’s just like the FLU. The CDC says that the Flu killed more people than the Wuhan virus. I thought we were safe here in America. Hey, even POTUS downplayed Wuhan. Life goes on.

February 17-
The Novel coronavirus is here. The DOH, CDC, and WHO issued their guidelines. At triage, get the travel history, check. Ask the patient if he has a cough, fever, or upper respiratory symptoms, check. If they’re elderly, double-check. Mask yourself and mask the patient. Isolate. The Infection Control staff is overseeing our response. The algorithm was distributed to the staff. We got this.

February 28-
We received about three patients with fevers, cough, and positive travel history and they were just mildly sick. It’s not bad, I assured myself, I assured my staff. Who was I kidding? I was scared.

March 8-
What’s going on? The hospital is full-on in Incident Command mode. There is a frenzy of activities; meetings after meetings. Don and doff training. Write the standard work for Triage. Plan for Surge capacity. Look for alternate places. I requested more RN travelers and techs to help us out during the apex of the COVID patients. 

The projection was that we have about 3 weeks before the patients who need the ventilators. Three more weeks to get the extra staffing and supplies. We need more N95s. I was assured that we have enough on stock but we might have to consider conserving the masks because the public is hoarding those masks. Hello? Mr. Q. Public, you are depriving the healthcare workers of the much-needed masks.

Oh, don’t forget to buy toilet paper. The Chinese factories are not manufacturing toilet paper anymore. The grocery shelves are bare while eBay sells the now-precious toilet paper at ridiculously illegal exorbitant prices. Hmmm, maybe buy a bidet?

Photographer- unknown

March 11-
The World Health Organization has declared COVID-19 a pandemic. Now reaching global proportions affecting 114 countries. The news brought a frisson of fear down my spine. I texted my family in the Philippines and instructed them to stay at home, to shelter in place, to keep my 89 y/o mother safe. I called my son who lives two towns away from me. I made him promise that he will work from home, that he should never leave without a mask, and that he should always wash his hands, He laughed at me indulgently and reminded me that he used to work in a research lab and that he, of all people, knows how to thoroughly wash his hands. He knows he has to self-distance and wear his mask every time he goes out. When we Face-timed, he jokingly rolled his eyes at me. He knows I'm just being a mom.

March 12-                                                                                                                                  Fear. It is scary. Like going to the battlefield. We wonder, "Are we doing this right?  Are we using the right PPE? Are we handwashing long enough?"

And yet we go to work. Every day. Despite our fears.

March 13-
It is good to step away from the hectic COVID-19 prep and planning activities (even for just a few minutes) to celebrate our Clark 8 Acute Behavioral Unit staff with a “Caught for being Great” citation from the amazing Physical Therapy team. As per the PT leaders Alicia and Helen, the Mount Sinai Morningside Clark 8 staff took the initiative to reach out to PT to borrow the patient lift device and get themselves trained on a machine that they never used in their unit before. The staff was so engaged and so receptive to learning new techniques to improve their disabled patient's experience.

March 14-
My email to the nursing staff:
I know that there is not much we can say as we go through this COVID-19 crisis together. What I know is that the ED staff continues to give their very best despite the anxiety of the unknown. The emergency department itself can be chaotic and stressful. This is the nature of our work, and right now, your minds are probably spinning with the barrage of inservice, instructions, and simply the demands of being on the frontlines in this war. I just want to thank you for your amazing hard work and resilience. Thank you, thank you. If you have any questions, please do not hesitate to e-mail or call us (Anthony, Cynthia, Lauren, and I- even if you just want to vent). FYI, all the COVID-19 testing for our admitted PUI patients came back NEGATIVE, including the last one who went to the ICU (WR, 35 y/o male).

We are trying our very best to mitigate our current circumstances and ease your workload during surges:
1. We are in the midst of finding alternate sites to move those who are Worried Well and those with mild symptoms that can be treated and released quickly. We may be using the Heal Center and Clark 9 with non-ED staff.
2. This weekend, we are piloting the use of the Ambulatory Care Clinic to refer the ESI 4-5 patients to decant the ED, thankfully with their own Ambulatory Care staff.
3. For admitted patients, more Isolation rooms were created in 7West and soon in 7E ICU for critical care surges.

What we ask of you is for you to be nice to each other. Watch each other’s back and use the buddy system when you’re donning and doffing. If you can come in for OT, please let us know, even if just to relieve for breaks. More than ever, we need you to come to work. And because we need to care for our own selves, try to Plan Your Joy. We’re in this together.

March 15-
It’s a Saturday spent at work. The ED is getting overcrowded with patients worried about their symptoms, we have the worried wells, but there are more patients coming with respiratory distress. We opened the ambulatory clinic on the second floor with the physician assistants and ambulatory clinic staff seeing those with mild-acuity symptoms. The ED leadership had a nice plan on how we will surge up. We meant to start allocating some rooms for COVID patients in the Main ED for Phase 1, then will advance to Phase 2 with additional rooms that can hold the COVID patients, then Phase 3 using Peds and Eval. It’s only Saturday and we’re already in Phase 2. Out of the 30 boarders in the ED, only two were not COVID. Now we see patients presenting with abdominal pains and testing positive for COVID.

It was a long tiring day. I ordered pizza for the staff, and they all came running to the conference room. I sat down to eat my ham with pineapple pizza pie but did not have the strength to finish the whole thing. I had the feeling that things are going to get worse, then worst before it becomes better. May God bless us all.

March 16-

Wow! A family with 4 kids from the community came to the Mount Sinai Morningside ED to thank the staff for our service during this COVID-19 pandemic. They brought several pies of pizza with handwritten Thank You cards from the kids. The ED staff works hard every single day but has been totally amazing these past weeks amidst the fear and uncertainty. Being on the front lines can be scary, but this gesture really warmed my heart. I am so glad that the staff is recognized for a job well done. I had my Joy late this afternoon after a full, exhausting day.

March 17-
I'm supposed to be off today but have been on the phone since 630am with back-to-back conference calls. Our hospital President just mentioned our ED with a special mention of my LinkedIn post about community appreciation.

March 18-
It’s my youngest sister’s birthday party but we cannot celebrate at our favorite restaurant. So, I just wrote on FB: “You are loved by everyone because you have a generous heart. Who would think that a grumpy little kid will grow up to be so lovable (a little less grumpy, hahaha)? We'll get take-out food, as everybody else shelters at home. I took the day off (although still working at home). At least, we have toilet paper, woohoo!!!”

March 19-
It was a heartbreaking day. We lost three patients in the ED today due to COVID. Their chest X-rays were horrible, "bilateral confluent diffuse airspace opacities". The doctors tried high-flow oxygen, then BiPAP. But the patients were tiring out. They needed the ventilators to give them time to marshall their immunological response to the virus. It was frightening to witness the patients gasp for breath. The nurses, the doctors, and technicians were the front-line staff who managed to conquer their fears. Equipped with their personal protective equipment (PPE) of gowns, face shields, goggles, and N95 masks, they ran towards the patients, reminiscent of how the firemen and EMS crews ran toward the World Trade Center buildings on 9/11.

The ED was full, NEDOCs score was in the 160s with 40 boarders and five waiting for ICU beds. There was a sense of urgency as we tried to arrange for transfers to the floors. I made several calls to Admitting office. Where are the beds? I was frustrated but there was not much we can do until the beds open up upstairs. The Incident Command Center was directing the storm of activities to support the hospital operations and ensure we have enough PPE. Although we are in scary times, I felt secure in the knowledge that the hospital leadership was truly responsive to our needs.

March 20-
I am the nursing director but I do not do direct bedside care like these brave men and women do. But I sure do my damn best to support them as best as I can do. I fight my own battles to secure more staff, equipment, and supplies. I spend 10-12 hours in the hospital five days a week, and then we’re expected to be on call for any emergencies. The nursing directors were just told that we have to do the Incident Management huddles at 830am even on Saturdays and Sundays. Even with all of these, it will certainly not compare with the higher risk that the bedside staff faces every single day.

I am both proud of and worried for all the direct care providers, nurses, doctors, techs, and respiratory therapists. Both the frontliners and the last recourse. They deserve all the glory and all the tributes for a job well done and for what they keep on doing. These are dark times, and the staff just keeps on rallying in the middle of the war against COVID-19. They are awesome and so inspiring.

Some of my staff were out sick on furlough; I was hoping that they were self-isolating with just fevers and a few aches and pains. I prayed, please no shortness of breath. I fought my tears as I called or texted the staff, just to check in, just to make sure that they are okay. I preferred texting because I didn't want my staff to hear the quiver of fear in my voice. I held my breath until they assured me that they were breathing fine. 

I received this text from a nurse: “Today was a rough day with all the sick patients in the ED but having our EMS there was soooo helpful. They were so eager to step up and work. They were so interested in all the patients, treated them with so much respect, and helped me out tremendously. If they weren’t there, I think today easily could have been one of those days you go home and cry or bury your face in a pint of ice cream. I hope they come back every day and thank you for having them there.”

I felt feverish. My temperature was 97.8. Thank God.

March 22-

In the #YearoftheNurse2020, the COVID-19 pandemic is certainly challenging the resolve of nurses, and all the healthcare workers (doctors, PAs, techs, registrars, handlers, and ancillary staff), all over the world. The Emergency Department staff steps up to the plate as they have done time and time again. In the war against this coronavirus, the warriors choose to give their best amid the anxiety, fear, and stress. Strength, courage, and dedication are manifested in every single one of them, no matter what their job entails. These are the faces of the brave ones, those who uphold their duty above all else. Thank you, everyone, as well as the other warriors in the inpatient units and in the ICUs. I am so proud of all of the healthcare workers here and everywhere.

As you can see, the community acknowledges all our efforts. The food just keeps on coming, a gesture of appreciation from the people who depend on us for their healthcare needs. The Thank Yous certainly mean a lot; they remind us of the reason why we are doing this. We are working for the patients who need our care. This is one department's journey in pictures, chronicles of individual and the ED team strengths. I started my COVID-19 album on Facebook. I wanted to capture in posterity those moments of levity in between moments of heartbreaks. We will survive this madness.

March 24-
The nerves were getting to the staff. As the handlers were giving out the new goggles, there was a misunderstanding about the distribution. I got to the ED right when one nurse burst into tears, she was frustrated because she did not get her new goggles, and she was holding her flimsy old ones with the frayed strings. I mediated and got her the new goggles that she deserved. I know that the tears were of frustration, were of fear. I could only pat her back and stay by her side until her tears stopped. She did not want to leave her assignment. Then she took a deep breath and smiled, “I am okay.”

The RN travelers are not here yet, but at least some Procedural nurses and techs were redeployed back to the ED. They can do tasks, labs, and lines, Team Nursing we go. Then, we received some EMS techs and paramedics arrived. All hands on deck. We needed all the assistance we can get. The doctors and nurses have been rushing to the rooms to resuscitate the sick patients who come right after another. I saw one of the doctors sitting at the desk with anguish on his face. He just called the patient’s son that his father passed away. The apex came two weeks early.

March 25-
The nurse manager and educator were out on furlough, and half of my leadership team. My assistant nurse manager was busy trying to staff the unit. For the first time in all my years as an ED nurse, I felt I was drowning. The ED NEDOCs score was high in the 170s, we are seriously overcrowded with two intubations going at the same time. I kept an eye on the ventilator reports. We are low on the BiPAP but we're getting some delivered in the afternoon. The hospital converted some inpatient units to ICU beds but our patients were not going up quick enough to decant the ED. I must say that I am impressed on how the hospital converted some units into COVID-receiving units in a matter of days.

A 55-year-old COVID patient succumbed to cardiac arrest. Too young to die. It could be anyone of us. There was shock in the nurses’ eyes. After he was pronounced, the team members offered a moment of silence to pay their respects to the patient. There was no family to mourn him at the bedside. I tried to help out with the post-mortem but the nurses told me that they can handle it. One nurse said, “We cannot afford you to be sick. Who else will look out for us?” I almost bawled in front of the team. I felt a little bit useless and somewhat useful, even needed.

March 26-
My nurse’s husband was admitted to the hospital for shortness of breath related to COVID-19 and she could not stay with him. No visiting rule, even for her. It broke her heart to be so helpless. I cannot do anything. As she cried on the phone, all I could do was listen and cry along with her. I called the nurse manager in that inpatient unit to keep an eye on the husband. I visited the unit but the patient was asleep. His breathing was normal and his oxygen saturation was 96% on nasal cannula. He will be okay. At least, my nurse’s husband is not in the ICU.

March 27-
I heard two medical codes being called in the ICUs in just one hour. There were more calls for respiratory therapists throughout the day. The ED is like a warzone, we are a COVID unit after all. I saw a blur of yellow isolation gowns when a group of doctors and nurses responded to Room 22 in the ED; they have to intubate the new patient. Not even five minutes later, another call for help in Room 1 for a high-flow oxygen machine. And another patient in respiratory distress was rushed in by EMS. The charge nurse called out for another team to Room 2. I had 36 boarders in the ED, all complaints related to COVID, some confirmed, some PUIs, some PUMs. The nomenclatures and the changing guidelines from CDC are confusing. The intensity level is high in the ED.

March 28-
After an exhausting week of being the Administrator on Call in the middle of a brutal week of COVID-19 response in the hospital, I needed to do self-care in order to get re-energized for probably a more brutal week. And then reading the Thank You cards from the #mountsinaimorningside community, I see the reason "Why" we are doing this. This is our "Ikigai", our reason for being. The ED received an outpouring of love and support from the community. Food deliveries came unsolicited almost every day. And they were calling the healthcare workers their heroes.

Late at night, I received a call from my assistant nurse manager about the Visiting rules. A family member wanted to see her dying mother in the ED. The No Visitor rule was just enforced, but for end-of-life moments, visiting was allowed. The iPADs help with facilitating communication between families but nothing can take the place of an actual visit. The unit leaders all said yes. My chief nursing officer and chief medical officer approved. It was a humane decision to allow a daughter to say her final goodbye. No one should die alone.

March 29-

The news painted a terrible picture of the dire situation at my previous hospital. Suddenly, Queens is now the epicenter within the epicenter. The harrowing details of devastating deaths and inadequate staffing, PPE, and ventilators told the rest of the world that we are in deep trouble. My heart broke for what my former colleagues were going through.

I posted this on LinkedIn and FB: I just want to pay tribute to the staff at Elmhurst Hospital, my work home for 21 years. My love to the ED staff who continues to give their very best. I left a piece of my heart with you. Even as I do my own work here at Mount Sinai Morningside, I think of you on the frontlines at the 'Hurst. May you get the help you most deserve. You are all amazing. Be safe, be strong. This Thank You sign in front of the hospital should let you know how the community appreciates you all. The artist Scott LoBaido showed his gratitude to the Elmhurst warriors thru his art. As a nurse, I appreciate the sacrifice you all do. We're in this together.


March 30-

Artist unknown

This says it all. It takes courage to go where nobody else wants to go. It takes dedication to leave our families behind. It takes resilience to bounce back from a shift of heartaches and frustration to come back another day. It takes some kind of craziness to be a health care worker at this time of great stress. It takes someone special and amazing to be on the frontlines of this war. The nurse represents ALL the healthcare workers in the middle of this fight against COVID. Kudos to all the nurses, doctors, PAs, NPs, techs, registrars, resp. therapists, transports, EMS workers, Security, EVS workers, engineering, IT support, and all the administrative leadership staff who work behind the scenes to open more and more beds for us. AJA! Laban lang!

April 1-

I don’t remember who and when the 7pm clapping actually started. Suddenly, there were videos of clapping and cheering emanating from the apartment buildings around Manhattan. New Yorkers rallying to support those who cannot stay home. They were united in applauding the healthcare professionals working on the front lines of the COVID-19 pandemic. It felt good.

Then at 7pm, the sirens of the New York Fire Department provided a heart-warming surprise tribute. The New York Fire Department Engine 47 gave their respects to the staff of Mount Sinai Morningside right at the corner of Amsterdam and 113th Street. A wall of heroes applauding the new, albeit reluctant, heroes of our time. The ED staff loved returning the applause. The rousing celebration of the work we do somehow validates all the sacrifices that we make. There were air horns, somewhere distant the clanging of pots and pans. Soon the ED staff was joined by other hospital workers from the inpatient units. They hooted and cheered, for a few minutes forgetting the horrors behind the front door of the ED. In moments of crisis, we savor those moments which make sense of everything we do.

April 3
The eyes have it. As I go through the ED, I see all the staff bravely going through the day. Behind their masks and face shields, they put their thumbs up but I could feel the rising anxiety. I had to peer into their face shields to see who I was talking to. The eyes told me what they were feeling. Sad eyes from the deaths they have witnessed, more than they ever did in a single shift. Worried eyes because they needed assurance that they will not bring this virus home to their family. Haunted eyes for witnessing the final goodbyes between the patients and their loved ones on the iPAD. 

But they are here, doing their job the best that they could. It's the worst of times but I see the staff stepping up. A physician assistant brought an iPAD to the room so the patient and the self-quarantined family can talk to each other. The doctors slumped in their seats as they held their phones to their ears, as they fielded questions from the worried families. The nurses and techs gowned up to prepare a patient for the morgue. At 3pm, the techs gathered around after huddle to say their prayers. They are the heroes of these uncertain times. And to survive, I see them supporting and being kind to each other, sharing the hand-made masks and surgical caps donated to them by worried friends. 

In the staff lounge, on her break, a nurse removed her tight N95 mask as she settled down on a chair to rest, the string marks stayed on her face; red bruises under her eyes and on her nose. She closed her eyes, probably in meditation, probably just to get her bearing. Like everyone else in the healthcare world, she was exhausted. I closed the door so she can have her moment of peace.

April 6-





Here's our Mount Sinai Morningside crew. Taking a respite from the heart-breaking work to just enjoy ourselves and support each other through the hard times. Somehow, we found time to just have a little fun, and at the same time exhort the public to stay home. #stayhome #flattenthecurve #mountsinaimorningside.

April 7-
Positive news of survival should be celebrated. In our fight against COVID, we have to gather strength and hope in those things that affirm our impact on our patients' lives. We have to find the joys that will keep us moving forward. The digital board in the lobby announced that there were 137 patients who went back home to their loved ones yesterday. Today, my nurse's husband was number 138. Finding our Joy in small victories.

A staff nurse who was out on sick leave called me crying. She saw the staff video and expressed her guilt for not taking her place at the bedside with her peers. Other staff members expressed the same thing to me. I told her gently to take care of herself first, that the best thing she can do for us is to just keep us in her prayers.

A week ago, I suggested to the Incident Command Center to post the Good News of our discharges, as a kind of a morale-booster to the staff, to remind them that we are saving lives. I wondered if our city will give the healthcare workers our own ticker tape parade, maybe in the Canyon of Heroes.

April 9-





Check this out. The husband of our ANCC Diana Velazquez from the Emergency Department paid tribute to the healthcare workers of #MountSinaiMorningside. Matt Hong serenaded us with a sexy sax rendition of "When the Saints Go Marching In". Cool!

This never gets old. A much-needed boost from our friends at FDNY, heroes themselves. There are new chalk marks of appreciation on the sidewalks leading to the ED, all from the Morningside community, their own little way of appreciating the staff at Mount Sinai Morningside. This time, the firemen were joined by the NYPD officers on horses. I saw my nurses' eyes filled with tears of joy and gratitude.

April 10-
I am glad I was able to witness a patient's discharge; he is a COVID survivor. The patient broke into a wide grin as he was met with a chorus of well-wishes and boisterous applause at the #MountSinaiMorningside lobby. It is an honor and privilege to be among a group of people who cheered this patient. Much as he appreciated the warm send-off, I felt similarly blessed. It was a great feeling, a much-needed pick-me-up. There was encouraging news about the downward trending admission rates but I couldn't shake a lingering sadness earlier because of some losses of people I know. At that moment, I was energized, I felt joyful seeing the patient's grateful smile. I caught his eyes and I felt my own tears fall as he mouthed. "Thank You". I never took care of him, but he was everybody's patient at that time. Sir, Thank you.

April 11-

Pause and Applause have started at #MountSinaiMorningside.

We PAUSE to reflect on the lives lost due to COVID-19 and to strengthen our resolve to fight for the lives we can still save.
APPLAUSE is a more joyous occasion. We clap when a patient is discharged. We applaud to rejoice for the life that was saved; someone's loved one who was given a second chance.

April 12-
"Always call upon our Father
When afflictions, you may suffer;
He’ll never forsake you in your hardship.
His help He will give as long as you shall live"

This I believe. I had to believe that the pandemic will soon end. Our worship service is now on Webex. The video was grainy, and the choir hymns were canned, but the minister delivered a spiritual and uplifting sermon. My church (Church of Christ) has been doing the virtual worship service by Webex for several weeks now. I miss going to Church; I miss the brethren, the hymn-singing, just being in the House of God. This is just a bump in the road, a little test of faith. After the service, the minister beamed with relief when he saw the faces on the screen. We waved back at him. My soul needed it.

April 13-
One of the nurses relayed that she triaged one of the first COVID 19 patients she took care of last month. She recognized the eyes of the patient; those same eyes who looked at her with dread when he came in with double pneumonia and had to be intubated on his first visit. She thought he was the sickest of the sickest that horrendous day with a poor prognosis. But he was discharged two weeks later. This time he came because he was short of breath on exertion.

As he sat on the triage chair, he relaxed and even laughed when the nurse stated she recognized him. His eyes were not as frightened anymore, just concerned. He later smiled with relief when his oxygen saturation showed as 99% on room air. He acknowledged he just had to give time to feel stronger, for his lungs to go back to normal. Nurse Jovy told me that she sobbed in relief when the patient left to go home.


April 14-

After a heartbreaking loss of a church friend that had momentarily shook my world, this picture somehow eases the pain, even for just a little moment. One of our own ED staff, a registrar, was discharged after weeks of hospitalization for COVID-19. The word Social Distancing did not really enter my consciousness at that time, sorry. In defense, everyone was all masked. The lobby of the #MountSinaiMorningside was filled with thundering applause amid chants of his name. It was a celebration of a life saved, of winning one against a dreaded disease, of teamwork and unity, of survival (not just for the patient but for all those who continue to fight).

Joining this celebration was one of my nurses who survived COVID herself. She was one of the loudest cheerers. Seeing both survivors were inspiring. The moment was all-powerful, and a big morale-booster for those in the biggest battle in our professional lives. It was a joyful celebration of the men and women who fought for this patient. As I saw the numbers on the Discharge monitor continue to climb, I am hopeful that this nightmare will soon pass. It was a special Thank You that another one got away. Take that, COVID!!!

April 15-
I feel a deep, aching sadness in my heart. Yesterday, one of the most-beloved members of our church passed away. I cried for the family he left behind and for the generations of church brethren that he touched. I cried for every single one of my friends and acquaintances who died due to COVID. There is a pain of loss and the continuing fear of losing some more. Too many friends who lost family members to this pestilence. Too many precious lives gone.


April 16-
There are others in other states with a myopic understanding of how dangerous this coronavirus is and they demand to ease the lockdown. The healthcare workers continue to venture out every day to take care of the sick so that others can stay home. I feel anger that there are people who bemoan about being bored out of their minds due to staying at home. I feel disgusted at those who disregard the tragedy of lives lost just because they think that their freedom is curtailed.

The Stop-the-lockdown movement is fueled by ignorant, uneducated people who were not yet touched by this pandemic. They are just adult versions of that stupid teenager during the spring break in Miami who stated, “If I get corona, I get corona. At the end of the day, I’m not going to let it stop me from partying. What is wrong with these people?

ADDENDUM: 

April 20- 
I must have looked dejected as I walked through the lobby. I had my surgical cap and my N95 mask on but I was still recognizable with my ubiquitous white lab coat. Somebody asked me “How are you”. I shrugged my shoulders, squeaked a weak “I’m okay”, and quickly turned around. My tears threatened to overwhelm me and I did not want to ugly-cry in the middle of the lobby. I did not want to break down, I did not want to curl into a fetal position. A part of me wanted to say "I'm having a tough time" but I was not ready to share. I just heard of a church friend and church deacon passing from COVID-19. This is heartbreaking. In my previous hospital, five hospital workers succumbed to the complications of Covid-19. The threat of contamination looms over our heads like Damocles' sword. When is this going to end?

April 23-

This morning looks like a miracle to me. I can breathe better. I had a good night's sleep after the surprisingly calming effects of my crossword puzzles and the soothing music of Anne Murray. Earlier that day, the Mental Health Liaison met with the staff to offer some options to de-stress, to decompress. We need to do our Mental PPE. I prayed not for myself but for my own family and my work family. Then, I turned to the one thing that always calms me down: I write. I wrote what my heart spoke.

There were only 8 patients in the ED, three of which are COVID patients waiting for the med-surg beds. No ICU patient at this time. More nurses than there were patients. For the very first time ever, our NEDOCS score is -2 (negative 2). The charge nurse later texted me in the afternoon that the volume had picked up. There were now 40 patients in the ED with some trauma codes and non-COVID patients in the mix.

FaceTime eased my loneliness when I spoke with my son. He had just been working at home and he is safe. My mom is also safe in Manila, enjoying her wine now that there was no more beer to procure. It is how she relaxes at home. Everybody at home and at work is safe. That's all I needed to know.

My temperature was 97.8F. Most of my staff members who were furloughed are back to work, ready to join the fight again. Governor Andrew Cuomo said that the COVID-19 war is not over but he cautions against prematurely stopping the lockdown.

July 30-

What a year it is. It's not over yet. The tsunami of admissions had abated here in New York but there is still fear of a second wave.  There are more non-COVID patients in the ED. The patient census had dramatically gone down. There are more nurses than patients. Now I can breathe better. I am sleeping better. There is light at the end of the tunnel.

Sept. 29-

To heal myself, I turn to the things that I am grateful for: my family and friends, my church, my work family, music, books, food, puzzles, and our dog. I look for my joy triggers. That is how I keep myself sane amidst all the challenges of life in the new normal. And then, I write. I write what my heart speaks.

October 4-

I hear the laughter now. I see my staff SMIZE; their eyes are smiling above their masks. They know it is not completely over yet, but they find strength in each other.

Nobody comes out of this pandemic unscathed. We have to actively and deliberately plan our joys in and outside of work. One of the nurses shared her joy when a recovered patient recognized her eyes when she cared for him in the ED.

As we all put together the pieces of our broken hearts, we march onward, stronger together. 

December 13-

The second wave is here. Covid 2.0. It is a scary time. But the vaccine is here. There is HOPE and RELIEF. It is the beginning of the end.  I am hoping that a few months from now, I can finally travel and hug my mom again.

For us. For our families. For you. For our country.

December 17-

I got my Covid-19 vaccine today and so did some of my ED and ICU colleagues. Finally, the Pfizer vaccine is here. I have been waiting for this. Now that we’re on the Second Wave of this horrific pandemic, I am confident that we have what it takes to fight back with a vengeance. I am joyful that this is the beginning of the end of this disease that has gripped us in a chokehold for so many months. T But now there is hope. I must confess that I was teary-eyed because I can see the light at the end of the long tunnel. The vaccine is a game-changer. This will afford all of mankind to get back to the new normal. Thank you to the scientists and the volunteer research subjects; they are heroes themselves. Maybe, a few months later, I will be able to travel and hug my mom again.  #LetsBeatCOVID19 #Havefaithinthescience

December 31-

It was a heart-wrenching year. A year of profound sadness, despair, and helplessness, of fears and anxieties that continue to haunt us to this day. This disease has gripped us in a chokehold for so many months.

Somehow, the collection of pictures turned into a journal of our collective experience during the pandemic. I encouraged others to share their personal reflections; I understand the need to share, to relieve the heart of the burden of fear.

The ED staff fought together, united as we were never before. We had to work together as a team; it was the only way to survive on these darkest of days.

For me, Journaling is a coping mechanism, it puts things in perspective; it slows things down to manageable parts. It is a therapeutic activity to drain the brain of stressful recollections. It gives me time to breathe, to process my emotions.

When written on paper, the pain loses its intensity. Like a catharsis of negative emotions. Not that we can ever forget. We just need to keep our hearts from breaking into a million pieces, just need to find comfort in the small triumphs. Just so we can continue to fight and survive.

The war against Covid-19 is ongoing, but having the vaccine is a huge relief. We have a fighting chance.

As 2020 closes… HOPE. Looking forward to 2021 being a better and safer year for all of us.

Check out the Virtual ED Nursing Journal

ED Nursing Stories

Finding my Joy in Nursing: Knowing my Whys

Life’s ebb and flow can sometimes sweep you into just going through the motion without the conscious enjoyment of living. The stress of work and personal lives can often leech out happiness in one or both worlds.

“Plan your joy”, Michelle Obama said. We need to care for ourselves and to take the time to invigorate and refresh ourselves. There needs to be a good work-life balance in order to survive physically, mentally, and emotionally. Self-care is being mindful of our needs so we can in turn care for others.

I actively and deliberately plan my joy outside work. Whether planning the itinerary for a vacation or just enjoying a no-stress-and-waking-up-late-week-end, I seek those things that give me comfort and happiness. Good books, funny movies, soothing music, food trips around Queens with my son and family, and indulging in my joy of writing. My guilty pleasures are to explore the things that make me uniquely interesting. Even just planning for a quiet time on my sofa with the dog snoring at my feet. There is a thoughtful consideration to enjoy my days off work in order to recharge myself. Last night, I attended a spiritual Holy Supper worship service; I am blessed.

Because I spend a lot of my wake time at work, I also plan my joy when I’m working in my hospital. Unfortunately, I have seen some co-workers who allowed their work to drain the joy in their lives and they end up burned-out and bitter, sometimes because they felt trapped in a job that no longer sustains them and sometimes because they are afraid to spread their wings and find an environment that gives them joy. I am luckier than most because I truly have enjoyed my nursing journey.

The emergency department itself can be chaotic and stressful. This is the nature of my work; there are sad times when some of our patients die but there is joy when we are able to give someone a second chance at life. In all my years of nursing, from my first job as a staff nurse at a chronic care hospital to my current role as director of nursing in a busy emergency department in Manhattan, I always make a conscious effort to enjoy these moments of joy. Being joyful is not being artificial and unrealistically pollyannaish. I would rather think of it as being Optimistic, not just a Value of the Month. It is just knowing that we can reframe our minds to find meaning and purpose and joy however stressful the work environment is.

As a nursing leader, I feel the responsibility to help my nurses re-discover the joy in their work. There are financial constraints in staffing, but there is always something to do to empower our nurses to enjoy their work, even if sometimes the trials to both body and spirit can be challenging. I would like my staff to feel that they belong that they are appreciated and that they matter. One day, a nurse stopped me to complain about the boarders in the ED, those patients take out their frustrations on the nurses because they were waiting for inpatient beds. I gently asked her if she is asking to transfer to another unit. As I actually expected, she burst out laughing and said, “Hahaha, I am just venting. I love my patients and I love my co-workers, Thanks for listening.”.

I celebrate the work of every healthcare person in the hospital. A single person can make a difference. At our leadership retreat, the testimony of a trauma survivor touched my heart. She was a pedestrian-struck patient who sustained multiple fractures and injuries. She recounted very candidly her ordeal back to recovery and gave thoughtful and honest suggestions on how we can make things better for the next patient. She was thankful for the many healthcare workers who made a difference in her care. She spoke about simple acts of kindness like the ice cream from a dietary aide and the shampoo that the trauma coordinator helped her with. She remembered the good, the bad, and the ugly, but she earnestly spoke of the things that lifted her heart.

I live for the unexpected Thank You. One elderly man thanked me for staying with his anxious wife while he parked the car. It was just a simple gesture, just a few minutes of my time. To this couple, this meant that the wife’s anxiety did not unravel into a full-blown panic attack. The elderly man didn't know that just a few minutes ago, I came from assisting in a cardiac arrest of a young man who succumbed to an overdose. The “thank yous” are our emotional rewards, Two simple words that gave me joy that day.

The comedian Michael Jr. explained, “When you know your ‘why’ then your ‘what’ has more impact because you’re working towards your purpose.” The man in the video discovered his WHY and sang Amazing Grace with his heart.

The author Simon Sinek wrote that "it is only when you understand your “why” (or your purpose) that you’ll be more capable of pursuing the things that give you fulfillment". A purpose-driven life clears your pathway and makes sense of your actions, therefore it is what gives you the reason to keep on going, to start waking up in the morning, and to stop the snooze button on the alarm clock. This happens when you find joy in your life.

My joy is in the numerous little ways that validate me as a nurse. The ways we make a difference strengthen me amidst the sadness and chaos; a reminder of why I am a nurse. The reason WHY I stay and keep on going is that it is indeed a blessing to be part of a service profession that gives patients more than just a second chance.

Moments like these give us joy in our work. Nurses appreciate the simple pleasures- a thank you from a patient or a colleague, a life saved, recognition for a job well done, and a chuckle shared with co-workers. I do not have to reflect long and hard to remember the joys in my nursing life. It is when you are successful in maintaining the right balance in your life. This is my “WHY”, my 'IKIGAI" or "my reason for being".