COVID-19: Once a nurse, always a nurse

Anne Hunstad

Anne Hunstad started working as a nurse in 1996 and continued to do so until Boehringer Ingelheim Norway became her full-time employer in 2019. Still, her heart remains in clinical work. She finds that useful in her daily work now as she is mostly engaging with nurses and patient organizations. 

‘Once a nurse – always a nurse’

 “As the COVID-19 pandemic moved towards Norway and the need for Intensive Care Unit (ICU) nurses became evident, I asked our medical affairs lead whether it would be possible for me to help out at the ICU I used to work at before I joined Boehringer Ingelheim. He was supportive and shortly thereafter the company also globally announced employees with a healthcare background who wanted to contribute during the COVID-19 crisis would be supported by Boehringer Ingelheim. The ICU welcomed me warmly, and I had refresher e-learnings in ARDS ventilation, prone position and proper use of protection gear before taking my first shift on April 1st. We agreed that I would have an 80% position at the hospital and a 20% position at Boehringer Ingelheim throughout April.”

The differences before and after the pandemic

 “The ICU I'm working at is small. It usually has 6 ICU beds and 6 postoperative beds. During March, they rebuilt the unit to facilitate treatment of 3 COVID-19 isolated ventilator patients at all times. The hospital even bought a cleaning automat that disinfected patient rooms between patients. The postoperative rooms were rebuilt for treating non-ventilated COVID-19 isolated patients, and all other patients were treated in the outpatient surgery unit in a different wing of the hospital. This meant the staff was split in half during each shift, which was solved by increasing the number of nurses on each shift in an extraordinary "corona shift plan". One part of the ICU became a clean zone, where the toilets, the staff room and a coffee/water station are situated. Needless to say, coming out of the ICU after 5-6 hours in full protection gear, having a toilet break, water and coffee, feels like heaven.

The hospital had cancelled all planned surgical and outpatient activity, so during the first two weeks of April nurses from the bed wards kept showing up at the ICU to contribute. This was very helpful, as a COVID-19 patient on ventilator demands at least two nurses 24/7. One nurse is outside the room doing documentation and providing equipment and medication from outside, and one is inside, in full protection gear. Halfway through the shift we switch places. If the patient needs added heart-, lung- or kidney support there's at least three nurses per ventilated patient to run the machines, infusion pumps and provide all the basic needs the patient isn't able to do for himself because of sedation and critical illness.

Staffing was the main challenge as the weeks went by, but luckily no ICU nurses in Norway have been infected with SARS-CoV-2 so far. It didn't take me long to find out that there was a big difference in working with a normal facemask on, and the FFP2 respirator. The FFP2 is tight, and leaves sore marks on the cheeks and ears. It's pretty warm inside the protection gear while turning the patient or doing other care tasks. My respect goes to all the ICU nurses who have handled the situation in ICUs around Norway for a month before I started contributing, and before the staffing was increased. The shift plan made us work every second weekend in addition to nights and evenings. I had forgotten how hard it is to stay awake and make logical, crucial decisions, at 4 am.” 

The COVID-19 ICU patients are different

 “My first COVID-19 patient started off relatively healthy and jumped off the ambulance stretcher and over to the hospital bed. Three hours later he was intubated and on ventilator. The patients are younger than the average ICU patients we see normally, and many have had a very dramatic development of the disease. All the COVID-19 ventilated patients I've been involved in treating, have at some point been treated with a muscle relaxant infusion due to Acute Respiratory Distress Syndrome (ARDS) to achieve better oxygenation and ventilation. All have received prone position treatment (turning them on the belly) to open more alveoli and improve gas exchange, and one was transported to a larger hospital for more specialist care. All these are treatment options that we rarely use in other ventilated patients.”

The balance between life and death

“We lost a COVID-19 patient due to multi organ failure, it was evident that we suddenly had our backs against the wall and no treatment options were working. The sad part of it was that even though the nurses and doctors had talked to his family on the phone every day, no visitors are allowed in the ICU during the pandemic. The family was rushed to the hospital and saw him for 10 minutes before he passed away in prone position, so they even couldn't see his face properly. It was a huge shock for his wife – she had only seen him when he was admitted to the ICU and hadn't really understood how ill he became. The patients we lost brought sorrow to the ICU team as well, who have been working day and night to turn the situation. An experienced ICU nurse can usually predict which way things are heading, and more than one nurse made comments a few days in advance that we probably wouldn't be able to save the patient. Would it have been wise to call for the family earlier? 

On the other hand, hindsight is always easy and the primary goal for the ICU is always to do what it takes to help the patient survive with as high quality of life as possible. We also keep a diary for all ICU patients on ventilator, so that they have an idea of what's happened while they were critically ill and sedated. Many have a memory gap even from the time before they entered the ICU and a while after they're taken off ventilator, so every day we write one or more pages to tell the patient about what happens and why we're doing what we do. A positive attitude is extremely important both for staff and patients. Patients need to experience something normal in all of this, so when sedation is reduced we always try to make sure that the patient keeps a positive mind. We also wave and smile to the patients through the window before hand over, so the patient has seen us at least once without full protection gear.” 

Why we do it

“Last weekend, I joined a colleague on the way to a bed ward with a patient diary for a patient out of the ICU. We always deliver the diaries personally, to assess the patient and so that he/she can ask questions about the ICU stay and the pictures that were taken in the ICU. Seeing the patient there, better than when discharged from the ICU, makes it all worth the hard work. It makes me remember what we're all struggling for in our daily business.” 

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Maarten van Helvoirt

The moment Covid-19 turned out to be a pandemic and the pressure on the healthcare system became higher and higher, Maarten van Helvoirt, working at Boehringer Ingelheim in the Netherlands, realized that he wanted to support the healthcare workers in any way he could. 

The moment I realized I wanted to help

“I'm a trained nurse, however I have not been working as a nurse since 2007. But with such high pressure, I felt I could make a difference under the current circumstances. This idea turned into action the moment Boehringer Ingelheim decided to support employees willing to engage.

I applied as a volunteer at a hospital and at a home for people with a mental disability. Soon I got the call and I could start at a home for elderly people with a mental disability who acquired Covid-19. We arranged a voluntary agreement and in good consultation we decided which shifts I would work. I’m working two shifts on weekdays and one shift on the weekend. Shifts can be during daytime but I also work evenings. During a shift I work together with a colleague who has the final responsibility.”

Workdays are intense, but rewarding

 “My first impression was that there was a high pressure on the team. They already had hard times together during which they lost one of their clients and had also worked extra shifts to take good care of the ill clients. A few caregivers also fell ill, which increased the pressure on the team and also scared people. They were very grateful that I volunteered to help and that Boehringer Ingelheim supports this help.

Workdays are intense, especially because you have to wear protective gear all the time and you have to be conscious to follow the hygiene rules at all times. My work consists of the primary help for the people, supporting them in daily care like washing, getting dressed and feeding them. I'm watching for signals of increasing or decreasing health, especially because for these people it's hard to tell about how they feel. Knowing their temperature and saturation is important to decide what type of care they need. But I also try to give them a nice day, having a laugh when possible and let them feel safe in this situation. It's hard, both mentally and physically, but it also gives me a grateful feeling that I can be of meaning in these hard times in Covid-days.” 

The cruelty of the disease

“The confrontation with the cruelty of the disease got to me. One of the clients fell ill during my shift and he died few days later. This had a huge impact on me. It made me realize that life can be short and how important it is to make the very best of it. So that's why I keep making jokes and have fun with the clients, they appreciate me being there and they even like my jokes. Other caregivers tell me my presence gives them a calm feeling and it reduces some stress. I am glad that Boehringer Ingelheim gives me this opportunity and supports the primary healthcare this way. I hope more colleagues will use this opportunity to support, I can highly recommend it.”