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Emergency Nursing

Houston ED nurses face a new kind of challenge

Elda Ramirez, PhD, ENP-C, directed student nurses at Houston’s George R. Brown Convention Center who cared for people displaced by Hurricanes Katrina and Harvey, but in her 30 years as an ED nurse, she has never seen anything like COVID-19.

“In Houston, we are used to disasters, but this one is very different,” Ramirez said.

Students from Cizik School of Nursing were not immediately able to step up to assist in treating patients the way they would in response to a hurricane. Clinical assignments were canceled or delayed, and classes moved online. However, approximately 60 Nurse Practitioner (NP) graduate students were already licensed, experienced, and working on the front lines when the pandemic hit.

Ramirez herself practices in three different Houston-area emergency departments. Early on, she said every shift was different. “Things changed every day based on what we were learning about the virus, and each facility used different methods to communicate,” she said.

But as the weeks and months wore on, wearing N95 masks and face shields on every shift became routine. “This is something we’ve always been trained to do, it was just not something we did every single day and every hour of the day,” she noted.

Gus Calvillo, RN, shifted from the ED environment to UTMB Health at Galveston’s urgent care clinic in Texas City in the summer of 2019 while working toward his Family Nurse Practitioner (FNP) degree. In the early days of the outbreak, the clinic tested a handful of patients each shift.

That quickly shot up to 80–100. A couple of weeks into the pandemic, he already felt as though he had been dealing with COVID-19 for months.

Amanda Sanger, NP, had also moved away from the ED to better balance work and school, switching to a post-anesthesia care unit instead. She is one of Ramirez’s students in the Emergency NP (ENP) post-master’s program. With clinical assignments and elective surgeries cancelled on the same day, Sanger shifted back to working in Memorial Hermann Health System’s floating pool for ED staff to meet the call of duty as cases started to soar in Houston.

Anxiety remains high among the patients. Especially as infections began to spike in the Houston area over the spring and summer, many patients were afraid to go to the hospital, Ramirez noted. When they finally showed up in the ED, they were more acutely ill regardless of the cause.

For Sanger, who worked a shift early on at a screening checkpoint outside of the ED at Memorial Hermann-Texas Medical Center, one of the most emotional moments was watching a positive-tested husband and his wife “air hug,” knowing they could not be together during his hospitalization.

Nurses, too, must overcome understandable fear to treat patients at this time. Even before the COVID-19 outbreak, Calvillo had begun taking extra precautions at work to prevent bringing home any germs to his infant son and wife. His co-workers soon followed his lead in donning PPE.

“I’m wearing mine all of the time because we just don’t know who might have it,” said Sanger. She and her husband, Damon, chief pilot for Memorial Hermann Life Flight, are also being extra careful to protect their two daughters.

“I come home, I take everything off at the door, I drop it in the wash, I take a shower,” Calvillo said. Refraining from holding his son is the hardest part of the pandemic for Calvillo.

Meanwhile, Ramirez strives to keep students like Sanger and Calvillo up to date with their coursework through what she calls “rolling information sessions.” She presents the same information in three or four different sessions and records them so that her working students have multiple opportunities to access the material covered.

“I want to communicate with my students directly and not just by email,” she said. “You need to have contact with people.” She also tries to break up her virtual sessions so as not to overwhelm her students with hours of sitting in front of a computer.

In addition to using technology to facilitate course work, Ramirez uses video chats to keep in touch with members of the American Academy of Emergency Nurse Practitioners (AAENP), of which she is a founding member. Sometimes the AAENP members help one another locate resources or overcome administrative hurdles. Other times, the nurses serve as a support group, sharing their common frustrations.

Through the AAENP connections, Ramirez kept in touch with colleagues in some of the early hot spots before the pandemic surged in Texas.

“We communicated with people who were in New York, and we were able to be better prepared because of what we learned from other states,” she said.

 

 

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Dr. Elda Ramirez
Dr. Elda Ramirez
ENP students socially distanced for a group photo.
ENP students socially distanced for a group photo following a pre-hospital simulation in July 2020.