3 nurses discuss what 2021 has been like for them on the front lines of the pandemic
ARI SHAPIRO, HOST:
A second winter of COVID is upon us in the U.S., this time with widespread access to vaccines, but also with a much more infectious form of the coronavirus spreading rapidly - the omicron variant. So for the health care workers in hospitals seeing the worst of the pandemic daily, is anything all that different?
Well, we've brought in three nurses from around the country to tell us about their experiences. Kathryn Ivey is an ICU nurse from Murfreesboro, Tenn.; David Mancini (ph) is a travel nurse based in San Antonio, Texas, who's currently in Washington, D.C.; and Mary Joy Garcia-Dia is president of the Philippine Nurses Association of America, and she joins us from New York City. Good to have all three of you here.
KATHRYN IVEY: Glad to be a part of it.
DAVID MANCINI: Yeah, we're excited to be here.
MARY JOY GARCIA-DIA: I'm glad to be part of it as well.
SHAPIRO: Would all three of you just begin by giving us a quick snapshot in one or two sentences of what you are experiencing right now? Kathryn, what's it like in Tennessee where you are?
IVEY: Numbers have started jumping up over the past couple weeks. We've filled the ICU back up. We're back to having ICU holds in our E.R. as well as on some of the medical surgical floors; people who've have had to be intubated on the floor and there's nowhere for them to go. So we're definitely - the surge is starting to hit, but it's nowhere near its peak yet.
SHAPIRO: David, you're currently in Washington, D.C. What are you seeing?
MANCINI: So we've seen the numbers increase. What's interesting is that patients seem to be not experiencing as much critical illness as they had been. That's not to say that COVID doesn't still negatively affect a lot of people in severe ways, but it's interesting that I've seen people with symptoms of - more like the common cold or the flu. They're still very sick, but they're not being hospitalized, they're not being intubated at the same rate that they were before.
SHAPIRO: And Mary Joy?
GARCIA-DIA: Here in New York, similarly, we have seen an increase with the hospitalization. I know that from the reports from our members, they've also noticed that people that are being admitted are younger. And at the same time, people are also seeing that there's more delta variants being admitted, but there is cases of omicron variants as well.
SHAPIRO: Oh, interesting. So the delta spike is overlapping with the omicron spike that's just beginning. Are you all still having the fights over whether the vaccine is effective, whether masks work?
SHAPIRO: This has been such a politicized - that's a very quick yes.
IVEY: Yes. I have had to tell multiple visitors in the last week who have been, you know, waiting outside their family member's room while we're, like, starting CRT or putting in a central line. They're standing out there with no mask next to a COVID-positive room, and I have to tell them - there's a big old sign that says, wear a mask everywhere. You know, I've had to tell multiple people, please wear a mask in the hospital if you won't wear it anywhere else.
SHAPIRO: And that must take a toll on top of the act of providing health care to sick people.
IVEY: It gets really old, really fast.
SHAPIRO: Mary Joy, you're nodding.
GARCIA-DIA: Well, I can tell that from our multiple efforts of amplifying the need for vaccine trust and confidence, it has been challenging. People are still hesitant for various reasons. But at the same time, the science proves that the vaccine is working.
SHAPIRO: David, as a traveling nurse, you must have a really unique perspective seeing how different parts of the country are dealing with this and how different populations are reacting to it.
MANCINI: When I triage a person, as part of a normal screening process, we ask every single patient if they've been vaccinated or not. And about half are very willing to pull out their card. They're excited to show, oh, yes, I've been vaccinated; here's proof. And the other half is sarcastic and rude and say, I'm not going to put that in my body. And it's - there's no in between. So all around the country that I've been to - here, we definitely have seen more vaccines, but in Texas, where I'm from, it seems like a lot of people are still hesitant.
Speaking personally, what I've seen is the people who are the sickest are the people who are not vaccinated. Up until maybe two months ago, I had not seen a single person who had been vaccinated get infected with the coronavirus. But now I am. But they're not as sick.
SHAPIRO: As your hospitals, as your ICUs start to fill up, is there room for non-COVID patients? I mean, if somebody needs cancer treatment or surgery or routine care, are you able to provide that, or is it all COVID all the time?
MANCINI: In the emergency room, we aren't admitting patients for COVID at such a high rate that we were before, so I can't speak to the ICU. But in the emergency room, we are full to the brim of people who are COVID positive. But that doesn't necessarily translate into a full hospital being admitted. So we still have room for people with other health complications.
IVEY: Just for example, I work in a about - a 34-bed ICU. Right now, about 10 of those beds are taken up by either people who have an active COVID infection or who are what's called recovered COVID, which just means they are no longer actively shedding the virus. But these people are all still intubated. As the surge increases - and this is what we saw with delta as well - you know, that number will eventually hit about 20.
SHAPIRO: Out of 34
IVEY: Out of 34. So during the last surge of the summer, there were multiple patients that died while we were trying to find them specialty center beds, you know, places like Vanderbilt that had a team of specialist physicians for these certain issues, and there were no beds available.
SHAPIRO: And so these are people who died who did not have COVID, but would likely have lived if it were not for the pandemic.
IVEY: There were no beds.
GARCIA-DIA: So I think from here in New York, Ari, the health care systems have really learned a lot. And some of the measures that I have seen in just conversations with nurse leaders around in our area is how they try to be more flexible in limiting elective surgeries so this way, they can better prepare themselves if - in case there's an anticipated surge just similar to what we have experienced last year.
SHAPIRO: Kathryn, you, if I'm not mistaken, started your career during the pandemic. You've been a nurse for about a year and a half, is that right?
SHAPIRO: Have you had any regrets about choosing this path given how challenging it's been?
IVEY: Strangely, no. I think, in some ways, it's easier because I wasn't a nurse before the COVID era. You know, I - somebody has to do this job. There's always going to be people who have to be able to do this job. And I love being able to do it. I love being able to take care of people and feel like I am making a difference, even if it's in a very small way.
SHAPIRO: Mary Joy, I know that you oversee a team of nurses, and you've been doing this for more than 20 years. As you advise people on balancing their jobs with the rest of their lives and staying in this for the long haul, do you have any advice for someone like Kathryn, who is just at the very beginning of her career and entering during this incredibly difficult time?
GARCIA-DIA: I know it must be very difficult career, Kathryn. As I remember my own experience during the height of the HIV way back in the 1990s, it was very scary. I was very fearful that I might get infected and what that would mean for me and my future. So I see the similarity, but at the same time, I see the graveness of the situation only because this has been going on for almost two years now.
And what we fear is the burnout, right? And that's what we would want people to understand, that this is really causing a lot of mental distress to many of our nurses. And that's in fact supported by the survey that was done by the American Nurses Foundation. Like, more than probably, like, 30% are contemplating leaving nursing either because they want to retire or because they're just tired and exhausted.
SHAPIRO: Kathryn, David, as Mary Joy describes that burnout across the nursing profession, do you identify with what she's saying?
MANCINI: Yeah, absolutely. That's why travel nursing is booming right now. We're filling in across the country for people who are done with the job.
IVEY: I just want to piggyback off what you said because the staffing crisis, which has been parallel to the COVID crisis, has been brewing for decades, and a lot of people who aren't in health care haven't known that that's been an issue for a long time. You know, hospitals for a very long time have undervalued nurses, underpaid nurses. So this has been a very long time coming, and COVID was just the thing that pushed it over the edge.
SHAPIRO: What do you have to help recharge your batteries? I mean, how do you keep going day after day, month after month? Now, it's becoming year after year.
IVEY: Weirdly, one of the things that I've been doing lately that remind - that helps me find perspective is reminding myself that, like, misery has always been a part of the human condition. And that's been kind of the thing that I've been clinging to, is that this, while, sure, it's an unprecedented time for us, it is not unprecedented for humanity. You know, we have been to this place before, and I am sure we will be at another place like this again. But there is still beauty in little things.
MANCINI: Mine's more of a selfish reason. I really enjoy being able to handle a critical patient and know that I made a difference. That's...
SHAPIRO: That sounds like the opposite of selfish, actually.
IVEY: Yeah (laughter).
MANCINI: But - well, hold on. It sounds altruistic, but it's an adrenaline rush. It's cool to be able to be the one to jump in. And if I can figure this out and titrate this medicine the right way and I'm on top of this and my full attention is on this patient, then I have made a difference in this patient's care. So yeah, I cope by knowing that my presence is making a difference. That's way better than my first answer was what - just going to be wine, but I also...
SHAPIRO: (Laughter) That's allowed too. Also that.
MANCINI: ...Really, really enjoy taking care of patients.
GARCIA-DIA: Well, for me, Ari, I have this heavy responsibility as the president of PNAA. In fact, even prior to my term, our president got sick of COVID. Her husband got sick of COVID and passed away. So I temporarily transitioned in that role early on, and that has been taking a lot of toll emotionally for me, even up to now, just talking about it.
And I think I find comfort in prayer. Of course, you know, that's really cultural. And I am so blessed to have a prayer group who has been praying since the start of the pandemic up to now, praying the rosary. And that fills me with comfort. And I know that physical activity's important, so I try to make a point and block a time for myself to walk with my dog and just, you know, enjoy the little things that we can do in spite of what's going on.
SHAPIRO: And Kathryn, I can see you've got Badger (ph), your little dog, there behind you, so I'm sure (laughter) he helps, too.
IVEY: He's a very small dog, but he carries an awful lot of emotional baggage with him, so he helps a lot.
SHAPIRO: That is Kathryn Ivey, an ICU nurse in Murfreesboro, Tenn.; traveling nurse David Mancini, who lives in San Antonio, Texas, and is currently in Washington, D.C.; and Mary Joy Garcia-Dia in New York City. She's president of the Philippine Nurses Association of America; all three of them working hard to keep us safe during the pandemic. Thank you for your work and for talking with us about it.
MANCINI: Thanks, Ari.
IVEY: Thank you, Ari.
GARCIA-DIA: Thank you for having us.
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