Five years ago, on March 23, 2020, the first COVID-19 case was reported in the Elkhorn Logan Valley Public Health Department’s four-county area, which includes Norfolk.
Faith Regional Health Services in Norfolk had started implementing its COVID procedures 13 days before that first case. These procedures included hospital and clinic visitor restriction, as well as screening patients for COVID-19.
On Nov. 10, 2020, nonessential elective procedures were postponed to allow more care for COVID patients, and 14 more negative-pressure rooms were created. These rooms ensured that airborne infectious diseases did not leave the patient’s room.
“A lot of unknown and a lot of changes,” said Kelly Driscoll, president and CEO of Faith Regional. “Everybody really rallied around that we always wanted to do the right thing, give the highest quality of care, with the information we had at the time, and to be nimble and change as information came in.
“Everybody on the staff did an amazing job at being ready.”
As the pandemic raged on, Faith Regional accepted the most patient transfers in the state of Nebraska from the state transfer center to care for COVID-19 patients, hospital officials said.
Registered nurse Hillary Carson, who worked in the hospital’s intensive care unit, said protocols constantly changed. She said that before, they used life support to save lives, but during COVID, life support was a last resort. Those who had to be put on life support during COVID rarely came off of life support.
“We essentially had to have a new way of doing every single aspect of our jobs, from giving medications and scanning them to actually performing CPR on our patients,” Carson said. “We had to have new protocols for everything.”
The rapidly changing information, with nurses often starting at 6 a.m. with one set of information and then receiving new information later in the day, frustrated nurses. Communication got better as time went on.
Registered nurse Morgan Matteo, manager of the ICU, said the nursing staff would be briefed on new information and research, with detailed explanations on why they were changing the way they did things.
They also had a COVID information book to help brief staff members who had been out for a period of time.
“You could open the binder and see what changes had been made,” Matteo said, “trying to just have good, clear communication.”
Carson explained that at the beginning of COVID-19, the fear was that of the unknown, dealing with something without knowing what to expect. Later, it was the fear of getting sick or of other non-COVID patients getting sick.
“We would do everything to prevent ourselves and our non-COVID patients from getting ill,” Carson said.
This included wiping down the room as they entered and left, changing scrubs at work and showering before going home.
Matteo added to this, saying that the initial big fear was that they didn’t know what the long-term effects of COVID were going to be or how it would affect themselves, immunocompromised family members and staff members who were pregnant and working at the time.
“We’ve just seen people of similar age to us getting really, really sick, so it was scary for a lot of people,” Matteo said
Another stressor was being alone. Carson said that since they tried limiting the number of nurses in a room, the nurse assigned to a patient was everything for that patient.
“You did everything for that patient while you were in there and then, ultimately, we were their (the patients’) family because they had no contact with their family other than through an iPad,” Carson said.
Carson said all nurses were emotionally and physically fatigued, and while Faith Regional and the community made sure that they had enough bilevel positive airway pressure machines and ventilators, there were days when they had to choose which patient gets a ventilator over another.
“We had to pick the sicker patient and maybe the patient that had the better outcome,” Carson said. “Not that we had a crystal ball, but you had to make the best educated choice that you could.”
The peak number of COVID-19 cases Faith Regional experienced was 47 inpatient cases at one time and 89 positive tests in one day.
One of the most difficult aspects was dealing with the families of patients who, because of restrictions, were unable to be there with the patients. Carson described emotional outbursts expressing frustration and constant knocking on the windows from families wanting to catch a glimpse of their sick relative.
“When a patient would pass, obviously there’s many stages of grief, but we would see all those stages because they didn’t understand what was going on,” Carson said.
Matteo added to this, saying that as nurses, they had obviously dealt with people dying.
“Nursing is you get to bring life into this world and you get to help transition out of the world,” Matteo said.
She said that it’s easier for patients when someone is there with them holding their hand and being there for them in their last moments. However, it’s more difficult when patients don’t have anyone there.
“We’re getting Skype calls or using Facetime to help them share their last moments with their loved ones,” Matteo said. “So I think that took a big toll on us.”
Families of patients would come to the windows of the hospital to catch a glimpse of their sick relatives, whether it was to celebrate a birthday, be with them in their last moments or to see if they were still living.
“Tears were shed on both sides, whether it was the staff, the patient or the families on the other side,” Carson said.
They tried to transport patients to other facilities but were often left frustrated as the facilities wouldn’t have beds available.
Camaraderie among Faith Regional staff members helped ease the concerns people had.
Faith Regional took the necessary steps to secure the equipment to keep nurses safe. For example, the hospital provided washable gowns, new N-50 masks and something called cappers.
“We looked like aliens (referring to capper masks) … we couldn’t hear what people were saying, but we felt safe and able to help and assist,” Matteo said. “They just did a really good job.”
Matteo added that it was important for her to be there with the nurses and help. She said the Faith Regional staff put in the work, while many people helped by bringing supplies down to the “trenches,” as she put it.
“Everybody was helping take care of these patients. and that’s really like ICU nurses and our whole organization became such a great team,” Matteo said.
Both Carson and Matteo said the shared sense of purpose among the team during that time, plus the positive patient outcomes, kept people motivated.
“For every negative outcome, you had three positives that got over being sick and got to go home,” Carson said.
The good memories of COVID
Community support also played a huge role in helping Faith Regional staff, with churches and businesses donating lunches. They added that Nucor helped by donating face shields. This support motivated Faith Regional staff to keep going.
“You hear about health care heroes, and we truly did feel that way,” Matteo said.
Carson shared that one of her best memories was discharging a patient who had been on a ventilator for four months, surviving the odds and being able to go home.
“It was one of those stories that made everyone positive and rally around,” Carson said.
She explained that they noticed that every patient had a turning point, where they were sick but started getting better after a while.
“We could take a deep breath and now they’re on the mend and they’re going to get better and they’re going to get through this,” Carson said.
The staff would celebrate a patient’s “graduation,” which came when patients passed 21 one days without symptoms or infection. Nurses would have meetings and excitingly note the graduation dates of their patients. They also would put graduation hats outside of the doors of patients close to graduating.
She shared that for their two longest-term patients, the staff would line the halls and clap as the patients left. Matteo noted that one had joked about toasting once she left and when she did leave, they toasted her with sparkling juice.
She also shared that during the latter stages of COVID, there was a tornado warning and patients were not moved. One patient could not be moved, due to being on high levels of oxygen, so Matteo sat with the individual to keep the patient company. A few months later, she was approached by a patient saying that she took care of her during a tornado warning.
“That’s what we have to look at and cherish so that we can get through those not-so-fun times,” Matteo said.
The light at the end of the tunnel
Carson said that when the COVID doors and walls were taken down, that marked the moment when it was the light at the end of the tunnel for them.
Both Matteo and Carson added that visitors coming back also marked the end of COVID for them. Matteo explained that they tried bringing visitors back early because of how important they were to the recovery of the patient.
Driscoll reaffirmed Faith Regional’s willingness to adapt and keep a good environment for the staff and their patients.
“Faith Regional Health Services is ready for anything big or small to take care of the health care needs of Northeast Nebraska …,” Driscoll said. “No matter what happens, we’re ready to serve our people and our patients.”
Carson wants people to remember that COVID was a trying time, pushing staff to perform jobs that they were unfamiliar with and forcing staff to come up with outside-the-box ways to help treat patients.
“I think the big thing nurses will tell you is COVID is real,” Carson said. “The illness and devastating effects that were left behind from the virus are real, and the toll it took on the staff was real. The memories are real. And to trust the science, trust the process, and it taught us we are all resilient and strong.”
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