NURSING TODAY, May 13, 2020

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Spokane nurses and respiratory therapist describe the challenges and adaptations of caring for coronavirus patients.

From PPE shortages to furloughs, the pandemic gives the in-demand nursing profession a serious stress test.

Despite isolation orders, psychiatric nurses continue counseling and prescribing medication via telemedicine practices.

Certified restorative nursing assistant found his job – and his life’s calling – working in a Spokane Valley nursing home.

Geriatric nurse juggles tricky balance between isolation and community in rural Washington adult care home.

Missed some of our previous nursing coverage? See some past stories, which ran as part of the recent series On the Front Lines.

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THE SPOKESMAN-REVIEW

MAY 6, 2020

NURSING

Medical professionals charge into unknown Health care providers adapted to virus on the fly

By Arielle Dreher THE SPOKESMAN-REVIEW

Nothing could have prepared nurses and therapists for what 2020 would bring: a potentially deadly and definitely contagious respiratory virus.

Emergency departments and intensive care units are always the scenes of life-or-death situations, but COVID-19 has changed how providers in those settings do their jobs.

Bill Putren has been a nurse for 28 years, and he currently works in the emergency department at MultiCare Valley Hospital.

“Call us what you want,” Putren said. “We call it the front door.”

And while those who work in an emergency room have seemingly seen it all, Putren said COVID-19 “had a different feel from minute one.”

What made it so scary initially was just how quickly information about the virus changed.

“What makes it frustrating is much of emergency medicine is based on algorithms and we follow this process, and there is none for this,” Putren said. “There is now, but there wasn’t so much at the beginning. We were forced to be so very flexible in what PPE we’re using, what was really effective and what information was reliable.”

To help bolster order and predictably, all patients entering Valley Hospital now come through the emergency department, and every person is treated as though they have the virus, Putren said.

The emergency department comes together in a “huddle” every day and every shift, Putren said.

Providers pass back and forth new information about how long the virus lives on surfaces, how long it can stay in the air – all of the factors that could have important implications in the emergency room.

Spokane County hospitals began seeing COVID-19 patients in midMarch, according to health district data, but due to lagging test results at the time, health care workers would not know if they had worked with a COVID patient for days.

Putren said he would be at home on his day off and get emails saying he had had contact with several COVID-19 confirmed cases. The Valley emergency department, like others around the state, saw a decrease in overall patient volume when the pandemic hit, but Putren described the patients who were coming into the emergency department as very, very sick.

Once the emergency department stabilizes a patient, they are sent elsewhere in the hospital for treatment or to the intensive care unit. COVID-19 patients take a longer time to recover than normal patients do, nurses and respiratory therapists said.

Katherine Taylor, an ICU nurse at Providence Holy Family Hospital, said COVID-19 has changed the way she is treating patients.

While she still usually works with only two patients on a 12-hour shift, she can’t just run into a room anymore to fix a machine or answer a patient call button.

Health care workers must don a lengthy list of personal protective gear every time they enter a room with a novel coronavirus case to protect themselves, but this process takes time.

Every time Taylor leaves a patient’s room, she has to take off some of her protective gear. That means she has to think about more

DAN PELLE/THE SPOKESMAN-REVIEW

Bill Putren is an RN in the Multicare Valley Hospital Emergency Department.

Katherine Taylor, left, is an RN in the ICU, and Denell Allen is a respiratory therapist at Providence Holy Family Hospital.

than just the patient’s immediate needs when she enters a room. She also also has to consider what she might need five or 10 minutes later.

It’s a high pressure role, and she said she spends about 80% of her time in her patients’ rooms. Nurses are getting creative in order to not waste time or re-use PPE. Taylor said nurses use small white boards and hold them up to the room windows to ask others in the hallway for supplies they need.

“We’re the eyes and ears for our patients, and it’s up to us to notice when small changes are happening, whether they are good or bad, to keep our physicians in the loop,” Taylor said.

That means monitoring vital signs, oxygen levels and other patient needs and alerting other team members when help is needed.

Respiratory therapists play a crucial role in caring for COVID-19 patients too and spend time in rooms adjusting ventilators and monitoring a patient’s airway and ability to breathe.

Denell Allen has worked as a respiratory therapist at Holy Family for 20 years. COVID-19 has presented unique challenges for Allen and others because respiratory therapy techniques almost always require aeresolizing, or dispersing particles into the air, which could

spread a patient’s respiratory droplets throughout the environment.

“Trying to find ways to not expose the nurses I work with has been challenging, while also trying to do the best for the patient,” Allen said.

Holy Family converted several rooms into negative air pressure rooms early on, which helped take some of the pressure off of the therapists, Allen said.

On a typical day in the hospital, Allen could be working on any floor, and running into an emergency situation is a normal part of her work life. But with COVID-19, Allen too must put on all the proper gear before going to check on a patient.

“On a good day prior to the pandemic, it’s often uncontrolled and very rapid, running in to a code situation,” Allen said. “And now with this, it makes it even more nerve-wracking. You want everything to be as controlled as it can be for a good outcome and not spreading it as well.”

The first time Allen intubated a COVID-19 patient, connecting them to a ventilator, she remembers having to calm her own nerves and not think about all the things that could go wrong. Ventilators are complicated machines, and if

her hand trembled and a certain circuit popped off or something became unhooked, things could go wrong, she recalled.

“I think the unknown is what’s scary about this,” she said.

Allen has noticed her patients with COVID-19 who come in sick can get sicker quickly, increasing the need for her continued attention and various respiratory therapies, including ventilation. Not having quick test results made care challenging for Allen at first because she did not know who to prioritize or who might decline quickly.

Connecting with patients and saving lives are a welcome part of the job for nurses like Putren and Taylor as well as for therapists like Allen.

COVID-19 has made this challenging, too.

Donning full PPE, patients can only see their caregivers’ eyes.

Sometimes, Taylor said she will use only her face shield to protect her face so that her older patients, who might have trouble hearing her, can at least read her lips so they know what she is saying.

No one can have visitors in the hospitals right now, leaving COVID-19 patients alone except for their caregivers.

Holy Family provided iPads to

patients in order to FaceTime with their families, and Taylor said one of the brightest moments of the entire pandemic was when she held an iPad so that a patient could spend 15 minutes talking to his family.

“Being a part of that and having to hold an iPad was something I never thought I would be doing in an ICU,” she said. “And in today’s world, that’s what we’re doing.”

Some patients on ventilators cannot speak at all, so Taylor said she does her best to keep her patients company, telling them how different the world is now, recounting her stories from the grocery store and sharing with them what the weather is like.

Anything “so they don’t feel like they’re laying there in isolation with no human interaction,” Taylor said. “That’s been really, really hard on patients.”

While front-line workers continue to treat COVID-19 patients, they do worry about bringing the virus home to their families. Some health care workers change clothes before they leave their hospitals or in their garages at home.

Others shower and change before they even hug their spouses or family at the end of a long work day.

“One of my biggest fears is to spread it to the people at the bedside or in my home or community,” Allen said.

And yet, they persist.

While Putren acknowledged that Spokane has not had it nearly as bad as other places, she said she and the system at large are prepared, whatever happens.

“We didn’t see what some of these other cities are seeing,” he said. “I don’t want to say we’ve got inundated because we’re not. (But) we’re ready, and I know we can handle it.”

While increased testing, increased availability of PPE and the creation of established processes to deal with patients are comforting to health care workers, Allen acknowledged there is still more to come.

“I feel like we are prepared – not to say that it’s not unnerving,” Allen said.

CONTACT THE WRITER:

(509) 459-5467 arielled@spokesman.com

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N U R SES W EEK 2020

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Best. Nurses. Ever.

This year, Nurses Week holds an especially prominent place in our hearts as we thank those who give so much.

Please join us in thanking our nurses, today and every day, for their compassion and commitment to care for all.

MAY 6, 2020

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PATIENT ONES

By Charles Apple | THE SPOKESMAN-REVIEW

Nurses — surely the unsung heroes of today’s coronaviral world — come in all varieties. They have different levels of training, different specialties and different acronyms to describe their profession. One thing they all have in common: They aim to make life a little better for patients and their families.

WHO NURSES ARE AND WHERE THEY WORK Nurses in the U.S.

3.3 million 43.7 Average age

Male

General medical/surgical hospitals

2.09 million

232,461 Nursing care facilities 179,933 Outpatient care centers 150,480 Physicians’ offices 140,042 Home health care services

Female

White

388,000 2.91 million 11.8% 88.2%

2.46 million

393,728 Black 305,458 Asian 72,857 2 or more 53,205 “Other” 10,963 American Indian

As of 2018, the most recent year for which data is available

FIVE LEVELS OF NURSES Typical duties may differ from clinic to clinic or from state to state

Nursing Aides or Assistants Nursing assistants may or may not have a degree or certification. In fact, some assistants may be nursing students. A Certified Nursing Assistant will have a certain amount of training.

LEVEL OF TRAINING

Some have only on-the-job training.

TYPICAL DUTIES ■ Checking vital signs ■ Serving meals and helping patients eat ■ Helping patients get into or out of beds and wheelchairs ■ Helping patients get dressed or use the toilet ■ Performing patient hygiene care ■ Relaying information to nurses

ADN: Associate Degree in Nursing A Licensed Practical Nurse might have one year of training at a vocational school or community college.

A nurse with an Associate Degree will have completed two years of study with some supervised clinical experience as well.

LEVEL OF TRAINING

2 years

TYPICAL DUTIES ■ Administering injections or starting intravenous drips ■ Performing therapeutic massage ■ Preparing patients for surgical procedures ■ Maintaining patients’ medical records ■ Changing bandages and dressings ■ Communicating patients’ needs to medical staff

BSN: Bachelor of Science in Nursing Most Registered Nurses have four-year bachelor’s degrees and have passed a nursing exam. Many of the nurses staffing medical offices, clinics, urgent care centers, hospitals or long-term care facilties are RNs. RNs are highly sought after for work in intensive care units.

LEVEL OF TRAINING

4 years

TYPICAL DUTIES ■ Operating specialized medical equipment ■ Empowered to make what are called nursing diagnoses, which may deal with a patient’s comfort, relief or risk ■ Can supervise work of nursing assistants and Licensed Practical Nurses ■ Educating patients and family members for further care once a patient returns home

MSN: Master of Science in Nursing Advanced Practice Registered Nurses have postgraduate training in a specific field of study and may have additional clinical practice. An MSN may be required for some higher-level nursing supervisory positions or health policy experts.

LEVEL OF TRAINING

6 years

TYPES OF ADVANCED-DEGREE NURSES ■ Nurse Practitioner, who may have many of the same duties as a doctor ■ Certified Registered Nurse Anesthetist, who works closely with doctors in an operating room ■ Clinical Nurse Specialist, who may work in fields like cardiology, obstetrics, oncology or neurology ■ Certified Nurse Midwife, who can deliver a baby — if there are no complications

DNP: Doctor of Nursing Practice Sounds like an oxymoron, but one can become a Doctor of Nursing Practice, achieving expertise in a practice-oriented leadership role. Alternatively, a nurse could earn a Ph.D. — a degree that’s more research-oriented.

LEVEL OF TRAINING 8 to 11 years

TYPES OF THINGS A DNP MAY DO ■ Make diagnoses and set up a course of treatment for a patient ■ Play a lead role in managing the care of patient populations or in administrating a nursing or health care organization ■ By 2025, all Certified Registered Nurse Anesthetists will need to be DNPs. ■ Teach

Sources: DeLoitte, NurseJournal.org, Nurse.org, NursingSchoolHub.com, NursingDegreeGuide.org, AllHeart.com, DoctorOfNursingPracticeDNP.org, RegisteredNursing.org, Commission on Collegiate Nursing Education

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NURSING “The most affected roles, during this crisis, are the same roles that were most affected prior to the outbreak.

However, the resulting effect has been amplified. These positions include care staff members such as caregivers, medication aides and nurses.”

An assisted living facility In a report to the Sentinel Network, which surveys health care settings in Washington state

From shortages to furloughs, pandemic gives high-demand nursing profession a stress test Balancing act to match caregivers, medical need

By Arielle Dreher THE SPOKESMAN-REVIEW

More than a quarter of registered nurses licensed in Washington state do not work here.

This revelation is one of many that came after months of analysis by the University of Washington Center for Health Workforce Studies, which published in March some of the most comprehensive data to date on how many nurses work in the state, where they work and who they are.

The report shines light on data that will help explain where nurses are working – and where they are needed.

As the state’s health care system has received an almost unprecedented stress test from the demands of the coronavirus pandemic, Washington’s existing needs and imbalances have become more apparent.

As the health care system has been called on to shift resources and personnel to ensure it is prepared to handle an influx of COVID-19 patients, nurses have been asked to work longer hours, move to new care settings and deal with shortages of critical supplies, including personal protective equipment. Other nurses have been furloughed or laid off as many nonessential procedures were paused.

The supply of nurses has long exceeded demand, and the pandemic has disrupted an already fragile pipeline tasked with ensuring the health care system is adequately and properly staffed. It has also disrupted the professional and personal lives of many nurses.

“Trying to match the demand and the supply is always challenging,” said Paula Meyer, executive director of the Nursing Care Quality Assurance Commission. “And I think this (the pandemic) will add one more challenge right now, immediately with layoffs and then with opening up the economy.”

The University of Washington study painted a detailed picture of nursing in the state before the pandemic. Among its central findings were the following:

LIBBY KAMROWSKI/THE SPOKESMAN-REVIEW

A sign from Slavic Baptist Church reads “Praying For Healthcare Workers” at one of the street entrances to the Providence Sacred Heart Hospital on April 26. l There are about 62,393 registered nurses working in Washington, but nearly 30,000 more – 90,975 nurses – are licensed to work in the state. l More nurses work in urban settings than in rural ones, and this divide is more distinct in Eastern Washington, where half the number of nurses work in rural settings compared to urban settings.

The new data also revealed the care settings where registered nurses in Washington work.

More than half of the state’s nurses work in hospitals and ambulatory care centers, making up about 68% of the workforce.

Long-term care settings and community health settings only make up 15% of the nursing workforce in the state. Both sectors have proved vital as the state continues the challenge of staving off the work effects of the COVID-19 pandemic.

In long-term care settings especially, finding registered nurses was a challenge before the pandemic. Skilled nursing facilities are required by state law to have a registered nurse on site 24/7, but shortages in longterm care settings persisted before the pandemic.

“We know that we don’t have enough people there,” Meyer said.

The pandemic has ex-

acerbated that problem.

Or, as one assisted living facility reported to the Sentinel Network, which surveys health care settings in Washington about their workforce, “The most affected roles, during this crisis, are the same roles that were most affected prior to the outbreak. However, the resulting effect has been amplified. These positions include care staff members such as caregivers, medication aides and nurses.”

Throughout 2019, nurses represented by several unions made headlines by striking and threatening to strike in different parts of the state, including in Spokane, to keep their sick leave plans, to push for increased staffing or to address pay concerns.

While those negotiations continued into the new year in some cases, contracts were settled on the whole, just in time to face a new challenge: a respiratory virus with no cure and potentially deadly consequences for some patients.

Nurses are on the front lines. New graduates, retirees and out-of-state health care providers answered the call to aid the outbreak of COVID-19 in Washington and fill any gaps.

Since Feb. 1, the nursing commission has issued 3,857 temporary practice permits, which allow nurses to fully practice

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while they wait for a full background check to come through. These are primarily nurses coming from out of state to help.

“It’s an all-time high,” Meyer said of the number of applicants in that time frame. “We were busy.”

So busy, the nursing commission asked the governor’s office for additional funds to help staff its office.

The commission has al-

so issued 364 emergency interim permits since March 24. These permits allow recent nursing school graduates to enter the workforcewhile waiting to take the national nursing exam, which was put on hold during the pandemic. (Testing centers are set to reopen in May, enabling new graduates to take their exams and get their licenses without need for an in-

terim permit.)

More than 600 nurses have volunteered to help fight COVID-19 from in and out of state.

“The year 2020 was designated the year of the nurse (by the World Health Organization) because of how critical nurses are to people,” Meyer said.

The timing for such a

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Thank you nurses and health care workers on the front lines and behind the scenes.

We are so grateful for your dedication and care.

Proudly educating nurses who impact the health and well-being of individuals across the globe since 1930.

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Each acknowledging other’s essential role

JESSE TINSLEY/THE SPOKESMAN-REVIEW

Mutual admiration: Health care workers from Kootenai Health applaud members of the Emergency Operations Center, local law enforcement, fire and emergency medical services and Emergency Management offices as they conduct a thank-you parade for their allies in health care in Coeur d’Alene on April 29.

NURSING Continued from 5 designation seems prescient. In hospitals around the country, nurses are treating COVID-19 despite a lack of PPE and despite staffing issues that have been at the forefront of nurses’ concerns as they respond to the pandemic.

Unions have called on federal and state leaders and agencies, as well as hospitals, to protect their workers from the outset.

PPE shortages nationwide and globally have led to unprecedented practices and guidelines for health care workers. Some hospitals are asking staff members to reuse some items if they can or are sanitizing materials for reuse. Other hospitals are turning to local community partners for PPE in lieu of backed-up supply chain orders.

“Our big concern around PPE is that extended use and reuse should not become the new norm,” said Sally Watkins, executive director at the Washington State Nurses Association.

“We need to eventually get back at some point, God willing, to what we call ‘the green zone,’ where people are practicing the way they’ve been trained – where people are using one-time-use things one time.”

Some nurses have quit due to PPE shortages and not feeling safe or protected while taking care of COVID-19 patients, Watkins said. Other nurses have been furloughed, laid off or forced to pivot in the midst of COVID-19.

With Gov. Jay Inslee postponing all elective surgeries and nonurgent pro-

cedures for two months, many hospitals dropped to low census numbers and furloughed staff. Other hospitals have tried to repurpose staff members.

Sofia Aragon, executive director at the Washington Center for Nursing, said the furloughs might be an opportunity for some nurses to consider other work settings, including nursing education, which needs to expand for the nursing workforce to grow statewide.

Moving nurses from one workplace setting to another is not as simple as it sounds, because nurses tend to specialize or stay in one care setting, Aragon said. Nurses are required to do continuing education to be licensed in Washington, but those requirements have been waived by the commission so nurses can focus on the pandemic at hand. Many skills in different facilities where nurses work are transferable, but a nurse must feel comfortable performing those tasks.

“The nurse has to show competency,” Meyer said, pointing to the state law the lays out how nurses must be prepared to do their jobs.

Furloughed nurses in the job market could also be competing against recent graduates for jobs in coming months.

“From a new grad perspective, one of their biggest concerns is, ‘Where am I going to get a job?’

This is going to be a pretty challenging landscape for them right now,” said Jo Ann Dotson, director of the bachelor’s nursing program at WSU College of Nursing.

Nursing schools received permission to be

flexible with soon-to-be graduates who could not do their final practicums due to the pandemic.

Some schools used simulation, and Dotson said students at WSU still had far more clinical hours than are required to graduate. WSU nursing students also were able to offer their skills, working with the local health department and community sites to provide virtual care and support to designated elders in the community, who cannot receive visitors or socialize during the pandemic.

Leaders are already thinking about the future, in the interim and into the fall, when there could be another surge in COVID-19 cases coinciding with flu season.

“We’re always looking at, ‘Do we have enough nursing students going into the pipeline?’ ” Meyer said.

Aragon said the pandemic could be used by nurses as an opportunity to change systems going forward, especially in terms of testing and personal protective equipment.

“They have an opportunity to change systems, so we don’t have to furlough or shut down elective surgery because we’re confident in terms of practice regardless of emergency,” Aragon said. “That’s an exciting thing and something we can take care to learn from the experience and make it better, so we don’t have these massive shutdowns because in the long term, we still need everybody and still don’t have enough.”

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Psychiatric nurses stay connected to patients, despite isolation orders

JESSE TINSLEY/THE SPOKESMAN-REVIEW

Damaris Aragon, a mental health nurse practitioner in private practice, often works on her laptop on the patio of her home, shown April 30 in north Spokane. She mostly meets patients over remote connections these days.

Making the shift to telemedicine to keep tabs on mental health fessionals in the pandemic, Damaris Aragon, a Spokane-based psychiatric nurse practitioner, is Even when you’re in isolation, working from home. you’re not on your own.

But she’s still available.

Like so many other pro“We want to help, and so please

By Adam Shanks

THE SPOKESMAN-REVIEW

reach out, because you’re not alone. This is a time when it’s more critical that we ask for help,” Aragon said.

Advanced practice psychiatric nurses, accustomed to treating pa-

tients face-to-face, have quickly by the stress of the COVID-19 panadapted their practices to con- demic. tinue counseling and prescribing For Aragon, the shutdown medication to patients with a meant transitioning from her broad array of mental health See PSYCHIATRIC, 9 needs that are only exacerbated

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‘‘

What I want people to know right now is that we are here, we are here for them. Things might be shut down, but we’re still available.”

Melody Bemis Psychiatric nurse practitioner with Frontier Behavior Health

COLIN MULVANY/THE SPOKESMAN-REVIEW

Melody Bemis, a psychiatric nurse practitioner with Frontier Behavior Health, is working with clients to keep them mentally healthy during the the COVID-19 pandemic, primarily through telemedicine.

PSYCHIATRIC

It was not without challenges. A phone call would get disconContinued from 8 nected, a screen would freeze. It’s only been within the last week downtown Spokane office to an that the new system has gotten at-home telemedicine practice in consistent. the span of about 48 hours.

“It is a lot harder to do it, so it

has required a lot of courage. ...

This is not how I’ve done nursing over the last 26 years,” Aragon said.

Advanced practice psychiatric nurse practitioners are highly educated and licensed to diagnose

and treat conditions like anxiety and bipolar disorder.

Melody Bemis has worked as one at Frontier Behavioral Health for a decade. Her interaction with patients is not focused on counseling, because sessions are limited

20 minutes, except in the case of a first-time patient, who undergos an hour-long session.

Instead, Bemis’ work is mainly to diagnose and prescribe medi-

See PSYCHIATRIC, 10

NURSES MAKE A DIFFERENCE It’s never been more clear how important nurses are for our community.

MAKE A DIFFERENCE FOR NURSES Let’s show them we have their backs.

Take action to help nurses at wsna.org/helpnurses

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PSYCHIATRIC Continued from 9 cation to patients based on their individual needs, while other clinicians and counselors are available to see patients at least once a month.

Bemis follows up with patients regularly to ensure the medication she prescribed is working for them.

That work has continued during the COVID-19 pandemic, but from her own home.

“It does impact because I think you can always get a better assessment if you see somebody in person,” Bemis said.

Now, Bemis interacts with patients over the phone, although there is hope that Frontier Behavioral Health will be able to add video conferencing as an option for patients who have access to the technology.

Luckily, many of the patients Bemis has talked to over the phone have already been into the Frontier Behavioral Health center she operates in, so she has an established relationship with them.

She makes it a point to remind patients she is almost always available by phone.

“If they have any questions, they can always call,” Bemis said.

For psychiatric nurses, working from home has been no vacation.

“I think we’ve tried to make our schedule a little bit lighter each day because of working remotely, but it doesn’t always turn out that way,” Bemis said.

Aragon, who operates her own practice, answers the phone, schedules appointments and treats patients – “everything except for the billing,” she said.

“I don’t have a boring day. Every single day is different for me.

It has its challenges, because I’m a single-practice person,” Aragon said.

Aragon looks at COVID-19’s impact on the health care system globally, and knows she has a role to play. She doesn’t want psychiatric patients to end up in the hospital, now more than ever.

“Mental health services are really critical,” Aragon said.

Aragon has worked as a nurse for more than 20 years, but it was only in 2013 that she graduated from Gonzaga University and entered the field as a psychi-

Sacred Heart housekeeper plays unsung but crucial role in stopping COVID-19’s spread

If you need help Call Frontier Behavioral Health’s 24-hour crisis hotline at (877) 266-1818.

By Jared Brown THE SPOKESMAN-REVIEW

atric nurse practitioner, launching her own practice in Spokane.

After years working with patients with chronic conditions, “it occurred to me I was talking to patients who had schizophenia and were there for diabetes, or people who had surgery who had depression or anxiety,” Aragon said.

Now in the mental health field during a pandemic, she’s worried about patients’ conditions worsening if they stop taking their medication and about patients relapsing if they have a history of substance abuse, for example. For the first couple of weeks after the pandemic brought life to a halt, it also brought a drop in the number of calls Aragon received.

But now, she’s seeing an uptick.

“It has to do a lot with anxiety,” Aragon said.

Aragon is recommending the patients – and everyone else, for that matter – make a conscious effort to get out in the sun for 30 minutes every day. Take a walk as a family or alone. Drink that first cup of coffee on the porch if you have one. And try not to read the news right before going to bed.

“Think of this as a time you’re protecting yourself, rather than this being forced on you,” Aragon said.

Likewise, Bemis recommended people seek out the sunshine.

“I always encourage (patients to) go out for a walk, get some fresh air – just keep your social distance,” Bemis said.

Bemis and Aragon both highlighted that for those in crisis, there is a 24-hour hotline at (877) 266-1818 operated by Frontier Behavioral Health.

“What I want people to know right now is that we are here, we are here for them,” Bemis said.

“Things might be shut down, but we’re still available.”

CONTACT THE WRITER:

(509) 459-5136 adams@spokesman.com

Just like health care providers, Lilly Haeger walks into the rooms of suspected and confirmed COVID-19 patients at Providence Sacred Heart Medical Center wearing gloves, a gown and face protection – then a second pair of gloves. But she isn’t there to provide hands-on care.

Just like health care providers, Lilly Haeger walks into the rooms of suspected and confirmed COVID-19 patients at Providence Sacred Heart Medical Center wearing gloves, a gown and full face protection – then a second pair of gloves.

But she isn’t there to provide hands-on patient care. Her job as a housekeeper in the hospital’s environmental services department is to disinfect rooms and keep disease from spreading to the next patient.

“I think what we do is different than what your housekeeper at a hotel would do because we’re more focused on keeping people safe from disease than making it look pretty,” Haeger said. “It’s been drilled into me to treat a room like your family member is staying there next.”

Haeger also functions as part of the hospital’s special pathogens unit, which was created in response to the Ebola outbreak in 2015. When the four COVID-19 patients from the Diamond Princess cruise ship were discharged, she was the one to do most of the disinfecting.

She also cleaned the empty unit regularly to be sure it was ready when the time came. And she watched numerous videos and underwent hours of training with health care workers in preparation for the worst-case scenario.

“For me, it wasn’t too nervewracking,” Haeger said about the four cruise ship passengers coming to Sacred Heart.

When the first possible COVID-19 cases from the Spokane community started arriving at the hospital last month, Haeger already had some practice.

“I have so much experience cleaning high-risk rooms,” Haeger said.

More than 13 years ago, a family

KATHY PLONKA/THE SPOKESMAN-REVIEW

Lilly Haeger, housekeeper and a member of the Special Pathogens Unit at Providence Sacred Heart Medical Center is photographed April 17. member of Haeger’s who was working at Sacred Heart said she should apply for a job at the hospital. Before that, she had been working in hotels as a housekeeper.

Since then, even in light of COVID-19, her job hasn’t changed much, except for the extra disease prevention guidelines she has had to adhere to for the last several weeks, she said.

“This is what we do every day, and now we have to put into practice what we had only watched on videos for the real special stuff,” Haeger said.

Now she enters rooms of a potential COVID-19 patient with all the supplies she needs in order to limit exposure outside. She doesn’t leave until everything in the room has been disinfected.

“Just any kind of surface in the room,” Haeger said. “Anything that could possibly be coughed on and be touched later.”

That includes chair and table legs, along with handles on dressers and cabinets, Haeger said. At home, she said people can apply the same principles to phones, TV remotes and shower knobs.

“Pretty much anything you can touch,” she said.

Haeger volunteered to clean the rooms of suspected COVID-19 patients as the first potential cases arrived because she sensed the apprehension in other staff mem-

bers.

“I knew (patients) still need the care that I provide,” she said. “It not only made them feel better, but it made the nurses feel better that I had cleaned. ... Any fear of getting it wasn’t on my radar.”

She has also trained her colleagues to clean high-risk rooms and make them feel safer doing so.

“I just express to them how important it is for things to be disinfected,” Haeger said. “And not only that, but everybody doing their job properly, so if we’re all doing our job properly we’re going to be protected.”

Haeger cleans other high-traffic areas of the hospital once she’s finished with patient rooms. Wiping down surfaces such as handrails has garnered more than one “Thank you” from physicians, she said.

“It really shows how important our job is, and how important it is to not only make our patients feel safe but also our staff feel safe,” Haeger said. “It brings a little extra comfort for everybody ... and that’s what we can take away and be proud of.”

Haeger also acknowledges the inherent risk in what she’s doing, with some contacts being riskier than others.

“I have a strong faith,” Haeger said. “So if I were to somehow get exposed, I am OK with whatever that path would take as well.”

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MAY 6, 2020

NURSING

Restorative care is his calling in nursing home CNA in Spokane Valley cherishes moments to make a positive impact

By Emma Epperly THE SPOKESMAN-REVIEW

In the halls of Sullivan Park Care Center in Spokane Valley, walkie-talkies are the new thing, helping residents play bingo from their rooms rather than gathering as usual.

Keeping up the fun and loving environment despite COVID-19 changing procedures across the board is a task Certified Nursing Assistant Christopher Zuniga has been training to do for his whole career.

Zuniga started volunteering at Sullivan Park Care Center over a decade ago.

He wasn’t quite sure what he wanted to do professionally, but after growing up with a father who was a registered nurse, he was drawn to the medical field.

“Sullivan Park is a special place, with the culture and how we treat our residents and so I wanted to be a part of that,” Zuniga said.

A director at the care center, which provides both rehabilitation and skilled nursing services, saw Zuniga’s potential and encouraged him to become a CNA. Now, Zuniga is a restorative nursing assistant who helps residents maintain the progress they have made in rehab while living at Sullivan Park.

He also takes new CNAs under his wing, acting as a mentor and helping them not only keep up a positive attitude but also hone their craft.

Certified nursing assistants deliver direct care to patients by helping with their daily routine, including assisting with bathing and grooming, helping with meal times and monitoring residents’ conditions and behavior.

During the pandemic, CNA’s have not only adjusted to the constantly changing safety procedures to protect patients

KATHY PLONKA/THE SPOKESMAN-REVIEW

CNA Christoper Zuninga is photographed April 30 in front of Sullivan Park Care Center in Spokane. He’s confident in their response to the COVID-19 pandemic. and themselves from COVID-19 but also have been helping residents connect with family and friends who can no longer visit.

The care center added hospitality aids to help facilitate Zoom calls with families, and care teams have been coming up with individualized activities based on each resident’s interests. They encourage families to write letters and send notes as much as they can.

“Families mailing letters has been a really big deal,” Zuniga said.

Zuniga recalled a resident who recently was supposed to have a special surprise visit from a family member to let him know they had named their daughter after the resi-

dent.

The trip was canceled, so instead the staff at Sullivan Park set up a Zoom call with the entire family.

“It was just a very touching process,” Zuniga said. “They’re still able to have that communication.”

For Zuniga, moments like that are why he has continued to work as a CNA and at Sullivan Park for years.

“There are so many touching moments with our residents, from seeing them coming in with a wheelchair and then seeing them walking out,” Zuniga said. “Watching that growth is a big deal.”

Zuniga loves facilitating growth in residents and in his fellow CNAs. He went back to

school to earn a bachelor’s in public health administration and has taken as many training seminars as possible from Prestige Care, Sullivan Park’s parent company.

The training and mentorship he received from the start of his career has helped him grow and create a positive and loving care environment, Zuniga said.

“I was just a kid too, so there was a lot to learn there but there was also a lot of opportunity to grow,” Zuniga said.

He passes that same advice on to young CNA’s today.

“You will get it. You’ve got to be patient,” Zuniga tells them.

“Don’t forget the negative, but change your focus to the positive.”

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thinking about becoming a CNA to come volunteer or work at Sullivan Park in a job that requires less training.

“This a very rewarding but a very hard job to be doing on a daily basis,” Zuniga said.

Witnessing CNAs in action everyday was a big part of why Zuniga took the leap himself and also why he has such an appreciation for the rest of the staff that keep Sullivan Park in action.

“It’s all of us,” Zuniga said.

“It takes every department – laundry, the kitchen – everybody doing their job correctly to create that environment.”

CONTACT THE WRITER:

(509) 459-5122 emmae@spokesman.com

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THANK YOU, NURSES Day and night, you’re at their side: Alleviating pain. Talking to families. Facing risks to your own health. Saving lives.

Thank you, nurses, for serving on the front lines of the COVID-19 pandemic — and for the dedication and compassion you give every patient, no matter the circumstances.

Join the effort: uw.edu/together

MAY 6, 2020

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WSU’S JANESSA GRAVES INSPIRES NEXT GENERATION OF NURSES, WITHOUT BEING ONE HERSELF

PHOTOS BY TYLER TJOMSLAND/THE SPOKESMAN-REVIEW

Janessa Graves, an assistant professor at Washington State University’s College of Nursing and a pediatric injury researcher, smiles as she is awarded a 2020 WSU President’s Award for Leadership Faculty and Staff over a Zoom meeting on April 21 at her home in Chewelah, Wash.

Instructor introduces students to world of clinical research

By Kip Hill THE SPOKESMAN-REVIEW

A mission in Fiji with the Peace Corps convinced Janessa Graves of the importance of public health, especially among people who need the most help.

“I was stationed on an island and there was this beautifully built hospital that literally did not have Band-Aids,” said Graves, an associate professor in the Washington State University College of Nursing in Spokane.

For the past three years, Graves has served as a fellow at WSU’s Honors College, allowing her to work with students in the nursing program with an eye toward clinical research.

Graves is quick to point out that she’s not a registered nurse (her background is in environmental biology), but over the past several years she’s worked with students preparing to treat patients and introduced them to the importance of scientific literature in a profession that’s demanding more academic knowledge from its front-line workers.

“When they’re in their jobs as nurses, they can be the ones that say, ‘I know how to do this,’ ” said Celestina Barbosa-Leiker, a colleague of Graves’ at the College of Nursing. “It’s more important than ever to read and understand science.”

Barbosa-Leiker said Graves’ unique contribution to students’ success in the field is one of the reasons she nominated Graves for the university’s President’s Award, which recognizes top leaders at WSU. And she wasn’t the only faculty member to nominate Graves for the prize, which WSU President Kirk Schultz presented to Graves in an online ceremony held April 21.

Graves’ research has focused on the needs and disparities in health care in rural settings for injured children, specifically those with traumatic brain injuries. Graves was the lead author on an academic study published last year in the journal Health Services Research that analyzed commercial insurance claims to show rural children receiving care for brain injuries were paying more than their counterparts in cities.

Janessa Graves, top row, middle, smiles as she is awarded a 2020 WSU President’s Award for Leadership Faculty and Staff.

And that’s not taking into account the extra hit to incomes on travel to get to areas where children can be treated, she added.

“It’s unfortunate. Because if you live in a city, maybe you have to take a little bit of time off work, but it’s taking a half a day off for people who live in rural areas,” Graves said.

Graves said she saw those rural barriers to care while growing up south of Missoula, and now in her own life as a mother caring for kids in Stevens County. In addition to caring for the body, an additional area of her research involves looking at the lack of mental health care options for families living in far-flung areas.

“With mental health counselors, privacy is an issue,” Graves said. “But when you both go to the only grocery store that’s in

town, within 40 minutes, you’re going to run into each other.”

Barbosa-Leiker, who is also not a registered nurse but approaches her instruction through a background in psychology, said it’s important for students to be introduced to the kinds of big thinking and research opportunities that Graves provides in the college.

“She’s not a nurse, but she plays this super, key role in the College of Nursing,” BarbosaLeiker said.

Jacquie Deichman graduated from the College of Nursing last year, and is a nurse specializing in neurology at Providence Sacred Heart Medical Center. Deichman said Graves introduced her to the possibility of continuing her academic career after practicing as a nurse, and that her help in

understanding academic literature helped give her a leg up when it came time to starting in the workforce.

“Before I even started, I would have said there was absolutely no way I would do clinical research. But she made me really enjoy the process,” Deichman said. “That’s because of her, and her passion for it. It just explodes out of her.”

Deichman worked with Graves on an honors project that explored whether a 2009 Washington state law had been effective in requiring children with traumatic brain injuries to be evaluated by health care professionals before returning to play. After examining emergency room statistics, Deichman’s award-winning thesis determined that more and more children weren’t be-

ing evaluated.

“She spends so much time with her students, and really gets to know them,” said Deichman, who called Graves a mentor.

For Graves, working with nursing students while also researching and publishing is a way to feel part of the important work she says the college is doing, a feeling that was strengthened when she was recognized by her colleagues and students as worthy of the President’s Award.

“I didn’t go to WSU. I’m not a nurse,” Graves said. I think it’s meaningful, it solidifies what I’m doing. I feel like I belong, working with these students and the Honors College.”

CONTACT THE WRITER:

(509) 459-5429 kiph@spokesman.com

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FACING DOWN CORONAVIRUS

Physician assistant volunteers to screen colleagues at VA

By Jared Brown THE SPOKESMAN-REVIEW

If not for the COVID-19 pandemic, Mann-Grandstaff VA Medical Center physician assistant Theresa Schimmels would be preparing to head to Seattle to receive a lifetime achievement award from MEDEX Northwest, the University of Washington School of Medicine program where she received her education.

Instead the dermatology specialist from Spokane has taken on a new role as a part of the VA Medical Center’s COVID-19 response, mainly by screening employees before they start a shift at the facility for the past three weeks.

“I feel like it’s a huge responsibility,” Schimmels said. “When they first asked for volunteers for this, I volunteered because I knew there would be people who would be more afraid than I was.”

Part of that is informed by Schimmels’ emergency medical background, she said. She worked at Providence Sacred Heart Medical Center in the 1980s during the early days of Heart-Flight, the original emergency helicopter transport program at the hospital.

Schimmels, who was a respiratory therapist at the time, also volunteered to care for some of Spokane’s first HIV/AIDS patients at the beginning of the epidemic.

“You never forget the drills,” Schimmels said. “You never forget the procedures. Some of what I’m doing now feels like an echo of that.”

At the VA Medical Center, Schimmels sits alongside nurses who screen each employee, then examines anyone whom the nurses are unsure about. She also screens employees who recently called out of work for an illness or recorded a fever – some of whom she’s sent home as a precaution.

“I get to ask the tougher questions,” Schimmels said. “I get to be

KATHY PLONKA/THE SPOKESMAN-REVIEW

Physician assistant Theresa Schimmels has joined the efforts to keep veterans safe from COVID-19. kind of the gatekeeper.”

“It’s about being prepared and making decisions for the benefit of others,” she added later.

Schimmels still gets to do her normal work in dermatology during the latter part of her day, now mainly through virtual visits due to COVID-19 safety measures. Her care often involves skin cancers, rashes and acne, she said.

“The limitation is, of course, you can’t do a biopsy,” Schimmels said.

Schimmels, who is a veteran herself, said she’s found it extremely rewarding to work at the VA Medical Center serving former service members since 2017.

She served in the Washington Air National Guard for more than 20 years as a professional musician in Fairchild’s 560th Air Force Band, known as the Band of the North-

west until it was deactivated in 2013.

She was in the Spokane Community College respiratory therapy program at the same time. And her roles included piano, clarinet, percussion and vocals, as well as band operations non-commissioned officer for about a decade.

“Being able to give back a little bit of what (the military) gave me... I can’t tell you how good that makes my heart and soul feel,” Schimmels said. “And I feel like that experience helps me with the experience I have with my veteran patients.”

Schimmels was eventually encouraged by other medical professional to enroll at MEDEX Northwest, which she graduated from in 1999 with her physician assistant certification.

“To help with the underserved,

that’s what being a PA is all about,” Schimmels said. “At the veterans center, a lot of people have nothing.”

Before the VA Medical Center, she worked at MultiCare Rockwood Clinic in dermatology for many years.

And during her career she’s served as president of the Washington Academy of Physician Assistants, as well as a member of the American Academy of Physician Assistants and Washington Medical Commission.

She now mentors students at the VA Medical Center, including those in the MEDEX Northwest program. She is currently advising second-year physician assistant student Julia Snider.

Schimmels said her proudest moments are when former stu-

dents call her for help with a patient, “and then have them get it right and know I taught them how to do that.”

She was initially “flabbergasted” about the lifetime achievement award from the University of Washington, she said. But “it made me realize that I’ve been doing this a long time already.”

And now, as daily case counts in Spokane County flatten out, Schimmels said she takes heart in keeping her colleagues and veteran patients a little safer.

“A lot of them it’s, ‘Hey, you’re safe. We’re screening,’ ” she said.

“Then they can pick up and brush off and carry on.”

CONTACT THE WRITER:

(509) 459-5135 jaredb@spokesman.com

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Rhonda Veile is Palouse Country Assisted Living’s only nurse at the facility that cares for the elderly in Fairfield, Wash.

COLIN MULVANY/THE SPOKESMAN-REVIEW

Keeping her cool in troubled times Isolation and community are tricky to balance in rural Washington care home

By Rebecca White THE SPOKESMAN-REVIEW

Rhonda Veile has learned two things after decades working as a geriatric nurse: stay calm and never mess with bingo.

But since the COVID-19 pandemic hit a month and a half

ago that has been challenging for staff at the Palouse Country Assisted Living facility in Fairfield, on both fronts.

Veile said bingo is an essential ritual for many residents.

For them, it takes precedent over doctors appointments, haircuts, bathing and eating sometimes. That comforting

ritual is still taking place, but the games are smaller and more spread out. Bingo changes, and the uptick of cases broadcast on the news everyday, has left many residents distraught, worrying about their routines, and if they’re going to be OK. Veile’s calm, like seemingly

everyone else’s, was disrupted when the effects of the global coronavirus pandemic began to reach Fairfield, a Spokane County town of a little over 600 people.

Fairfield’s only clinic closed last year, leaving Palouse Country Assisted Living as the health care facility in the area

and Veile as facility’s only nurse.

As the only nurse, Veile is also the facility’s director of nursing, overseeing two certified nursing assistants who take care of many of the residents’ needs.

But access to other health care providers, especially doc-

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FAIRFIELD Continued from 16 tors, has been extremely limited for the last few months. Spokane, where most of their doctors are, is about a 40-minute drive away and the demands of COVID-19 has made access even more difficult than usual.

While some doctors have been seeing patients over video since the outbreak, internet access in Fairfield is limited and many patients have been unable to see their doctors even remotely for at least a month and a half. A few nurses from Providence visit the facility, but they and emergency responders are some of the only nonstaff members allowed in the facility.

And it’s not only medical providers who are no longer visiting the facility.

Volunteers are no longer allowed inside, and neither is family.

“It’s very quiet, kind of eerie quiet,” she said.

Many of the 44 residents are from Fairfield or small farm towns around the area, such as Waverly or Latah, Veile said. She said they’re used to visits from family, birthday parties and regular games of bingo.

But along with having to work hard to stay calm, Veile has also had to mess with bingo and other activities to reduce the risk of a resident contracting COVID-19.

Residents who love bingo now must play socialdistance-style with participants and games spread out.

Birthday parties have been reduced to just residents and a staff member playing the piano for them.

Visits from families have now been reduced to phone calls, or a greeting through a window.

Veile said the staff, many of whom have lived beside residents in the Fairfield area for years, are the only family they get to see

“If something transpires, I have to keep a smile on my face when I walk down the hall. I can’t look worried, (because) they can read me like a book.”

Rhonda Veile Nurse at Palouse Country Assisted Living

everyday.

“Our activities staff has stepped up, but there’s only so much you can do,” she said. “That’s part of the stress, too, keeping everybody happy and functioning the best that we can.”

She works to keep herself smiling and maintain an outwardly calm demeanor whenever she is on the floor to reassure both residents, who are cut off from their families, and staff, who don’t have enough personal protective equipment.

“If something transpires, I have to keep a smile on my face when I walk down the hall,” she said. “I can’t look worried, (because) they can read me like a book.”

She said she has also been working desperately to get PPE for staff.

Members of the Fairfield community who quilt have made a cloth mask for every staff member, which has been helpful, but the facility has only 25 N95 masks for 43 employees.

“We don’t have the supplies if there was an outbreak” of COVID-19, she said.

So far, she said, the home has been lucky – but staff have also been proactive in their efforts to prevent the disease from entering the facility.

Most of the staff live within 10 miles of Palouse Country Assisted Living and rarely go into Spokane. They also have a strict protocol for staff entering and leaving the facility. There is a locker room where staff can pick up and leave their uniforms, a bathroom where they can sanitize before

they enter the facility and protocols to ensure their temperatures are taken often.

Veile said there have been no symptomatic residents or staff members.

Three staff members were tested after they were exposed to someone with COVID-19, but they all tested negative.

Veile said her long career in elder care has likely helped prepare her for this moment. She started taking care of her grandmother in high school, and has been drawn to the needs of older patients since she graduated college and became a nurse.

She’s now worked in some form of elder care for 36 years, eight of which have been in the Fairfield facility.

She said she and the staff have been working harder to make sure the residents don’t completely isolate themselves in their rooms, stopping by to offer books and magazines, finding ways they can stay connected with other residents while social distancing and trying to make sure some of the celebrations they would have with their families, such as birthdays, can still happen in some form.

“It’s been more like family because we’ve been put together in this situation,” she said. “If you lived in a house and all you had were the people in that house, your differences kind of melt away. You can respect the differences, but you have to work together to make the house work.”

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Dealing with depression?

If you or a loved one is suffering from depression, we can help. Transcranial Magnetic Stimulation, TMS, could be the solution for you. For more information on this treatment please visit us at www.nwn4me.com or call us at 509-747-5615.

CONTACT THE WRITER:

(509) 459-5039 rebeccawh@spokesman.com

(509) 747-5615 • www.nwn4me.com

This day helps to reminds us that we have everyday heroes in our midst: our nurses, who serve in the retirement healthcare industry.

We wish you all Happy Nurses Day! • You are the heart of healthcare.

• You respond to the need, great or small.

• You make a positive impact on the lives that you touch.

• A nurse is hope with a stethoscope!

Nurses save lives.

We appreciate you and thank you!

www.rockwoodretirement.org

1-800-727-6650

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THE SPOKESMAN-REVIEW