March 31, 2020 COVID-19 report

Another day… and another COVID-19 RNAO CEO report…this one for March 31, 2020… late in coming as it was a long night of reflections. It was a day filled with inspirations, worries, pain and hope. Let me expand…

Inspirations and worries shared with RNAO by nurses and health organizations – our on-the-ground soldiers fighting this war against COVID-19. Their lives turned upside down by a pandemic for which no one was prepared and that we all must fight. Pain, excruciating pain, over so many lives lost and many more to come. Hope, from the resilience, valiance, compassion and expertise that our colleagues – nurses, doctors, respiratory therapists, personal support workers, administrators, and so many others --  show day in and day out - - as they soldier this horrible storm. Hope over our Prime Minister announcement – on that, more below.

Nurses in the United States are sharing about their ordeal and the extraordinary sacrifice. I received a forwarded beautiful – and painful – message. It does not say who the author is. Here is an excerpt, with the full text at the end of the report:

To the nurse who has worked 4, 5, 6, 7 consecutive, 12 hour shifts. To the nurse who is supposed to get married soon. To the nurse who has a spouse also on the front lines. To the nurse who was physically assaulted by a patient when they got there. To the nurse who hasn’t hugged or kissed their family in weeks. To the nurse who has no childcare but must report to work. To the nurse who is pregnant and feels guilty for not accepting COVID cases. To the nurse who is immunocompromised, but can’t help but feel like she’s failing her coworkers. To the nurse who watches some people on the outside defy physical distancing recommendations. To the nurse who now has skin breakdown from prolonged mask-use. To the nurse who has been denied COVID- testing. To the nurse who is a single parent and has had to send their kid away to live with relatives.

And so it goes. She ends with this:

My name is Kim....... I am a Nurse. 

To my sisters & brothers in nursing all around the world, I feel you. 

I share your pain. I have your back.

You are me. I am you. We are each other.

Let’s show them our truth.

Kim, we have your back too. Indeed, you have the back of 44,000 members of RNAO and hundreds of thousands of other health providers everywhere across Ontario and Canada! In Ontario, Canada, we are working together to make sure that health providers have the back of their decision-makers and governments.

Yesterday was a good day. The federal government is mobilizing industry to fight COVID-19, increasing Canada’s ability to respond to the outbreak with necessary medical equipment and supplies, boosting capacity to manufacture items such as portable ventilators, surgical masks, and rapid testing kits. It is also investing $2 billion to support diagnostic testing and to purchase ventilators and PPE, including for bulk purchases with provinces and territories. The government has ordered millions of supplies to ease the pressure on health care facilities. It has also signed letters of intent with five companies to produce additional test kits, hand sanitizer, and protective apparel including masks and gowns. Our response to the prime minister is: FANTASTIC!!!! Now, we need a breakneck delivery timelines as Canadians and healthcare workers lives are on the line. No equipment or supplies will help months from now – there is not a single day to waste.

RNAO has been at the forefront, pleading to governments to procure PPE and ventilators to protect workers and save lives. We are glad that, finally, we feel a sense of urgency with governments and they are taking aggressive action. Let’s hope it is not too late. Employers, in hospitals and in home care, are not waiting for answers. They are doing their best to find PPE and arm their workers to carry-on the fight.

RNAO has been also led in addressing critical shortages of staffing levels during the COVID-19 emergency. Health providers are going into quarantine, falling sick, and staffing needs are growing. RNAO launched its COVID-19 ViaNurse on March 13 and it has already registered 146 nurse practitioners, 677 nurses with experience and continued competency in the provision of critical care health services, 5,568 nurses for virtual/clinical care, and has registered 268 organizations seeking PSWs. We urge chief nurse executives and managers to access this talent now, so you are not scrambling later on (see details below).

Every day we welcome readers to this daily report: thank you deeply for the work you do during this health crisis, and also for keeping us well informed. You can see previous reports at RNAO updates and resources on COVID-19 for members and other health professionals. Feel free to share these updates with other health professionals at home or abroad. RNAO media hits and releases on the pandemic can be found here. Daily Situational Reports from Ontario's MOH EOC can be found here.

Again, today, most of the emails received asked for assistance with Personal Protective Equipment (PPE) shortages, and most came from nursing homes. Clearly, there is a link between lack of proper protection and mounting infection clusters in nursing homes. RNAO has been sounding the alarm bell on this fear for several weeks. The time is NOW, to ensure all nursing homes are provided with sufficient quantities of surgical masks and other essential PPE, so that all staff wear one at all times – to prevent outbreaks and NOT after an outbreak as it currently is happening, RNAO has said it over and over and over. Also community health organizations – home care and primary care – are suffering from dire shortages of PPEs.  

While RNAO continues to call on federal and provincial governments to aggressively take measures to procure the required PPE, you can also donate PPE items. Please contact Heather McConnell .  

Today was day #13 of the #TogetherWeCanDoIt campaign and the noise is becoming louder and louder in streets, workplaces and social media to #cheer4healthworkers. Join-in this community building moment every evening at 7:30pm local time - until we defeat COVID-19! and post tweets from your communities and workplaces with your cheers, lights, claps, songs or pots and pans (my preferred choice)! Because: #TogetherWeCanDoIt.

MOH EOC Situational Report #66 here  for Tuesday, March 31. EOC reports that the total number of confirmed cases in Canada today is 7,424 cases (1,166 new) and 89 deaths. EOC reports 260 new cases in Ontario which brings our province to a total of 1,966 cases (this includes 534 resolved cases and 33 deaths). In Ontario, a total of 51,629 people have been tested. There are currently 4,280 tests under investigation. EOC reports the following actions taken:

• Launched a website for emergency child care for health care and frontline staff. It aligns with guidance document on Emergency Childcare Centers, on the ministry’s website.
• New guidance document for Temporary Foreign Workers uploaded to the ministry website.
• The case definition has been updated and uploaded to the ministry’s website.
• CMOH Directive 5 updated to specify that it applies to nurses who are represented by the Ontario Nurses’ Association and employed by public hospitals (see here).
• Health Canada issued advisory on their website (English and French) urging Canadians not to buy more medication than usual during the pandemic as this can lead to local shortages.

Situation Report 71 from WHO updates that worldwide there are 750,890 confirmed cases (57,610 new) and 36,405 deaths (3,301 new). There are 140,640 cases in the United States (17,987 new), 101,739 confirmed cases (4,050 new) in Italy, 85,195 confirmed cases in Spain (6,398 new), and 41,495 confirmed cases (3,186 new) in Iran. Other countries to note are Germany (with 61,913) and France (with 43,977). China has 82,545 cases (with only 98 new), and 9,786 in South Korea (125 new), both countries clearly managing, at this point, to “flatten the curve”. The number of confirmed cases worldwide have reached three quarters of a million. The virus is now starting to spread in the South Asian and African regions, including many countries with very weak health systems, which is extremely worrisome. These are countries with very limited ability to test, so the reported numbers may not reflect the reality of the pandemic. There are enormous concerns regarding the impact in refugee camps, conflict zones, slums in large cities, and other populations at extremely high risk around the globe. 

You can also find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE. These numbers are more updated than those of WHO. They report a total of 1,966 cases in Ontario and 8,591 total cases in Canada. There are 189,633 cases in the United States, topping China as the country with the largest number globally. Worldwide, there are 862,234 cases.

On 27 March, WHO European Region published an article on mental health and psychological resilience during the COVID-19 pandemic; highlighting the potential mental health impacts on children and the elderly. For more information, see here.

Other Information Resources

Public Health Ontario maintains an excellent resource site on materials on COVID-19. This is an essential resource for Ontario health providers. 

Ontario’s health provider website is updated regularly with useful resources here. An important reminder that the health provider website is for you – as a health professional – and not for members of the general public.

Ontario’s public website on the COVID-19 is there to inform the general public – encourage your family and friends to access this public website. The WHO has provided an excellent link for you to share with members of the public here.

Please promote the use of Ontario’s COVID-19 self-assessment tool: It also has a guide where to seek care, if necessary. Its use will provide the province with real-time data on the number and geography of users who are told to seek care, self-isolate or to monitor for symptoms. Data will inform Ontario's ongoing response to keep individuals and families safe.

Health Canada's website provides the best information capturing all of Canada. It contains an outbreak update, Canada's response to the virus, travel advice, symptoms and treatment, and resources for health professionals.

Worth repeating: RNAO policy corner – Lessons for a pandemic, from those who’ve experienced one

Nurses and doctors in Médecins Sans Frontières have long experience fighting epidemics around the world. They are now sharing advice for Canadians preparing for one. There is no room for wishful thinking, they say. One must prepare for the worst-case scenario, while doing everything we can to avoid it. We must be mentally and organizationally prepared to deal with the conditions that are rocking Italy and Spain:

1. As much as possible, set up medical facilities dedicated only to COVID-19 patients: either stand-alone structures or a separate hospital within a hospital. It is tempting to try to manage COVID-19 cases within existing structures. This might work where case numbers are low. But when the numbers become overwhelming, chaos will take over and foster cross-contamination. There needs to be a dedicated COVID-19 area and a non-COVID-19 area with no interchange of staff or patients between the two. By separating patients, and by having separate staff, one can significantly decrease the risk of medical facilities becoming centres of amplification. Dedicated staff may also reduce the volume of personal protection equipment (PPE) required as staff will not go from one COVID-19-positive patient to a non-COVID-19 patient.

2. Our health-care workers are our best and last line of defence in a pandemic. For their sake and ours, we need to protect their physical and mental health. We need to make sure that our medical staff will always have the right PPE available at all times. There should be guidelines prepared to guide health providers with the complex and harrowing decision-making they will face, should it become necessary to do so. We also need to help health-care workers protect and take care of their families. Should medical staff stay away from their loved ones? If medical staff are infected by COVID-19, where should they be hospitalized? Can health-care workers and their families count on being fully supported if they fall gravely ill? The mental pressure and anguish faced by health-care workers in a pandemic is unimaginably high. They must have access to psychological counselling and support.

3. We must ensure that critical care to non-COVID-19 patients is maintained. During the height of the crisis, COVID-19 could get all the attention and monopolize all available resources. We have to make absolutely sure that highly treatable and preventable medical conditions do not become lethal. We should not create a second-rate status for non-COVID-19 patients with acute needs.

RNAO’s ACTIONS

Health Human Resource Capacity – RNAO’s COVID-19 ViaNurse Program

RNAO started its Via Nurse program to recruit RNs, NPs and nursing students on March 13.

As we continue our strong advocacy on the need to expand the capacity of Ontario’s health system to meet emerging health needs in tackling COVID-19, we need your help. The knowledge and skills of RNs, NPs and nursing students are needed to meet a range of health-care needs. For those of you who have already responded to our surveys asking for help, we thank you for your enthusiastic and generous response. Working in collaboration with the Ministry of Health, we are reaching out to RNAO’s network of RNs, NPs and nursing students asking for your willingness and availability. Our surveys/registry remain open for:

Critical Care

Virtual and Clinical Care

Nurse Practitioners

Nursing Students

If you are available to help, please complete the appropriate survey listed on our COVID-19 webpage.

Critical Care survey

We asked for your help, and got it!  We released a survey on Thursday to establish a registry of the available health human resources in the critical care areas of Emergency Rooms, Recovery Rooms, Intensive Care Units, Step Down Units or other relevant clinical area.  Your response was immediate, and strong.  We have received responses so far from 677 nurses with experience and continued competency in the provision of critical care health services in these specialty areas.  This response, while not unexpected, is truly heartwarming in these difficult times!   As we receive requests from hospitals in your area, we will make connections so you can start the necessary HR hiring processes.  Many, many thanks for your enthusiastic and generous response. To others: The survey remains open. We have already connected all the respondents with an indigenous health authority in Northern Ontario who was very appreciative of RNAO’s timely assistance. We are already addressing the needs from hospitals approaching RNAO for HHR augmentation.

NP survey

The knowledge and skills of nurse practitioners are needed to increase Ontario’s capacity during the COVID-19 pandemic. NPs with experience, current competency and specialty certificates in primary care, adult care and paediatrics and who are able to return to work if retired or increase their hours of work, are asked in a survey RNAO launched on Friday, March 28 to share their availability in providing health-care services during this unprecedented emergency. Until now 146 NPs have filled out the survey to indicate their willingness and availability to work during the pandemic.

Virtual and Clinical Care survey

RNAO’s survey on virtual clinical care and non-clinical services: As of today, 5,568 RNs and NPs responded to the RNAO survey with availability to provide virtual clinical care or non-clinical services. We continue to deploy colleagues as requested. We know that you are ready and eager to help and thank you hugely for it!  

PSW positions for nursing students

RNAO is helping to increase LTC Homes, Seniors’ Housing and Community Service Providers’ capacity to meet human resource needs to tackle the COVID-19 pandemic. The facilities listed in this registry are looking to fill personal support worker (PSW) positions. These are paid positions. They are looking for second, third or fourth year nursing students to fill these positions. The registry includes 268 senior’s residential care organizations, can be searched by city and organization. Students can apply from the page and the DOC or HR person of the home will receive the student’s application and take it from there. Several organizations, including all those in an outbreak, have already been served by accessing RNAO’s ViaNurse.  

 

NOTE TO ORGANIZATIONS SEEKING TO EMPLOY RNS, NPS AND PSWS

RNAO can help organizations increase their nursing human resource capacity to tackle COVID-19. To request RNs and NPs for your organization, fill out this form.  RNs and NPs in the city where your organization is located will be connected with you.

To request nursing students in second, third or fourth year for personal support worker (PSW) positions, fill out this form and your organization will appear in a registry where students will select hiring organizations through this registry. (Your home will appear on the registry within 24 hours.) Nursing students will be able search the registry by city and name of the homes. 

Worth repeating: COVID-19 and persons experiencing homelessness

RNAO's Director of Policy, Matthew Kellway, has been seconded to serve as Director, Public Affairs for Inner City Health Associates (ICHA). Matt will be working closely with Dr. Andrew Bond, ICHA's Medical Director, Dr Leigh Chapman, ICHA's Director of Nursing and former RNAO Communications Director, Sine MacKinnon. ICHA, who provides health care to many of Toronto's shelters and drop-in centres, has been funded by the province to urgently bring to life an innovative, nurse-led program, to provide care to Toronto's homeless population through this Covid-19 pandemic. Absent urgent intervention, Toronto's shelter system threatens to be the epicentre of this pandemic in the city given the vulnerability of the population and the impossibility of social distancing in existing shelter facilities. I am so proud that ICHA is staffing it's program with RNAO members using RNAO's VIANurse program and I have the utmost confidence in ICHA's commitment to keep its nursing staff as safe as possible as it fulfills its critical mission.

ACTIONS FROM OTHERS

The College of Nurses of Ontario (CNO) is working quickly to help support Ontario’s health care system during this unprecedented and rapidly changing situation. To enhance Ontario’s nursing resources, it is expediting registration for non-practicing nurses, including those who have retired or have an expired registration implementing an emergency class for nurses who work or have worked in other jurisdictions in Canada or the U.S. For more details see here.

URGENT STEPS FOR GOVERNMENT TO TAKE: RNAO’s VOICE

1. Continue to prepare for a New York City scenario. Yes, our approach must be to continue to prepare for 'worst-case' scenarios such as in Italy or New York. Incubation periods and the delays in obtaining test results means today’s data reflects the reality of a couple of weeks ago. This means we do not have a good grasp of where we are in the curve. We are only testing a relatively small number of symptomatic individuals and likely missing a much larger number of persons without or with mild symptoms – thus test data is likely quite incomplete. This means there is lots of uncertainty as to the actual shape of the curve. It is RNAO’s view that policymakers and governments should continue to plan according to the worst-case scenarios. Unfortunately, we are seeing this scenario unfold in the United States. In Ontario and Canada, we do hope that social distancing will flatten the curve, but for the moment, we are seeing large numbers of new daily cases. We hope to avert worst-case scenarios, but we cannot afford not to plan for such a case, that might risk the tragic death of thousands of people.
2. Communication: We are entering a very challenging period for all. During this period, it is crucial that governments at all levels engage in honest communication with the public. Don't try to gloss over issues, don't minimize them, be transparent when decisions are driven by lack of resources (such as shortages of PPE), acknowledge we may be entering into more difficult scenarios, with many deaths and, very likely, an overwhelmed health system. During this period we need to acknowledge the challenge and that we all, each one in our own way, are trying to do the best we can - and that we are all in this together. Not only governments and those filling essential services have a role – also the public has a crucial role in bringing down the curve, through "staying at home" and keeping "physical distance."
3. Nursing homes: RNAO has been reporting for days our extreme concern about nursing homes and their vulnerability to outbreaks, given the vulnerability of their residents and the staff. We were pleased with important steps in government’s recent announcement. The Ministry is currently focusing on providing central supplies to Long-Term Care Homes that already have outbreaks. However, this is the wrong approach. A government directive MUST go out that all the staff should wear PPE – RNAO suggests providing at least one each day, upon entrance to the building, until there is more availability. The purpose ought to be to prevent outbreaks, not come to fix them after they have happened, residents died, and staff got ill. Staffing shortages should be addressed, taking advantage of available resources. On this point, RNAO has launched ViaNurse -- free of charge, including 5,000 BScN students ready to serve as PSWs. It is important that when one finds a single case of COVID-19 in a nursing home, then every person in the facility, both residents and staff, should be tested. Medical directors and attending NPs in nursing homes should ask for a test immediately that they see a symptomatic resident or staff.   
4. Home Care: Many of the home care agencies have only a few days of PPE supplies left. Staff are quitting as they demand PPE and clients don't let them go into their homes without PPE. Patients that require home care are persons with cancer, wounds, and more - they need home care. This situation must be fixed.
5. Expand Testing, contact tracing and self isolation: Now is not the time to slow down on testing. Ontario MUST continue to increase its testing capacity and maintain rigorous contact tracing and self-isolation. Even when we manage to flatten the curve, as China, South Korea and Singapore and other countries have so far done, the virus will remain out there and ready to raise its head again. Only a rigorous, comprehensive system of testing, tracing and isolation, which is the case in those countries, will allow us to go back to some normalcy after the peak of the epidemic, until such time as new therapies or vaccines are ready to be used. Since contact tracing and isolation is a laborious process, if we need health personnel to strengthen public health units, RNAO can assist through the ViaNurse program. 
6. Shutting down of all non-essential movement in the streets.  Let’s educate that the more stringent the shutdown, the shorter the period we will live through it. The more gradual, less effective, and less enforced are the physical distancing measures, the longer the shutdown will prolong and more people will die. We need to double down on making the shutdown effective. Government took a few days ago an important step by prohibiting gatherings of more than 5 people. The loopholes to the shutdown, allowing non-essential businesses to pass as essential (example, condo building), and the lack of enforcement of quarantine – all these have a price in shutdown time and lives. Clearly, there is still a sector of the public that believes they are invincible or does not understand the situation. Governments must enact actions to either educate them, or enforce the measures.    
7. Telehealth: Virtual care plays a central role in physical distancing and helping fight the pandemic. Telehealth can help keep people in their homes and avoid them going to clinics and ERs. RNAO has reiterated the call to strengthen Telehealth to better fulfill that role at this crucial time. About a week ago we were receiving reports of wait times of 10 hours or more. Let us know if you have more recent experience using the service. In RNAO’s view, the Ministry should monitor wait times and assign resources so that they are within acceptable parameters.
8. Extensive Use of Surgical Masks. Given the wide community spread as well as the solid evidence about asymptomatic transmission of COVID-19, RNAO has been, for the past two weeks, actively recommending to health officials that all health workers should be using surgical masks while facing patients/clients/residents.
9. Procurement of all Personal Protective Equipment (PPE). RNAO has been vocally urging the federal and provincial governments – and will continue to do so - to aggressively secure a supply chain for all the required PPE to protect our colleagues and their patients. Health organizations – across all sectors -- are reporting shortages of PPE. This situation is unacceptable and governments must address it urgently, including preparing for a huge increase in the demand for PPE as we move towards the peak of the pandemic. Government took an important step by providing an update on PPE stewardship, procurement and distribution. While this is welcome first step, RNAO urges to change the planning parameters of the Ministry to assume worst-case scenarios (such as Spain, France or New York City). The planning document specifies additional procurement of 12 million surgical masks from suppliers and the federal government. In comparison, the government of France announced the purchase of 1 billion surgical masks, given that their weekly consumption is 40 million masks. If we translate those numbers to the population of Ontario, it means a purchase of 217 million masks for a weekly consumption (during a worst-case scenario such as France) of 9 million per week. These numbers suggest that the current procurement of the Ontario government will last, during a France-type situation, roughly for a week and a half. In the view of RNAO, Ontario is still not well prepared for what likely is coming ahead, a pandemic that will last for several weeks, if not months. We call for URGENT and massively increased, procurement of PPE. We were pleased to hear the federal government is investing $2 billion to support diagnostic testing and to purchase ventilators and PPE, but we didn’t hear about timelines for delivery.
10. Hospitals: Hospitals are working to ramp up their ability to receive an avalanche of COVID-19 patients, while trying to serve the needs of non-COVID patients. Government should provide the regulatory and financial resources so they can do so. Several are already building makeshift structures, redeploying personnel, and taking the measures to expand capacity. In New York State they have added tens of thousands of beds, including through a military hospital ship. Are we ready for to scale up capacity in this way? Let's plan for the very worse so we are ready to execute, and celebrate if we don't.
11. Expansion of ICU beds and ventilators. The information provided that the government has been successful in entering into contracts for “up to 10,000 ventilators” is great news. However, there is no specification about delivery dates, and how reliable those dates are, as Ontario Health has earlier reported that “it will take months” for orders to start coming in. Ventilators on a procurement contract that may be realized within a year are not going to help. We have, at best, only weeks, perhaps days, available until hospitals are overwhelmed. In a different jurisdiction, the governor of New York State is asking for 30,000 ventilators, as the worst-case scenarios become a reality across the United States. If the equipment and specialized personnel are not available, people needlessly die. That has been the horrifying reality in Italy, which has had one of the highest death rates – about 5% --from COVID-19. For RNAO, no one’s life should be lost because the proper equipment was not available. This past week RNAO issued a public statement on ventilators and PPEs and we also discussed these matters extensively in the media (here). We urge the government to substantively increase the procurement of ventilators. We heard yesterday good news that the federal government is investing $2 billion to support diagnostic testing and to purchase ventilators and PPE, but we didn’t hear about timelines for delivery.
12. Support for vulnerable populations and workers. Governments should implement urgent measures to alleviate the enormous burden placed by fighting the virus. COVID-19, and the measures required to address the emergency, have profound social equity impacts, especially on vulnerable and disadvantaged populations. This includes Ontarians experiencing homelessness (see RNAO and ICHA action above) and those living in crowded shelters, as well as Indigenous communities and northern and isolated communities. Both the federal and provincial governments have announced important measures to protect workers from losing their jobs as businesses suspend operations or they have to stay home to take care of children. RNAO is urging for much more to be done to assist low-wage earners and those in precarious employment, who may transmit disease simply because they have no option. RNAO’s response to the recent Ontario economic statement can be found here.
13. Massive public education and enrollment. Please become a champion for #StayAtHome and #SocialDistance, by educating your families, friends, colleagues and members of your community. RNAO and our members are heavily engaged in mainstream and social media to keep the public fully informed, engaged and enrolled into #socialdistance action. We ask that you follow us at @RNAO and @DorisGrinspun and retweet + Facebook as much as you possibly can. Send your friends and members of the public to the government website and here
14. Solidarity during a difficult time. It is very important to call on citizens to organize informal networks of support, largely virtual, for people who live alone, who may be elderly, or vulnerable, or who do not have the money to buy essentials, or who are struggling through this period in so many ways. With mental health and other conditions exacerbated by isolation, we call on all of us and the public at-large to display solidarity and humanity like never before – message: #togetherwecandoit.

Please continue to keep in touch and share questions and/or challenges of any kind, and especially shortages of PPE. Send these to me at dgrinspun@rnao.ca. We are responding daily and are continuously solving your challenges. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

THANK YOU DEEPLY colleagues in the front lines; in administrative roles; in all labour, professionals and sector associations, and in governments in Ontario, in Canada and in other regions – especially New York, Italy, Spain, France, Iran and Germany – now hit the hardest. We are here with you in solidarity. These are stressful and exhausting times; the only silver lining is coming together and working as one people – for the good of all!

Together, we are and will continue to tackle COVID-19 with the best tools at hand: accurate information, calmness, determination and swift actions! 

Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT
Chief Executive Officer, RNAO   

 

 

MESSAGE FROM AN ANONYMOUS NURSE IN THE UNITED STATES

To the nurse who was fired for wearing their own mask. 

 

To the nurse who has been told they’ll be written up for not adhering to hospital policy. 

 

To the nurse who has been told they can trust policy because it’s based on, “CDC guidelines.”

 

To the nurse who has worked 4, 5, 6, 7 consecutive, 12 hour shifts. 

 

To the nurse who is supposed to get married soon.

 

To the nurse who has a spouse also on the front lines.

 

To the nurse who was verbally assaulted on their way to work.

 

To the nurse who was physically assaulted by a patient when they got there.

 

To the nurse who hasn’t hugged or kissed their family in weeks.

 

To the nurse who has no childcare but must report to work.

 

To the nurse who is pregnant and feels guilty for not accepting COVID cases. 

 

To the nurse who is immunocompromised, but can’t help but feel like she’s failing her coworkers.

 

To the nurse who watches some people on the outside defy physical distancing recommendations.

 

To the nurse who now has skin breakdown from prolonged mask-use.

 

To the nurse who just graduated and is in their first year of nursing.

 

To the nurse who has been denied COVID- testing. 

 

To the nurse who is a single parent and has had to send their kid away to live with relatives.

 

To the nurse who only sheds tears in the shower so that they can drain with the water.

 

To the nurse who has had no food or drink their entire shift.

 

To the nurse who is diabetic and now their glucose is low. 

 

To the nurse who is skilled in operating the ventilators.

 

To the nurse who wonders what was the point of all those ethics papers back in nursing school.

 

To the nurse being bombarded by the media to make statements about their experience. 

 

To the nurse who works on a unit that does not have pulse ox cords in some of the rooms. 

 

To the nurse who was told they no longer need an N95, "per the CDC."

 

To the nurse who filled out their Advance Directive- Medical POA after a tough shift. 

 

To the nurse who must find their voice and now use their patient advocacy skills, for themselves. 

 

To the nurse on the floor who has been cancelled for the 3rd time, displaced, or redeployed.

 

To the nurse who knows deep down this is not just droplet + contact.

 

To the nurse who’s 25-year old abdominal pain patient was found to have ground-glass opacities on the CT.

 

To the nurse who realizes none of the team wore PPE, since abdominal pain was not part of the criteria.

 

To the nurse who is hiding their pre-existing condition for fear of retaliation, or coming up short for their coworkers. 

 

To the nurse who was just handed their one mask and plastic bag for the day, for the week. 

 

To the nurse who has been living out at a motel to avoid infecting their family. 

 

To the nurse who is running out of sick leave and PTO.

 

To the nurse who found out their patient was COVID (+) via word of mouth, through the grape vine.

 

To the nurse who didn’t pack lunch today because their work schedule does not permit time to buy groceries.

 

To the nurse who stayed up last night sewing together pieces of fabric so that they’d have a mask.

 

To the nurse who wonders when that mysterious tent that was put up outside will be put into use.

 

To the nurse in charge who has received 3 CPRs, a stroke, and a trauma, back to back. 

 

To the nurse who searches anxiously for a new mask; they’re locked up now. 

 

To the nurse who is thinking about putting in their resignation.

 

To the nurse who wonders well what about the ANA Code of Ethics, you know, provisions 5 and 6? (CNO Code of Conduct)

 

To the nurse who has arrived at a shift with 8 sick calls. 

 

To the nurse who catches a glimpse of the freezer truck parked out back that is being used as morgue overflow.

 

To the nurse who stands alone in their PPE next to their intubated patient, as they silently have an anxiety attack.

 

To the nurse who just gave themselves a Cardi-B pep-talk so they can get back out there.

 

To the nurse who has been told to cohort the cancer patient with the suspected COVID patient, because there’s just no more space.

 

To the nurse who was told they signed up for this.

 

To the nurse who is active in the union and spends off days writing up Demands and Calls to Action. 

 

To the nurse who just performed the last round of CPR on their 30-year old patient. 

 

To the nurse who stepped outside to catch their breath but instead ended up pulling an unconscious man out of a car. 

 

To the nurse who is on a travel assignment and nowhere close to their loved ones. 

 

To the nurse who just risked their job by sounding the alarm and exposing their hospital.

 

To the nurse who knows there are no more ventilators left and their patient will die by morning. 

 

To the nurse who just received a lab call notifying them that their COVID patient’s blood work has hemolyzed.

 

To the nurse who has been made to feel like their life does not matter. 

 

To the nurse who realizes the public did not truly know what nurses, “do,” until now.

 

To the nurse who is being reassured by leadership shift after shift that PPE stockpiles exist... somewhere.

 

To the nurse who woke up to a text message that another one of their coworkers has died.

 

To the nurse who can feel their spirit breaking. 

 

To the nurse who is not being offered mental health support.

 

To the nurse rushing to don their PPE as their patient de-sats.

 

To the nurse being told by higher ups during huddle to abandon all they’ve ever known to be true about appropriate infection control and safety precautions. 

 

To the nurse who muttered under their breath, “yea, but I bet you wouldn’t go in there without an N95.”

 

To the nurse who just wrapped themselves in a trash bag before entering the room.

 

To the nurse who was abandoned by the same system they dedicated their life to.

 

To the nurse who woke up in the middle of the night with a fever and cough.

 

To the nurse who has tested positive for COVID-19.

 

To the nurse who can no longer breathe on their own. 

 

To the nurse who has been admitted to the ICU.

 

To the nurse who was just intubated by their own colleague.

 

To the nurse who did chest compressions on this nurse with tears streaming down their face.

 

To the nurse who backs away for the last time, as time of death is called.

 

To the nurse who has been referred to as, “just a nurse.”  

 

To the nurse who wonders if this is how they treat, “heroes.”

 

My name is Kim....... I am a Nurse. 

To my sisters & brothers in nursing all around the world, I feel you. 

I share your pain. I have your back.

You are me. I am you. We are each other.

Let’s show them our truth.

 

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