I work as an RN on a busy Labor and Delivery unit in a large urban medical center. Since the onset of COVID 19 nursing care on our floor has dramatically changed. I work the night shift so the anxiety starts about 7 am when the daily symptom check-in text comes through to my cell phone. I quickly respond start, then think about my runny nose and a slight cough. Is it allergies (I am pretty sure it is) so no for cough then think about the question for fatigue. Is this unusual fatigue or just the usual fatigue I experience as a night nurse. I decide it’s usual and pass the first test of my day. The next wave of anxiety hits when I read my work email. The head of the department has sent out revised guidelines for the use of PPE(personal protective equipment). This includes what to wear, when to wear it , when a N95 respirator is required. Every day the guidelines change, frequently based on the availability of equipment and tests, not necessarily scientifically based from what I can tell. Now my head is spinning and I’m not sure what I’m supposed to wear to protect myself. The third wave of anxiety hits about 5 pm when I realize that I’m the charge nurse tonight. Now I start to worry about the volume of patients on L&D and whether we have enough nurses and how many positive patients we will have tonight. As a tertiary care facility, we take transfers from many smaller hospitals who do not have the resources to care for COVID positive pregnant Moms. Four of our labor rooms and one of our three ORs are blocked off as precaution rooms. If these rooms are all filled it ties up a huge amount of nursing resources, a nurse for each room and runners who will help the nurses in the rooms get supplies or send labs. Vacations have been taken away and nurses have been deployed to medical units so that there is enough staff to care for patients in other areas of the hospital. As a nurse in Labor & Delivery, we are on the frontlines as our patients frequently present to us in labor or some other crisis. At any point in time, we could be exposed to an aerosolizing procedure which increases the risk of contracting this virus.
I arrive at the medical center at about 7 pm and immediately another wave of anxiety hits. As soon as I enter I am greeted with someone handing out masks. We are required to wear masks at all times while in the medical center. I go immediately to the locker room, change into scrubs and my hospital clogs, don a surgical cap, and head up to L&D. At this point, the only part of my body showing is my eyes. My goggles are up there along with my N95 mask, hanging on a clothesline in the break room, waiting to be re-used. Our N 95 masks have been used for weeks. The hospital has just started a recycling program so that we can have our used masks treated and returned to us. I walk onto the unit and find the day charge nurse to get a report. There are 3 COVID + patients in labor rooms, 2 COVID + pregnant Moms in the ICU, and multiple other Moms who are in labor with no symptoms. I quickly look at the list of nurses on for the night and decide if we have enough resources to care for all of those patients.
Being a labor nurse is such a unique specialty. For the most part, we are with our patients during one of the happiest moments of their lives. Touch is important to us, putting a baby skin to skin with a Mom is important for regulating the baby’s body temperature. Joy, happiness, holding hands, and encouraging Moms during the pushing process is so very much a part of our daily lives on the unit. Caring for patients with only our eyes showing has presented a challenge to many of us. We pray that our eyes express our joy and happiness for the family during and after the birth of their child. We pray our eyes express compassion and empathy when things are not going as planned and our patient has experienced a loss. And we pray that our eyes express a sense of calmness during emergency situations which can occur at any time on our unit. I hope my teen patient who is giving her baby up for adoption can see in my eyes how strong and brave I think she is. I hope my Mom delivering a baby after hearing it no longer has a heartbeat can see the tears and sadness in my eyes for her and her partner. I hope that my patient terminating her pregnancy due to her cancer diagnosis can see in my eyes and hear in my voice how much my heart is breaking for her. And mostly, I hope and pray that my patients know how much I want to hug them, hold them close showing what a privilege it is to care for them.
Amidst this whole pandemic, there have been so many moments of sadness as well as so many moments of great joy. When a COVID positive Mom has a baby go to our NICU she cannot visit the baby until she tests negative. This could take weeks and my heart breaks for those moms who give birth and cannot hold or see their babies for days or weeks at a time. I am so incredibly proud of my coworkers who show up to work night after night ready to take on whatever challenge is thrown at them. They don their PPE despite their faces being bruised and their ears hurting like crazy. The policies change every day but everyone is committed to staying on top of this virus and providing our patients with the best and safest care possible. I am grateful for my work community and the way they have come together to fight this virus. We lost 5 of our nurses to medical floors or ICU’s without so much as a complaint. We have created ICU beds from units that were not ICU’s. We have deployed staff who are not working right now to care for patients in alternate ways. I am proud of where I work for the advances in testing patients as well as the care we are providing. Every shift presents new challenges that prompt us to change our plan of care. Frequently I feel like we are working with a moving target, trying to keep up with its trajectory. The support from the community has been overwhelming whether it be food or headbands with buttons for our masks or donations of N95 masks. Seeing our community come together to support healthcare workers as they fight on the frontlines is what keeps us going day after day and the gratitude our patients have that we are doing everything we can to keep them safe and support their goal of having a healthy baby is icing on the cake.