THE COVID-19 PANDEMIC has put pressure on us, whether it’s financially, socially or mentally - everyone has felt it in some way, and particularly so for healthcare workers.
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At Echuca Regional Health it was no different.
Emergency department (ED) clinical nurse consultant Jade Jones came into the new role on January 31 this year, which was originally designed to support staff in the department.
However, as Jade said, when the pandemic arrived, “it all went a little bit south”.
“On March 12, we went into COVID-19 and my role changed dramatically from what it was going to be,” she said.
The staff quickly had to become experts in Personal Protective Equipment (PPE), everyone had their temperature checked when they arrived at work and education sessions were run so staff were up to speed with the new COVID-19 guidelines.
Jade also took on the role of co-ordinating the COVID-19 screening clinic, which was set up in the ED’s former short stay unit.
“We liaised really closely with some excellent staff members in Bendigo Health emergency and got some advice on how they set up their clinic, which they’d only started setting up two or three days before us,” Jade said.
“It’s grown from a one-nurse clinic to now we have two nurses per shift and a ward clerk five days a week.”
The clinic runs seven days a week, with the nurses coming from within the ED staff roster.
“It’s put a lot of pressures on staff at times because it’s a different way of nursing,” Jade said.
“You’re having to wear PPE for the full shift, but everyone has really come together as a team to make this work.”
Jade said initially there was a lot of fear and anxiety amongst staff towards working in the clinic and potentially coming in contact with people who were infected.
“We did everything we could to support those staff, initially it was a voluntary thing, but as time’s gone on everyone got on board,” she said.
“The whole team alternates through the roster, so it’s not up to just one staff member.
“If you wear PPE for four hours it’s unbelievably hot, because you’ve still got some scrubs on as well and you have to keep working at a certain level – there’s sick patients you’re looking after,” she said.
Since the screening clinic opened on March 12, over 6500 people have been tested for coronavirus at ERH.
During the first wave, Jade said they had restrictions on how many testing swabs they would be supplied with.
“That’s really nerve-wracking – imagine if we run out of swabs, and we’re a regional hospital, we’re not the Alfred or the Royal Melbourne, we’re not the priority,” she said.
“We only get to this day, what the Department of Health and Human Services send to our store.”
When elective surgery was significantly wound back under government direction, reducing activity in theatre, nurses were redeployed to support the roughly 40 in the ED.
“We had to step it up to two staff because the demand was there,” Jade said.
“We were sometimes screening up to 80-plus people a day, that’s a lot on top of your normal ED business.”
The extra workload for the department also made it challenging for the triage nurse who would have a large queue in the waiting room, some of whom may have mild COVID-19 symptoms while others may be in a critical condition.
“You don’t want to miss the person with chest pains because he could just collapse and die on you,” Jade said.
“When it was really peaking we had a second triage nurse, called the triage assist, so that helped with the traffic control and not missing the normal business of ED.
“A lot of hospitals have their clinic run by a separate department whereas we’ve taken it on in ED.
“I think it’s worked and we’ve staffed it really well,” she said.
The other success has been the relatively low number of cases detected in the area.
According to DHHS local government area data, Campaspe Shire has recorded a total of nine COVID-19 cases, however not all of these were in the area at the time.
During the first wave from March to June, there were three positive cases in Echuca which were all related to overseas travel.
“That was excellent, it was a really good outcome for us that there was no community transmission,” Jade said.
“The second round of COVID-19 we had three cases within the Campaspe Shire that were well-contained too.”
While all the cases were mild, and no-one required hospitalisation, the team was ready just in case.
“We have trained for very unwell respiratory distress-type patients with COVID-19 symptoms,” she said.
“We changed our practice into putting high acuity patients under ventilators in our isolation room.”
There are only two of these isolation rooms at ERH, one in ED and one on the medical ward, where only four staff are allowed in at a time.
The staff have been participating in regular simulation sessions to keep their skills up to date.
“We go into a closed isolation room with negative pressure and that’s where we have intubated as per COVID guidelines,” Jade said.
“It’s totally different from what we’re used to and the team’s done just amazingly.”
Jade said they intubated four patients since March who were “high risk and highly suspicious” of being infected with COVID-19.
Intubation takes over ventilation of a patient’s lungs with a breathing tube, when a patient is unable to maintain a satisfactory level by themselves.
“With COVID-19 it’s something we do earlier rather than later because it’s the only proven therapy that really works, but it also reduces the aerosols,” Jade said.
“Where healthcare workers are contracting COVID-19 is through the aerosols that come out of other forms of respiratory therapy.
“Luckily for us not one of the four we intubated were positive.
“We don’t have onsite testing that will give us a result within an hour, so when they are highly suspicious as a COVID-19 patient that’s how we treat them until we know.”
Jade has been nursing in emergency for 24 years and while she vaguely remembers the bird flu, she said it’s “absolutely nothing” compared to COVID-19.
“I can’t believe we come to work and wear masks for a whole shift,” she said.
“I think it’s actually good for our practice in one way.
“As an emergency nurse you rush in there to save somebody’s life – that’s your priority – but at the moment we’ve had to stop, think about our own safety and prepare by putting on the PPE.
“All our community needs to be proud of ourselves that we’ve abided by rules set by the government and we’ve managed to keep it all under control.”
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