I Became An ICU Nurse During The Coronavirus (COVID-19) Outbreak

by | Mar 15, 2020 | Nursing, Video

I graduated from nursing school in December 2019, and started my nursing career in an Intensive Care Unit (ICU) in the middle of the new coronavirus outbreak. Here’s my take on it, and what I think we should do at this point.

The statistics in my video were from Dr. Aaron Carroll’s article. There’s been a lot to take in as I start an ICU nursing career in a city that’s been hit by COVID-19 (and if yours has not, it will be soon.) 18 minutes is really the tip of the iceberg. In this video, I take a look at how the healthcare system is at risk of being overwhelmed by COVID-19, how I feel about starting my nursing career in the middle of it, and what we can do to help slow the spread of the illness.

I could’ve touched on several general response topics as well: why it’s not a good idea for a healthy person to hoard masks, why panic-buying groceries is not helpful, and the reality of how young and “healthy” people have died from COVID-19 as well. Everyone should be taking intelligent precautions. I’d also like to highlight that I’ve seen a lot of xenophobia and racism during this COVID-19 outbreak, which is something i will always call out. Please watch out for fake news— for example, that “instruction” to keep drinking water to flush the virus out of your throat and into your stomach is a hoax. The only things we can do to slow the spread is practice general hygiene and start physically distancing ourselves from other people.

You will get so tired of hearing “coronavirus” and “COVID-19.” I’m already exhausted, and dreading this being the new normal. It’s ok to feel that way, and we’ll tackle this both as healthcare professionals and as educated citizens.

Hi, I’m Alley, and I’m an ICU nurse that just graduated nursing school in December 2019.

I’m going to talk to y’all about the recent coronavirus, or COVID-19 outbreak and what it’s like starting my career as a nurse in the middle of it. So as a nurse I have to balance the same thing as everyone else, deciding not to panic and deciding how to still be cautious. It’s definitely a scale. Different nurses will take different risks in all the fields.

Nursing is a huge field, it has a lot of diverse roles. So emergency room nurses definitely took the brunt of the risk at the beginning of this, when we didn’t really see very many cases, and so we have people coming into the emergency department with flu-like symptoms. So my friends that started as emergency department nurses were wearing masks every time somebody reported flu-like symptoms because they could be exposed to COVID-19 without anybody in the room knowing that they were. The patient wouldn’t know, the nurses wouldn’t know, and the other patients in the room could also have been exposed to the disease, so the emergency department nursing, when you’re taking the public off the street like that, was a very early risk group for being exposed COVID-19.

Now ICU nurses like me come in a little bit later, and I want to say ICU nurses are going to start coming in now in the United States. They’re really coming in other countries, like South Korea and China and Italy, where we’re seeing respiratory distress. We’re seeing the big effects of this new coronavirus in populations where they’re not being able to breathe on their own, and they’re going into respiratory failure. So when you’re in that stage you are in the Intensive Care Unit, or the ICU, and ICU nurses are being exposed to that by trying to keep these patients alive.

Now ICU nurses and all nurses have to worry about the same thing that the emergency department’s worried about right now, which is being exposed to COVID-19 without knowing that they’re being exposed, without knowing that the patient is positive for COVID-19. So when we are not testing for coronavirus like we have not been since the beginning of 2020 very much, the criteria for testing before very recently was you had to be in close contact with someone with a confirmed case, or you had to have symptoms and have traveled from certain countries predetermined to be at risk for COVID-19, you could not just get tested because you had a fever and a cough and you felt like you had COVID-19. Because of that, a nurse could get a patient who had flu-like symptoms, a cough, a fever, and was ruled out for flu strains and be the normal flu, and not be able to test for COVID-19 until very recently. You just had to walk around as a nurse saying, “I think my patient might have the new coronavirus. I think I might have been exposed to it but I have no way of telling you whether it’s true or not, because I can’t get them tested.”

So as a new grad starting, so I started my job in February right as this all started taking off, this is a very crazy time to be a new graduate and new nurse, because you have this kind of underlying sense of unease when you take care of patients that were not there in 2019, and in January and February nurses would be taking care of patients wondering if that patient might have the new coronavirus, and not being able to test for it. Essentially as I start my career as a nurse in 2020, which the World Health Organization has identified as the year of the nurse, I’m starting my nursing career in the middle of a pandemic. It has been recognized as a pandemic as of March 2020.

So what makes ICU nursing different in the COVID-19 pandemic that we’re seeing right now?

To address this question I’ll be quoting an article written on March 12th, 2020 by Doctor Aaron Carroll who is a professor at Indiana University School of Medicine, and a pediatrician. Among other credentials, he is the Director of the Center for Health Policy and Professionalism Research. He does write for the New York Times, this article is a New York Times article, and I did my research, know my doctors, this guy knows what he’s talking about. So we’re in a pandemic right now. Let’s say that it gets worse because one person gets infected, they infect a number of other people who infected a number of other people and it spreads like this. Doctor Carroll highlights that the United States has 2.8 hospital beds per 1,000 people. Now, this is actually less than some of the countries that have been affected by COVID-19. This is less than Italy and less than South Korea because the United States is a big country. People are getting very sick from COVID-19.

Now the numbers right now are a little fluid, but it really seems like about 80% of people that get COVID-19 right now are not getting very sick, and then 20% are starting to develop this respiratory side-effect, and then a certain percentage that I don’t want to throw a number out there right now, are going in to essentially respiratory failure. So they’re having trouble breathing, they can’t breathe on their own and they need the help of a ventilator to breathe for them. The United States has about 45,000 ICU beds for 330 million people. There are 330 million people in the United States, 45,000 ICU beds. We also have about 160,000 ventilators, and ventilators are very hard to move around and get to the people that may be sick, so that number is not necessarily something that I would say is a good thing or a bad thing, it’s just ventilators are hard to move around, it’s hard to get those 160,000 wherever an outbreak may be.

Ventilators are huge, they’re hard to work, and that’s why respiratory therapists are my best friend as an ICU nurse. So Doctor Carroll speculates that if we reach a moderate outbreak, then that’s 200,000 people that will need 45,000 ICU beds. Now I’m really bad at math, but it does not add up if all 200,000 people need 45,000 beds at once. So that leads us to our problem. The problem here is that COVID-19 is spreading too fast globally. If we don’t slow it down, then we cannot cram 200,000 people into 45,000 ICU beds. We need to slow it down and slow the spread of the disease so we don’t get to the point where our healthcare system is overwhelmed. If we don’t slow it down then we’ll run out of those ICU beds, we’ll run out of those ventilators, you won’t have the ICU nurses and the respiratory therapist to run all that equipment and save your life. We will run out of those ICU nurses and respiratory therapists to take care of you, and physicians who specialize in infectious disease, and as we’re seeing in these countries like Italy for example, we have all hands on deck there.

Doctors that were never dreaming of treating infectious disease, their whole name of the game is the new coronavirus. Everybody is treating it right now because we do not have enough medical personnel. So this is where we get to the nursing part, and this is where we get to the personal side of it. I work in a city right now that has seen a significant number of cases. I personally think there are more cases than have been confirmed, and that number will grow very soon across the country. I think there are way more cases than we have been testing for, because like I said earlier we could not test people unless they had traveled from a country that had the outbreak going already, or unless they have had confirmed contact with somebody that had been diagnosed with COVID-19. You could not just get tested because you have symptoms of COVID-19, they were turning those people away before now.

At the time of this filming, President Trump has declared a national emergency. A couple of days ago, the CDC and World Health Organization categorized this as a true pandemic. I think because of those two things we’re going to start getting a proper response to this pandemic within the United States. We’re going to be getting more testing. I need to see a lot more testing personally as a nurse, and what I have seen we need to be testing everybody that has symptoms, there’s no reason why we shouldn’t be testing these people. We need a better idea of how far this has been spreading already. I have been watching events get canceled. I’ve been watching just these big, just swathes of money going down the drain. South by Southwest in Austin, where I went to college, pretty much every concert you can think of is being canceled. Every singer is canceling pretty much March through April to try to stop the spread.

Okay here’s the deal. If this COVID-19 pandemic is properly dealt with and everybody complies with the cancellations, this will seem like a huge over-reaction. All these cancellations will seem wildly out of proportion. That’s what I want. I want people to think that we overreacted. The goal of public health is to make people think nothing happened. The intended results of the effort of public health outreach is invisible. We want people to think there was never a problem to start with because that means we prevented everything. It’s like when the superheroes stop the villain before the townspeople even realize that something was wrong. I love public health nurses, I hope I get to be one someday. The amount of stuff they do behind the scenes to keep us safe is incredible, whether it’s rabies or contagious diseases or I can’t even think of how much I had to take in the last time I followed a public health nurse for nursing clinical. The results are supposed to be invisible. You’re not supposed to really know that public health nurses exist.

So 45,000 ICU beds just waiting to be filled by potentially 200,000 very sick people. What can you do to not make sure this number happens all at once? What can you do to slow the spread of this disease? Here’s what I think you can do. One, don’t touch your face. Two, wash your hands for 20 seconds and look up your favorite song. The chorus of a song’s about 20 seconds. Don’t touch your face. Avoid large gatherings of public people if you don’t have to be there. Don’t touch your face. You’re touching your face. Stop touching your face. I will tell you I am horrible about not touching my face. I have gotten very good at washing my hands, but I’m horrible about not touching my face.

While we’re on the topic of washing hands, if I do nothing else with this video, I would like to convince some people to move from the hand sanitizer camp into the soap camp, because that’s what I’m going to do with my nursing degree today. So hand sanitizer, we love it, it’s in the hospitals, I use it 800,000 times a day, and the goal is for it to kill germs, right? That’s great. That’s cool. It doesn’t kill all germs everybody knows that, 99.99%. I’m not a microbiologist but it doesn’t kill all germs. If you dipped your hands in the dirt and then used hand sanitizer, then I guess you killed some germs, but you got that film on your hands and your hands are still dirty. With soap, I love the mental image of soap. If you wash your hands for those 20 seconds, and you know have your evil plan going, you are lathering up with that like a base of a soap, that oily slippery soap, and you are lifting the microbes, the germs off your hands and then you are washing them off your hands and down the drain. You’re literally washing all these germs down the drain, leaving your hands totally clean. So go buy that soap, don’t go on eBay trying to find hand sanitizer. Hand sanitizer’s good, but if you are in a position where you can wash your hands, you got running water, wash your hands. You will literally get rid of COVID-19 and send it down the drain.

Now if I had a different degree I could sit here and tell you what we’re thinking on how hardy the virus is, how long it can sit in the air versus on metal, versus on the skin, versus on the wall. I am not a microbiologist. I’m not an epidemiologist. I can’t tell you these things and everything I see is a little bit different, but what you can do is wash your hands and don’t touch your face, because even if the virus only lasts five minutes on your hands, you can do a lot with your hands in five minutes. You can rub your eye, touch your face, touch your mouth, and if you sit and look at people, if you go people watching, you will see how many times people touch their face, so don’t rely entirely on hand sanitizer, don’t rely entirely on soap as much as I prefer it to hand sanitizer, it really is the best way to get your hands clean, but whether your hands are clean or not, it’ll really help you from, keep you from getting infected if you do not touch your face.

What is this pandemic going to look like in the coming months, I don’t know, and that is what worries me as a new grad because I just don’t feel like I’m very trained yet as an ICU nurse and I know that as we get more people get very sick, then I’ll be coming into work and helping these patients and I don’t, I’m not worried about getting sick, that’s why I got into nursing, but I want to be the best nurse possible and to really show up for these COVID-19 patients that I did not know I was going to get when I graduated in 2019. I don’t know if you’ll remember, well I know y’all remember the Ebola outbreak of 2014. It was a small outbreak because of the way the Ebola virus spreads. It doesn’t spread very efficiently, but that case did pop up in my hometown in Dallas, and where he, the patient traveled. And in the emergency room it turned out that he did have Ebola and one of the nurses taking care of this patient did get infected with Ebola as well because of some, just failures I guess, with the hospital protective equipment.

And it’s just things happen, the proper protective equipment for Ebola is just kind of difficult to come by. It really looks like a hazmat suit and there were just a lot of breakdowns in communication and protocol with that hospital, but I was a senior in high school when this happened and I was applying to universities to be a nurse while this nurse had Ebola, and I remember thinking “do I want to put myself “in that position where I take care of people “with these new illnesses that I don’t know about “and that could be a pandemic situation?” And long story short I did decide that I would want to be the nurse taking care of this person, no matter what they come through the door with. And now and 2020, five to six years later, I am starting my nursing career in the middle of a pandemic. And it is on my doorstep, it is in my city, and it’s here. So I do go to work every day with the same conviction that I had in 2014 when I decided to be a nurse. I’m going to take care of these patients. I’m not afraid of getting sick. I am afraid of passing the virus on to other people. I don’t want to give it to my grandparents. I don’t want to give it to my family and friends, and I want to show up and be a good nurse, whether I’m taking care of a patient with COVID-19 or taking care of a patient with a different infectious disease. It really doesn’t matter what kind of disease they have, and it has grounded me as a new nurse and reminded me why I became a nurse in the first place. Just be cautious. I mean people have joked that it has shown people how to wash their hands again.

COVID-19 has taught the world how to wash their hands. And it kind of is true. It’s re-taught me how to utilize hygiene to become a better nurse, and it’s really just showing me that yes I did sign up to be an ICU nurse. So yeah. Wash your hands. Don’t touch your face. Balance that idea of don’t panic versus be cautious. Just really balance that scale for yourself, and just follow what the government does in these next couple of months. I hope to do a happy update video on this. Being a nurse really is about being on the front lines, and I’m on the front lines and every nurse that you see that works in a hospital setting or a public-facing role is on the front line. It has been quite the wild initiation for being an ICU nurse, but I have absolutely no regret. Thank you for tuning in and sitting down with me and going over this COVID-19 pandemic so far. Please subscribe if you enjoy nursing content, ICU nursing content, and I do make content for nursing students as well. This is a very new channel. I’m a very new nurse. So I am excited to continue this path and move forward with it. Thanks, bye y’all.