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Q&A with NP Monee Carter, Caring for COVID-19 Patients in the ICU

Monday, July 20, 2020   (0 Comments)
Posted by: Erin Cusack
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Monee COVID-19 Interview from Texas Nurse Practitioners on Vimeo.

 

Monee’ Carter-Griffin, DNP, MA, RN, ACNP is an administrator, educator, and practicing nurse practitioner. She has been in academia for over 7 years and the nursing profession for over 10 years. As an ACNP, she has focused on pulmonology and for the past 8 years has practiced in pulmonary critical care. She teaches in the Adult-Gerontology Acute Care Nurse Practitioner Program and the Doctor of Nursing Practice Program. Additionally, she serves as the AG-ACNP Director and Associate Chair for Advanced Practice Nursing at a Texas university. Currently, she has been actively participating in the COVID-19 pandemic from the educator and provider perspective. Her clinical interests include pulmonary disorders (specifically COPD), antibiotic stewardship, geriatric polypharmacy, NP utilization in the hospital setting, and the leader as coach in higher education.

 

Q: What is your nurse practitioner specialty, and what patients are you currently taking care of?

A: I’m a pulmonary critical care nurse practitioner, or intensivist. I practice solely in the Intensive Care Unit (ICU) unit for a physician group that works in several hospitals in the area and includes a team of physicians, NPs, and PAs. Right now, we are taking care of a lot of COVID-19 patients.

Q: What is it like being a health care provider in the middle of the current surge in hospital cases, dealing with the most critically ill COVID-19 patients in the day-to-day?

A: Back in March/April, we came out of the peak much better in comparison to other parts of the country. Then when things started opening back up in May, due to the incubation period and other factors, we thought there was going to be a peak in mid-May or late May. But it didn’t really come until the end of June. Everyone was prepared, but I’m not sure everyone was prepared for the surge. I will say that hospitals have done a really good job banding together and learning lessons from other states like New York to adequately prepare here. Before we got to this point, when hospitals did start to roll back out, they did so extremely slowly and were still operating under COVID-19 precautions even though the rest of the economy was opening up a lot faster. As far as the conditions now, some days are more stressful than others. It just depends on the number of COVID-19 patients you’re currently taking care of, the severity of cases, adequate staffing, availability of respiratory therapy, and other factors. It’s the whole team dynamic because it really does take a team to care for these patients. But at the end of day, I’m really lucky to be part of a team that’s cohesive with great communication. We are constantly educating one another, being there for one another, and checking in, which has made a time that could really be very stressful a whole lot more manageable.


Q: What kind of trends are you seeing with current COVID-19 patients?

A: Since I work for a physician group, we work in different facilities. Based on the facility, the trends might look a little bit different. There are a few more younger patients coming in – patients in their 30s, 40s, and quite a few in their 50s. We’re still seeing a lot of 70-year-olds and 80-year-olds, but we’re just seeing a case mix at this point with patients spanning from the 30s to the 80s. What’s really interesting is some of the trends not just in the ICU, but in the Emergency Department as well. When I was working in the ED the other night, it was interesting to see what kind of COVID-19 patients felt sick enough to come to the ED or who were admitted to another part of the hospital but not the ICU. There are a lot of patients in their 30s, 40s, and 50s who were there and did need to be admitted. I don’t expect a 30-year-old with no significant past medical history to be admitted and suffer poor outcomes from a respiratory virus, but that’s what we’re seeing in some cases.

Q: Is there anything that we’ve learned over the past few months or that we’re doing differently in treating COVID-19 patients?

A: We’ve learned from other parts of the country, like New York, and even other parts of the world that have dealt with this on a much bigger magnitude and really bore the brunt of this virus. Therapy has changed quite a bit since the onset of the pandemic. In the beginning, we were using hydroxychloroquine and azithromycin to treat COVID-19 patients, but now we’re not really using those treatments. The health care community realized that the risks outweigh the benefits and we just weren’t seeing the efficacy that we wanted. We’ve started rolling out different therapies. Now we know that redemsivir seems to be a good option and decreases mortality, especially in severe COVID-19 cases. There was a recent recovery trial that showed steroids can decrease mortality in a specific subset of the patient population as well. Some of the other things we’re doing right now include the use convalescent plasma. We’re essentially using the antibodies of patients who were previously infected and throwing those antibodies at patients who are currently infected. Another thing that’s changed is that we used to be a lot more aggressive about intubation and getting these patients on the respirator or ventilator early on. We’ve since learned that COVID-19 patients are extremely difficult to get off of the ventilator, so we’ve changed approaches a bit. Now we’re using a lot of oxygen therapies first, such as high flow nasal cannulas, BiPAPs, and CPAPs.

Certainly a lot of things have changed, but there’s also been some things we’ve kept the same. We’ve always tried to minimize as much access as possible to these patients. That’s one of the hardest things about taking care of these patients: coming up with alternative ways to take care of them, while also minimizing exposure and risk for health care providers.


Q: Have you personally experienced caring for a patient/s who weren’t able to have contact with their family or say goodbye to their family while they were hospitalized with COVID-19?

A: People don’t realize – we lock down the ICU. When cases come in with COVID-19, we are locked down and do not allow anyone in unless they are employed by the facility or are a care provider. So when these patients need decisions about their care, these decisions come through phone calls, and that’s it. Essentially families are making decisions about their loved ones without ever having conversation with them. It’s really hard.

The even harder part is for the patients who are not COVID-19 positive, but who are in the ICU and dying for other reasons. We still cannot let anyone in to see these patients when other patients in the unit pose a risk.

I have to give kudos to all of our nurses out there – bedside nurses and all the other nurses caring for COVID-19 patients. I have witnessed nurses as patients are being removed from life support, sitting in the room with them and saying “no patient dies alone.”

Q: What are some of the challenges and barriers you’ve experienced during the pandemic?


A: One of the biggest things people have pointed to is personal protective equipment, or PPE. Do we have enough PPE to keep us safe? While I haven’t experienced this at the facilities where I work, I’ve talked to some of my colleagues who have had to stretch their supplies, and no one wants to wear the same mask for three days. Ventilators have not really been a huge issue in my workplace, but we use a lot of high-flow nasal cannulas, which have proven invaluable in keeping patients off the ventilator, and sometimes this equipment can be hard to come by.

I will say that if you are a provider doing procedures on COVID-19 patients, it is really challenging – not because of the procedure itself but because of everything else that’s involved. People don’t realize how much stuff you have to put on: gown, face shield, N-95, and sometimes a surgical mask on top of that. If you’re going in to do a procedure on one of these patients, you put another gown on, something else on your head, and maybe two or three pairs of gloves. You’re sweating trying to do this procedure.

Another challenge has been navigating life-saving moments. Whenever you’re intubating a patient or a patient has a cardiac arrest, we’re used to people rushing in the room. It’s been a challenge to remind providers that they cannot rush in without PPE or they risk exposing themselves or others. Our first instinct is to “save, save, save.” Yes, we need to save, but this needs to be a coordinated effort on everyone’s behalf. We don’t need 50 people in the room, we just need the necessary individuals to do what they need to do.

Q: What message would you have for policymakers who are navigating this crisis right now? What message do you have for NPs?

A: While we need policy to move healthcare forward, we also need to remember that this is a virus. A virus doesn’t care about your gender, race, profession, or your age. I’d like to take this idea of policy and redirect it to efforts that are really going to uplift and save lives as many lives as possible.

I cannot say enough – I know everyone is tired of hearing this – but wear a face mask! I know people are saying it’s not 100 percent effective, but I hate to tell you: in health care nothing is 100 percent. You can look at it one of two ways. You can wear the mask and reduce the risk of exposing someone else significantly. Or you cannot wear the mask and run the risk of not only exposing it to other people but getting it yourself.

As far as policy from the standpoint of nurse practitioners, I have to give kudos to all of the nurse practitioners out there -- in the hospital setting, in clinics, and in primary care -- for doing what they’re doing during this time. It’s amazing to see our community of NPs. I think it’s time for policymakers to look at how the nursing profession, including APRNs, has stepped up during this critical time to meet the needs of patients, patients who otherwise may not have received care. We are really filling in those gaps – it’s undeniable how we are filling those gaps. We’re seeing disparities in healthcare from this pandemic that are just glowing at us, and now is the time to do something about it. Nurse Practitioners represent the most viable option to be able to do something about this problem and care for patients with these disparities. One of the big things that is hindering us at this time is not being able to practice to our full scope. So I would just encourage policymakers to look at what nurse practitioners are doing. There are a lot of areas in this state that need more health care providers, and nurse practitioners are answering that need. We’ve done it throughout this pandemic, we did it before the pandemic, and we’re capable of doing it after the pandemic. Let us move forward and do what is needed to care for patients.



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