UNLV School of Nursing graduate student Ally Keefe works in a Reno emergency department while she’s pursuing her master’s degree to become a family nurse practitioner.

“To say I knew what I was getting myself into as a young nurse — this isn’t what I imagined,” she said. 

As a nurse, Keefe is used to situations where she’s had to work on the fly. But lately, she says every shift she shows up to, the protocols and procedures change throughout. Professional routines are heightened.  Personal routines are limited.

“Honestly, when I’m off, I try not to even leave my place,” says another UNLV graduate student, who asked to remain anonymous for privacy purposes. She works full time at a Las Vegas hospital and always wanted to be in the medical field.  “I’m not trying to put myself in a situation where I’m going to be around other people [outside of work], and I’ve told my family 'Until this is done, I probably won’t see any of you.'”

Both she and Keefe are on the frontlines of a pandemic that has no end in sight. 

The novel coronavirus outbreak has, for now, shut down most of the world as death tolls rise, number of cases grows with every day, and personal tragedies mount. People isolated in their homes to avoid infecting others.  Lives lost. Jobs lost. There's growing uncertainty while we wait for the all-clear sign as health experts push for a vaccine and appropriate safety procedures in the meantime.

With all this happening, it is a critical time to be a nurse. 

Protection Spread Thin

“This is not the norm,” says the anonymous UNLV student. “As nurses, we have to stand together.”

At her hospital, there’s a section there just for patients with respiratory illnesses like COVID-19, the disease caused by the coronavirus. At least 14 rooms converted to accommodate those specific patients. Not every hospital has this. She says some of her friends work at hospitals where COVID-19 patients just go into the ICU. Even having a sectioned off unit still makes her nervous.

“It is stressful because you’re, wondering, Am I assigned to that unit?”

Keefe, too, works in a Reno hospital with an area dedicated to COVID-19 patients. It’s a similar setup with the same objective: isolation and prevention.

“If they have any kind of respiratory complaint [patients are] directed to a tent outside where they are screened,” Keefe said. “[They] go inside this kind of back door. We blocked off about 20 rooms that are just respiratory rooms.” 

Keefe notes an increasingly prevalent concern throughout hospitals and clinics around the globe: the lack of personal protective equipment, specifically masks.

When we first spoke with Keefe on March 25, she told us she was allowed to change her mask every four hours. A week later, she says she’s issued just one mask per shift (each shift is 12 hours).

“There is just a general tension because we know that we don’t have all the personal protective equipment that we need.” 

The nurses are instructed to wear gloves, a surgical mask, and a short-sleeve gown when meeting a respiratory patient.  But if that patient tests positive for coronavirus, they can wear powered air-purifying respirators -- full masks connected to a machine and blows air out of the mask so no contaminated air can come in.

The unnamed UNLV graduate student says that while those respirators are effective, there are only so many machines to hook up to them. 

Precautionary measures are designed to protect, but in some ways, it also perpetuates shortages of protective equipment.

“The issue is protecting myself, and I don’t feel like we have enough equipment to actually do that,” says the anonymous student. “I have to ask my charge nurse every time I need a mask and I’m supposed to throw those masks away every time I exit the room.  I’m pretty much only getting one mask per shift. So that’s kind of scary.” 

She hasn’t noticed a lack of gowns, but up in Reno, that’s another crucial piece in short supply.  Keefe’s hospital is short on disposable long sleeve yellow gowns for isolation, so they must wear short-sleeve patient gowns. 

One of the questions surrounding the equipment shortage on the frontlines is whether surge capacity is working.  “Surge capacity” refers to the ability for a hospital to add more resources and response teams from different areas in the event of a disaster.  But that strategy changes when multiple areas are facing the same crisis. 

“There is no surge capacity that can respond to a nationwide pandemic.  It doesn’t exist,” Nursing assistant professor Dr. Aaron Bellow Jr.  said. He compared it to a hurricane hitting Texas.

“Absolutely those of us from Oklahoma, Florida, Louisiana, and surrounding areas will all go into Texas.  We’ll bring healthcare personnel and supplies and temporary hospitals,” he said. “But if that’s happening in Texas at the same time it’s happening in Louisiana at the same time it’s happening in Florida, nobody’s coming.”

Keeping Calm

Keefe's experiences with COVID-19 show how the outbreak is impacting not just the physical health of nurses, but the mental side, too. 

“I’ve just found my mind wandering to bad places sometimes,” she said.

“We had to intubate a COVID-19 positive patient. This woman I work with who’s a super experienced nurse volunteered to take care of that patient.  And I had this kind of overwhelming feeling of ‘Are we going to get to the point where we start seeing my workers getting sick and possibly dying?’ You try to stay focused on your work, but that feeling when I’m watching her in the room thinking, ‘I know you volunteered and you’re the most qualified, but why did we put you in there, when we should have put a young person in there?’”

Working as a nurse, or any healthcare provider, requires you to maintain your composure despite the chaos around you, these nurses explain. Because how can a patient stay calm if you’re not? But it can be difficult when fear and panic are just as infectious as the virus you’re trying to stop.

There’s a line that nurses have to draw between a patient’s wellbeing and their own, to help mitigate fear for everyone. A Centers for Disease Control and Prevention guideline, for example, says that if a nurse runs out of surgical masks, that person should wear a bandana. It’s frightening for a nurse to be that exposed, and it could lead to less patient trust in healthcare providers (though Keefe had a patient tell her that seeing her in full protective equipment was itself a frightening event).

“We have to stand up for what we believe in,” the anonymous UNLV student explains. “So, if we see something’s not right, I know a lot of us are signing petitions, stepping up voicing our concerns, but we still have to take care of patients, because if we don’t, then who does?”