Stories from the Field

On March 11, 2020, the Governor of New Mexico announced the first cases of presumptive COVID-19 in the state. Shortly thereafter, I was invited to join the University of New Mexico (UNM) Health Sciences Center (HSC) Incident Management Team (IMT). While I was new to academia, I had almost 20 years of public health emergency preparedness experience in the United States Departments of Health and Human Services and Veterans Affairs. Major issues for consideration by the HSC IMT included:

• How to manage clinical experiences to maintain safety of the students and meet necessary requirements
• How to manage students who were exposed to COVID-19 or who were COVD-19 positive
• How to establish alternate learning to replace clinical experiences
• How to support students with their information technology needs, especially those in remote areas with limited and unreliable access to internet services
• How to provide general support to students (eg, educational and emotional)
• Communication

I participated in reviews of policies, including hospital surge capacity plans; the creation of a database for volunteers of faculty and students; facilitated coordination of student placements with the NM Department of Health; and assisted with an issue about expired medical products and home health clients, in addition to conducting the general work of the IMT.

The College of Nursing (CON) initially decided to stop most clinical rotations until more was known about the new virus and its transmission and to relieve stress on the health care system. The CON consulted with the Board of Nursing with respect to the number of clinical hours required and what percentage of those could be simulation. Alternate learning experiences included simulation and virtual simulation, integrating public health-related opportunities such as clinical consultations at the COVID-19 Call Center, outreach to older persons and others who were homebound, vaccinating health professionals and the public, and contact tracing and telehealth opportunities.

Policies and procedures for students who tested positive or who were exposed to COVID-19 had to be created, including processes for identifying COVID-19 positive students; reporting requirements such as daily attestations (fever, cough, etc.); travel, testing, and quarantine/isolation for students who lived on and off campus and who were ill or exposed.

UNM is a Hispanic Serving Institution, a Minority Institution, and a Minority Serving Institution. New Mexico is also a majority-minority state with high rates of poverty. Support for students was a priority. In addition to frequent communications regarding current polices and resources, efforts focused on library services, technology support, and emotional support.

I am grateful to have had the opportunity to contribute to the College’s and Health Sciences Center’s COVID-19 response. The responses supported the continuation of courses in the undergraduate and graduate programs and the on-time graduation of all students in 2020.

– Mary Pat Couig, PhD, MPH, RN, FAAN
Associate Professor and Carter/Fleck Endowed Professorship
Director, Center for Health Equity and Preparedness
College of Nursing, University of New Mexico

COVID-19 presented unique, new challenges for the National Disaster Medical System (NDMS) nursing cadre. The impacts of the pandemic over multiple months continue to reflect on the challenges and progress we have made to increase preparedness. The most significant takeaway is that we must continuously prepare for the next event that will cause us to respond outside the typical mission sets, such as hurricane responses.

NDMS began responding to the COVID mission in February 2020, with the identification of COVID on cruise ships with American citizens as passengers. The coordination to move Americans back to the United States under isolation precautions, collaboration with the United States and the Japanese government, and the cruise lines, provided unique opportunities we had never engaged in before. Arrivals on the US side required fast and deliberate collaboration with many partners to receive thousands of cruise passengers and provide them with the best care. Medical care, food, social support, housing, including all associated logistics, were all roles that NDMS assisted. Additionally, teams were sent to multiple areas throughout the US to support these requirements.

Once the repatriation activities slowed, NDMS was requested at and tasked to multiple locations throughout the United States to augment overwhelmed medical facilities. NDMS nurses brought expertise in ICU, pediatric, and respiratory care for augmentation and support; helped to decompress overwhelmed emergency rooms; supported alternate care sites; provided assessment teams to assist in triage; and provided subject matter expertise to nursing homes on infection control. NDMS supported three federal monoclonal antibody treatment sites, decreasing the burden on the participating hospitals and admissions.

As testing and vaccines were being distributed, nurses working multiple deployments were asked, once again, to support mass testing and vaccination sites across the country. When not deploying with NDMS, the same nurses supported their home medical institutions.

The COVID-19 pandemic drove the most extended consecutive deployment in the history of NDMS. The commitment of each deployed nurse became challenging both professionally and personally. Professionally, the nurses needed to complete online training modules before deployment to understand COVID and were required to be FIT tested for personal protective equipment (PPE), as they would be exposed to very ill patients, many of whom died due to complications associated with the viral infection. NDMS nurses traveled across the country, feeling the pull between staying home and deploying, which meant challenging their mental health and risking their safety to work in a world that was constantly learning about the virus and its impact each day. Personally, they deployed, away from their families and friends, at a time when no one knew what the future held regarding the virus. They were concerned they might bring the virus home after a deployment, and they were not always able to escape the virus themselves, impacting when they could return home or return to work due to quarantine precautions.

NDMS has collected feedback from its responders and established various mechanisms to support them. Mental health sessions allow responders to verbalize their feelings and thoughts after these deployments, education is updated online to keep information relevant, funding is secured to hire more nurses, and responders have a vocal voice in deployments in the future.

– Helga Scharf-Bell, DNP, CRNP, MSN, RN, NDHP-BC
Chief Nurse, National Disaster Medical System (NDMS);
Senior Advisor, Administration for Strategic Preparedness and Response

As the world began shutting down, I was hastily returning home from travel on March 13, 2020. On landing at the airport, I opened my phone to find a message with deployment orders. I was to report to the Princess Cruise ship quarantined in California, and my attached flight itinerary had me leaving in four hours. I rushed home, threw a load of laundry in the wash, and headed right back to the airport with a bag of not-quite-dry laundry and a jumble of emotions, leaving behind a nervous spouse and elated kids who had no school “for a week or two.” As a disaster researcher at the University of Michigan, and a nurse practitioner on a Disaster Medical Assistance Team, I felt more committed than ever to be of service. But most of all I felt scared. I felt really scared about going across the country to be on the frontlines of the response to an unknown virus, scared that I would get sick myself, scared that I would be trapped in California without transportation home as the country shut down.

My role was to support the “guests,” as we were to call them, who were part of the first federal quarantine in almost 50 years. These were some of the first known individuals in the United States with COVID-19, and at the time there was a great deal of uncertainty about personal protective equipment (PPE), personal safety, and the transmissibility of the virus. I provided healthcare to the individuals who were in this mandatory quarantine, where I monitored them for symptoms of the virus, and coordinated transfers if advanced care was needed. While this was a group of generally healthy older adults, there were a number who did develop symptoms, or became ill.

In fact, in the first few minutes of my very first shift, I was called to a patient’s room who was ill with symptoms of COVID. I remember the thoughts going through my head as I walked to the room to see the patient, wondering, “Am I really doing this?” I also felt fear for what our country was facing, “Is our nation really facing this kind of event?” And then I went in the room, and there was a person—a grandmother, a kind and friendly and brave woman who was just as afraid as me. As I introduced myself, clarity came to me—she needed help, and I was there to do my job. That’s when my basic nursing training kicked in—this was a patient who was sick and I had the skills to help them—and above all, as a nurse, to care for them. This woman was not a subject in one of my research studies, or a nebulous person impacted by policy I help draft. Rather she was someone who I could help using the culmination of my learned skills as a nurse, researcher, and policy advocate.

– Sue Anne Bell, PhD, FNP-BC, FAAN
Assistant Professor, University of Michigan School of Nursing