On the front lines of the COVID-19 pandemic, nurses are being recognized for their bravery and commitment. “COVID-19 has caused the role of nurse to be highlighted as extraordinary and heroic,” said Barb Taylor, Ph.D., R.N., dean of PLNU’s School of Nursing (SON). “I would say indeed that it is, but it is of no greater value now than before COVID-19.”
The SON has always viewed the role of a nurse as sacred work — Taylor quotes Florence Nightingale in saying that nursing involves “the divine imposed duty of ordinary work.”
That belief is being lived out among PLNU’s nursing alumni as they serve during the pandemic.
Lauren Struffenegger, BSN (19)
In March 2020, Lauren Struffenegger learned that her intermediate care unit at UCSD La Jolla was being converted into a 26-bed COVID-19 unit.
“In my unit, we get patients who can’t be at home, but who aren’t needing ventilation – those who do go to ICU,” she explained.
For Struffenegger, who is just 23, some of the emotional toll of the pandemic has come from having to limit her interactions with the patients she longs to comfort.
“The healing touch is a little harder right now because I can’t spend as much time with a patient as I want to. I can’t hold their hands or spend time talking to them,” she said. “Every minute we are in the room increases our exposure. That makes it harder to express love the way we want to.”
It’s also been difficult seeing the suffering and hardships of some of her patients.
“We had a really sad case of a young mom with a newborn who was intubated for 12 days,” she said.
But Struffenegger has also witnessed people recover, which is encouraging. When that happens and a COVID patient is released from the hospital, UCSD plays a special song to celebrate.
Although spending the very early part of her nursing career on the front lines of a pandemic hasn’t been easy, Struffenegger is grateful that her hospital has been well-prepared.
“UCSD has done very good planning,” she said. “We don’t have to reuse masks or gowns. We do reuse face guards, but that’s because they can be cleaned.” She has also appreciated the gratitude and generosity of the community and her patients.
Robin Keil (15)
Robin Keil has worked in an emergency room in Visalia, Calif., for the past three years.
“With the news from Italy and New York, our hospital prepared early and did really well,” she said. “We changed processes in the ER and have three tents outside the hospital to pre-screen potential COVID patients.” Keil noted that at first testing and even treating patients was difficult.
“At first, testing took days to get results,” she said. “And we were treating patients with constantly changing criteria – once the protocols from CDC changed three times during a single shift.” Early in the pandemic, Keil’s hospital was planning against potential shortages of isolated rooms and resources.
“Now, there has been an improvement in testing,” she said. “We can get results in 30 minutes, and our work flow is more normal.” In fact, the census count at Keil’s hospital has been much lower than normal as people stay home and potentially avoid care because of coronavirus fears. This has been a trend throughout California.
“Our census is below 50 percent of normal,” she said. “We’ve had to send nurses home early, and it’s never like that in the ER. Our experience has definitely been different than New York nurses.”
Still, lower than feared numbers doesn’t mean there is no fear. Though ER nurses are used to being in a high stress environment, Keil and her colleagues have had to cope with concerns about potentially bringing a serious illness home to their loved ones. “In the beginning, it was scary especially because the media highlights worst case scenarios,” Keil said. “But I think for me, as soon as I get in the room and I am geared up, the knowledge that this is my job, this is what I was trained to do, that takes over.”
“I think what Point Loma gets right is that we focus so much on compassion.”
Keil has been reflecting on her training and education during this difficult time. “I think what Point Loma gets right is that we focus so much on compassion,” she said. One memory that has become increasingly important to her is something PLNU does at the beginning of each group of nursing students’ educational journey.
“We do the blessing of the hands at the beginning of every nursing class,” she said. “We wash and pray over hands that will welcome brand new life and hold the dying. You don’t really know the full significance of that at the time, but recently holding a patient’s hand for a minute at the end of his life, that really came back to me.”
The patient Keil referenced was brought in after being found at home with GI bleeding. He had symptoms suggestive of COVID, and they had to intubate him.
“That is an aerosolized procedure,” she said. “There are usually a lot of medical professionals in the room for it, but right now it’s limited to one nurse, one doctor, one attending, and one respiratory therapist for COVID or suspected COVID patients. They don’t want you going in and out of the room because of limited PPE and the risk of exposing others.”
Because the ICU was busy that day, the patient stayed in the ER after he was stable. Keil ended up staying with him in his room for six hours. In the end, he passed away.
“I never even got to hear his voice,” she said. “I took it really hard because I didn’t have the full grieving process. Usually the family comes, and I always saw that as passing the torch to the family for grief. Not to have that was really strange. I was the last one to look into his eyes and to hold his hand – but it was a gloved hand, not even skin to skin. This is not ideal, we don’t want you to die without a family member or a friend. What I wish the public knew is that we cry over you guys, too.”
Rachel (Rivadeneyra) Timmins, RN, BSN, CHPN (14)
As the clinical manager of a hospice and palliative care program in Los Angeles County, Rachel Timmins has a lot of experience serving individuals and families at the end of life.
Timmins oversees four clinical teams who serve Orange County and Los Angeles as well as a six-bed, in-patient hospice house. Normally, hospice is Timmins’ dream job.
“It’s a beautiful thing to be able to be an expert in the field and to walk alongside patients at the most vulnerable time, to help them prepare and accept what is happening,” she said of hospice care.
But COVID-19 has changed end-of-life care, and it brings Timmins to tears.
“It’s changing the way death happens,” she said. “It’s stealing the dignity and sacredness of an end of life experience. Death is now lonely and isolated and sterile.”
“This is what I feel I am meant to do. In accepting a call to be a nurse, these things come up. I have tremendous faith that God’s hand is in whatever happens.”
Echoing Keil’s thoughts, Timmins said, “Right now, we are being forced to make people die alone, without closure, without the touch of a comforting hand.”
As of April 2020, there were more than 150 skilled nursing facilities in Los Angeles County with at least one positive COVID case, including all the facilities where Timmins and her team have patients. They have had to be diligent with their PPE and utilize telehealth visits whenever possible to limit their staff’s exposure. Even still, she has several nurses under her supervision who have had to self-isolate after being exposed. Their greatest fear, she said, isn’t for themselves but that they may have unknowingly exposed other patients before they knew they were at risk.
Timmins also feels the weight of her own responsibilities: “I’m responsible for all of my staff and keeping them safe and making sure they have what they need. I also have a 10-month-old daughter I am responsible for, but I have to leave her every day. It’s scary. It’s stressful.”
In this difficult time, Timmins’ faith keeps her going. “This is what I feel I am meant to do. In accepting a call to be a nurse, these things come up. I have tremendous faith that God’s hand is in whatever happens. I can be a strength for my staff. We have a call every day to give updates and to listen to their feelings; we are doing a lot to try to surround them, provide for them, and make them feel heard and acknowledged.”
Kitima Chaimongkol, BSN (14)
Kitima Chaimongkol also understands the roller coaster of emotions that accompany nursing during these times. After at first believing that people were overreacting to the seriousness of the pandemic, she became an unintentional advocate for social distancing after treating her first COVID-positive patient.
Chaimongkol is a travel ICU nurse, and at the time, she was working in San Francisco.
“On March 15, I had a patient who went from having a nasal cannula straight to needing intubation and the maximum support you can give on a ventilator,” she recalled. “Her blood pressure was dropping. We had three ICU doctors, three ICU nurses, and two respiratory therapists all working to save her. It was a wake-up call.”
Chaimongkol ended up having to stay in the patient’s room for four hours. Her necessary N-95 mask caused irritation around her ears and left her feeling lightheaded by the end of the shift. When she got home, she posted about her experience on social media, and her post went viral.
“It got shared almost 6,000 times and got more than 3,900 likes,” she said.
The next day, San Francisco issued its shelter-in-place order. Chaimongkol says it has made a difference. Her hospital didn’t experience the spike in numbers that was seen in Italy and New York. In fact, Chaimongkol learned the need was greater at her former place of employment, Sharp Chula Vista in San Diego County.
“I really wanted to be in an area where I could be helping more,” she said.
Now, at Sharp Chula Vista, she has been working in a 28-bed medical ICU unit converted to a negative pressure unit with airborne precautions for COVID patients. Chaimongkol said one important part of working on such a unit is using advanced PPE, including a powered air purifying respirator, or PAPR. While the PAPR makes Chaimongkol feel safer, she did have a scary experience with it.
“I was about to go into a patient’s room when an ICU doctor stopped me to ask me a question,” she said. “After we talked, I forgot to put the battery in my PAPR before going into the room, so the air wasn’t running. I got super lightheaded, but I had a medication I had to crush and put into the patient’s NG [nasogastric] tube. I did it as quickly as possible, but I ended up with a tension headache after that.”
Despite that experience, overall the PAPR combines with other PPE to keep Chaimongkol and her colleagues safer. It’s so vital that even in emergency situations, they gear up before entering a room. When one of her colleague’s patients experienced a collapsed lung recently, Chaimongkol helped stabilize him — but only after they had all suited up and put on their PAPRs.
Chaimongkol is glad to be in a situation where she is helping make a difference during the pandemic. “I feel like Chula Vista has definitely risen to the occasion,” she said.
Alysha Woods, MSN, PMHNP-BC (14)
Alysha Woods is a psychiatric nurse practitioner at a children’s hospital in Los Angeles. Many of her patients have cancer and are immunocompromised.
“To say young people are not affected is not accurate,” she said. “Medical issues can make them just as afraid.”
Aside from patients’ fears of getting sick and healthcare workers worrying about carrying illness to their patients and/or families, “A big mental health challenge is that we are limiting patients to only one visitor. Some families have sacrificed jobs to be with their child; some have rarely left the hospital before now.”
“We are going to realize over time that this is going to have immediate and long-term mental health effects. That makes this a wonderful time for providers to be more available and educate people on how to stay emotionally healthy.”
Echoing Timmins, Woods said one of the hardest parts for everyone is patients at the end of life who are dying with limited family members at their side.
Despite the hardships now, Woods believes that by bringing more focus to the importance of mental health, something good can come from this stressful time.
“We are going to realize over time that this is going to have immediate and long-term mental health effects. That makes this a wonderful time for providers to be more available and educate people on how to stay emotionally healthy — whether that is through therapy, connection with family and friends, or working on their purpose. We are also all realizing what’s really important as we miss family and community. Mental health is having purpose and staying connected to your communities.”
Rennell Diaz, BSN, RN, AC (11)
Rennell Diaz is an advanced clinician at Sharp Memorial Hospital where he is in charge of a group of nurses in a progressive care unit that specializes in cardiac and thoracic patients. He also works part-time at UCSD urgent care and has been a clinical instructor at PLNU in the past. He’s won a “Love My Nurse Award” and been nominated for a nurse of the year award twice. He’s also been invited to present at a nursing conference.
During the pandemic, Diaz has remained positive. He is proud of his hospital and San Diego. He’s proud of PLNU.
“I have a lot of trust in the healthcare organization and what we are doing here at the local level. I can only say that because I have worked alongside and have a lot of communication with upper management – like CEOs and CNOs. At Sharp, we have a lot of comradery; we are really organized.”
At Sharp, Diaz has been training nurses, providing frontline workers with needed information, and helping ensure quality of care. In the UCSD urgent care, he himself is on the front line, making decisions about care. Like Keil, he has noticed that the urgent care numbers are down overall as San Diegans have followed stay-at-home orders.
“There aren’t so many Bird scooter accidents now,” he joked.
Diaz feels pride in not only his current colleagues but also his fellow PLNU nursing alumni. That pride helps with his upbeat attitude.
“I rave about Point Loma at work all the time,” he said. “I don’t know if people know this, but Point Loma nurses have a huge reputation in San Diego. I’ve been on hiring panels numerous times and that stands out a lot. What we have in terms of leadership and the way we set goals along with our faith, it puts an expectation on the students to go the extra mile, stay hungry, and seek more. When I see students who I have actually taught grow, it’s very satisfying and rewarding.”
SON Dean Taylor agrees: “Realizing our students are fulfilling our program outcomes and being faithful to the profession and calling is very, very comforting.”
If you are a nurse or other health care provider and would like to share your story with us, we’d love to hear from you at email@example.com.