As a pediatric ICU nurse in a hospital that has not experienced an overwhelming surge of COVID-19 patients, it has taken me some time to register the ways this pandemic has affected my perspective and practice.

Non-COVID diagnoses left in the shadows.

Photo by Unjay Markiewicz/ Unsplash

I recently took care of two young patients, each with acute and unexpected conditions. One was under post-operative care after a brain tumor had been removed the day before. The other had been newly diagnosed with acute lymphoblastic leukemia. What stood out to me as I interacted with their families was that these were some of the only people I would interact with in this period who did not have COVID foregrounded in their mental and emotional space. This feeling was followed by the sobering realization that this was only because they found themselves dealing with something just as insidious, if not more so.

In both cases, the families observed confusing symptoms in their children and had to wrestle with whether or not to go to the ED in the midst of a pandemic. Only when the symptoms became so severe and concerning did these families decide they could no longer avoid the ED. Now facing an inpatient hospital stay and future hospital visits, these patients and families found, ironically, that dealing with a non-COVID medical condition required exactly the increased exposure to the hospital system they had initially tried so hard to avoid. They also found that their children’s condition made them vulnerable to poorer outcomes in the event of any future COVID infection.

Many health care professionals are raising concerns that other patients with non-COVID health care issues may be falling through the cracks because they have delayed seeking care or have had their planned and needed care delayed. What are we unknowingly blind to because we have foregrounded COVID as the one worst disease anyone could have right now?

Nurses’ voices can provide perspective.

As much as the public relies on nurses and other health care professionals to provide proper medical advice about the prevention and treatment of COVID, they also rely on us to provide perspective as health educators who recognize the ongoing existence of other health problems.

Nurses need to use our voices to remind the public about what healthy lifestyles in pandemic times might look like, what symptoms or conditions should not be ignored, and why it is still safer to seek medical care than not if people are concerned a serious medical issue may be arising for themselves or a loved one. For all of the very important public advocacy that nurses and other health care professionals need to do regarding proper PPE in the hospital, we also need to consider whether we are also highlighting the ways hospitals are working to maintain a safe environment for people to come and seek care.

As one who has certainly witnessed how my hospital has needed to take a conservative approach to PPE usage in these times, I do also fear that our very necessary public advocacy for adequate PPE unwittingly may be sending a message to the public that they are not safe coming to us for serious non-COVID concerns. Nurses need to use our voices to help bring balance in the spread of information about prevention and disease management of serious non-COVID conditions.

COVID’s power over non-COVID cases.

Even as COVID gets relegated to the background for these non-COVID patients and families in our unit, its effects are never far from us. I think of the COVID-negative patient who showed signs of severe sepsis and had coded on the night shift before I came on shift as charge nurse one day. We had already made an exception to our current one-visitor policy to allow a sibling to be at the bedside as a support for their mom after the code. The brother pleaded with me to allow other adult siblings to come “just for a short visit to see her because she’s so sick.” He stated they had all recently tested negative for COVID-19.

Our social worker and I wrestled deeply with whether or not to stretch the visitor policy, but because the patient seemed to be stabilizing, we ultimately decided to say no in order to limit traffic and potential exposure in and out of the unit. I felt terribly conflicted about this decision. This family seemed respectful and nondisruptive, yet despite their own COVID-negative status, the pandemic’s cruel hand still held sway over their ability to be together during their own crisis within a crisis. As the charge nurse that day, I felt caught in the middle, at the mercy of COVID’s unpredictable power.

COVID’s distancing impact on human connection in basic nursing care.

I think of my emotional connection with the sister of our newly diagnosed ALL patient. She was strong and calm with the patient, but as soon as the patient would step out of hearing range into the bathroom, her tears would flow and and she would pour out her fears and anxieties to me. As I said goodbye to them at the end of my shift, I instinctively leaned over to give a side hug to the sister. She patted my back and thanked me graciously, and I realized immediately that I had made her uncomfortable with the physical contact that once felt so natural as a nurse.

Unlearning and relearning anew how to care for non-COVID families in this time requires keeping COVID to the forefront of my mind in certain aspects of nursing care; this limitation can leave me feeling disconnected and upside down.

These are only some of the important spaces where COVID hurts our non-COVID patients, their families, and those of us who care for them. These are the spaces we are trying to find ways to safely fill as nurses in a time when social distancing is necessary for the greater well-being.