The accounts of nurses working in the midst of this pandemic vividly remind me of my work as a nurse in the early days of the AIDS epidemic. I am reminded of the period when we did not know how the disease was transmitted, when we believed that caring for them involved great personal risk. I remember masking, gowning, and gloving every time I entered a patient room. I still recall the wonderful patients I had the opportunity to care for, and I understand that watching a patient die alone is the probably the most difficult experience that we will ever face as nurses.
I spent years on the front line of the AIDS epidemic and now am teaching future nurses. I am dedicated to helping nurses cope in times of crisis. We have chosen difficult work. Work that is more difficult than we could have possibly understood when we entered nursing school. Work that can also be extremely rewarding. I am proud to be a part of this noble profession, and I hope that it may be useful for me to share some of the things that I have learned.
1. It is extremely important to take care of your physical health.
I remember days I didn’t have time to eat or drink water or take care of the most essential needs. I realize now the importance of caring for ourselves in order to care for others. Some of these things are so basic—have enough water to drink when you are working. Bring a healthy lunch to work. I learned to prepare healthy food ahead of time. I used days off to cook and cut up fruit. You will probably only have the energy to microwave something when you come home from work. If there isn’t something healthy available to eat at work, there’s a strong risk of eating junk food.
2. Know that your friends and family may not understand what you are going through.
I remember trying to “be normal” when the people I was around had no idea what I had seen that day. Allow family and friends to help you in ways that they can. Let them know what you need, whether it is quiet time, a distraction, a meal, or help with the kids. Have your support team of nurses and health care workers. The deepest and most profound relationships I have ever had have been with other nurses who shared my experience.
3. Have self-care practices.
Yoga, bodywork, running, meditating, or using guided imagery are all helpful. Choose the practice that works for you; in fact, I’d suggest choosing more than one. I found guided imagery more helpful than meditation—I just could not clear my mind enough to meditate. I found peace from imagining being in a healing and safe place. Get a massage or a Reiki treatment. I learned the importance of bodywork and how we hold stress in our bodies. I remember getting a Reiki treatment at a retreat and crying throughout the whole thing, not really knowing why. The practitioner said that I was holding grief in my body.
4. Bookend your days.
Take a moment to prepare yourself for work. Take some deep slow breaths, let go of other concerns, and look up at the sky or listen to the sounds around you. Cultivate a sense of calm and peace. And at the end of the work day, spend a moment to let it go. The best thing for me was to go for a walk and be in nature. But if you only have a few minutes, stop the car someplace scenic and take some deep breaths before you go back into normal life. Listen to some music. Just taking a couple of minutes to breathe and let go is helpful. I learned that spending just a few minutes unwinding had great benefits.
5. Know that you will never do everything that you wanted to do for patients.
Make peace with that. Do the best that you can do. I drove myself crazy thinking about all the things that I wished I could have done. I had this constant feeling that I had forgotten something. I realized at one point that there was never a day where I felt that I had done everything that I wanted to do or could do for patients. It took me a while to understand that what I was asking myself was impossible. Know that you were the best nurse that you could be for that day.
6. Pray or have a spiritual practice.
At the end of the day, I prayed. It was a way to let go. I left things in God’s hands.
7. Let go of the “why” questions.
“Why is this happening?” “Why do the best people die?” Why? Why? Why? It will drive you crazy and you will never know the answer.
8. Aim to be a calm and comforting presence.
As nurses, we are present for all of life. There are times when being present is the most caring thing that we provide—not saying or doing anything. Just being there.
9. Have hope.
I remember times of feeling so discouraged. At times, it seemed unbearable. We dreamed of the day that AIDS would be a chronic manageable disease. And now it is. I wish I had had a crystal ball.
10. Participate in rituals.
I did not realize at the time how important it was to grieve and to feel that I had community. It was such an important experience for me to see the AIDS quilt. I remember a reading of names of people who had died. I cried among other people who’d known them. I remember singing “Amazing Grace” at a conference, with hundreds of people standing together. It was a powerful experience.
I hope that you can be well and I am so proud of the work you are doing and honored to be a part of this great profession. Please take good care of yourselves.
Stephanie Windle, DNP, RN, CNE, assistant professor and level 2 coordinator, School of Nursing, San Francisco State University.
Excellent recommendations and insight into surviving the pandemic. I was a new nurse when the HIV/AIDS epidemic unfolded. At the time I worked hematology/oncology. Despite daily exposure to blood borne and enteric pathogens such as Hepatitis B, known as the healthcare workers’ disease, and an unknown disease that was impairing immunity, we had one box of Latex gloves for the 50 patient floor. The enterostomal therapist instructed us that we would be fired if caught using gloves to change or empty a colostomy bag so as to not convey to the patient that the procedure was dirty or shameful to endure. We rarely reported a needle stick as we used dangerous needle breaker containers and piggy-backed antibiotic drips with unsafe needles. Our patients has low platelets, steroids and chemotherapy resulting in them frequently bleeding on us.
My point in all this is that we did not have OSHA regulation for blood borne pathogens or safe needle systems. Those regulations were pioneered by union nurses in California who were exposed and infected with HIV. Their being organized and politically active has resulted in, with many more nurses and healthcare workers joining in the fight, innumerable lives saved by forcing healthcare employers to provide PPE, Hepatitis vaccines, and safe needle systems and policies.
This pandemic has been as political as it gets in leadership, regulation and oversight deficits resulting in a continued pandemic and nurses and healthcare workers infected and dying. Nurses must protect their patients and themselves by standing together to enforce safe standards for PPE, adequate supply, safe vaccine development, safe staffing standards and regulation for oversight by the state and federal government agencies that have been lacking.
Everything in healthcare is regulated and funded in some way by the state or federal government. My advice to nurses in this pandemic is to get educated, get active and when regulations are being written or not, programs are being funded or not, policies are being written or revised, be there, be organized and be effective.