On the Front Lines in Delaware

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Two ChristianaCare Emergency Department nurses share their personal experiences in the battle with COVID-19

Two days ago on Fox News Sunday, U.S. Surgeon General Jerome Adams predicted that the week ahead would be the “hardest and saddest week in most Americans’ lives.”

As Delaware struggles to stay safe – just 150 miles from the nation’s COVID-19 epicenter in New York City – the staff at Out & About thought it would be valuable to talk to local hospital workers and learn how they are coping with being on the frontlines in this formidable battle. Perhaps it would lend a sense of greater appreciation and promise to the rest of us during the days ahead.

What follows is an interview with two nurses from Christiana Hospital’s Emergency Department: Josie Robinson and TJ Czapp.

Although the nurses have different tenures – Robinson with 17 years and Czapp with three – each has been recognized with honors within the organization.

In October 2014, Robinson was honored by ChristianaCare’s Professional Nurse Council with a DAISY Award, an internationally-established acknowledgement of outstanding nursing practices. She was first nurse in the ChristianaCare organization to win the award.

Similarly, last July, Czapp was one of 30 nurses in the organization recognized with an Excellence in Nursing award in the Acute Medicine division.

Here is what the two nurses had to say about their recent experiences at the hospital amid the crisis, their means of dealing with the stress of the job, and what advice they could offer the non-essential workers staying at home.

O&A: Addressing the COVID-19 virus has been a challenge to communities across the country. ChristianaCare responded quickly to the crisis as early as March 13, conducting free drive-thru testing at the Wilmington Riverfront. In what other ways has ChristianaCare responded to help address the situation?

Robinson: I actually was working the weekend of March 13 when they did that drive-thru. And it directly impacted us in the ER. It kept hundreds of people out of our ER that weekend specifically, which is wonderful. But aside from that…

O&A: So, instead of them going into ER, they were going through drive-thru and getting tested. [Thus] it prevented unnecessary [and/or additional] traffic in the ER?

Robinson: Yes. Absolutely.

O&A: Okay, I’m sorry to interrupt. So go ahead, keep going.

Robinson: One of the biggest things that I am appreciative of – although I haven’t had to use it – [is that] I’m a mother of two children, [who] are now home with me doing remote learning, and ChristianaCare had set up a survey for childcare very early on. They’ve made alternate arrangements for those providers needing childcare, which was a huge help.

Again, I haven’t had to use it because my husband, [who’s] a firefighter in the city, and me, work opposite of each other. So, we’ve got it covered. But, in the event that we need it, it’s there.

Additionally, for those that care for elders – those who have their parents living with them – [ChristianaCare] has offered them options for alternate arrangements. And [for those who have] pets as well, which is great.

The resources there are tremendous. Just wonderful. It just helps remove a little bit of stress from the situation.

O&A: What about you, TJ? Did you notice similar things?

Czapp: Yes, Josie hit the main ones right on the head with nurses and hospital staff [who have] different family members to take care of. So, that was huge. Like Josie said, that alleviated a lot of stress from these workers. We also implemented hazard pay for our hospital workers who are directly in contact with patients who potentially have the virus.

O&A: What other ways have you seen ChristianaCare responding in ways that might help people detect the virus? Maybe at home? Or what proactive measures are they taking in the community, similar to the drive-thru testing that they did at the Riverfront? Is there anything else like that going on?

Robinson: We have self-screening tools, so that we’re self-monitoring, essentially. There are resources on the website, too, that tell you when to seek treatment; how to evaluate how you’re feeling; who you can reach out to you if you have questions; and how you can handle these situations. So they’re trying to provide educational resources to us and to the general public.

O&A: There’s been a lot of talk lately in the media and on social media about the courage and strength of doctors and nurses who are on the frontlines in this battle. How does that make you feel in terms of the value of your role during this challenge?

 Czapp: I feel that the roles of nurses and doctors on the frontlines have always been very important. I feel like it’s always been valued, even if it hasn’t necessarily been talked about every single day. That value is the same. We work in the emergency field for a reason. And it’s times like these that we’ve been mentally working for – not necessarily a pandemic like this – but more so to help people who actually really, really need our services and our help. So, I feel like the value has stayed the same, it’s just expressed a little bit more in the community.

Robinson: Yes. I definitely feel valued and needed by the public. Our expertise is crucial at this point; and the ability to evolve and adapt to fluid situations. That’s something that we are well-skilled in and well-versed in – in the ER specifically. Because things constantly change there. So that’s, that’s something that we’re used to: We adapt and overcome.

O&A: Right. That’s a good point. So Josie and TJ, looking back on your past, what experiences or training exercises have prepared you for the challenge that the COVID-19 response poses?

Robinson: That’s a tough one because, like TJ said, the magnitude of this situation is huge. This is an unprecedented event. This is something that the majority of the working population has never experienced before. So I think that the ongoing training and smaller-scale incidents like mass casualty events, or smaller scale – but larger-than-normal events – have helped prepare us for this unusual situation.

O&A: Right. I would guess, that you’ve been in situations before where – let’s say there was a bad accident on I-95 with multiple casualties – and you’re having a day where you’re working long hours and you’re trying to save as many lives as possible. It seems like that’s what this is every day.

Robinson: Yes, exactly. I was just going to say the same thing. That’s actually the only life for us. That’s what we are used to: Whatever is thrown at us, you just pick up the baseball bat and you knock it out to left field. That’s what you do. You adapt and overcome.

O&A: So, let me ask a little bit more of a personal question, then. With doing this day after day – being on the front lines – it must be very demanding and understandably exhausting. What keeps you energized and positive in this fight?

Czapp: I think that is something that’s going be different for everybody and that’s going be very personalized. I know…

O&A: Well, I’m very interested in what you two do. That’s why we’re talking. It might be different [from others in your field]. But what are you two doing?

Czapp: Well, me, for example, I have the mentality – at least from my past – that I will get through anything as long as it doesn’t kill me. And you know the term, “What doesn’t kill you makes you stronger.” I think it’s very cliché, but I think that is something that pretty much every emergency worker in our department can relate to.

And, just knowing that, keeps you going.

Coming home and playing with my dogs. Just making dinner with my girlfriend. I’m trying to go back to as normal a life as possible. Obviously, with the social distancing and staying at home, it’s very changed. But it gives you an excuse to really spend time with your family a little bit more. And that’s been extremely beneficial for [coping with] the stress that we’re under right now. So, it’s almost like a blessing in disguise.

Robinson: Absolutely. I went from sports two-to-three nights a week with my kids and homework to staying home and being able to enjoy the things at home: getting a little more one-on-one time with my family and my kids uninterrupted; not having a crazy schedule; being able to make dinner; and still finding time to play board games at night.

Or crafting. That’s one of my big things. I don’t have to focus on anything outside of the world other than finishing the project that I have in front of me, which is a huge stress relief for me. I kind of block out the rest of the world. And that’s it. That’s all that matters in that moment. It’s me focusing on that, and I don’t have to think about anything else. So that’s a big stress relief for me.

Spending the quality time with my husband and my kids, that really helps. There’s a lot of stress the night before shift. There’s a lot for me, personally, and I know I speak on behalf a lot of other nurses. The night before my stretch of duty, my mind starts racing. I start thinking about things. I look at numbers and all these different things.

But I try to remind myself to focus on what I can learn from all this. That’s always been one of the big things for me, is learning. I always need to know the answer to why. I want to know why things happen and the reason behind it all.

So, actually, focusing on this as a learning experience has been a tremendous help for me. earning how to manage this new population of critically ill patients; learning how to manage such volume [of patients] in a pandemic; and the little intricacies that come with these new experiences. That’s a big thing for me. I have a lot of experience in critical care. But this is a new thing. I try to focus on that aspect.

O&A: Are there any things right now that the hospital is doing to kind of help keep up morale? I can imagine it might be very challenging. With all the anxiety that you were talking about, if it’s a shared experience, what kind of things happen to keep the spirits up?

Robinson: I think that the hospital is very focused on the big support. And at a unit base level – meaning at the ER level – we have been trying to build camaraderie and morale within ourselves, and a lot of the other units as well.

We’ve been trying to pay it forward and show our appreciation to other departments like environmental services, who are the unsung heroes of our institution. And to the other units that are caring for these patients, as well. Just to say thank you. And then, amongst ourselves, we’re trying to encourage team-building exercises like Zoom happy hours.

[In our unit] somebody recently colored and posted pictures of llamas on the [staff] refrigerator and said, “Keep a llama’s distance from your buddy.” [laughs] Because a llama is about six feet long. Little things like that.

O&A: Being where you are and being so close to this, if you had to give our readers advice as to how they could also keep up morale, while also keeping healthy and safe during this time, what advice would you give?

Czapp: I would give them the advice saying they’re safe at home. You need to stay at home and take this seriously. You’ve seen the numbers all across the world. And you’ve also seen the statistics for flattening the curve, and what social distancing and self-isolation can do. And it’s just very, very, very critical right now to just stay at home. You know, if you don’t need to go out, just don’t go out. If you can FaceTime somebody or Zoom somebody, choose that instead.

And try to look on the bright side, if anything. Take advantage of spending this time with your family. And kind of like reconnecting, possibly, like we were saying earlier. And really just do your part as a citizen to try to flatten this curve. So, we can all work together.

Robinson: Absolutely. Finding a way to make a difference, in your own way, is very gratifying. That’s in our DNA. It feels good to do something good. So, finding something good to change the world in your own little way. It could be something as simple as a card to an elderly neighbor or anything that will help you feel accomplished for the day. It could be walking somebody’s trashcan up or picking up the trash outside. Anything that you can do to make someone else feel good, in turn, will help you feel better.

So, what do you think? Please comment below.