Nov 07, 2020 1:35 AM

COVID-19: My Story Episode 10-ICU Nurse Jon Miller transcript

Posted Nov 07, 2020 1:35 AM

Jon Miller:

It's no respecter of age or how healthy you were before. The virus has been very opportunistic. And if you have any kind of co-morbidities, either diabetes or high blood pressure, it finds a weakness in some way and can have its effect. My name is Jon Miller. I'm a registered nurse and also a relief charge nurse at Hutchinson Regional Medical Center, and this is my COVID-19 story.

Nick Gosnell:

Welcome to COVID-19: My Story. I'm Nick Gosnell. I had a chance to talk to Mr. Miller about his role as a nurse at Hutchinson Regional Healthcare System. Here is that conversation.

Jon Miller:

First off, I have gone online and purchased the material and made scrub caps, various different colors, schemes. And that is part of something that I end up wearing all day long, because when I get ready to put on the protective gear, if you will, what I choose to use it's an air-cooled helmet. If you think of a construction helmet, there's a motor inside that blows cool air. There's a cord that comes off of that, that goes down my back. And I plug that into a battery pack which it slips into a pants pocket.

Jon Miller:

And so that provides protection. There is a shield that comes across the front and then, I don't know how to describe it, a cellophane cover that comes underneath around my neck to seal that off. I then proceed to putting on a gown. There are disposable throw away. We also have gowns that are laundered in the company that we contract with to do our laundry, provides the gowns. Put that on and, of course, a pair of gloves. And then I am set to enter a COVID-19 patient's room.

Nick Gosnell:

Talk to me about what special training those in critical care must have to take care of those who are intubated.

Jon Miller:

When you enter into a specialty area like ICU, there's various courses and services that are offered if you're a new graduate nurse. And all of us have gone through that, whether it's cardiac related, have some relief, cardiac monitors to caring for a patient on a ventilator. It's an in-depth conversation regarding, first of all, the anatomy of the lung and how the lungs normally work.

Jon Miller:

And then in the case, as we're discussing here of COVID-19 patients, the work of the ventilator, as it pertains to someone obviously requiring the need for a ventilator and then the physiology, if you will, via technology that provides the same type of functioning that the lung normally would, but for the person whose lungs are affected, impacted by COVID that the understanding the settings and what the ventilator is trying to do for these people is required ventilatory support.

Nick Gosnell:

Using a ventilator for COVID is different than using a ventilator for some other conditions. Isn't it?

Jon Miller:

If you, let's say for example, had an open heart surgery, the induction of the surgery and being asleep during that, when you come out of surgery and then for a heart surgery, you're recovered essentially in via an intensive care unit, a person may come back on the ventilator. But the difference would be mainly until person first off wakes up enough, comes out of the effects of the anesthesias to be able to breath on their own.

Jon Miller:

Then we're looking for if the person is awake enough to follow commands, and certainly that their vital signs are stable. That if they meet the criteria, then that ventilator, the tooth from the ventilator can come out in anywhere from, we've done it in 15 minutes or so after someone's come back, to three to four hours. Or depending on the person's response, coming out of anesthesia, it may be overnight.

Jon Miller:

But the goal was to get the breathing tube out as soon as possible. So there are various times and ways that we use the ventilator. If someone has overdosed on a medication that depresses the respirations, they may need to be on the ventilator again until they wake up enough there to demonstrate the ability to breathe on their own. And then the breathing tube could be removed.

Nick Gosnell:

Ventilation for COVID-19 is a much longer period than any of those things you've already talked about.

Jon Miller:

Correct. It can be, I've read stories in the course of what's been happening. There was one person that I saw was on the ventilator for 99 days. It all depends on the individual. One of the realizations of working in and around this virus and its effects on people, it's no respecter of age, or how healthy you were before.

Jon Miller:

Certainly health plays into that as far as this virus has been very opportunistic. And if you have any kind of co-morbidities, diabetes, or high blood pressure, it finds a weakness in some way and can have its effect. What we've seen on people at the beginning when this virus happened, we were successfully able to people who were on the ventilator... In fact, one of the stories was in the Hutchinson News in regards to the length of time that this individual was on the ventilator, went to a specialty hospital, because they needed more time and work to be able to have the ventilator removed.

Jon Miller:

And then the article appeared in the paper was home again and up and about. So those certainly are the success stories. What's been seen in this wave coming around here, coming into the fall with the opportunities for success and getting these people off the ventilator that the track record has not been favorable. And it is not without the best efforts, the best care that's been offered, the latest approaches to contending with people who need to be on the ventilators. But it's just the body's ability to be able to recover.

Jon Miller:

One of the things that we have found in articles that I've read has to do with COVID, you develop a pneumonia with. And then along with that, just like if you have an influenza and the seasonal flu, if you will, there's an intense reaction by the body's inflammatory response to eradicate or get rid of the COVID. That the secondary complications that are generated by the body's trying to resist or fight off this infection is what contributes to the demise or the deterioration further up people's health.

Jon Miller:

And in this case, the damage that can end up causing the lungs, which can require settings on the ventilator that are really high. And we're just not able to, what we refer to is wean, dial those numbers back to be able to successfully get that person off the ventilator. So just seems in this way, that what we're in the midst of right now, these people are coming in and very sick, and varying ages throughout.

Nick Gosnell:

How many patients can a nurse handle at once with COVID depending on its severity?

Jon Miller:

What we find and I'm very appreciative of management Hutchinson Regional Medical Center's take on what we are into and providing assuring that the staff ratios can be safe. And certainly, I can start off the day and typically, first off, answer that question. Generally, it's two patients. You may have one, two who are running similar courses. You may have one that's more seriously ill than another. But the idea is to keep it manageable in two patients. Unless the condition of a patient coming in is so unstable, they're so critical that they require one-on-one attention. And sometimes that can be even two or more. But the general ratio would be is to look to be maintained at two patients for each RN.

Nick Gosnell:

Are there staffing challenges at Hutchinson Regional as a result?

Jon Miller:

There are further issues that develop in a ripple effect. And what it is recognized is ICU, and certainly just a shout out to all nurses who provide care for patients in whatever setting that is. There's challenges within that, in patient care, whatever setting you're in. In an ICU setting it required the training and not only the training, but as I have oriented new graduate nurses, one of the things I say is there's no substitute for just raw experience or just getting in.

Jon Miller:

We learn from each and every experience that we have with each and every patient. It can take a while just to get up to the speed and the experience and confidence in taking care of certainly existing clinically ill people. So what we had as far as what we were able to maintain on a daily basis, we were able to work with that. Census could go up and then drip down.

Jon Miller:

And we see that fluctuation in today's healthcare environment. Patients are admitted and then just moved right on through the system in a timely fashion, that has to do with costs. There's the reimbursement factors and insurance companies who are allotting a certain amount of pay. And then the need for other patients to be able to come in.

Jon Miller:

So what we're up against in this situation is as sick as these patients are, and the ratios that are needing to be maintained, the unit has been filled more with COVID related patients. For example, if you're familiar with our ICU in Hutchinson Regional, there's a 14 bed unit that is on a circle, semi-circle and then we have another additional four rows, what we've called a cube. And this is part of that new design of the ICU that we've been in for a couple of years now. That has evolved from when we first started having these COVID patients from the spring, and then even into the earliest part of the fall. As the census started picking up, we, and even utilizing those two units, not having enough staff to be able to cover.

Jon Miller:

So we've now been basically primarily been using the circle that the four rooms are available if we need, but just having the staff or the trained staff that can do that. We have courageous nurses who have cross trained to ICU. But again, for the protection of their experience in working with critically ill people, we try to assign patients to those, that group of people who float in to be able to work within the scope and have the confidence to take care of the less critically ill.

Jon Miller:

Technology is there. And we have the capacity for X number of ventilators that really is what comes down to is the people power, that the numbers of people that it's required to be able to take care of these people is that as I reflect back yesterday as our discussion on the ratios of generally two patients to one nurse. And so what happens then it can be a case-by-case basis.

Jon Miller:

One of the other responsibility that I have, I do relief charge nursing. So I get to see that management side and the shuffling and what has to happen to be able to admit a patient. And we're really at the point now that take for example, Monday, there was a patient that needed a COVID patient from our step-down unit COVID floor that needed to come down and come back to ICU. But the only way that we would be able to accept another patient was to be able to move one of our COVID patients who had stabilized out.

Jon Miller:

And so it just can be a chess match or trading back and forth. That's the work that's behind the scenes that goes into play each and every day, or it can vary hour to hour for management, nursing management, supervision, administration, to counselor to provide the care as safely as possible. But recognize the limits and the constraints of we're working in as far as number of nurses available to do that.

Nick Gosnell:

Are you concerned about infection as you go to work each day?

Jon Miller:

Each experience calls for just making the adjustments to that. I had a discussion with a physician here a while back. The question posed to me was, are you afraid of COVID? And I said, "Well, I'm not sure it's as much about being afraid of respecting the virus for what it is for what is the potential. And for what I see

when patients become sick enough to come into there, it spurs me on to, obviously I want to be able to go to work each and every day.

Jon Miller:

So the precautions that I can take when I'm at work, doing good hand-washing, thinking through the process." As we started this conversation about the protective equipment that we utilized in going into these rooms, and just thinking through that process, making sure that I'm dressed in the way that the gowns, the face covering shield or the N-95 mask, wearing gloves.

Jon Miller:

But also then when I come home, the first thing I want to do is... Well, actually, I trade shoes. I feel like I'm Mr. Rogers in Mr. Roger's neighborhood, but because you come into the parking lot at 6:30 in the morning, or whatever, you may see me sitting on the edge of the trunk of my car switching shoes, ones that I'll wear into the hospital and then come out of the evening, I switch back again. When I get home, take my shoes off and just inside the door. And then I immediately head for the shower because yeah, just taking those precautions for family.

Jon Miller:

My wife is also a nurse in healthcare. And I think about those who live in our house here and looking out for them. Live with that awareness. But the idea is just to take those steps, to minimize the risk of contracting. There's no guarantee, even if I should succumb to it, knowing that I've done my part to try to help minimize the risk.

Nick Gosnell:

When patients can't see their families due to a COVID-19 infection, what do nurses do to help in that regard?

Jon Miller:

We're very fortunate for our ICU to be on the ground floor and that's accessible. We just direct people to come around to the employee parking lot side of the building. And there's been creative ways to do that. First off, we will put route numbers using the conventional magic marker and white paper, writing the room number on. So the family members knows which rooms to stop at. And then what I work to do, and other nurses that have their own ways of doing that is just being able to position the bed, physically turning the bed towards the window and positioning the patient as best, the head of the bed up being high enough that they can make eye contact.

Jon Miller:

And then a lot of times with technology in this day and age with cell phones, the family can call in, or they could FaceTime. But they're able to have communication through a window. Certainly that, phone calls, as patients are able to, if they're feeling well enough, they can talk to their families on the phone. Yeah. We just try to make provisions in that way, because it's a no visitor policy to someone who's currently in treatment for COVID just for the safety and wellbeing of the family members. And then certainly people who are outside that those family members may be in contact with.

Nick Gosnell:

What tips would you give the general public on how to mitigate their infection risk?

Jon Miller:

Even if you don't understand it, respect it and respect COVID-19 for what it is and its capabilities. The political overtones that has taken seems to gained a lot of momentum with this and that's for different reasons. But coming back to the point, if I'm going to a physician for, I need to have a surgery or I'm having some kind of physical ailment, I'm having chest pains. What I'm paying for is the expert advice of that physician who has trained years. If you have four years of college, four years of medical school, three years of residency, and then a fellowship in whatever that might be.

Jon Miller:

Let's say currently what COVID has to do with is infectious disease specialists who know. And again, to state upfront here, medicine is not a perfect science, but it's the best we know up to date. And I think it's important to vote for which voice to listened to. For me it was what I listened to. I have great respect for the medical community, the physicians and their commitment to what it takes to become a physician.

Jon Miller:

And then the work and the humility that I have seen in physicians as they work, and they wonder. We've learned a lot about the body and viruses, and illness that there's a lot to be learned. And so I think it's behooving to decide who you're going to listen to for the truest source that we have, or the most credible source, and then follow those leads and what the recommendations are. Hand washing, wearing a mask, it's not only for your benefit, but for the other person who was out there.

Jon Miller:

I may feel like that I'm healthy and I'm a low risk, but I never know who the person is who maybe be vulnerable in some way with their own health issues. Or maybe a healthy person, but somehow the virus gets a hold of them and has the potential fatal effects, even at its extreme. It goes beyond myself and thinking about my neighbor, my family, and following the precautions of good handwashing, wearing masks and social distancing. But also on a personal note, I think how we take care of ourselves as people and that's working to eat right, drinking plenty of fluids, getting good sleep.

Jon Miller:

That seems so basic, but I think we need all the help we can get from what we've known about this virus to help minimize the risk to ourselves and find the time to do other things that help people to help one relax. Life has I've seen slowed down, which to me is not necessarily been a negative thing entirely. So I look at the opportunity just to take a different tack on life is a perk, and maybe life doesn't have to be so rushed is what it seems like in our faster paced society for today.

Nick Gosnell:

Our thanks to Jon Miller from Hutchinson Regional Healthcare System for giving us a nurse's perspective on COVID-19: My Story. If you have a COVID-19 story, feel free to email us at [email protected], and you may be the subject of a future episode. Thank you so much for listening to COVID-19: My Story on hutchpost.com and your favorite podcast app.