BORN TO BE A NURSE

One year ago, quarantine lockdowns were announced in the United States due to the COVID-19 global pandemic. Jennie Leininger’s job as a medical-surgical nurse in Washington changed but the spiritual connection of serving our sisters and brothers with health challenges remained the same.

How did the pandemic change your job as a nurse?

The general concept has remained the same, but the logistics changed overnight. My hospital received our first confirmed positive case on March 6, 2020. It’s interesting to think back on how we continually evolved during that process. I was out of work for almost three weeks with COVID-19 myself in the very beginning, and I got texts daily from co-workers to make sure I was recovering and to say, “Work is so different! Be aware of this when you get back.”

Tents were erected outside the building to triage patients, and respiratory patients were separated from everyone else. Nurses were trained in skills they wouldn’t normally do, like drawing blood, respiratory treatments, or other tests. Normally, techs and respiratory therapists would do these things, but they wanted to limit who was coming in and out of dedicated quarantine units. Staff within that unit, once changed into hospital scrubs and PPE [Personal Protective Equipment], could not leave for the shift. Food was brought in.

Policies changed several times daily as new information came. Mask. Don’t mask. Wear this PPE when that happens. Don’t wear this type of PPE, wear that. PPE can be worn between patient rooms when both patients were confirmed positive. Also, in the beginning, it took a long time to get results back. So there was a “rule out” unit, with patients waiting for results, where PPE was not worn between patient rooms because a potential positive patient could spread the virus to a confirmed negative patient. Once a positive result came back, they were transferred to the “positive unit” where single PPE was worn all shift, but hands were washed as usual and gloves changed between patient encounters.

We have always worn PPE for different reasons. So the issue wasn’t how to use it properly to avoid contaminating ourselves and others. It was, “What are the characteristics of this virus? How is it spread? What combination of pieces should be worn to avoid transmission?”

Throughout the rest of the hospital, other types of infections no longer required certain PPE, so that more was available for the COVID unit. Cloth masks were temporarily allowed so that supply could be stretched further. Once we had enough supply, staff wasn’t allowed to wear masks other than the disposable type, provided by the hospital.

Classes and trainings were canceled. We had to figure out how to have meetings online, just like everybody else. Nonessential procedures were canceled, outpatient clinics closed, and all staff was deployed to the “labor pool” – extra helping hands to deliver food, take donations, divide donations between neighboring hospitals, be in the units to hand things into rooms – all in an effort to conserve PPE. We had what we had. and we didn’t know when more would be available, so we had to safely stretch the supply. We were all worried. We didn’t know what would happen from one day to the next, or how things would change more, or how we would have to adapt.

A year prior, nurses were accused by a Washington state senator of not needing rest breaks because they just sit around and play cards all day. For the first time in my ten years as a nurse, I felt valued and supported by my community. Restaurants kept us fed. Churches had prayer and worship services in the parking lot. We were applauded at shift change. I was called a hero and compared to Rosie the Riveter. It was different, but I felt, “This is what I have always done. It’s nice to finally be recognized for the hard work I do, instead of the Hollywood portrayal of nursing, but this is what I do. I’m not a hero. I’m doing my job, my calling. Nothing special.”

How has your nursing remained the same?

Nurses have always been masters at adapting. New evidence-based practice comes out all the time as new studies are released. There are very few things I learned in nursing school that are the same now.

We have a plan, but we have to be able to change gears in a heartbeat with a poker face. We guide patients and families through difficult things and we need to be the calm in the storm. We have to be the strong one in the room. That didn’t change. Our dedication to patient-centered care and our ability to be creative didn’t change. Our dedication to nursing and caregiving didn’t change.

When people have tested positive, most stay home in quarantine and wait it out with a variety of symptoms. What is the level of illness to be admitted to a hospital?

Any virus runs its course. Recovery efforts are geared toward symptomatic treatment, to ease the symptoms or support areas in the body that aren’t handling it well. Hospital admission happens when you aren’t getting any better at home and continue to decline, requiring more aggressive treatment.

The emergency symptoms of COVID are difficulty breathing, sudden confusion, change of coloring, or chest pain. Any or all of these should warrant a trip to the emergency room under normal circumstances. There are many things that could cause these symptoms. We just now have a new, highly-contagious virus that these symptoms could also point to. Because it is new, people are dying because it takes time to learn about it, and how to prevent and intervene.

You will be admitted from the emergency room to the hospital if you need extra oxygen while your body heals, or if you need certain types of nebulizers stronger than inhalers that you’d use at home. You will be hospitalized if you need IV fluids – some older people are quite dehydrated because they’ve lost their appetite due to being sick.

Certain medications can only be given through an IV so needing any of those will require admission. There is an experimental medication, Remdesivir. It’s not approved by the FDA [Food & Drug Administration] yet – it helps with extra symptoms and can shorten the duration of the virus. You qualify for it if you have a lack of oxygen. There are also parameters around using convalescent plasma, from somebody who already had the virus and developed antibodies. These antibodies can give a boost to your immune system to help fight the virus.

What do you do as a nurse with a COVID patient that is different from other patients?

At this point, the main difference is strict isolation in a dedicated quarantine unit because it is transmitted so easily. In good health, your body maintains a state of normal – a normal level of chemicals, fluids, and electrolytes maintain all of your systems working together. Your body has backup systems for when this balance is thrown off and there are backup systems for those backup systems. The technical term for this is homeostasis. Disease happens when homeostasis is thrown off, whether by an invading bacteria or virus, a failure of one of the systems, chemicals being off balance, etc. So the treatment of any disease or chronic condition is going to the source and restoring the state of normal.

COVID-19 is a respiratory illness, and treatment is focused on the bottom line – returning your lungs to a normal state while preventing other organs from being affected. Because the lungs and heart are so closely related, any prolonged problem with the lungs can lead to your heart beating abnormally which can be dangerous. So treatment can be respiratory and cardiac medications. Sometimes a person won’t respond to steroids, plasma, or Remdesivir, and require advanced methods of oxygen delivery or even continuous medications going through an IV to regulate the heart. This level could put somebody in the PCU [Progressive Care Unit] where they are too sick for the general floor, but not sick enough for the ICU [Intensive Care Unit], or continue to get sicker and sicker, eventually requiring the ICU and a ventilator.

We have found that being in a prone position – lying front down – helps oxygenation levels. Just having a patient change positions can mean the difference between increasing levels of breathing support. There are heavy organs on top of your lungs – your heart and ribcage – and your lungs are working super-hard to breathe from the virus. Those extra heavy organs make it even more difficult. So if you’re on your side or your belly, you no longer have that resistance and the air can flow better.

We also have lung exercises that can be done to strengthen the lungs. On the general medical floor, I can teach patients to prone and do these exercises. They can control it themselves to get stronger, in combination with other treatments they may be receiving, and be able to go home. This gives power back to the patient. So many things are unknown and out of their control – these are things they can control to aid in recovery.

Hospitalization doesn’t mean all these patients on ventilators. That’s just for extreme cases?

To qualify for a ventilator, you’re the sickest of the sick. You are just so low on oxygen and we’ve tried everything else. We’ve tried many, many, many, many liters of oxygen supplementation, through different delivery methods. A ventilator is the last option to support oxygenation and is basically a machine that breathes for you.

I saw the stats of our hospital in an email – how many COVID cases we’ve treated from the beginning. About a quarter had been in the ICU. Of that portion in the ICU, there was even a smaller portion who were on a ventilator. So just because you’re in the ICU doesn’t mean you will be on a ventilator.

I’ve been in the ICU just to help a handful of times and seen intubations done. Basically, they use medication to sedate and paralyze you while putting a tube down your throat into your lungs, to then connect to the ventilator machine. It’s not pretty. The reason for the medications is to help the patient be more comfortable, and to prevent them from grabbing the equipment in a panic if they were to wake up. So imagine waking up – you’re on your belly in prone position, you’ve got pillows all over to provide padding, you have a tube down your throat and can’t talk, you have a tube in your bladder so we know what your kidneys are putting out … It’s not a pleasant experience and the ventilator comes with its own risks. You’re definitely not saying, “Oh yeah, I was just on a vent for a few days, and now I’m good!” – it’s a huge deal to be on a vent.

What’s the balance between “it’s just a cold” and “lock yourself in your house or you’re going to die”?

I have to laugh a little when people ask if it’s like a cold. I’ve come to the conclusion that people who ask if it’s a cold are those who think it’s not real or even a hoax, and want some rationalization. Finally I said, “If you’ve ever known anybody who had to be in the ICU and ventilated for having a cold, it’s exactly like that.” I don’t know if I’ve changed anyone’s fundamental belief on the reality or danger of COVID but it makes me feel better after people not taking it seriously for an entire year.

On the other hand, the media gives the worst possible story and makes it sound like this is how it is all the time. Yes, the cases they share are real, but it’s not a true representation of every case, every time.

I’ve seen a lot of people on each side of the extreme. Where I live, people gathered in huge groups at a park with no masks to protest. I got online with one of them and said, “Why?” She basically said, “I have to put my faith over my fear,” so precautions weren’t necessary. So when you click your seatbelt, is that fear over faith? When you lock your doors at night, when you tell your kids to wear a bike helmet, or put your baby in a carseat – is that fear over faith? She ended the conversation without answering. I wasn’t trying to badger her. I seriously wanted to know. I don’t understand the difference. If someone understands this differently, please tell me!

The balance is – we need to live our life, but we also need to take precautions and do our part. There is a level of protection from keeping your covenants, but God also expects you to use your common sense. President Uchtdorf said something along the lines of: God is much more willing to help the guy who is pushing his handcart with all of his might, than the one sitting off to the side offering a prayer, no matter how eloquent. We need to do our part as much as we can. We’re in a partnership with God. We can’t pray, “Make it go away,” and it miraculously disappears without any effort from us.

So what’s our part?

At the beginning, I didn’t promote masks because too many people use the mask incorrectly and have a false sense of protection. People need to be taught how to use it, just like we see signs about correct handwashing all over. Why aren’t there campaigns to correct use of a mask?

The correct way to wear a mask is using a clean technique. Wash or sanitize your hands, and pick up the mask by the loops – you don’t touch the mask portion – put it on your face. Adjust the loops and nose wire for a good fit, covering your mouth and nose. Sanitize your hands again, and after that, you do not touch the mask. Don’t take it off until you’re done, because it’s contaminated. If you do end up touching it, sanitize your hands again immediately. When you remove it, take it off by the loops, seal it in a plastic bag, and it’s ready for the washing machine. Don’t take it off, wad it up in a ball, and put it on again, because you’re contaminating your face with the very thing you just tried to protect yourself from, if it’s on the mask surface.

What are your thoughts about social distancing for holidays and family events?

I have such mixed feelings. I understand the need to get with your hundred-member family. I understand the need to have all of your friends over in college for Thanksgiving.

However, some believe that the only patients to end up in the hospital are those with comorbidities. “I don’t have heart disease, I don’t have diabetes, so I’m going to be fine. I can get my friends together.” I have seen patients in their 20s to in their 90s. Some have the biggest health history in the world. Some have zero medical history. There’s just no telling which person is going to end up in the ICU with all of the interventions, or who is going to need a couple of days of oxygen and can go home, or who won’t need to go to the hospital at all.

It’s been such a political topic but it shouldn’t have anything to do with politics. I understand the need to gather. People react so differently to the virus so it could be spread from a person with no symptoms to another who may not be so lucky. I have mixed feelings but have to promote staying apart. There really isn’t any excuse, especially with the technology we have today…I mean, you and I are on opposite sides of the country and we’re talking face to face. Get creative, yes. Will it be different, yes. Will it be hard, yes. Is it possible, yes.

I think about the Spanish Flu pandemic a hundred years ago – you see pictures of people wearing masks and they quarantined. I haven’t done a lot of reading about what their life was like, but they made sacrifices and they did not have the technology we have today.

It’s hard for everybody. Everybody is doing the best we can with what we have, and we all have different ways of coping with stress. A person saying, “They can’t tell me what to wear,” maybe they just don’t want one more thing that’s a loss of control for them. We’re kind of seeing the worst of everyone right now, because we all have different coping mechanisms. I take extreme reactions with a grain of salt. I’m sure I have extreme reactions over things.

What has the nursing profession taught you about resilience and how to handle challenging situations?

While details are important, the big picture is the most important. Plans and expectations change, so make sure you are heading where you want to go. When things go downhill, know and use your resources. Know your way out. If you don’t know your way out, grab a buddy and walk through it together. Be honest. Allow yourself to feel whatever you’re feeling, and find a reason to laugh.

Sometimes I sense a patient doesn’t want to know what I’m thinking in a tough situation, so I have a poker face because they need a brave person in the room. Other times, I have a rapport and I’m able to say, “This is what I’m seeing, what worries me, and what I don’t want to happen. This is what we’re going to do. Fair?” It’s okay to be vulnerable like that.

I had a patient once who said, “This hurts so much, I just want to die!” I looked him in the eye and said with a straight face, “Please don’t do that because then I’d have to start CPR, and that would be an awkward situation when your wife comes in.” He just started laughing. That little burst of energy and comic relief was enough to get him through.

It’s that way in life. Do whatever you have to do to make it, trust that there’s a solution, and make things work with whatever you have.

How does your faith and spirituality connect with being a nurse?

There is a piece of art that depicts a nurse caring for a patient, and Jesus Christ is standing by her side. It is a beautiful, beautiful piece of art – I saw it in an Institute class and I ran up to the teacher. “Where is that? I need it!” I have a friend whose mom was a nurse, and she has passed on – my friend said, “my mom would be right there with you if she was here.” I’m sure she already is, because there are angel nurses who walk the halls.

At the beginning – when we knew some things, but less than we know now – we went into rooms in the COVID units only when it was absolutely necessary because of possible exposure for ourselves. There was a COVID patient with Down Syndrome. She was screaming, crying, calling out, and we couldn’t do anything about it. We had her on a camera to make sure she was safe, and I remember she was suddenly calm. I looked at the camera and she was looking around, smiling and reaching out. I have no doubt there was an angel nurse in that room.

I had a patient just the other day – she and her husband were roomed together because they were both sick. The husband passed away and she is going through the ugliest grief. I had the thought go in and sit on her bed with her. So I did, and I just talked to her. Tell me about your husband – how did you meet, how did he propose. They met when they were 14 years old at a roller-skating rink. She had an abusive father. She grew up with terrible self-esteem. This man taught her what she was worth and stood up to her father, and really took good care of her. I held her hand and frankly, I didn’t really care about my personal exposure at that point. I had all my PPE. I just held her hand, and I noticed her hair was sticking all over her face. I combed her hair, I made her some hot chocolate. She told me we’re going on a road trip so I said, “Great, what are the snacks?” I spent a good hour and a half with her, just being there with her and talking. She needed a human connection. She did not need medication to calm her down. She was feeling real human emotion for a real situation in a really difficult time. I felt that connection with her and it was really special, and I’m sure her husband was there.

The spiritual connection is serving our fellowman – giving of everything we can to help another. The most effective nursing isn’t giving medication, it’s not dressing a wound. It’s connecting with people, spirit to spirit. I am there for somebody on the worst days of their life, sometimes when nobody else can be. It’s the whole aspect of service – when we’re in the service of others, we’re in the service of our God.

I was born to be a nurse – it is my passion and my calling. I’ve wanted to be a nurse since I was wee, wee little. Don’t get me wrong, there are definitely impossible days when I question my life choices. Sometimes a really bad day can erase 100 good days. On those days, I lean on my team. Most of the time I know right where I’m supposed to be. Pushing myself through school was the best thing I could have done for myself because I love what I do. I can give someone who is suffering a glimmer of hope, and that makes the difficult times worth it.

At A Glance

Name: Jennie Leininger

Age: 34

Location: Vancouver, Washington

Marital History: I have been married to Will just over a year

Children: 2 kitties that are completely spoiled rotten

Occupation: Registered Nurse

Convert to the Church: Born in church

Schools Attended: Bachelor of Science in Nursing

Languages Spoken At Home: English and sarcasm

Favorite Hymn: Be Still My Soul

Interview Produced By: Trina Caudle