Putting Patients First Without Hesitation

Even a pandemic can’t stop frontline nurses from caring, and turning that caring into doing.

When deciding between assuring her own safety or providing the best care for her patient, Alexa Munguia, RN, a labor and delivery nurse at Lucile Packard Children’s Hospital Stanford, didn’t hesitate. Her COVID-19–positive, pregnant patient needed an emergency cesarean section, and Munguia was right there, by her side.

“I didn’t want her to feel like a virus, like she couldn’t be touched,” says Munguia. “So I did what I always do when a mom needs help getting in the right hunched position for an epidural. I hugged her face-to-face.”

During the procedure, Munguia kept reminding herself that she trusted her personal protective equipment (PPE) and her training to keep her safe. She repeated the words “You are safe” to herself, over and over again.

“It was second nature. If a patient needs me, I’m there,” she says.

Thankfully, both mom and baby recovered just fine. Munguia’s story is just one of hundreds that have played out within our hospital walls over the course of the last year. Frontline workers have faced the pandemic head-on, with selflessness and courage. Take Michelle Tan, RN, Pediatric Intensive Care Unit (PICU), for instance.

“I cared for a child with COVID-19 who was very sick and kept getting worse. As nurses working with COVID-19 patients, we give each other breaks, but I chose to stay with the patient for three weeks straight without a break because I knew the family and they knew me,” says Tan. “I wanted to provide that continuity of care.”

She had another extremely sick COVID-19 patient who was in critical care and needed extracorporeal membrane oxygenation (ECMO) to survive, the highest level of life support available. Not everyone who needs ECMO survives.

“The child surprised us and recovered super-quickly. Seeing that patient leave the hospital felt really great,” Tan adds.

Coping with the risk

Nurses wear extensive PPE that needs to be put on and taken off correctly to avoid transferring any possible virus particles. There’s the N95 mask, much beefier than the average medical mask. Then the goggles, the face shield, the hair net, the gown, and the booties.

“I’m hot, I’m sweating. My goggles are fogging,” Munguia says. “The N95 mask hurts my nose, and I want to itch or rub. But I focus on what I’m doing and keep going.”

Despite its challenges, nurses welcome the PPE. They know it’s what they need to keep themselves and their patients safe.

“I know other California hospitals ran out of N95 masks, and nurses had to wear them for multiple patients or days. But we’ve always had a good supply,” Tan adds.

While exhaustive protocols were quickly put into place to protect patients and staff, some exposure to staff while caring for COVID-19–positive patients simply can’t be avoided. When a pregnant woman is in the throes of delivery, she’s huffing and puffing and wants to pull down her mask to get more air. She may need to bring her mask down to vomit.

“We have to be there to help an expectant mom push, so we remind her to keep her mask on. Realistically, as a bedside nurse, you take on some level of risk,” Munguia says. “It is scary, especially the thought that if I got sick, I could pass it on to my family. But it’s my job and I love it, so I don’t hesitate.”

Exposure might also happen when a nurse is working hard and has to lift his or her goggles for a second to clear fogging. Or, a patient or parent tests negative at admission but actually has COVID-19. It’s the nature of caring for patients in a pandemic, and the sacrifices extend beyond the nurse to the family.

“In the beginning, there were so many unknowns, so it was extra-scary. I have two young children. My husband and I had a plan that if it got bad, he and the kids would go live with my mom to isolate from me,” says Veronica Gutierrez, RN, MSN, for the hospital’s COVID-19 patient care unit.

Gutierrez’s floor, which is physically separated from much of the hospital, was turned into a COVID-19–positive unit with heightened care protocols—essentially a landing zone for all positive patients or those awaiting test results. Some were extremely sick and had other health issues, like cancer, cerebral palsy, or appendicitis. When asked why she continued working in the face of such risk, she simply responded, if not her, then who?

“When there’s something huge like a pandemic, you don’t think of only yourself,” Gutierrez says. “What if everyone said no—then who would take care of the kids?”

Thankfully, she never got sick and never had to send her husband or kids away. She credits the tight control that her floor had regarding rules, visitors, and staff.

“I fully believe we were the safest place in the hospital. We didn’t allow both parents up, unless it was for special circumstances, which we needed to get approved. We also didn’t allow parents to come and go. Our protocols were incredibly strict,” she says.

The special COVID-19 patient care unit has been shut down due to low COVID-19 numbers and an increased confidence hospital-wide about caring for patients on every floor. Innovative ideas sprang from the unit, which will likely have sticking power after the pandemic fades—such as putting an interpreter app on patient tablets for easy communication when an interpreter isn’t available, or using room cameras and intercoms to speak with patients rather than always walking into their rooms.

Keeping patients safe while maintaining comfort

Despite strict COVID-19 care protocols, Packard Children’s stays dedicated to high-quality, personal care. In labor and delivery, COVID-19–positive moms are generally separated from their babies. Yet the staff knows the incredible value of skin-to-skin time and breastfeeding for newborns. When an infected mom wants her baby close, labor and delivery nurses empower her by putting her baby inside an in-room isolette, which blocks out germs and allows for safe touching. Positive moms can also breastfeed. They wear a mask, and nurses wipe down both mom and baby before and after.

On the COVID-19 patient care unit, nurses regularly advocated for patient needs. The rules on the special unit were that one parent could stay with a child, but he or she couldn’t come and go, and the parents couldn’t take turns. Gutierrez gets emotional talking about a particular patient who didn’t speak English and whose mom had other kids at home, so she couldn’t stay.

“The preteen was newly diagnosed with cancer and all alone in the hospital, sick, in pain, unable to communicate, and getting procedures,” she says. “The rule that mom couldn’t come up really bothered us nurses, so we put in a request for a special consideration to allow her to visit.”

Appreciation and brighter days ahead

Nurses are thanked for their sacrifices by hospital leadership, who organize food delivery sponsored by area restaurants, spontaneous staff ceremonies, and playful awards. But the most meaningful thanks are words of appreciation from families and smiles on the patients’ faces when they walk out the door.

Nurses are feeling more hopeful about COVID-19 these days. They are comfortable caring for positive patients, and the high rate of vaccinations and low rates of infections in California are lifting their spirits.

“We’ve all encountered stress during this pandemic,” Gutierrez says. “It helps to focus on the good.”