The
Clinical Advisor conducted an audience survey in early April
2020 to gain insight into how the current novel coronavirus (COVID-19) has
affected their clinical practice. We heard from 543 nurse practitioners (NPs)
and physician assistants (PAs) from across the country, some who are
experiencing the pandemic firsthand and others who are bracing for the storm to
come. Here is a sampling of the comments (edited for space) describing
experiences on the frontlines of care, on transitioning to telemedicine, and on
being furloughed.
On
the Frontlines:
New York, NY: It has been a war zone. I
work in the catheterization laboratory, which turned into a full COVID-19 unit
with ventilated patients fighting for their lives. We are all learning as a
team but inevitably people do die and their families are not allowed to be by
their side.
Boston, MA: I am a PA hospitalist
and our schedules and roles have been ever changing since COVID-19 hit the
United States. I have served as a direct care provider to COVID-19 patients, as
well as taught PAs from other specialties how to care for them. I come to work
uncertain of where I will be stationed and uncertain of how/when my patients
will deteriorate. This virus is completely nondiscriminatory; perfectly healthy
patients in their 30s have deteriorated quickly. When I am not at the hospital,
I spend the bulk of my time trying to figure out how I can best help my
colleagues who are working (prepping notes, medication reviews, etc). I feel
overwhelmed by the need to do more, yet fearful I won’t be good in the new role
that I am placed in.
New York, NY: Life has taken a 360-degree
turn since COVID-19 hit New York City. [Our urology] practice is covering for
multiple providers as they are reassigned to hospitals, emergency departments
(ED), and intensive care units. We are trying to prevent patients from going to
EDs, thereby decreasing burden of overload. My [urology] NP colleagues who are
in the hospital running COVID-19 floors were not given any training and/or
orientation except for online electronic health record [EHR] documentation
training. I am nervous about my turn, but I will do my best to provide the best
care for the patients and their families. I never expected this level of unpreparedness
in a country like the United States, and I believe this COVID-19 crisis has
taught us all valuable lessons in infection control and disease prevention.
Southfield, MI: Don’t miss the atypical
presentations. I have had a COVID-positive patient that presented with vomiting
and a small amount of diarrhea, another patient that presented with headaches,
and another with runny nose. All of these patients were working and were
unknowingly exposing others to the illness; no one has mentioned these atypical
presentations.
Salem, OR: Out of our staff of 60, 11
clinicians have tested positive for COVID-19 and 6 have suspected cases. We had
to close our office for 2 weeks, and just reopened yesterday [April 14, 2020].
During those 2 weeks, the physicians took calls, either via phone calls or
telemedicine. Getting test kits and testing our staff has been a problem; 1 week we only had 8 COVID tests and had to
decide who the highest priority was and then wait as long as 13 days for the
results. Three weeks ago we ordered 50 of the new antibody tests by Lochness
Medical. Today we learned that US Customs has held the tests at the border.
Telemedicine Challenges
Southfield, MI: Masks and glove supply
depleted by mid-March so moved to telehealth.
Yukon, OR: We started by trying to isolate
the office, screening patients by phone before they entered the building, and
keeping the clinic “clean.” We encouraged but did not insist on telemedicine
appointments. When it became clear that there are many asymptomatic people who
are spreading disease, I chose to completely convert to telemedicine. Much of
the office has now done the same. So far, most of my scheduled patients are
just cancelling and waiting to reschedule until restrictions are lifted.
St. Louis, MO: Switching to telehealth and
virtual visits has been a huge learning event for us. There were so many
details that were being worked out on an hourly basis. I found, through
experience, that my virtual visits were of much shorter duration and ran on
time. Nearly every patient has been positive regarding the virtual visits and
appreciate it as an option.
Three Rivers, MI: In transitioning almost
completely to virtual office visits we’ve really streamlined the way we provide
healthcare. I’ve noticed from the administration down, the ever-present “bottom
line” has taken a backseat in our outpatient practices, and we are providing
the type of patient-centered, innovative, accessible medicine that we wish
could always be our sole focus. Out of this horrific tragedy, we are making
enormous strides in just a few days that would have taken years to change in
any other reality — to adapt, provide the best possible care to our clients,
and survive as a health system.
Furloughed
Dallas, TX: It has been economically
devastating. We have had to reduce staff hours by 75%. Relatively few cases in
Dallas. The hospital and clinics are nearly empty awaiting a flood of COVID-19
patients that don’t appear to be coming. Obviously a good thing but hard to
comprehend how we get stared again. Really need a quick test to screen all
hospital admissions to protect patient and staff safety.
Fayetteville, GA: With no elective surgeries allowed and
seeing only urgent/emergent orthopedic patients in the office, most of the
advanced practice providers have been furloughed or let go. I am the most
senior PA in my office and was the first furloughed. Also, many of the other
clinical and administrative staff have been furloughed or let go. Those still
working have taken a 20% pay cut and had hours reduced. I have learned that we
need to be better prepared.
New York, NY: We have cancelled well visits
for 18-month-old and older children. We provide telephone visits, no video. The
clinic will need funding to survive. We have nurses and staff hanging out with
nothing to do; only the doctors and NPs continue to work with the telehealth
visits.
