UCLA nurses, nursing students discuss patient care and education during pandemic

As the novel coronavirus pandemic continues to affect medical workers, a popular nursing adage propels them forward, said fourth-year nursing student Julia Wenzel.

Hope for the best, but prepare for the worst.

“When you work with (the virus) every day, you kind of just adapt and become more comfortable,” said Scott McPherson. “You just try to do the proper procedures … and hope that it doesn’t happen.”

McPherson is a nurse who works with coronavirus patients daily at the Ronald Reagan UCLA Medical Center.

The medical center is one of the biggest hospitals in Los Angeles, a city with over 27,000 confirmed coronavirus cases, according to the Los Angeles County Department of Public Health. The hospital employs 1,500 full-time physicians and more than 2,500 as support staff. It is also the primary teaching hospital for David Geffen School of Medicine at UCLA.

At the medical center, patients with severe coronavirus cases are confined to the west side of the Cardiothoracic Intensive Care unit, where McPherson works.

Patients in the ICU are often reliant on ventilators or are likely to require one soon. Some patients also experience acute respiratory distress syndrome, or ARDS, which can prevent organs from receiving sufficient oxygen to properly function.

As a critical care nurse in the Cardiothoracic ICU, McPherson focuses on oxygenating and ventilating patients, as well as managing their ventilators, he said. For severe ARDS cases, McPherson said he will turn the patient on their stomach to increase the amount of oxygen in the patients’ blood in a procedure called prone ventilation.

Since the beginning of the pandemic, the unit has adjusted its routines and patient care methods to ensure the safety of both staff and patients.

Critical care nurses are given surgical scrubs so they do not have to use their regular scrubs when caring for coronavirus patients. In addition, masks must be worn in all regions of the hospital. This includes wearing simple surgical masks in the lobby and more protective masks within the critical care units. Certain nurses are designated to supervise and ensure proper compliance with personal protective equipment.

All the extra special protective equipment has made patient care more taxing, McPherson said. Nurses often get hot and sweaty wearing a gown, goggles and N95 mask while inside patient rooms.

The hospital also established procedures to protect nursing students who are working in the hospital, although not directly with coronavirus patients.

Before entering their shifts each day, nursing students are screened for coronavirus symptoms. They are given a single mask that will be used all day and must be discarded at the end of a shift, said fourth-year nursing student Ayaz Merchant.

Although the medical center has been able to provide critical care nurses with enough personal protective equipment, fear of infection has persisted.

“The biggest fear is … the unknown and getting your family sick,” McPherson said. “Especially in the beginning, it was extremely stressful. I think everybody was kind of on edge.”

On top of managing their own stress, nurses are tasked with keeping their patients calm amid uncertainty and isolation. Since family members are not allowed in the ICU, patients are alone except for limited time spent with nurses and doctors.

“They could have a TV on in the room, but it’s 24/7 coronavirus, and there they are with the coronavirus, … just wondering if they’re going to survive, or what’s going to happen to them,” McPherson said. “It’s just kind of a surreal experience for (patients).”

The new circumstances have also altered nursing students’ plans for their immersion requirement.

Nursing students begin working in the hospital winter quarter of their third year. After gradually gaining hospital experience, in the final quarter of their senior year, students are assigned to a hospital, unit and nurse who they must work alongside for 280 hours in order to graduate.

Wenzel was originally scheduled to work in the Labor and Delivery Unit at UCLA Medical Center, Santa Monica, but she was informed on short notice that the Labor and Delivery departments had been switched into COVID-19 units. Instead, Wenzel was assigned to work within the Resnick Neuropsychiatric Hospital at UCLA.

“I was honestly pretty devastated when I found out that I couldn’t work in labor and delivery,” Wenzel said. “I eventually want to be a midwife and women’s health nurse practitioner, so maternity and (obstetrics) stuff is my jam.”

Although faced with a difficult switch, Wenzel is grateful for the opportunity to continue to work in the hospital units at UCLA, as many other universities have postponed their students’ academic schedules because of the coronavirus, she said.

“I think it’s made us all really recognize that even though we want to work in specific areas, our job is to protect the health of everyone,” Wenzel added.

Merchant has also grappled with the sudden and unexpected changes in his immersion plans.

Merchant said that he was not entirely comfortable with the unpredictability of the pandemic at first, but he came to understand that in nursing, the risk is inevitable.

“I chose this profession to become a nurse and be the frontline in health care and be part of the essential task force in cases such as a pandemic like this, and personally I look forward to tackling the obstacles and challenges that come with being in the hospital during this national emergency,” Merchant said.