TNA’s Cindy Zolnierek: Covid is Threatening the “Whole Infrastructure for Providing Healthcare” (Part 1)
The Texas Nurses Association (TNA) has a rich history of accomplishments and has played a key role in setting educational and workplace standards for nurses in the state. Today, the TNA is still tirelessly advocating for nurses and patients in Texas. As the state struggles with a frightening surge of Covid-19 cases, DailyNurse asked Cindy Zolnierek, PhD, RN, CAE, CEO of the TNA, about the most pressing healthcare issues in America’s second largest state. In Part One of this two-part interview, Zolniek spoke about the challenges of fighting Covid-19 in Texas.
DailyNurse: Some aspects of Texas geography must present serious healthcare challenges even in the absence of a major public health crisis.
Cindy Zolnierek: “We do have these great expanses, and they tend to rely on critical access hospitals. [Critical access] hospitals take care of basic emergencies, but they're very used to shifting patients off to larger facilities and other communities. This has long been standard practice in the areas of the state that have those largest expanses like West Texas. After you leave that El Paso, you go a long ways before you hit another decent sized city. [It’s] the same with Amarillo and Lubbock, Laredo, and the Midland Odessa area, which are some of the hardest hit areas [by Covid-19] in Texas. And now, with those hospitals being full, overflowing with patients to critical access, hospitals are left with no place to send their patients to. So it's not just the communities themselves that are impacted—it’s the whole system, the whole infrastructure for providing health care, and care for cases like strokes and heart attacks and highway accidents is being impacted significantly.”
DN: So the whole healthcare system is being placed under severe strain during the pandemic?
Zolnierek: “Well, [normally] patients go to the nearest facility, like a critical access hospital, which patches them up, does the assessment and anything you need to do for life-saving. They then send the patient to a trauma facility. [During the pandemic] the problem has been that the hospitals are full. Hospital sometimes go on what they call diversion or bypass, you know, you send them to another emergency room, [but now], everybody's full. And what you see is, care gets delayed. And delayed care can have very negative impacts on people.
Right now there are patients even with COVID that are being held in the ER waiting for a bed to free up. We know there are expansions occurring in communities with using ambulatory surgery centers for in-patients. There have even been attempts to use acute care facilities for cases that might normally be cared for in the hospital. So we’re seeing a lot of very creative ways to try to make space for patients that are needing care. Our system is compromised, and we can't provide care and people will die who might have otherwise live. Because we don't have the resources to do it all at the same time, you know.
DN: It may be some time before we know the full impact on patients with other, non-Covid health conditions.
Zolnierek: “A lot of folks were avoiding going [to regular medical appointments], so they weren't seeing their doctor or their nurse practitioner. Some practices even closed, because they couldn't stay open. Patients weren't wanting to be exposed, which is wise, but it's not wise to delay your care. For instance, if you don't take care of your diabetes, and it's not under control, you're going to have kidney problems, you're going to have other problems as a result that require advanced care.
I think the good news—if there is any good news—is, we’re not seeing the tremendous impact of the regular influenza this season, at least in Texas, and perhaps some of that is due to people, you know, following hygenic practices, wearing masks, washing their hands, social distancing.”
DN: Is the situation complicated by political/ideological attitudes toward social distancing policies?
Zolnierek: “Yes, the Texas political environment includes individuals that strongly feel that wearing a mask somehow is infringing on their rights, and do not want to adopt that behavior themselves. And we have some local authorities that refuse to enforce the governor's order for masking in public. This is unfortunate, because we know there are things that we do for the greater good. And there are laws about that. You don't drive 70mph when you're passing a school, because we know that children can be unpredictable and run across the street and someone will get hurt. We have certain rules about things for the greater good, and I think masking is one of those. It may be an inconvenience, but it is for the good of the whole population, because maybe you're not at risk, but [your neighbor] who also needs to go get groceries may be receiving chemo therapy, and could be at extreme risk if they contract Covid.”
DN: The resistance to masking must be very frustrating, especially for frontline nurses.
Zolnierek: “I'm not working in the clinical area right now, so I almost feel guilty. You know, [you feel guilty] because you're not in the trenches, but I have a job to do that maybe can support nurses in the trenches. But nurses feel when they see people that aren't doing what they can to take care of themselves. What I hear from nurses is, that's a slap in their face, because they are working in horrendous conditions right now. Frontline nurses talk about being surrounded with death [in a way] that they've never seen.
You know, we're used to seeing maybe elderly folks that may pass away, that's part of our life, you know; we were born and we will die. But right now, nurses are surrounded by so many [sick] young people, and people passing without being able to be with their families... and when they see people being so careless, it just it feels like a slap in the face.
Kit Bredimus, the chief nursing officer and VP of Nursing at Midland Memorial Hospital, went to the Midland city council and pleaded with the mayor to enforce the governor's order for masking because they were seeing an escalation of hospitalizations and it was more than they could keep up with because staff gets it too. And when staff gets sick, we're really struggling. It’s not just a shortage of beds—you need that nurse caring for the patient in the bed. So he went to the city council and pleaded with them to enforce the order. And Bredimus said, ‘We health care workers are no longer the frontlines; we are the last line. The frontlines now belong to the community.’ Nurses are the last line of defense to protect your life. And you need to be the first line of defense and do what you can do. Because if you end up with in our hands, you're at the last line of defense. [Ed: the mayor refused to enforce the masking order and other Covid safety protocols.]”
DN: Another issue that must be difficult for frontline nurses is that they have to stand in for patients’ families and loved ones and facilitate virtual visits via Facetime or Zoom.
Zolnierek: “I think we're very used to dealing with situations when a patient is dying and the family is there and we're supporting the family as a unit with that that individual who's passing. But to be the only person there for that person... I mean, it's an honor and a privilege. But it is also draining. You know, it is tremendously emotionally draining. Not that nurses don't want to do it and don’t want to be there. But it's also awkward because they're not the intimate partner or family member of that person. And so there's also the grief that this person can't have that loved one with them.
It's difficult. That's where, you know, we hear a lot about physical PPE. I wrote an article about psychological PPE, and it made me think, the whole other part of protection is how we support nurses psychologically. And some of that is doing our part in the community. So nurses [think], ‘okay, I'm doing my part in the hospital, and the communities are doing their part out there. So we're all in this together. Why are you fighting me? By not protecting yourself?’
By: Koren Thomas
