1. Glaze, Jane

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As I write today in late April 2020, most of us are confined to "stay at home" orders to help mitigate our state and country's cases of COVID-19. As we work from home, acting as our own technology consultant; engaging in telemedicine with patients; virtual visiting with family, friends, and colleagues; entertaining and homeschooling children of all ages; cooking two to three meals per day; and shopping weekly with masks and gloves-it is truly hard now to imagine how robust life and work will be at the time that this journal issue reaches your home. With so much uncertainty for business as usual in the coming months of summer, I will instead opt to address the experiences of today. It has been just 2 months since we in Canada and the United States started taking precautions and being asked to alter our lifestyle in response to COVID-19. In fact, within this time frame, we have gone to naming this pandemic COVID-19 versus just a new corona virus. Yes, life has changed with lightning speed that none of us could have anticipated or recognized.

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I have reached out to several Dermatology Nurses' Association (DNA) members to understand what experiences you are going through at work and home during this public healthcare crisis. Through sharing our experience, we all gather collectively to support and understand better the varied paths we all walk. Nurses are a hardy bunch, and we empathize, sympathize, and care for others. Sharing stories is a glue to bind us and make us proud to be nurses in healthcare today.


From around the country, your DNA colleagues' stories are the following:


Genell, RN, in Springfield, MO, emails to our DNA office: "I am thankful for my physician's leadership. He has taken measures to secure, protect his staff and our patients, regardless of monetary costs. He trusts staff to build new surgery schedules for urgent cases only[horizontal ellipsis]. I am thankful for my team."


Trudy, RN, MSN, in Rochester, MN, emails to DNA staff: "[horizontal ellipsis]dermatology nurses have been deployed to help with COVID-19 activities[horizontal ellipsis]. I have been assigned to lead two swab clinics[horizontal ellipsis]. I am working incredibly long hours."


Jessica, APRN, CWON (April 22), in Northern Illinois reports: "Our Wound and Hyperbaric clinics are open to meet the needs of patients who would otherwise be high risk for infection, limb loss or end up in the emergency department adding more strain to their service. Telemedicine was quickly rolled out as a response to the pandemic. We use this to manage patients with stable wounds who can do their dressings safely at home. It has been highly successful for both wound and ostomy patients."


Emily, APRN, in Colorado (April 10) reports: "My entire practice is in this together and we are all taking cuts[horizontal ellipsis]. I am under excellent leadership and I am so much more fortunate than others. I have heard from corporate dermatology practices that they are just laying off Nurse Practitioners with no guarantee of rehiring. Our healthcare system will look different after this is all over, I'm sure."


Kelley, RN, in Oregon (April 8) says: "Things have been crazy with two kids at home. Remote learning seems to require more help from parents than people may have realized. [horizontal ellipsis]challenge to work and help kids with schoolwork.[horizontal ellipsis] My husband is home more, and the burden tends to fall on him. I stay busy at work with phone advice lines. Our large hospital with many clinics throughout region has closed the dermatology clinics-and moved Obstetrics, Gynecology and Maternal Health clinics into our dermatology clinic site-along with young pediatrics. I am happy to be working with relatively healthy people-but that could change."


Kristen, APRN, in California (April 1) writes: "the phototherapy business is stressful. Many patients do not have viable alternative options and could suffer symptom flaring without treatment. Treatment is open under strict Center for Disease Control guidelines and even more meticulous cleaning procedures than done routinely. We have reduced staff and schedules with no new patients, serving only those known patients."


Sue, RN, from a Wisconsin Level 1 hospital center (April 21) states: "Pay cuts/furloughs (based on job volume) just announced. Older nurse working at home on phone triage while I go into clinic for phone advice/triage. I have >500 Mohs patients to prioritize and reschedule. What a mess! Each Mohs surgeon can see 5 urgent patients/week. So many patients fall into the 'urgent' category. We worry most about potential metastasizing of rapidly growing squamous cell carcinoma and melanomas. I have been super busy, but with a different workflow. I also help General Dermatology clinic convert thousands of appointments into telemedicine or video visits. We do not yet know if Medicare will reimburse telemedicine visits but think video visits will be reimbursed-minus the facility fee."


Londa, APRN, in Maryland (April 13) reports: "Working from home since mid-March. My hospital has set up a COVID-19 specific unit. By mid-April, 72 employees tested positive. The Dermatology Clinic is seeing only urgent patients. Providers using Telemedicine. Inpatient consults dropped significantly. Employees are becoming skilled in use of WebEx, virtual meetings, and incorporating virtual visits into the Electronic Medical Record."


Sue, RN, MSN, in Pennsylvania (April 22) reports: "So, we aren't really switching research gears (all prior research will continue as the situation permits) but we will be adding a vaccine research as a top priority to the work of the department of dermatology. I anticipate that I will be the lead coordinator working on this study along with other research staff. The study has not been cleared by the Federal Drug Administration as there are details to be sorted out. I anticipate the study to start in June 2020. The name of the new vaccine will be PittCoVacc-short for Pittsburgh Coronavirus Vaccine. It follows a more established vaccine approach, using lab made pieces of viral protein to build immunity. The delivery system will be through the Microneedle Array patch."


Nancy, researcher, RN (April 22), in New York reports: "The clinical trials portion of our practice is at a standstill now[horizontal ellipsis]. I have transitioned into working in the phototherapy department 3 days a week which remarkably has had an increase in patient visits. Hard to explain. I am semi-retired, so my hours have not been affected[horizontal ellipsis]. The medical group I work for has had a 50% reduction in the work force and the full-time employees have had their hours reduced by 25%. Because of my research coordinator experience, I have been asked to help with a clinical trial at the University looking at the administration of Sarilumab to COVID-19 patients in the Intensive Care Unit[horizontal ellipsis]exciting although not dermatology related. I have also been volunteering at the local Food Bank and have spent some time helping to coordinate a Medical Advocacy Group for the Family Justice Center where I volunteer with Domestic Violence clients."


Diana, APRN (April 23), in Colorado writes: "The way I like to think about this is that while this is a temporary situation, we can see it as an opportunity to improve and change how we function in the long term. We have a chance to break old habits that are no longer serving us. While doing Telehealth visits with my patients I have realized that so many problems can be handled without bringing people in person. Some of our patients take 3 buses to come for their appointment. Why make them do that if we can have a video or phone visit with them?"


I would like to acknowledge the DNA members who have reached out to share their stories but who may not be included here. It is important to tell your story and remember these times, lest we forget the many lessons we have learned. Yes, the U.S. healthcare system will change going forward. We have hope that the supply chain will be improved and the emergency response on a national level will be more robust. Our individual nurse and provider workflows may permanently change as we incorporate more telemedicine. Some authorities suggest that business will change-with less travel and more meetings and conferences on virtual technology. We can only imagine the changes now, but they will come, and hopefully, we as a nation and world will be better for them.


The COVID-19 pandemic has shined a bright light on healthcare systems in our world. For the better, it has elevated the image, role, and work of our healthcare providers. I salute, honor, and appreciate beyond words our dedicated nurses in Canada, in the United States, and worldwide who have given so much, including in some cases their lives, to care for patients with COVID. Although DNA nurses may not be caring directly in the COVID units, you have continued to contribute to the healthcare systems in your communities. In 2020, continue to be proud of your work and your nursing profession. I ask each of you to celebrate in mind and spirit yourself and your colleagues worldwide. After all, 2020 is the "Year of the Nurse."


Jane Glaze, BSN, RN, DNC


Dermatology Nurses' Association