Authors

  1. Kriebs, Jan M. MSN, CNM, FACNM

Article Content

I do not know how many of our readers, dealing with a 2020 complicated in so many ways, saw the Facebook group called "View from my Window" that began during pandemic lockdown. The large majority of those posts were lovely, peaceful scenes, expansive or confined, shared from all over the world. As our world closed in, the windows onto it opened. At the same time, a few brave souls offered their windows into major cities where they were homebound as a result of the Covid-19 pandemic with no chance to see open parks or greenery, no way to hear birdsong or frogs. Some of those who shared were on missions to staff hospital units overrun with severely ill patients, looking out from windows only temporarily their own.

 

We in healthcare have been challenged as never before in our lives. Some have had to make life and death decisions-who gets the next intensive care unit bed, the last ventilator, the new medication. Others have had to make decisions that affected one of life's most intimate experiences. Who can have a partner during labor? Who can breastfeed their newborn, or even hold them? Still others have worked to exhaustion, trying to keep the rest of the system moving and free up those most deeply involved. Nurses and physicians have taken on roles that we did not plan or train for. The lucky ones "only" had to work with the risk of exposure to a virus that might follow them home. Others were laid off because their facilities had cut back on routine visits, elective surgical procedures, or outpatient care. At the same time, economic calamity, political turmoil, and a revitalized racial justice movement have all demanded a share of the nation's attention.

 

What shall we do next? I want to start by quoting John Robert Lewis, the US Representative from Georgia who recently died:

 

Do not get lost in a sea of despair. Be hopeful, be optimistic. Our struggle is not the struggle of a day, a week, a month or a year, it is the struggle of a lifetime. Never, ever be afraid to make some noise and get in good trouble, necessary trouble.

 

While Rep. Lewis spoke of the long battle for civil rights and racial equity, it seems to me that his words can offer direction for the broken healthcare system as well. It would be easy to feel knocked down by the waves of patients, some communities' resistance to precautions, and, yes, the long inadequate supply chains and inadequate staffing. It would be easy to lose the empathy that underlies great care. It would, in some cases, be easier to leave the professions we have cherished and grown in, rather than deal any longer with the issues-already known and now magnified-that have overwhelmed many hospitals, birthing centers, and offices.

 

Words such as resilience are brought forward in times like these to suggest that, of course, health professionals are strong enough to handle any challenge, but we need support. Not only do we need accurate and timely information sharing but also better models of healthcare management, availability of gear that will protect workers at all levels, or strategies for emergency planning that remember pregnant families and newborns. We need systems that are mindful of the psychological stressors and address them in real time and realistic ways. We need mental health access readily available to help individuals cope with grief, depression, and posttraumatic stress disorder.

 

All of us need to sit down as the wave of illness recedes and debrief our response. We can do better, and nurses are well positioned to push for unit- and facility-based changes. After all, you are the ones who are there every day and night, the ones "in the room where [healthcare] happens," and now may have the loudest voice in demanding changes to healthcare. Nursing's seat at the tables where decisions are finalized has too often been placed below those of finance and physicians. Our hope must lead us to action that will place the seats on an equal footing. Optimism must encourage us to search for better solutions as well as better ways to communicate with patients and families.

 

What can you see from your window-looking in or looking out? Speak up and speak out for what you have learned from this pandemic. Whether it was a personal lesson as you found ways to survive and grow in a stressful time, an observation that could lead to improved quality of care, or a structural challenge that needs to be confronted. Future nurses need your hard-won insights. Let the barriers that separated families from loved ones and caregivers from patients be a window into a better way to solve the next problem.

 

Today, a goldfinch perched on my window screen and peered into my study. The daylilies are blooming-messily as always-on my hill. If I walk around the house, I will see ripe blackberries from one window and a tangle of tomatoes and bean plants from another. In the background, I can hear Bernadette Peters singing "You are not alone" from Into the Woods. The year will be turning when you read this. The small brown birds that come to my feeder will huddle together for warmth. It will be winter from my window and perhaps a better year will be ahead. May you all find comfort in the changing seasons around you. Look up, look out, look ahead. What can you see?

 

-Jan M. Kriebs, MSN, CNM, FACNM

 

Adjunct Professor

 

Midwifery Institute at Jefferson University

 

Philadelphia, Pennsylvania