1. Finifrock, Monica M. BSN, RN, PHN


A community health nurse's perspective on COVID-19.


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It's 8 AM in Seattle in April-the pandemic is in its early stages here in the United States. The sun is beginning to push through dark clouds as I drive on a mostly empty freeway to the community health clinic where I work. I pass closed restaurants, schools, and parks, while listening to the morning news on the radio. The announcer shares the latest number of COVID-19 cases and tells a heartbreaking story about the suicide of an Italian nurse who had been diagnosed with the virus. Under severe stress, she was fearful of spreading the virus to her patients. There is a pause, then the announcer gives a shout-out to King County health care workers. I appreciate it, but it doesn't make me feel any better about leaving my family behind today. I arrive at work, get screened at the entrance for my temperature and respiratory status, then head into the building.

Figure. Monica M. Fi... - Click to enlarge in new windowFigure. Monica M. Finifrock. Photo courtesy of the author.

I don't consider myself on the front lines of the pandemic. I'm not in the ED or on a critical care unit. I'm not watching patients take their last gasps of air or making hard decisions about who gets a ventilator and who doesn't. I'm a community health nurse, and my role during the COVID-19 pandemic is to do exactly what I always strive to do-serve the community. I am triaging, assessing, reassuring, treating, and educating patients.


Though some community health clinics in Seattle have closed, ours hasn't. Thankfully, many urgent care centers and primary care offices are still open. We are doing all we can to operate as a kind of buffer between acute care facilities and people at home. Those of us working in the community setting face unique challenges in the "buffer zone" and are dedicated to doing our part during this crisis. In fact, the community needs us now more than ever.


'I'm a nurse, that's what I do.' In one of the exam rooms, I remove a foreign object from a patient's ear (a chunk of Q-tip). She immediately expresses relief and thanks me.


"Doesn't that gross you out?" she asks.


"No," I reply. "I'm a nurse, that's what I do. I try to make people feel better."


A few minutes later, I call an ED nurse at a hospital nearby. A physician wants to send one of our elderly patients to the hospital for dehydration and dangerously abnormal blood counts. I apologize to the nurse before I give her a report because I know she's busy. She sighs and says, "No problem, go ahead with the information."


Fifteen seconds into my report, the nurse tells me to hold on. The receiver clunks, and I can hear a commotion in the background, people yelling, and the nurse giving rapid directions about where to dispose of something. Back on the phone with me, she begins to vent: "Why can't people be patient? We're doing our best."


"I hear you," I say. "I know it's hard. What you are doing is incredible."


"Thank you," she says, her voice breaking. "Let's do this." We finish the call, wishing each other well. When I hang up, I feel as though I absorbed all her stress through the phone-my chest is heavy, shaky. But before I can process what I'm feeling, I'm asked to go to the lobby to screen a patient with a cough who only speaks Mandarin.


I greet him from a distance and begin asking him questions. He responds appropriately, but then stops and puts his hands out toward me. "Where did you learn Chinese?"


He can't see the smile behind my mask when I respond, "In China. I lived there for 10 years, sir." The patient gives me a thumbs-up and thanks me. "It's nothing," I say. "The doctor will see you in a few minutes." He is here for labs for his diabetes and to follow up on his asthma.


Walking back to the nurses' station I think about how unsettling it must be to walk into a clinic where you might not be understood, where you might be ignored, especially during a pandemic. After years of working in other countries, I know that feeling of insecurity in a health care setting where my culture or language might not be understood or even accepted. This makes me even more determined to make sure our patients receive information about COVID-19 and get answers to their questions in their preferred language.


Back at the station, I make phone calls, administer some shots, change a dressing, and phone triage several patients who we send to our COVID-19 testing drive-through station downtown. I listen to one of my colleagues triage a patient over the phone who can't finish his sentences. His temperature is 103[degrees]F, and he says through gasps that he thinks his chest is going to explode. She sends him to the ED. I call a Vietnamese patient using a telephonic interpretation service to let him know his COVID-19 test result came back negative. The interpreter on the line tells me the patient is relieved; I write myself a note to check in on him next week.


I work through most of my lunch break, but when I see that the rain has let up, I pop outside for a quick walk around the block. I text a friend of mine who works in a cardiac ICU and tell her to hang in there, "I'm thinking of you." I think about my nursing colleagues at our downtown community health clinic standing outside in the chilly Seattle air, swabbing noses from the curb. I think about my former nursing students who graduated back in June and wonder how they are coping. One of them sent me a voice message a few days ago. She was crying as she said, "I had two COVID-19-positive moms give birth today . . . we had to separate them from their babies. Can you imagine?" I can't.


Nothing like this. In my 22 years as a nurse around the globe, I've seen my share of medical crises and disasters, but nothing like this. The toll the pandemic is taking on the health care system here in the United States is frightening. And in times like this, community health care workers have an important part to play as a lifeline to people who are healthy or not sick enough to go to the ED. We want to flatten the curve by triaging appropriately and caring for non-life-threatening illness because people are still getting sick, not just from COVID-19, but also from the flu, bronchitis, and strep. People still need their lab work for medication adjustments and health maintenance. People still fall, have accidents, and need to be evaluated-like the little boy who came in today because he fell off his bed during a pillow fight with his big sister. People still need to keep their behavioral health appointments for mind and soul care. People are still trying to get off methadone and need to have their suboxone treatment, like the young man who came in yesterday admitting he took a hit last week. "Give me another chance. I want to get off this stuff and start my life over." People still have wounds that need to be examined and bandaged. People still need to care for their reproductive health-a pregnancy checkup or an IUD removal. People still get rashes, stomachaches, joint pain, headaches, and ear infections. People still need care management for diabetes, tuberculosis, asthma, allergies, sexually transmitted infections, and other ailments. And people still get foreign objects stuck in their ears.


Community health nurses serve all. We serve the walk-ins, the poor, the uninsured, the day laborers, the undocumented, the students, the elderly, the people in tents, and the ones in mansions on the lake. All are welcome-no matter their color, beliefs, sex, ancestry, language, housing status, bank account, job, age, cough, travel history, temperature.


When I drive home at the end of the day, I feel shaky again, my throat is tight. One of the nurses was close to tears when I left the clinic; a medical assistant had to step away for a moment (after a patient took off with a box of gloves and hand sanitizer). The stress of possible exposure to the coronavirus, watching the size of our staff decline because so many are sick, and seeing our supplies dwindle is a lot to take in. Though I know a multitude of people are in my shoes, at this moment it feels like the whole world is at home except for me.


And then I remember what I told my patient earlier today. "I'm a nurse, that's what I do." It's not about me, it's about serving my community, pandemic or not. It's about remaining steady in the buffer zone one day at a time, because we are all in this together.