Delaware Nurses on Reinvention During the Pandemic

Photo by Luigi Ciuffetelli

A year into the pandemic, we take a look at how these Delaware nurses repurposed their skills and rose to new challenges every step of the way.

When the coronavirus struck with a vengeance in March 2020, it threatened to overwhelm our healthcare system, so Delaware’s nurses sprang into action. We spoke to eight nurses who transitioned away from their regular jobs to fight on the front lines of the pandemic. Read on to find out how it happened and what the experiences meant to them.

Brenda Ewen, RN
Risk Management Supervisor
ChristianaCare Legal and Risk Management Department

Imagine working in one of the East Coast’s busiest hospital systems—the emergency departments at ChristianaCare’s Christiana Hospital, Wilmington Hospital, Union Hospital and Middletown treat more than 225,000 patients each year combined—and then contending with a once-in-a-century pandemic.

For experienced nurse Brenda Ewen, a risk management supervisor in ChristianaCare’s Legal and Risk Management Department, it meant all hands on deck. It also meant suddenly moving from reviewing clinical issues to triaging patients on the front lines as they entered in the Emergency Department.

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“They let us know over the summer that the nonbedside nurses might be asked to support the bedside nurses if we had a [COVID-19] surge, which we did around the holidays,” she explains. “There were a lot of patients, and it was very nonstop. We were still doing our other jobs, so a couple days a week I would be doing risk management, and then I would do three four-hour shifts in the Christiana ED triage area.”

Still, despite the pace, Ewen welcomed the experience and offers high praise for her fellow medical staff and workers. “It’s really been wonderful, quite frankly. Now, even though I haven’t done patient care for a while, the reason I became a nurse is because I wanted to take care of people and help them through stressful situations. And that kicked right back in even though I hadn’t been at the bedside for a while. That came rushing back like I just graduated,” she says.

“A lot of what I did was take vital signs and check blood sugars, move patients around, help people to the bathroom, get water. I spent a lot of time roaming the halls and the waiting room just letting people know that we were sorry if it was taking longer than we would want it to be, but we knew they were here, we were going to get to them. So a lot of my role was just making sure that people were aware we were caring about them.” This relieved pressure on the regular ED nurses and allowed them to focus on other aspects of patient care, she says.

“The staff in the ED was wonderful,” Ewen adds. “We have wonderful patients at ChristianaCare and I met some really amazing people who were kind and gracious, even though they felt terrible and they were waiting their turn in a busy ED. I really enjoyed it a lot, and it was rewarding to be able to help our colleagues.”

Still, she says, “It was very stressful. …I think all of us are stressed from the pandemic, but the patients were so great and the nurses were so caring and devoted.”

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Nonetheless, she found it immensely rewarding. “The patients were so appreciative every time that I stopped by to check on them and made sure they were covered or got them an extra blanket. I can’t tell you how many times I was called an angel during my experience in the ED. The patients were so wonderful.”

Ewen emphasizes that addressing the pandemic was a hospital-wide effort involving every department. “When we staff nurses went back to the bedside, there was other work that we normally do, and it really took the support of everybody at ChristianaCare to make this Capacity Assistance Program work. The attorneys in my office all reached out to us immediately when they heard we were going back to the bedside and asked what they could do to help, and then our paralegals and the people we work with in the patient safety areas. It was really ChristianaCare-wide effort to support the nurses. I guess it sounds a little corny, but it made me very proud to work here and to see everybody pull together and try and support the frontline people.”

Kelly Bald, RN
Care Coordinator
ChristianaCare HomeHealth

Kelly Bald has been a nurse for 13 years, spending the last decade in home health care: “It’s my passion and what I love to do,” she explains. After working in the field directly with patients, she transitioned to her current role as care coordinator, ensuring clinicians adhere to quality and safety guidelines when caring for patients.

But when the pandemic hit, everything changed. “When coronavirus first started, there was so much fear,” Bald says. “The patients were so scared of being exposed that they were canceling their in-home visits with the nurses and the therapists. So what we really wanted to do was give them an option that we could provide the continuity of care that they needed but lessen their fear. So that’s how we started to develop doing the virtual visits.”

Due to the nature of the pandemic last March, there wasn’t a lot of time to pivot, she says. “It was super fast. We heard about it one week and we were working out the policies and procedures for it, and within the next couple weeks, we were up and rolling.” Nurses were able to virtually work with patients on everything from wound care to diabetes education, she says.

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Because of the novelty and speed of the new virtual treatment types, ChristianaCare became part of a groundbreaking research study on how patients are reacting to virtual visits, Bald says. “It really put ChristianaCare at the forefront of advancing nursing treatments to be able to provide the most effective care to patients.”

There is somewhat of a silver lining to the past year as well, Bald says. “There are a lot of things that were developed because of the pandemic that work so well and are so effective that they might as well just become a part of our everyday routine, because they do seem to work so well for the patient and for us. And it just makes their overall care even better.”

Making the transition to virtual care ended up being easier than expected as well: “I feel like the experience that I had working in the field before this was what really enabled me to develop the skills that I needed to complete the virtual visits because my assessment skills were proficient enough that I was able to provide a quality evaluation by video. I feel like if I had not had the experience that I had had previously in home care working in the field for so long that maybe I wouldn’t have been as comfortable.”

Currently, they’re continuing with a hybrid online/in-person visit system, which Bald anticipates will continue. “I cannot say enough good things about all the people that I work with and the organization itself.”

“I humbly helped out for short periods of time. The real heroes are still over there battling the pandemic every day.” -Joan Tuner./Photo by Luigi Ciuffetelli

Joan Turner, RN
Clinical Surgical Nurse Quality Reviewer
Beebe Healthcare

Joan Turner has been in health care for 40 years, including working as a surgical and ICU nurse, and most recently reviewing surgical cases to help improve patient outcomes.

When the pandemic hit last March, it was time to marshal the forces. “At Beebe, every nurse who was not in direct patient care was mobilized as part of the hospital’s surge plan for COVID-19,” Turner explains. “I wanted to help because I knew it could be my family member that might be affected. And I went through specialized training to take care of COVID patients and was deployed to the ICU.”

She spent April and May there, returning again this January. Despite the urgency, the transition was “very structured,” Turner explains, with classes to ensure everyone was trained on floor duties and ventilator use if needed.

Even after working during health crises like H1N1 and AIDS during her long career, “I’ve never seen anything like the present pandemic,” she says. Still, “On a personal level, this made me cherish the simple things in life, like visiting family and going places. It’s also deepened my Christian faith. But as a nurse and part of Beebe Healthcare, it’s made me appreciate my co-workers. It was amazing to see how everyone worked together as a team. And myself, I just humbly helped out for short periods of time. The real heroes are still over there battling the pandemic every day.”

Greta Endres, RN
ChristianaCare Cardiovascular Critical Care Complex
Christiana Hospital, Newark

Greta Endres has been a nurse for more than a decade, focusing on caring for patients after they’ve received open-heart surgery. “It’s very hands-on,” she explains. “It’s post-surgery, so we want to try to get the patient up and ambulating so they can either go home or to a rehab facility once they’re done with us.”

But, when the pandemic came on last spring, “They suspended the surgeries, and that’s when I start repurposing at first,” Endres says. “When that happened, our intensive care unit nurses were busy taking care of COVID-19 patients and also learning how to safely put on and take off the personal protective equipment.”

That’s where Endres stepped in. “For a time, I helped them don and doff the personal protective equipment. I also help them with other needs that they would normally handle, like racing somewhere to grab resources or materials that they needed care for the patients. I also got the opportunity to care for ICU patients with or without COVID-19 with the ICU nurses.”

Using the specific PPE for droplet or airborne precautions needed to protect against COVID-19 was new for a lot of nurses, “so a lot of the time, we were reeducating people on how they put on equipment and take off the equipment safely,” she explains. This included using gear like N95 fitted masks, air purifier masks, face shields, isolation gowns and gloves in the correct order, in the right location and at the right pace to avoid spreading infectious droplets, as well as ensuring her fellow nurses were properly equipped if they had to attend to an emergency situation quickly.

Endres is now back in her previous role, but looking back at the experience, she credits ChristianaCare for providing everything from daycare to emotional support for staff. In the pandemic’s initial stages, “We were little anxious,” she says. “There were a lot of changes, especially since my staff was repurposed, but it was definitely exciting learning something new and doing something different and new,” she says. “I really enjoyed working with the ICU staff, whether it was donning and doffing the equipment or working with them on the floor taking care of the patients. Nursing is always about learning. Nursing’s always changing, always evolving, and I feel privileged and honored to work with my co-workers.”

“I helped them don and doff the personal protective equipment. I also helped with [things] like racing to grab resources or materials that they needed care for the patients…and caring for ICU patients with or without COVID-19.” -Greta Endres./Photo by Luigi Ciuffetelli

Megan Smakulski, Nurse Manager
ChristianaCare’s Intensive Care Unit and Stepdown Unit
Wilmington Hospital, Wilmington

Megan Smakulski has been in nursing for a dozen years, spending the last eight with ChristianaCare and now serving as nurse manager for the Intensive Care Unit and Stepdown Unit in Wilmington.

Before COVID-19, Smakulski was responsible for all of the day-to-day operations. “We are the only critical care unit at the Wilmington campus, so we do see the sickest of the sick from our community,” she explains. “I work on budgeting. I ensure that the staff has the resources they need to do their jobs so that our patients get the best possible care.”

Then everything changed.

“When the pandemic started, there were obviously a lot of questions from myself and members of my team about what was going to be happening. Basically, we realigned ourselves with the leadership team so that we had 24/7 presence for the teams. That way if they had any questions or concerns, they would be able to have a manager present on site to help them address any issues or concerns that they had. It was a lot of updates, as there were are a lot of changes initially to policy and procedure,” Smakulski says.

“But our worlds were essentially flipped because none of us had worked through a pandemic before, so it just took a lot of resilience and trust in the organization. And ChristianaCare was absolutely amazing. We had all of the PPE that we could have possibly needed to get through this event. And they provided the nurses with lodging if needed. They really went above and beyond to ensure that the frontline caregivers felt supported during this really trying time.”

Smakulski moved out of her current role and began vaccinating her co-workers, she says.

“Our senior leadership really wanted to be able to keep our frontline caregivers at the forefront of caring for patients because they are the most skilled people to do that. And for me personally, I couldn’t think of a better way to give back to the organization and to my fellow caregivers than by vaccinating them. I felt like I was playing a role in helping our organization protect our caregivers and it was the first time in a long time where you could see smiles and you could see hope in people’s eyes once we got that vaccine.

“It’s been hard on staff and on patients, but we’ve developed different strategies so that we can stay with our patients in their rooms or just talk to them a little bit more,” she explains. “We’ve incorporated different technologies so that we can have them FaceTime with their families. Different things like that just to bring a smile to their faces, right? I made a COVID heroes board on our unit just to recognize my team because the work that they’re doing is extraordinary. We have a commitment to our patients to get them back to the best level of functioning that they can be. There were hard times—I’m not going to pretend like there weren’t—but you know, when you had those wins, that meant a lot to the team to see patients get better, and it just made our days a lot brighter.”

Becky Parlow, Nurse Manager
Pediatric Intensive Care Unit

Nicole Asher, Nurse Manager, 2 West
Nemours/Alfred I. duPont Hospital for Children

Becky Parlow and Nicole Asher are both exceptionally experienced pediatric nurse, with 16 years and 27 years under their respective belts, with stints spanning the pediatric intensive care unit (PICU) and oncology.

Pre-coronavirus, Parlow would kick off her day in the PICU with in-person huddles strategizing with 50 or so staffers crowded into the hallway, and then tackling meetings, emails, staff education and projects. Asher echoes this, noting, “Our typical day was mostly focused on our daily operations. I think when we talk about ‘typical,’ it’s something that really stands out for me because things quickly became atypical. That really changed with COVID.”

Since the incidence of pediatric COVID-19 didn’t necessarily align with how it was affecting the adult population, Alfred I. duPont Hospital for Children faced a unique challenge, one that Asher and Parlow were happy to assist with.

“When the pandemic hit, as an organization we quickly mobilized and made some really quick decisions on how we were going to respond to the pandemic, and not only in the care of children but also in the potential necessary switch or addition to potentially even care for adults,” Asher says.

“It was decided that 2 West, which is the patient care unit that I am in charge of, would be the geographic location to house COVID patients, and that decision was made thinking about our connection on 2 West to the PICU. We are both located on the second floor and we have a very collaborative relationship,” she explains.

“And so we combined efforts, and we quickly had to pivot to really create a COVID unit that was held physically on 2 West, but was a combination of providers from both the critical care for the PICU and from 2 West, as well as respiratory therapy and a lot of other interdisciplinary team members. We figured it out as we went along what the team needed to be able to care for these patients without really having much information about COVID, the impact on children, and ever changing recommendations from our guiding scientific bodies, like the CDC.”

Parlow was on vacation last March when the pandemic exploded. “Things shut down and I flew home next day, and we just found ourselves in the middle of this complete unknown activity, and it became essential to strategize. We’ve had ICU patients on 2 West before as an overflow, but this was truly a partnered model where we were potentially even going to put critically ill children over there, so planning the right supplies and the resources and getting the technology so that any bed could take care of any type of patient—critical care, acute care—and because we didn’t know what it would look like in children and how sick they would get, we did plan for a lot of various scenarios. In those early days, communication was key,” she says.

COVID community mitigation strategies helped keep kids safer, and she explains, and the hospital shut down elective procedures. Combined with school closings, “We didn’t really have any patients,” she says. “And that is something that was intentional because we were creating capacity. We began to prepare for adults and for overflow at the request of the governor. …Thankfully, we never needed to, because the community responded to the strategies and they complied and we didn’t see that surge that we expected, which is a good thing. But we spent a lot of time planning for all those scenarios to be ready to care for any sick patient.”

Asher adds, “When we think back to what had to happen and how quickly that happened in order for us to respond in what was technically a disaster at the time, it’s just amazing to me that staff were able to become engaged and respond in ways that were brand new. We literally started at ground zero. The way that our teams engaged in this effort was just incredible, despite the fact that, as people and as human beings who had families, I think all of us were so fearful of the unknown.”

At this juncture, Parlow says, “I think overall I’m hopeful. From a pediatric standpoint, we’ve never had a ton of COVID patients, so the pediatric population is relatively unaffected, although there have been some for sure. A lot of our infectious disease experts…are hoping that maybe the spring and summer, we will be able to see some herd immunity and some relief. And so while I’m hopeful for that, I think as things begin to open up in those times, we we still need to be cautious and keep a close eye on spread.”

Asher says, “It certainly has affected me personally in that in the beginning of the pandemic, it was a real challenge to balance work and life. …But I have witnessed so much resilience in my team. And have had such a sense of pride for my team. I think that that’s probably the most important thing that has come out of this for me.”

Parlow agrees, adding, “It really highlighted the need for teamwork. I’m proud of how well we were able to make changes quickly and communicate them.”

“At first, it was nerve-wracking, because no one knew what the virus was. I always say that surgical nurses adapt easily, because we’re always under a lot of stress and we never know what’s coming in through the door, so we adapt well to different situations.” -Gina Waite./Photo by Luigi Ciuffetelli

Gina Waithe, RN
Perioperative Service Coordinator
Union Hospital, Elkton, Md.

With more than a decade of nursing experience in fields as varied as geriatrics, acute care observation and surgery, Gina Waithe’s versatility was well-established. So when COVID hit, Waithe was ready to jump in to help.

While her typical day as a circulating nurse entailed preparing patients for surgery, among other duties, that changed last March.

“We basically came in one day and found out that due to the pandemic, surgical proceeding had stopped. Our manager was really great and our command center found us different areas in the hospital to utilize our skills.”

Waithe explains that she and her co-workers would be assigned through the hospital according to need. “Eventually I ended up in the ChristianaCare testing site, testing the general public for COVID virus. Being a surgical nurse helped me to understand aseptic techniques [keeping hands clean, maintaining situational awareness and avoiding touching anything or oneself], and wearing a mask for a surgical nurses was a daily habit. This was normal for us, so we were able to adapt easily when it came to testing patients. My role as surgical nurse prepared me for this. I understand aseptic technique, and I was able to stay with a mask for long periods of time and gown up with gloves and mask and face shield.”

The sites included infection control measures, as Waithe explains: “We had certain number of patients come into the facility and we tried to keep the numbers as low as possible. After every person sat down, we ensured that the entire area was wiped down.”

While Waithe has returned to surgery, she recalls her experience on the front lines. “At first, it was very nerve-wracking, because no one knew what the virus was. We were facing a global pandemic, but I think my role as a nurse and as a surgical nurse prepared me for this situation that we were faced with. I always say that surgical nurses adapt easily, because we’re always under a lot of stress and we never know what’s coming in through the door, so we adapt well to different situations.”

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