Nurses’ resilience: When final goodbyes are part of your job

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For nurses and clinicians who care for the oldest among us, final goodbyes are part of the job. It’s never easy. Right now, due to COVID-19, it’s particularly tough, especially when you’re caring for vulnerable seniors in nursing homes.

“You can’t imagine what it’s like to do this job until you’ve done it,” says Traci Miller, vice president of medical clinical operations at Optum, whose team helps care for residents living in skilled nursing facilities.

From early on, nursing home staff and clinicians knew they’d need to prepare. When the virus first hit the U.S., experts warned that seniors with pre-existing conditions living in communal settings would carry a heavy burden.

Now staff and clinicians are caring for those who have been infected with COVID-19 and protecting those who haven’t. And, because these facilities no longer permit visitors, they are also providing a much-needed line of communication for family members who cannot visit their loved ones at this time.

It is a role they are honored to play.

“The relationship between the clinicians and the members is a very close one,” says Miller. Her team of 1,500 registered nurses, physician assistants and nurse practitioners work alongside skilled nursing staffers to provide preventative care and treat chronic and acute conditions for more than 70,000 members in 1,600 nursing homes across 26 states.

“They not only see their members regularly, they also communicate with their families about issues like treatment plans, goals for end of life care … conversations that require a trusting relationship,” Miller continues. “We talk with the member and their family to ensure what we are doing aligns with the member’s goal of care.”

Miller’s team supports partners like Saber Healthcare Group, with nursing facilities across the Southeast and Midwest, to keep members safe and healthy.

“Their goal is to keep people medically stable and treat in place in the facility,” Saber Healthcare Group Chief Medical Officer Nancy Istenes told Skilled Nursing News. “So that allowed us to know that we’d already maximized the care for those residents, so that our residents are in the best medical condition that they possibly can be coming into a potential epidemic.”

As the number of acute cases rose within nursing homes, so too did the level of care that advanced practice clinicians (APCs) provided. In this video, Miller describes that change.

Read the transcript

Ensuring safety and support

To ensure that the highest levels of care can continue, Miller says her teams are focused on clinicians’ well-being, including both their physical and mental health.

To prevent transmission of the virus, all APCs were trained on the correct personal protective equipment (PPE) to use and retrained on how to properly put it on and take it off. “You learn all of this as a nurse, but in a situation like this it’s important to retrain,” says Miller.

Miller also says communication about PPE became important. “We ask that if they don’t have the proper protection, they don’t go into the nursing home that day and let us know so that we can get them the proper equipment,” she says.

In some cases, APCs have the opportunity to manage their members virtually from home. But Miller says many are opting to continue to go into the nursing homes for face-to-face visits.

Being away from families and dealing with losing patients can create an emotional strain. To help APCs cope, new programs have been introduced on resilience, crisis intervention and bereavement. In addition, ongoing peer groups are available for APCs who want to talk with others who have walked in their shoes.

“The support groups give APCs the opportunity to grieve or to celebrate their members who have passed,” she says.

Miller knows it’s an incredibly stressful time and is amazed by the resilience of her teams. In this video, she describes their dedication to their patients.

Read the transcript.

APCs continue caring for members in nursing homes, underscoring the strength of their relationship with members and their families.

They are providing compassionate care, being there for members when others could not and have proven that COVID-19 will not deter them from doing the job that they love.

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