Portrait of a Tender (#1) - Adelle - Newborn Intensive Care Unit

 If you have had a newborn in the NICU or special care nursery at either UVA or MJH,  then you have likely had the good fortune of  meeting Adelle.  She has been caring for our town's tiniest beings for 31 years.  Adelle always knew she wanted to take care of  babies and that is what drew her to a career in nursing.  With a little mist cloaking her big brown eyes, she reflected on "how blessed" she feels being "one of the first people to touch these brand new lives.  I have the chance to give them some feeling of warmth, a gentle stroke on the cheek... these tiny souls are a blank slate and I have the chance to make an impact on their lives...". For Adelle and many others, "Nursing is touching." and the pandemic has made it exceedingly difficult to continue practicing in this way. Touch has been a primary means of caring for parents who are struggling with their newborns' hospitalization.  Throughout the pandemic, fear of transmission and the necessary protective gear have made connecting through touch relatively impossible. "Not being able to reach out and  hug a worried mom or hold her hand... the fear of transmission and the physical barriers of protective gear... that has been the hardest part."

 #LoveConnectTend

#PortraitofaTender

 #aprojectolastalifetime 

 Heidi knew from the time she could talk that she wanted to be a nurse.  In high school she fell in love with the realm of childbirth while interning on labor and delivery at UVA. She began working as an RN in the birthing center at MJH shortly after the birth of her first child, and that was 17 years ago now.  "The honor and privilege of helping someone do what I consider to be the best thing they will ever do, becoming a mom,  that's what has kept me in nursing."  Although birth is often a celebration, it is also one of the most anxiety provoking or downright frightening events in many women's lives, and it is frequently the first time they have ever been hospitalized.  The pandemic has brought a host of extra worries and restrictions to an event that is already laden with stress and fear of the unknown.  Trying to balance the responsibility of enforcing restrictions and ensuring safety,  while also providing the deeply emotional and physical care that nurses give women during childbirth, and "doing it all with a smile and a positive attitude, it has just been utterly exhausting."   #LoveConnectTend

 #portraitofatender

 38 years ago, Sue started her first nursing job on labor and delivery.  She was a single mom with two babies at home. Sue  had been working as a unit secretary in a hospital  when she realized that she wanted to "be on the other side of the desk, where the action was".  With the help of family, she went back to school for her nursing degree and has been "in the action" on labor and delivery ever since. Just last week, Sue shifted her career into partial retirement. Closing out a 38 year career in labor in delivery during the COVID 19 pandemic has been bittersweet and far from how she had envisioned her last few years in the hospital.  The work of laboring women is "hands on" and we have all been living through a two year period of "hands off".  PPE, though absolutely necessary, creates barriers to touch and connection that inhibit nurses' ability to give their patients their full support. This hurts both the patient and the nurse. The person in need isn't able to fully receive and the giver cannot fully give.  It's a heartbreaking reality for all involved. These barriers to connection and tending are evident in many facets of nursing,  but nowhere more than in the physical and emotional work of assisting women in childbirth.  Nurses come to labor and delivery and stay because they LOVE this incredibly demanding yet infinitely rewarding WORK.  It's not the charting or the chatting. It's the deep connection that is created in the labor room doing the most magnificent thing women do. The women coming to give birth are both excited and afraid like never before.  All of the fears and worries that surround childbirth and plague many women are still swirling about, and now there is a lethal pandemic to consider on top of it all.  Some are walking into a hospital as a patient for the very first time, and a long awaited brand new baby is going to be entering this world as well.  The tenders need to tend and the gardens need tending...like never before. This awe inspiring crew at Sentara Martha Jefferson Hospital has figured it out.  They are doing it, friends, but they are really tired.  The fatigue is deafening.  

    Erin was first drawn to a career in tending mother earth and her flora and fauna.  She worked for several years at the Wildlife Center of Virginia before switching gears and heading back to school. Her pathophysiology class turned her attention to nursing, and she flew off to Tanzania shortly after to help with a group called Cross Cultural Solutions and further flesh out her plans in nursing.  While working in Africa she found herself attending a woman in childbirth, quite by accident and necessity. Erin delivered the newborn safely and sagely, and her place in nursing was discovered.  "Caring for women during this momentous time in their lives and educating first time moms. That's what I love to do."   For Erin, the generalized fear surrounding Covid has been the most challenging piece of working through the pandemic. Everyone is afraid, the patients, the hospital administration, the nurses, the families... the pandemic has brought more fear into the hospital than ever before.  "Some are managing it well and others are not.  The fear of COVID 19 has changed relationships within families and within communities." It has changed so much about how we interact.   On a nursing care level, Covid related restrictions have come at a cost as well as benefits. One significant challenge has been the necessary safety requirement of laboring women to mask in the presence of healthcare workers. Patients are able to be in their own room unmasked but must mask up when healthcare workers enter. This is a necessary safety measure, and it creates new issues for nursing, especially for those assisting women in labor. Patients and nurses must constantly weigh the pros/cons of laboring unmasked and having their nurse at bedside.      The restrictions have also limited visitors to the unit. For a time, no visitors were allowed at all.  Although disappointing to many families, it also allowed new parents much needed time to rest and get to know their new baby.  It removed any obligations of the parents to people outside of the hospital and "created a little cocoon around the families".  In some ways this was restorative and healthy for new parents and their newborns.

#LoveConnectTend

#PortraitofaTender

Wildlife Center of Virginia

Nursing was a second career for Laura.  She was working as a clinic coordinator for a surgery office when she recognized that she wanted to be on "the patient side" of things working as a caregiver.  She went to nursing school and has been working on labor and delivery at MJH for 15 years now. The opportunity to "support women at their most vulnerable" is what Laura finds most rewarding in her work, and "of course, there is nothing in the world like the first moment that parents see their new baby".  There is a unique mixture of "fear and excitement" inherent to childbirth.  "No two mothers are alike, and  you never know what's coming next."   Childbirth remains very unpredictable despite many efforts to schedule and anticipate outcomes.  The intensity and acuity level on a labor and delivery unit can change drastically.  An emergency threatening the life of mother and child can walk through the door at any moment on any given day. "It keeps you on your toes!" she says, with a smile. It is certainly not for the faint of heart, and it's clear that brave hearts are at work here.      Laura reflected on how much she has enjoyed seeing former patients in the community over the years.  They were always so happy to see their labor and delivery nurse.  Since the pandemic, patients and nurses aren't easily able to recognize each other in the community because of masks. It's another little piece of connection and reward lost. 

For 36 years Allyson has worked  as a nurse helping new mothers and their babies.  She knew since high school that she wanted to be a nurse and was most attracted to the wellness aspect of  the field. She started on labor and delivery right out of school, then moved to postpartum care and found her passion there, helping moms learn to breastfeed their babies.  Allyson became an International Board Certified Lactation Consultant 25 years ago.  "Some things about breastfeeding have changed over the years, but the need to love and support mothers on their journey has not."Allyson is finishing out her career by teaching the next generation.  She began as a clinical instructor for the Nursing School at UVA about three years ago.  "I enjoy sharing my love for the amazing process of birth with my students.  I really want them to understand how incredible the female body is, that it is capable of growing, birthing, feeding and nurturing a tiny human being."The Covid pandemic changed many aspects of care in the hospital.  "Everyone was so fearful. Family support disappeared. Mothers were afraid to break isolation to get breastfeeding help.  My colleagues and I were heartbroken to not be able to help families in the way we knew they needed. Covid made us all afraid of being with others."  Although life in the hospital has yet to return to pre-pandemic normalcy,  Allyson is relieved that they are able to offer their full services again and continue helping mothers and babies get to know one another.

36 years ago, Chris started her first nursing job on an oncology unit, caring for cancer patients.  Three years later she moved on to labor and delivery and that is where she continues caring for patients today.  Chris has been working here in Charlottesville at the birthing center at MJH for the past 24 years.  Reflecting on what brought her to a career in nursing, Chris shifts in her seat a bit, ever so demure, and says "I don't really have an exciting story about how I became a nurse.  I was born the oldest of three children in my family.  I've been a caretaker my whole life.  It's just part of me, and nursing seemed like a good fit."  Three and a half decades later, one can conclude  that nursing was indeed a good fit for Chris.Nurses have encountered a myriad of challenges while working through the pandemic.  Hospitals have struggled with adapting and implementing  evidence based policies that protect against an ever evolving novel virus while also maintaining consistency and support for staff.  It seems an impossible task.  Necessary quarantine restrictions have been particularly difficult on both patients and staff .  Depending on their Covid status and medical needs, it was necessary at times to separate babies from parents.  Symptomatic Covid positive partners were not allowed in the hospital, not even for the birth of their child.  Although necessary for the safety of everyone, it was hard.  Chris tells of one patient she had where this happened, and the mother was particularly saddened that her partner could not sign their baby's birth certificate. Chris took the birth certificate  outside to him, and he was grateful to have the chance to sign his name.  Sometimes the smallest act can feel the biggest at the time. 

HAPPY INTERNATIONAL WOMEN'S DAY!
At the age of 15,  Diana gave birth to premature twin girls in Colombia, South America.  The newborns were born 3 months early, tiny and frail, and stayed hospitalized in the Newborn Intensive Care Unit until close to their due date.  Diana spent those three months at their side, worrying and watching as nurses tended to her daughters and kept them alive.  They were not expected to survive, yet they have thrived.  It is a testament to their indomitable spirits, their mother's love, and the meticulous care given to them.  Diana decided during that time that she wanted to be a nurse some day.Two years later, in 2002, Diana moved to the United States. She graduated from nursing school in 2012, and was hired onto labor and delivery at SMJH, her "dream job", after six months on a medical/surgical unit.  She worked there as an RN for 10 years and obtained her Nurse Practitioner license in 2020.   She recently took a position as a nurse practitioner with Jefferson OB/GYN here in Charlottesville, Va and is looking forward to continuing her work with mothers and their newborns.Throughout the pandemic Diana worked on various units at SMJH, including the step-down ICU.  When asked what was most challenging about working as a nurse through the pandemic, Diana did not hesitate.  "Patients not having the support they needed was most difficult to watch.  The isolation, the despair, the loneliness...they were sick and scared and unable to see their loved ones."  People died  and loved ones watched helplessly through their phones.  It has been a most excruciating time for all involved.

Kristin had always known she wanted to help people. She decided on nursing as a conduit to this mission and graduated from the nursing program at St. Vincent's Hospital in Greenwich Village 38 years ago.  Shortly afterwards, she moved here to Charlottesville, VA and has been working on labor and delivery at SMJH for 36 years."Birth is a sacred event and I feel blessed to be able to help guide and support women through it... At SMJH we are able to practice independently and provide the least amount of intervention possible, while still providing the safety that the hospital provides."Kristin also chose nursing because of its value in providing medical mission work.  She has been traveling to India for 30 years with  Virginia Children's Connection ( https://vcc.avenue.org/ ), a non-profit medical volunteer organization based in Charlottesville Virginia.  VCC  was originally created to serve the vast need for facial reconstructive surgery in India due to high rates of cleft lip and palate birth defects.  The reason for these high rates in some developing countries is multi-faceted, Kristin explains. She has learned through her work that poor maternal nutrition plays a role as well as "other reasons we don't fully understand yet".Kristin has travelled to Giridih, India about 11 times over the last 30 years and she has witnessed  firsthand a shift in services needed over the years. Burn and scar revision now competes with cleft lip and palate surgeries as a main service provided by VCC.  Kristin, a surgical nurse as well, estimates that over 75% of the patients she assists for surgical scar revision are women.  They are frequently burned in household accidents, cooking over gas stoves.  She notes how the use of synthetic materials for saris has led to an increase in accidents because of their extreme flammability.  However, accidents are not the only cause of high rates of facial burns in this area. Sometimes the burns are also the result of  violence against women.  Working through the pandemic these last two years has been a challenge like no other.  Being a first assistant in the OR at the birthing center, Kristin is no stranger to PPE, but the necessary wearing of it for patients and staff alike has created barriers like never before.  "The PPE creates such a separation between patients and nurses."   There were practical issues to overcome as well. Kristin looks back on the mothers she assisted as they pushed, sometimes for hours, to birth their babies, grabbing what breath they could between pushes, often in pain, sometimes vomiting... through it all mothers were expected to remain masked as well as staff.  This was for the safety of everyone in the room, and a brutal reality for everyone involved.  Hospitals around the country were constantly reviewing and responding to emerging science and recommendations surrounding Covid in order to achieve a balance of safety and support for their patients and staff.   Nurses did what they could, when they could, and how they could in an effort to keep everyone as safe as they could.  It's been hard on everyone

When Mei Ling was 20 years old, she sat at her dad's bedside as he lay dying of lung cancer in the hospital.  She watched as the nurses came in and out, tending to him best they could.  One day, shortly  before he passed away, she told him "I'm going to be either a teacher or a nurse."  She decided on nursing after having had so much experience interacting with them while her father was ill.  She graduated from nursing school in 2000 and worked in the special care newborn nursery at SMJH for 15 years.  In 2020 Mei Ling began a different role in women's health care working  at the UVA Breast Care Center.  Women diagnosed with breast cancer come to this center for their chemotherapy.  Nurses like Mei Ling are in charge of administering the chemotherapy infusions and caring for the patients while they are there.During the pandemic, patients were not allowed to bring their support people with them to their appointments due to infection risk.  This was particularly difficult for patients with a recent cancer diagnosis.  "Chemo is scary anyway, but to have to do it by themselves was so sad and made us all feel bad." There is a tradition at the Breast Center  called  "The Bell Ringing" where patients celebrate their last chemo infusion by ringing a bell and all the nurses  line up to hug them.  With necessary Covid restrictions in place, hugging was no longer permitted.  Mei Ling and her colleagues were not to be deterred and designed a work around that they coined "The Big Warm Hug".  They used extra warm blankets and wrapped them snugly around their patients as a comfort measure.  "It is a little thing we can do" to show they care.

"I've always been a caretaker.  That's who I am." says Sharon, her bright blue eyes shining with a certain comfort in this knowing.  After giving birth to her twin boys, Sharon found her true calling and decided to be a labor and delivery nurse. She has been working with mothers and babies at SMJH for 27 years now.  Although she took on a new role in nursing professional development several years ago, she still finds time to help when staffing is low and fills in as a bedside nurse.  "Being present at the bedside helping women do what is often the hardest thing they have ever done... Being a part of this sacred time where women are simultaneously  the most vulnerable and the most powerful... I just fell in love with it."In her current role, Sharon has the opportunity to share this love with new nurses who are just starting out and works hard to ensure that a culture of normalcy and empowerment  surrounding birth continues to take precedence at SMJH.  She emphasizes that "being present at your patients' bedside, being able to make them feel safe, and actively listening to them is what really matters." She is optimistic that this practice is still possible in corporate healthcare, and  they are making it a priority at the Birthing Center at SMJH.The pandemic has produced two years worth of nursing school graduates who have had  little to no experience in the hospital due to Covid restrictions.  Nursing students normally spend  a lot of "clinical" time working with nurses on the job. Due to Covid restrictions, most hospitals did not allow nursing students, so new grads are going to need a lot of extra training and support when  hired.  Sharon will be doing her best to ensure these nurses learn the art of nursing as well as the skills, with passion and compassion leading the way.

Cari's grandmother was a nurse and her grandfather was a doctor. They  inspired in Cari a desire to tend to others and to work in healthcare some day.  For a while she thought she wanted to be a doctor until she earned a "C" in her college Chemistry class.  Her advisor encouraged her to go into teaching instead and she went on to earn a Master's of Arts in Teaching Spanish.  She taught for 7 years, until she ultimately decided she wanted to fulfill her childhood dream of working in healthcare.She left teaching and began taking her prerequisite courses for nursing school, one of them being Chemistry again. This time around, Cari earned the highest grade in her class.  Her teacher was so impressed with her performance that he encouraged her to consider a career in Chemistry, but Cari was determined to reach her goal of becoming a nurse.She was accepted into UVA's Clinical Nurse Leader program in 2012.  Her grandfather fell ill soon after from cardiac disease and the last thing she was able to tell him before he passed away was that she had been accepted into UVA's School of Nursing.  She was finally going to achieve their shared dream.Cari graduated in 2014 and excepted an RN position on the Coronary Care Unit at UVA Health and she has been there ever since.Working through the pandemic brought a host of challenges to an already high stress job.  Patients in the Coronary Care Unit are being treated for serious heart problems, and life threatening emergencies are a frequent occurrence.   During the pandemic, nurses were expected to incorporate new and constantly shifting protocols into the daily regimen.  The protocols involving Covid sometimes changed daily and sometimes changed based on the availability of equipment.  The workload increased significantly while the pay remained the same.  During the shutdown, most people were either working from home or staying home with pandemic pay, but not the nurses.  The nurses were still going to work as they always had, working harder and longer, taking care of sicker patients, risking their own lives, and doing it all for the exact same pay they had always received.  This was the expectation and Cari not only met that expectation, she exceeded it.