When the first Ebola patient to be treated in the United States was headed for Emory University Hospital this past summer, two of the... Voices from the front lines: How nurses feel about Ebola
Dr. Kent Brantly is congratulated by Emory University Hospital nurses and staff as he is discharged after receiving treatment for Ebola.

Dr. Kent Brantly is congratulated by Emory University Hospital nurses and staff as he is discharged in August after receiving treatment for Ebola. Photo credit: Samaritan’s Purse

When the first Ebola patient to be treated in the United States was headed for Emory University Hospital this past summer, two of the hospital’s nurses canceled their vacations to be there.

That’s how registered nurse Barbara Ribner described the dedication of the Emory nurses who deal with Ebola. Her husband, Dr. Bruce Ribner, is the medical director of the Serious Communicable Diseases Unit, which has successfully cared for four patients with Ebola.

Nurses are on the front lines of treating such deadly diseases, and have been in the forefront of the news surrounding Ebola in the U.S. Two nurses in Texas contracted the disease from a Liberian man who eventually died, and an American nurse returning from West Africa was subject to a controversial quarantine in New Jersey and Maine.

GHN talked to several Georgia nurses — some who work at Emory and some who work elsewhere — about caring for Ebola patients. The viral disease, originally identified in West Africa in the 1970s, has killed more than 5,000 people there this year, and for the first time has turned up in a few places outside Africa.

Emory nurses who cared for the Ebola patients discussed the complexity of the medical procedures at a recent conference. And at the same time, they said it was rewarding beyond their expectations.

“It’s a different feeling, because there’s this barrier between you [the nurse] and the patient,” said one nurse who preferred not to be identified. “You cannot touch your patient” to support them or help them understand that the staff is doing everything possible, the nurse said.

President Obama hugs Dallas nurse Nina Pham after she underwent successful treatment for Ebola.

President Obama hugs Dallas nurse Nina Pham after she underwent successful treatment for Ebola.

People with Ebola symptoms are contagious, and the sicker they are, the more risk of contagion they pose to others.

There is no “one size fits all,” explained another infectious disease trained Emory nurse who preferred to remain anonymous. Putting on the personal protective gear took 38 steps, while removing it took 50. These highly specialized nurses counted each step while another trained nurse watched every move.

Day after day and week after week, they could not make a misstep even once during this demanding process.

“Not everyone who went through our rigorous training passed,” said one of the nurses. Each nurse working with Ebola patients had to be 100 percent detail-oriented by following the highly complex procedures every time one of them entered or left the patient’s room.

The fear came not from getting the infectious disease, explained one Emory nurse, but “we were more afraid of giving the virus to someone else.” And for that reason, each nurse was fastidious about every procedure.

The nursing education coordinator for Emory Healthcare, Kelly Shelby, said that depending on when they started nursing, “nurses were probably frightened by other types of infectious diseases as well.” For some it might have been polio, while others feared SARS and AIDS.

 

Taking the danger seriously

 

“I think there is fear [of Ebola] because it’s a scary disease,” said Lorine Spencer, a nurse and a  CDC public health adviser. Fear of the unknown is a problem.

CDC workers and prepare to enter an Ebola treatment unit in West Africa.

CDC workers and Doctors Without Borders personnel  prepare to enter an Ebola treatment unit in West Africa.

“We are getting evidence-based, accurate information out there,” Spencer said. “We continue to learn from those that have been to West Africa to treat patients and returned safely.”

Rebecca Wheeler, an RN and past president of the Georgia Nurses Association, told GHN that “we [nurses] must seek out the latest information and evidence-based practices to respond to any emergency or infectious disease outbreak.”

Communication, training and equipment are critical. The U.S. is not accustomed to managing Ebola, so information and strategies will evolve as more experience with the disease is gained, said Wheeler.

Valdosta nurse Jody Leonard added, “The public has a much greater risk of dying from influenza [than from Ebola], so please, just get your flu shot.” When discussing the Ebola problem with family members, Leonard reminded them that the risk of contracting Ebola in the U.S. is extremely low. Not so for the flu.

 

Fear and uncertainty

 

 

The scientific information about Ebola has not changed. Experts have long known that infected people are not contagious until they have developed symptoms. That means the disease, though it poses a serious risk to people who care for ill patients, is not easily spread in casual settings.

But public fears about the disease have waxed and waned, reaching a peak last month after several Ebola diagnoses in the United States in quick succession.

Dr. Kent Brantly appears with Emory physicians, nurses and staff as he speaks to the media.

Dr. Kent Brantly appears with Emory physicians, nurses and staff as he speaks to the media.

Americans are both divided and uncertain about the threat posed by the illness, according to a recent Washington Post article. A Washington Post-ABC poll showed that just 24 percent of Republicans believed the federal government was doing all it could reasonably do to stop the disease. In contrast, 50 percent of Democrats believed the government was doing enough. But even 50 percent is not a ringing vote of confidence.

“The key is for the front line [health care providers] to have accurate information from reliable sources like the CDC. But they also need training and appropriate equipment,” said Wheeler.

Nurses and other members of health care teams need to speak up when they feel they are getting the things they need, and they must be listened to, Wheeler said.

In early October, National Nurses United stepped up the call for U.S. hospitals to immediately upgrade emergency preparations for Ebola. NNU is calling for all hospitals to immediately implement a full emergency preparedness plan for Ebola or other disease outbreaks.

Georgia health officials have not yet revealed the hospitals that are being prepared to treat Ebola patients. But infectious disease training remains ongoing for nurses and other medical professionals, as it has for years.

 

Quarantining nurses: Is it realistic?

 

October was a scary month of Ebola headlines. Thomas Eric Duncan, recently arrived from Liberia, died of the disease in a Dallas hospital. Then two nurses who had treated him were found to be infected with the virus. Then a New York doctor who had recently treated Ebola patients in Africa was diagnosed with the disease, amid media reports that he had roamed all over the Big Apple just before falling ill.

All three of those health care professionals were successfully treated — one at Emory — and all fully recovered. But officials around the country began to talk about not just isolating Ebola patients, but quarantining people who might have the disease.

When nurse Kaci Hickox returned to the United States in October after treating Ebola patients in Sierra Leone, she was placed in quarantine by New Jersey and then by Maine.

Hickox, insisting she did not have Ebola, objected to the quarantines. In Maine, she took the matter to court. A judged ruled there were insufficient grounds for quarantine, saying Hickox should simply submit to direct active monitoring. She did, and eventually was confirmed as not infected with the virus.

An Ebola isolation tent in Newark, N.J., for Kaci Hickox

An Ebola isolation tent in Newark, N.J., set up for Kaci Hickox

After the court fight, Hickox said, “We’ll only win this battle as we continue this discussion, as we gain a better collective understanding about Ebola and public health, and as we overcome fear . . .”

The American Nurses Association opposes the mandatory quarantine of health care professionals who return to the United States from the Ebola-ravaged areas of West Africa.

On Oct. 27, Gov. Nathan Deal announced that Georgia plans to increase Ebola monitoring for all people arriving from affected countries. His directive also included the possibility of quarantines, but none have been implemented.

An open letter to Georgia’s nurses (co-authored by Public Health chief Dr. Brenda Fitzgerald and Carole Jakeway, a Public Health Department official), called for vigilance in recognizing early symptoms of Ebola. “As nurses, this is the type of situation we have been trained for,” the letter reads, while discussing the potential for anxiety and stress among Georgia’s nursing personnel.

Nurses are a good source of information about this potentially deadly disease, said Texas Nurses Association Executive Director Cindy Zolnierek.

“Also, I have advice for a concerned public: Talk to a nurse. Very likely, you have nurses in your own family or as friends,’’ she said in a statement.

“Nurses are a great resource for information and a calm voice of reason. We hope you care for nurses as much as they work to care for you.”

 

Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.

 


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