Now is the Time for All Good Nurses to Come to the Aid of Their Country
So we are at the phase where it is “all hands on deck” for those who know how to give an intramuscular injection and also possess free time. Like everything else in the covid19 pandemic, the federal government could have been getting this organized last year while we were waiting for the vaccine, but – they did not. I took some Public Health courses at undergraduate school back in the 1970s and even then it was a well-known axiom that politics and controversy will always accompany every public health initiative you can think of.
I am an RN, over sixtyfive, still working and yes, I have pre-existing conditions that put me at risk. I swear the retired RN who gave me my second shot looked like she was eightyfive years old. The pandemic creates opportunities for retired nurses, it’s the “work until you can’t hold a syringe” employment event. I should add, she had impeccable technique. I told the nursing students with me that they would now have a story they could tell their grandchildren as to what they did during the Great Pandemic.
Nursing ShortageMost nurses who want to work are now employed as nurses already. Here in Tampa Bay, there was an estimate that one thousand nursing jobs were unfilled prior to covid19. This is Florida after all, and older Americans want to retire here. My county in Florida has about 1.5 million residents, and there are eleven entire US states with fewer people to vaccinate.So the school where I teach is now partnering with the County Public Health Agency to allow nursing students to help staff the clinics that are taking place. We send a group of four or five at a time along with a faculty member ( an RN with a Master’s degree or even a doctorate) to a predetermined location to meet the Public Health staff, and away we go.
I actually did it first, prior to the beginning of the semester, and I reported back to my colleagues what it was like so they would have an idea. I was asked to gather teaching resources so the students would be prepared, and so I put together a small list and shared it on our Learning Management Software. (the computer app on which all aspects of college courses resides these days. It’s very different than when you went to school!).I decided to also share the list with my blog, for other nursing faculty who have not yet read up on the details. So, here goes.
The Pfizer “Package Insert.”When nurses learn pharmacology they are taught to make a “drug card” for each medication they administer so they can have a handy reference summarizing what to tell the patient. The Pfizer vaccine came out too recently to make it into the reference books every nursing student is required to buy and study. Here is the source document from the drug company that gives all nursing-related info on the Pfizer vaccine: https://www.fda.gov/media/144413/downloadPlease note that the package insert is thirty pages long. The last fifteen pages include a review of studies related to the drug. I do not require students ay my level to digest that section.
Moderna vaccineLikewise, the Moderna company has also made their “package insert” available. https://www.modernatx.com/covid19vaccine-eua/eua-fact-sheet-providers.pdf
The CDC site specifically for Health Care Providers who need training:https://www.cdc.gov/vaccines/covid-19/downloads/COVID-19-Clinical-Training-and-Resources-for-HCPs.pdf
A CDC checklist on vaccine administration for the nurse.
The CDC has many documents and videos etc on their site. One that I thought applied to nurses was this checklist. It was made for the covid19 vaccine but it goes over items needed for all vaccines. https://www.immunize.org/catg.d/p7010.pdf
The seventeen dollar CD
At the top of the above checklist are the instructions for how to buy a CD of all these resources. The DVD “Immunization Techniques: Best Practices with Infants, Children, and Adults” helps ensure that staff administer vaccinescorrectly. It may be ordered online at www.immunize.org/dvd.
Another helpful resource is CDC’s Vaccine Administration eLearncourse, available at www.cdc.gov/vaccines/hcp/admin/resourcelibrary.html. Browse the CDC site. Among other items you will find the meticulously-detailed storage procedure for the various vaccines. As you no doubt are aware, the Pfizer vaccine requires cold-temperature storage until use that adds a complicating element to distribution. They go through it step by step.CDCTrain – CDC developed a training module for health care providers: https://www.train.org/cdctrain/course/1095082/
How to give a deltoid injection
I hate to admit how old I am, but at the beginning of my career, medical care relied on intramuscular ( I.M.) injection for delivery of many more than meds than they do now. Giving a pain shot was a frequent event in any hospital setting. Somewhere along the way, the new standard became to deliver pain meds through the intravenous. It hurts less, there is more reliable absorption, and the patients like it more. These days a student can readily learn to give insulin ( a subcutaneous injection), but does not get as much I.M. practice. In every nursing school, this is part of the curriculum and every nursing student is required to get checked off on the procedure, including passing a quiz and showing a demo of how they would go about it. Every Fundamentals of Nursing textbook describes it in great detail including the basic checklist. However, the injection technique is still worth a review the night before joining a clinic.
There are many YouTube videos on the subject. Here is my favorite: https://youtu.be/DBHnd3N-5Ns Note, “RegisteredNurseRN dot com” is famous among nursing students. They have 1.2 million subscribers, and have produced 762 videos. Her delivery style is excellent and when I have required my own students to make an educational video, some of the groups will create a sort of parody of her delivery. They love her and I think the info she presents is of high quality. ( disclaimer: I am not associated with RegisteredNurseRNdotcom in any way and this testimonial is freely given with no inducements of any kind).
We are targeting nursing homes and longterm care facilities first. For these, the administrators provide a list of eligible residents, and collect the consent form. The county plans out the details including where to send the team and the location of the nearest hospital in case of any problem. If the residents can come to a common area they are brought there, but if not, the team will go door to door to find them. The county has a master list of all such locations and has made a systematic plan.
This has been new. There was an initial learning curve on how to set up a drive-through event for a thousand people at a whack, and it involves a lot more traffic control than you might have imagined. ( most people drive up with one or two recipients in the car. You don’t want to create a bottleneck by taking up a lane on the actual street where traffic is moving!) At the first one I joined, they had about eighty volunteers managing traffic and they set up a pattern using orange cones. So, I included some videos showing what it was like to be part of this. When they hold a drive-through clinic, they need to have a plan for the staff to wash their hands, go to the bathroom, and get lunch. I knew this so I brought some snacks the first day and I think I was the only one. (the organizers provided gloves and about a gallon of hand gel per person). They did supply lunch and a break.
Note: you do not need special training to volunteer as a traffic director. Any reader can phone up the local agency in charge of this and volunteer. They will lend you a reflective vest. Dress appropriately!
Here are some YouTube videos that give an idea of what it is like. You may have seen these on the news. There is a learning curve for the organizers.
2) Tampa Bay:https://youtu.be/l_9uPyO4k6M
3) University Mall in Tampa:https://youtu.be/3t5t9eiRHxo
4) Plant City Florida clinic at the fairgrounds of the world-famous Strawberry Festival:https://youtu.be/AzVT9s4SQDA
5) Miami Florida I would be lying to you if I said politics was never involved: https://youtu.be/OpWbULM3-z8
Cross-Posting to WordPress
I will post this on DailyKOS where I hope people will forward it to any and all Health Care Providers who might be helped by this, but also on my own blog that I usually reserve for entries related to Nepal health care. https://wp.me/p1pDBL-1L6 For those who have followed me, I sometimes have written about the political situation in Nepal, but I did not travel there to teach in summer 2020 due to the pandemic and I don’t expect to go there in 2021 either. In Nepal we frequently discuss the concept and application of the idea of “excess deaths” but it was not something I thought would ever enter into the national conversation here in USA.
One of my personal favorite DailyKOS diaries that I ever wrote was my movie review of Contagion, back along. Was it really nine years ago? I think the review stands the test of time. Let me know.
At my WordPress site you can read about my work teaching both critical care skills and de-escalation skills to Nepali nurses and doctors.