{"id":9658,"date":"2020-05-10T17:43:45","date_gmt":"2020-05-10T21:43:45","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=9658"},"modified":"2020-05-10T17:44:39","modified_gmt":"2020-05-10T21:44:39","slug":"thank-you-to-inpatient-nurses-the-people-doing-the-most-direct-covid-19-patient-care","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/thank-you-to-inpatient-nurses-the-people-doing-the-most-direct-covid-19-patient-care\/2020\/05\/10\/","title":{"rendered":"Thank You to Inpatient Nurses — The People Doing the Most Direct COVID-19 Patient Care"},"content":{"rendered":"
\"\"<\/a>

English stamp commemorating nursing care, 1999.<\/p><\/div>\n

Anyone who does inpatient medicine or surgery knows well the major imbalance in time spent on direct patient care between doctors and nurses.<\/p>\n

Nurses spend way<\/em> more time actually with patients than we do — I’m referring to time in the rooms caring for patients.<\/p>\n

While we round and review charts, document lab test results, bring up radiographic images, write orders, and debate the merits of the latest hydroxychloroquine or remdesivir study, they<\/em> do direct assessments and respond most immediately to patient needs.<\/p>\n

It’s been this way for years. The late Dr. Arnold Relman, former editor of the New England Journal of Medicine<\/em>, sustained a major injury several years ago that required a prolonged hospitalization. Writing about the experience<\/a>, he cited how doctors (vs. nurses) practice medicine today:
\n<\/span><\/p>\n

What I hadn\u2019t appreciated was the extent to which, when there is no emergency, new technologies and electronic record-keeping affect how doctors do their work. Attention to the masses of data generated by laboratory and imaging studies has shifted their focus away from the patient. Doctors now spend more time with their computers than at the bedside. <\/span>Reading the physicians\u2019 notes in the MGH and Spaulding records, I found only a few brief descriptions of how I felt or looked. Conversations with my physicians were infrequent, brief, and hardly ever reported. What personal care hospitalized patients now get is mostly from nurses.<\/em><\/p><\/blockquote>\n

Emphasis mine.<\/p>\n

COVID-19 only brings this stark disparity into sharper focus. A diagnosis of COVID-19 means necessary isolation — single room, no visitors. Clinicians must put on (“don”) personal protective equipment (PPE) to see patients, then take off (“doff”) the PPE without contaminating oneself — a strategy best done with an attentive monitor. It’s not easy to get it right.<\/p>\n

Since PPE supply chains have been strained right from the start, we must limit the number of clinicians with direct patient care. Bring on the telephone or iPad consults — that was never a thing before. Way<\/em> fewer doctors in the room, both during rounds and the rest of the hospital day. But all patients still have the same amount of nursing care.<\/em><\/p>\n

We ID specialists say this again and again about the risk of transmission of SARS-CoV-2, the cause of COVID-19. The riskiest activities involve spending prolonged time in close proximity to someone with the disease — especially someone who’s acutely ill and coughing.<\/p>\n

And in the hospital, the health professionals doing most of this high-risk activity are the inpatient nurses.<\/p>\n

I’ve thanked them before<\/a> for this. But May 6-12 is National Nurses Week<\/a> — an excellent reminder to be grateful again for what they are doing in this very challenging time.<\/p>\n","protected":false},"excerpt":{"rendered":"

Anyone who does inpatient medicine or surgery knows well the major imbalance in time spent on direct patient care between doctors and nurses. Nurses spend way more time actually with patients than we do — I’m referring to time in the rooms caring for patients. While we round and review charts, document lab test results, […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,5,8],"tags":[],"class_list":["post-9658","post","type-post","status-publish","format-standard","hentry","category-health-care","category-infectious-diseases","category-patient-care"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/9658","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=9658"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/9658\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=9658"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=9658"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=9658"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}