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Roswell Park ICU members prepare for COVID, support each other during uncertain times

By KATE MOSTACCIO

While some public and private hospitals open to the general public were flooded with overwhelming numbers of COVID cases, Roswell Park Comprehensive Cancer Center hit the ground running to prepare staff and create policies in the event the virus came to them.

Shiloh Bromstead, clinical nurse manager of the ICU at Roswell Park

Shiloh Bromstead, the clinical nurse manager of the ICU at Roswell Park, said most of their patients are immuno-compromised – a population particularly susceptible to COVID and its devastating complications.

Thankfully, the hospital did not see a surge.

“Because we don’t have an emergency room, we haven’ t been hit like general hospitals,” Bromstead said. “Some of our patients have had COVID-19. We’d had more than a handful in the ICU. Two were on a ventilator, and we really didn’t think either would make it. Both ended up pulling through and were discharged.

“We are thankful we haven’t been hit like the general hospitals,” she said. “It’s been difficult because it’s a total change. There was a lot of fear in the beginning. But once our nurses realized we had the supplies we need and they would be taken care of, it was better.”

A lot of work went into COVID response planning. ICU nurses, who are trained to work with ventilators, certain cardiac medications, and continuous monitoring, skills that would be vital to treat COVID patients, began training other nurses.

“We did have a plan if we were to have a surge,” Bromstead said. “I worked a lot on it with the step-down nurse manager. We had nurses from other floors do a little bit of training. We brought OR and recovery nurses up to the ICU to up-train. Every single day the ICU nurses were training somebody. Sometimes that can get overwhelming, as they had to take on the extra responsibility of training.”

Because Roswell Park didn’t have enough patients with COVID-19 to merit designation of a COVID-only ward, other changes in response to COVID-positive patients were necessary.

“We can change up assignments if a patient is COVID-negative or COVID-positive,” Bromstead said. “You have to have a designated nurse for those COVID patients. We didn’t have enough to have a designated unit.”

The hospital activated its incident command team and created new procedures.

“A lot of new policies were coming out, we had to keep checking emails and internal websites,” Bromstead said. “We were preparing for the surge we expected and didn’t get. We knew there was no way with current staffing we could accommodate a surge.

“We were going to go to a team nursing approach,” she said. “Right now it is a primary nurse approach. If we switched, you’d have teams of three people and they would have four to six patients.”

The teams would include critical care and floor nurses, covering the gamut of possible skills needed to treat the patients.

While the plan may not have been needed since there wasn’t a surge, it’s now prepared and ready to be used if needed.

Alexa English

“It’s great that we do have it now, if anything happens in the future we can just go right to it,” Bromstead said.

For much of the last few months, visitors were generally not able to be with inpatients at Roswell Park. It was a difficult time for the nurses, their patients and patients’ loved ones.

“We do make exceptions for end of life,” Bromstead said. “It was really hard for the staff, especially since they know how hard it is for the patients. It gives them an emotional connection to the patients because they are the ones there now providing the emotional support.

“We received a donation of iPads through our COVID-19 Response Fund that allowed families to have virtual meetings and conversations,” she said. “And a lot of nurses pulled out personal phones if the patients didn’t have a cell phone themselves, to let them Facetime with family.”

Bromstead said things have eased a bit since Governor Cuomo and the New York State Department of Health designated the cancer center as one of the sites for a statewide visitation trial.

“We have started the trial where we are allowing limited inpatient visitation,” she said. “Patients can designate only two people, one person per day, who can visit for a two-hour period.”

Therese Kurtz

Bromstead has been with the hospital for 20 years, working her way up from floor nurse to ICU nurse manager.

“I learned I really wanted to do critical care,” she said. “I worked on the floor for almost two years, then got a job in the ICU.”

When the critical care nurse manager in the ICU was retiring, Bromstead was in school finishing her bachelor’s degree.

“They didn’t have anyone to fill her position and they wanted a temp person,” she recalled. “Never in a million years did I think I would like management. But I did.”

After finishing her degree, she applied for the position and got it.

Throughout the changes brought on by COVID, nurses have stepped up to challenges, at every turn.

“The nurses have been absolutely great. They just get right in there,” she said. “They know there is a patient in there that needs them.”

Because COVID brought with it so much uncertainty and fear, nurses working together was vital.

“The support that the nurses have for each other is extremely important because this is such a scary time,” Bromstead said. “Nobody was prepared for this and nobody could see this coming. If it hadn’t been us all supporting each other, I think I would have lost a couple nurses along the way — going out on leave or not being able to do it.”

To brighten up their days, as well as the days of their patients’ families, Bromstead said Roswell Park’s ICU has been decked out with rainbows.

“Rainbows are a sign of hope and healing,” she said.

What started as one nurse bringing in rainbow colorings from her kids turned into a much larger campaign.

“Now they’ve made it a challenge to do something even more,” she said. “We are getting each other involved and supporting each other. And the families really love it. They really liked the fact that it had a meaning behind it.”