Kristen Renner helped prepare for the H1N1 and Ebola outbreaks, but neither compares to the coronavirus pandemic. Nevertheless, the intensive care unit clinical supervisor at CHI St. Alexius Health in Bismarck says the goal is the same it has always been.
"No matter what type of patient we care for, we are here for our patients and we will do our best to make them better, to see them walk out of our unit," said Renner, who has a 26-year career in health care.
Sixty-two people have been hospitalized in North Dakota for COVID-19, the disease caused by the new coronavirus. Twenty-three patients remained hospitalized on Wednesday, per North Dakota's Department of Health. More than 670 people in the state have been confirmed positive for COVID-19, 229 of whom have recovered. North Dakota has about 21,000 nursing licensing registrants, said State Board of Nursing Executive Director Stacey Pfenning, including 400 certified registered nurse anesthetists who can run ventilators. The state is "positioned very well" from a nursing standpoint, she said -- from getting new graduates started working to easing licensure for former and out-of-state nurses to work.
"I just have seen so much interest in nurses wanting to help," Pfenning said.
Nurses in Bismarck say their efforts have involved teamwork in caring for COVID-19 patients and also high-level safety, from wearing personal protective equipment and changing clothes to keeping safe environments in COVID-19 units. Amanda Ketterling, 27, joined Sanford Health in Bismarck 10 years ago as a certified nursing assistant. She's been a nurse for about four years, initially drawn to the field after seeing how health workers cared for her grandfather and family when he died, and from a desire to help people.
She's been a charge nurse, or head nurse on a shift, in Sanford's 24-bed COVID-19 unit, which is served by about 30 nurses on staff rotating on 12-hour shifts. Various health care specialists, such as an intensivist and pulmonologist, also care for patients, who have separate rooms. Cameras help monitor patients. Caring for the patients involves reassurance and working together, according to Ketterling. Patients can be scared or uncertain of their prognosis, but the hardest part is being without family, she said.
"(Family) is usually what gives them comfort," she said.
Patients are able to call family on the telephone and use iPads for video calls. Nurses provide regular updates to family members, as well. Intensive care unit nurse Jess Kurtz helped take on CHI St. Alexius' first hospitalized case, "happily," she said. Some other nurses are pregnant or have conditions such as asthma, and she wanted to step up. She wears a respirator, gown, gloves and goggles in CHI St. Alexius' COVID-19 unit, which replaced the regular, 15-bed ICU, which is now in another area for other intensive care patients. Ketterling wears essentially the same gear.
Both hospitals' units have negative pressure, which prevents potentially contaminated air from leaving the unit.
"It's been not necessarily a struggle, but it's been a lot of time to make sure that we're keeping our patients safe, and running two ICUs has taken a whole team to make this work," Renner said.
Thirty-four ICU nurses have helped in CHI St. Alexius' COVID-19 unit. There have been success stories, Renner and Kurtz said: beginning treatments of convalescent plasma transfusions and seeing patients discharged. Kurtz expected a few more to go home soon. But the recovery continues after hospitalization, such as quarantining, using oxygen and maintaining good hygiene, and watching for worsening conditions, she said. And there is the nurses' own safety, too, such as changing out of clothes and showering when arriving home.
Kurtz, 29, said she has worried about potentially bringing the virus home to her fiance. She no longer visits her family in Devils Lake. To unwind from her 13-hour shifts, she watches an episode of "Outlander" or a show on Netflix and enjoys a glass of wine and the company of her dog, Ajax, or takes a long nap. Ketterling likes to walk her dogs, Curls the Labradoodle and Mesa the Morkie.
Exercise has been Renner's "go-to" relief, as well as getting outside in the warmer weather. Though the times are stressful amid the unprecedented pandemic, Kurtz said she rolls with the punches.
"I just try to stay on the positive side of life here because otherwise you only can see so much negativity everywhere else, it's just going to take you down with it," she said.
Ketterling said the pandemic has been challenging, making her more reliant on her skills.
"It's making you do much research and keeping you on your toes because you want to learn about it, you want to cure these people, you want to help them (feel better), because it's not just the elderly, it's not just the sick people, it's healthy people who are living their normal lives," she said.
Renner said she intends to "forge ahead," that "strength is going to get us through this."
The nurses each said the public can take several steps to mitigate the spread, especially hand washing and social distancing.
"I don't think this is over anytime soon, and I don't think people understand the severity of this disease," Kurtz said. "I've seen people walk in and they have the ventilator tube in within the next couple hours because they just (worsened) so quickly.
Jack Dura Reporting
The Bismarck Tribune