COVID-19 drive-thru testing centers are often staffed by RNs whose normal jobs have been interrupted by the pandemic.
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Melissa Bacon, RN[/caption] Melissa Bacon, BSN, RN, CNOR, recalls how when one door closed during the COVID-19 crisis, another opened. As the doors at the Cleveland Clinic's Twinsburg Family Health and Surgery Center, in Twinsburg, Ohio, temporarily closed during the pandemic, Bacon accepted the task to run Cleveland Clinic's COVID-19 drive-thru testing site in a parking garage of the main campus. "As many healthcare systems, we had to adapt to this new world of COVID-19, so many of the employees have been deployed to other places to support the needs of our COVID-19 patients," Bacon, nurse manager of the surgery center, said. Kadie Randel, BSN, RN, nursing manager for Primary Care Pediatrics at St. Luke's Children's Hospital in Boise, Idaho, was in a similar situation. In mid-March, Randel stepped in as lead RN for one of four COVID-19 testing tents the health system has in Idaho.
What's the job like?
The testing center leadership team of nursing managers at St. Luke's begin their days helping set up the tents with needed supplies and required personal protective equipment. Nurses, nursing assistants and patient specialists who register patients work at each of the tents.
The day starts with a morning safety huddle, during which a nurse educator talks through donning and doffing PPE and safety strategies throughout the day, according to Randel.
"They make sure our swabbers, which have been LPNs and medical assistants, are signed off on their competency before doing the swabs," Randel said. "I usually run the nurses who are doing the screenings through an orientation of the materials. As we all know with COVID-19, it has been very fluid. CDC regulations have changed testing criteria. Part of our responsibility as the nurse leaders for the tent is making sure we are up to date with any changes that may have occurred the night before." Bacon oversees about 40 people at her testing site. Nurses, including assistant nurse managers and charge nurses, make up part of the staff. Medical assistants make up about 75% of the team. The training for roles in testing centers doesn't take long but it's vital for safety. Staff from nursing education, infection prevention and quality lend their support to Cleveland Clinic's COVID-19 drive-thru testing site, teaching nurses and other staff about proper donning and doffing of PPE, what PPE is needed for each testing site patient care role, as well as proper swabbing technique, according to Bacon.
Not your typical nursing role
Randel and her staff have worked outside challenges like snow, rain and strong winds. "We did have to close Easter weekend because we had 24-mile-an-hour winds," she said. "And of course we'll close for lightening, but otherwise we're staying open. We're in the Rocky Mountains. It can be gorgeous and 75 degrees one day and 40 degrees the next." The type of care nurses can provide at make-shift testing sites is different than what they would do in the clinic or hospital, Randel said. Nurses are used to putting their hands on patients for comfort but are unable to at the St. Luke's tents for safety reasons, Randel said.
"I think that feels weird to people," she said. "They get used to it. People are staying in their vehicles and so positioning can be challenging. Especially pediatric patients can be challenging. We just try to maintain safety for the people who are doing the swabbing. They are the most at risk because they're potentially going to be receiving a cough or sneeze in their face. So, they have all sorts of protective equipment on -- face shields, masks, gowns, gloves and hair covers. They are well protected."
Lessons learned
Test result turnaround at the St. Luke's testing sites is faster now that the health system processes the tests in-house, versus outsourcing the lab work, according to Randel. Nurses do not make follow-up calls with results, Randel said. Rather, patients can access their medical records with an online patient chart system. "We register everyone with a MyChart account, whether they are a St. Luke's patient or a patient of another health system," Randel said. "If it's a negative, they receive a MyChart notice. If they're positive, they will be called by a provider. Patients' primary care physicians get the results, if they have a primary care physician established." Adaptability is key for a successful COVID-19 drive-thru testing site, according to Bacon. Testing criteria and supplies have been changing since these sites have opened nationwide. And Cleveland Clinic continues to evolve how it uses the testing site. For example, the health system is starting to test its pre-surgical patients as more surgical patients come into the system. "That will continue to evolve as things open up in healthcare, as we starting trying to do the elective surgery," Bacon said. "I think the biggest lesson learned is you have to be adaptable and look at the situation and see how we can best serve our patients and caregivers."
A gratifying experience for these nurses
Staff turnout from all areas of the hospital that have a low census has been incredible, Randel said. "People have been very willing to step up and learn and to take on this challenging situation," she said. She also feels safe doing the work. "I'm a breast cancer survivor -- that was a few years ago and my health is fine and my immune system is fine," Randel said. "I say, 'I feel safer under the tent than I do going to the grocery store.' We're covered in protective gear. We're outside in the fresh air, even if it's windy and rainy. Our infection prevention team has looked through our processing and said we're doing a great job. We had a military nurse who rotated through, and she said she was very impressed with our setup. She felt like it was something she might have seen set up in a military base." Bacon, who still is the manager of the Twinsburg ambulatory surgery center, said her assistant nurse manager is taking the lead for now to ready the ambulatory center for a possible opening in the coming weeks. In the meantime, Bacon doesn't know how long she'll be needed at the testing site.
"To watch the nursing assistants, to watch the nurses, to watch our registration people provide quality, compassionate, empathetic care to our patients no matter what our healthcare setting has been just awe-inspiring to me," she said. "I think that truly shows what healthcare is right now. We have everything we need to safely take care of our patients here, but we do not forget that personal aspect."
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