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From the frontlines
Nurses feel prepared for ‘the storm,’ predict long-term change
nurses feature
The pandemic is changing nursing and bringing nurses together at Monroe Clinic. From left to right: Melva Johnson, Ashley Alexander, Jeni Killeen, Michelle Knell, Susanna Sigafus, Beth Martz and Jodi Kaiser. - photo by Brenda Steurer

MONROE — One thing is clear to Michelle Knell, a nurse in the intensive care unit at Monroe Clinic & Hospital.

“We’re never going to go back to what we were,” she said in a phone call on her way home from a 12-hour shift on a recent Thursday night.

As partisan politics rage around the coronavirus pandemic and Wisconsin navigates reopening from safer-at-home orders, health care workers like Knell are at the frontlines.

Green County has seen relatively few confirmed cases of the new viral respiratory disease COVID-19, which has no vaccine or cure, but the virus has sickened some enough to be hospitalized. The disease can ravage a patient’s lungs and cause such significant oxygen needs that “it’s scary,” Knell said.

Since March, Knell and other nurses at Monroe Clinic have adjusted to heightened safety precautions like mandatory masks and respirators. They’re interacting with patients in new ways that are both emotionally taxing and rewarding. They’re adapting to near daily protocol updates as scientists and doctors learn more about COVID-19.

It’s transforming the way they do their jobs. And it’s life-changing.

“It’s a hard time for all of us, but it’s also one of the most powerful things I’ve ever been part of,” Knell said.

It’s a hard time for all of us, but it’s also one of the most powerful things I’ve ever been part of.
Michelle Knell, Monroe Clinic & Hospital ICU nurse

In interviews, Monroe Clinic nurses described a fierce dedication to each other and their patients, praise for their managers and gratitude for the community.

They’re also worried about increased viral spread as safer-at-home rules become optional. The Wisconsin Supreme Court blocked statewide safer-at-home orders May 13.

Green County adopted a local safer-at-home health order the following day, to last until May 26, then lifted it May 18. Public Health Director RoAnn Warden cautioned that “while the order has been lifted, the virus is still here. Numbers locally and in Wisconsin continue to grow.”

So far, Monroe Clinic has not seen the surge in COVID-19 patients that overwhelmed hospitals in other parts of the country, but as confirmed deaths nationwide from the virus approach 90,000 as of May 18, epidemiologists predict the pandemic will persist into 2022. This could look like small waves of outbreaks, a monster wave that hits this fall or a “slow burn” of debilitating regional outbreaks.

“I wish we had a crystal ball to look into to see what this fall is going to look like,” said Beth Martz, an in-patient nurse for seven years. No one knows, “and that’s the scary part.”

Melva Johnson, also an in-patient nurse, is bracing for a wave of cases locally as people become more relaxed about social distancing and staying home, especially on the heels of Memorial Day weekend.

“We know it’s coming, but how soon it will be here is another story. So we’re preparing for the storm,” Johnson said.

Martz said, “I know people need to get out and get working. I just hope people are careful.”

Whatever happens, Martz and others agree Monroe Clinic is prepared.

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Michelle Knell hugs her children, Zachary and Lillian, as she leaves for work early Saturday morning, May 16. - photo by Brenda Steurer

“Oh gosh yeah, we’re as prepared as you can be,” she said. “I think we’ve got the whole package here: the respiratory therapists, the hospitalists, everybody from social workers to cleaning crew ... We’re all in this together. It’s a really great place to work.”

Monroe Clinic has been lucky enough to receive limited supplies of convalescent plasma and the anti-viral drug remdesivir to treat COVID-19, Knell said. The Food and Drug Administration issued approval May 1 for emergency use of remdesivir to treat severely ill COVID-19 patients, after a federal trial showed it had potential. Convalescent plasma contains antibodies from people who’ve had COVID-19 but are fully recovered.

Both treatments are considered “investigational products” but are showing promise in speeding recovery and lessoning the severity of symptoms, Knell said.

That’s exciting for her.

“We might just be a rural hospital but I feel like we’re expanding,” she said. “Because we are able to have access to these groundbreaking medications that are potentially treating this unknown disease, Monroe Clinic can treat people just like (bigger hospitals in Madison).”

Change, for better and worse

Knell’s life looks much different now than it did in February. Her children, ages 5 and 6, used to have a playroom. Now, with schools closed, it’s their makeshift school room.

Her husband, Zach Knell, who works in IT at Monroe Clinic, was put on furlough for up to 13 weeks beginning May 4.

He’s one of about 2,000 SSM Health employees, roughly 5% of the workforce, being furloughed across the organization’s four-state network. Postponement of elective procedures, a measure taken to prepare for a surge of COVID-19 patients, has slashed the revenues of many hospitals. Slowly, though, those services are returning. Monroe Clinic announced May 18 it will “cautiously and slowly resume some services that had been stopped as a precaution against COVID-19.”

It’s not to be saying that I am sick. It’s ‘I’m protecting me and I’m protecting you.’
Melva Johnson, in-patient nurse on wearing a mask in public

“No one wants to be on unemployment. He’s never been on unemployment before,” Michelle Knell said. Her husband is using vacation time first before drawing on payments, and he could be brought back to work anytime.

The uncertainty is unnerving, but “he’s busy with the kids and he has a ‘honey do’ list,” she said.

The Knell family has settled into a new, slower routine. Spending more time outdoors. Taking the dogs for walks. Planting a garden. Trying to buy from local businesses whenever possible.

Out in public, Knell sees changes that will be long-lasting if not permanent, like the prevalence of hand sanitizer dispensers and increased hand-washing. It wouldn’t surprise her if the plexiglass shields in stores never come down.

Wearing masks, at least while the pandemic is still present and especially during flu season, is also “going to be our new normal.” She wears a mask in public, viewing it as a professional responsibility and sign of respect.

Johnson said she would also be wearing a mask more in public.

“It’s not to be saying that I am sick. It’s ‘I’m protecting me and I’m protecting you,’” she said.

One of the toughest aspects of the pandemic at hospitals nationwide, including at Monroe Clinic, has been the restrictions on visitation. It’s a precaution to protect patients and prevent spread of the coronavirus but it also means patients can’t see family and friends in person.

“I just had a patient the other day — she got a terminal diagnosis and she had nobody there with her,” said Mariah Dach, an in-patient nurse at Monroe Clinic for two years. “This is one of our big hardships right now in the hospital.”

Monroe Clinic has iPads for patients to use for virtual visits, and nurses coordinate phone calls to connect patients with their loved ones and to answer family questions.

The visitation restriction has increased nurse-patient interactions, however. That could be a lasting change, beyond the pandemic.

There’s more “sitting and talking with the patients,” Johnson said. “We get to know them and they get to know more about us. We find out there’s a lot of unique people in this area. People have a lot of special talents that you wouldn’t necessarily see on the surface.”

Going forward, “I think we’ll probably see more interactions with patients. I think it will be built into our routine,” said Johnson, who’s been a nurse at Monroe Clinic for over three decades. “We’re slowing down, we’re taking that time. It’s not such a rush.” 

‘Brought all of us together’

Through it all, Monroe Clinic nurses have been looking out for one another, emotionally and practically.

“We’re all just checking in with each other throughout the day, even when we’re not working,” Johnson said. After work, “we’ll decompress out in the parking lot.”

“We all have this mutual understanding of our situation, of our struggle,” said Knell. “It’s really brought all of us together.”

Martz started making dozens of cloth extenders with buttons to ease the strain of wearing a surgical mask for 12-plus hours in a day. The mask’s ear loops get wrapped around the buttons instead.

Dach said early on “people were having some trouble with the backs of their ears being raw from masks,” so she enlisted the sewing skills of her grandma, Jody Carlson of Winnebago, Illinois, to make similar ear-saving headbands for the staff.

Dach also helped coordinate six “thank you” baskets for the nurse managers, filled with goodies from local stores and quilts that Martz made.

“Last week we set them up in the lobby and surprised all the managers. There were tears,” Dach said. Not only have the managers “supported us since the beginning,” they spend countless hours in meetings learning the latest coronavirus developments and then pass it on.

“Pretty much every time I come into work I learn something new about (the virus),” Dach said.

The support from the community, too — like delivered meals and heart shapes in windows — has been “just unreal,” Knell said.

One day Martz came home from a 12-hour shift to find a colorful sign taped to her dining room window: “Stay positive!” It looked like a child had drawn it, but she never did find out who.

Martz said she hopes this kind of community kindness and resourcefulness continues.

As Knell observes the political anger the pandemic is causing, she cautioned against rushing to judgment: “You never know what someone is going through.”

One thing she wants to stay the same is her job. Knell has been at Monroe Clinic for seven years and is pursuing a master’s degree to become an acute care nurse practitioner at the hospital.

“I thought being a nurse was selfless before, and now it’s just taken to a whole new level. It’s pretty neat. It’s stressful, don’t get me wrong, but I wouldn’t change it.”