The news reports during the week of October 3, 2016, stated that Hurricane Matthew, which had just caused widespread destruction in the Caribbean, was moving up the coast and was headed straight toward the state of Florida, where I was employed as a nurse navigator for a large, multihospital system in Jacksonville.
Headed Our Way
As a member of the multihospital system’s Early Response Team (ERT), our focus was to coordinate care for all patients for the following time frame: approximately 24 hours before the storm hit, and throughout the duration of Matthew’s devastation, until the next group of post- hurricane staff could make it to the hospital. We had to be staffed and ready for the worst-case scenario in case any of our structures collapsed (which of course would cause an even greater strain on our resources).
In the days prior to the storm smashing into our area, I tried to remain calm as I remembered nurse co-workers who bravely cared for victims during Katrina’s catastrophic destruction. Their stories and videos played in my head, again and again. I prayed that this would not be as bad as I imagined it could be. I listened fervently to the weather report from one hour to the next, hoping for the storm to veer to the east and weaken, but that did not happen.
First, Personal Preparations
Before attending to my duties at work, I first had to prepare my own home and secure a place for my family to be safe (which was on the west coast of Florida). Family members of staff were not allowed to stay at the hospital-no exceptions. It was particularly difficult to say “good-bye” to my daughter, because I did not know when I would see her again.
Once I knew she was on her way to safety, I could focus on what I needed to survive in the next few days. I also had to think about the very real possibility that I could lose my house in this storm. I asked myself, “What would I really miss if I didn’t have it anymore?” and “What will I need in the next few days if there is no electricity and massive flooding?”
This is what I ended up packing:
• Licenses, certification documents, passport, birth certificate (for identification);
• Credit cards, health care cards, cash (the means to obtain care and supplies);
• Water, energy and protein bars, and tuna (nutrition without cooking);
• A week’s worth of clothing and all personal medications;
• Air mattress with electric pump (note: must inflate air mattress before losing electricity; or need a manual pump);
• Sheets for air mattress, blankets, 2 pillows and towels;
• Cleaning wipes and paper products, such as paper towels, disposable cups and plastic ware (means to eat and clean up if there is no water to wash dishes);
• Flashlights, batteries, candles, lighters and matches (in case of power outage); and
• Pre-charged cell phone and computer with extra external chargers (in case of power outage).
Yes, I packed a lot of things; but I felt confident that I was ready for whatever was going to happen.
Discharging Some, Accepting Others
Meanwhile, back at my healthcare facility, it was approximately 18 hours prior to the activation of the ERT. Administrators had met with community emergency personnel to coordinate the evacuation of all patients currently residing in hospitals in South Georgia and on the Florida coastline. It was determined that patients would be transported via ambulances (sometimes 2 to a vehicle if there was no isolation concerns) to hospitals located 15 miles inland.
Other staff members at the facility were busy ordering extra food and linens, so these things would be readily available. My focus was on facilitating the discharge of any appropriate inpatients, and ensuring a smooth transition of their care.
Within our hospital system, nurses from other facilities escorted patients to our organization, and then stayed the night, working 7 p.m. to 7 a.m., until the ERT arrived. One family member was allowed to stay with each patient. Many surgeons, medical doctors, and anesthesiologists also elected to stay for a couple of nights (to be there in case of an emergency).
Some hard-copy medical information arrived with some of the patients (who were relocating from non-EMR hospitals). Within our hospital system, the patient record can be accessed using the “downtime computer,” which provides 24-hour accessibility to patient information.
Elective surgeries and procedures were postponed indefinitely; and I was told that several obstetrical patients’ labors were “facilitated,” to prevent having them give birth with potentially suboptimal delivery conditions during the height of the storm.
Nursing Care Never Flickered
Staffing on each of our nursing units was excellent during this time, as we tried to reassure patients and their family members (and each other!) that we were all ready to weather the storm. A few hours before the brunt of the storm, the lights kept flickering and I thought, “This is it.” I grabbed my flashlight in case the emergency generators did not turn on.
Throughout the next 8 hours, I am proud to report that nursing care didn’t flicker like the lights did. Everyone did their best to carry on with the normal business of the day, hoping and trusting that our structure would not be put to the ultimate test. Meals and medications were delivered to patients on time; blood pressures were checked; and we responded to patients’ questions and requests. We did what we normally do in the hospital.
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The staff worked better as a team during this stressful, trying time than I have ever seen. We worked with staff members who we had never met before, and made new friends. The stress of the situation brought us closer together, as we talked about personal matters that we probably never would have shared otherwise.
We were provided meals by the hospital, and we slept wherever we could-in offices and in nursing units that were no longer used as such. We used ear plugs and fans (“white noise”) to try to drown out the ever-present alarms that we usually have to answer. Our sleep was brief and often interrupted for two nights in a row-these were times that would not be forgotten!
Immediately after the storm, we wondered how long it would be until the roads and bridges reopened-not only for ourselves (we were all eager to get back to our homes to assess the damage), but also for these patients, who all needed to get to their ultimate destinations. Many patients did not have a safe way to get home. Nursing homes, skilled nurse facilities, and rehabilitation facilities were not admitting patients, and of course, home health services could not be arranged. So many people were in a holding pattern.
Then the beautiful Florida sun rose, the recovery shift arrived at 0700 hours, and members of the ERT were finally released. Though there were many leaks and drips in our medical facility, nothing serious happened. We have memories of minor inconveniences, lots of singing, and some stress-relieving laughter.
As I reflect on these events, I realize that my focus shifted several times throughout Hurricane Matthew, and these sequential steps are what helped me the most as I navigated my way through this stressful time. Before the storm, I was concerned first and foremost about my family. Then, I focused on what I had to do to prepare myself. After I felt prepared, I could engage my full attention to my duties as a member of the ERT: taking care of our patients and their family members.
During the actual storm, I got to experience the unintentional, but flourishing, feelings of strength and unity as we worked together as a nursing team. Never have I experienced such a sense of coming together and working as one to meet a common goal. Truly, this was an unforgettable nursing experience.
Victoria S. Cate wrote this when she was working as a nurse navigator for a large, multihospital system in Jacksonville, Fla. She is also a doctor of nursing practice student at the University of North Florida Brooks College of Health School of Nursing.