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04/01/2020 08:30 AMWhen Caroline Mullaney, administrator of the Westbrook Visiting Nurses and Public Health (generally referred to around town as the VNA), heard about the coronavirus, she began preparations. That was in early February.
“We were able to do some strategic planning and realize that we may be getting these patients in the homecare setting,” Carol says. “We wanted our nurses to be protected when they made those visits.”
The VNA, once the public health department for Westbrook, these days works closely with the town’s full-time health director and provides public-health programs to the public. Nurses are able to pay visits to Westbrook residents “as much as once a month just to see how they’re doing, how they’re managing, if we think they’re high risk,” Carol explains.
The VNA also provides home care services when cases are referred by a doctor. It is one of the few remaining municipal home care programs in the state.
The VNA, in other words, is all about caring, in many senses of the word. And it’s caring—for patients and for staff—that led Carol to spring to action in early with the assistance of Cherie Bolduc, the organization’s administrative assistant, and the support of First Selectman Noel Bishop.
The two researched personal protective equipment (PPE) began to place orders well ahead of time. There wasn’t much left in the organization’s budget for equipment, but Bishop told Carol to order what was needed. The result is that the VNA now finds itself in good shape for the task ahead.
“We have lots of gowns, protective eye equipment, lots of gloves,” Carol says. “We found some additional N95 masks,” the sought-after protective masks that shield healthcare workers from airborne particles and liquid.
“We have a good amount of all the equipment and we do have additional hand sanitizer,” she says.
Carol was also able to get many of the VNA’s nurses fit tested for the N95 masks at the Guilford Fire Department, which has one of the few fit testing machines in the area. N95 masks must fit properly in order to be effective. There are two nurses who have not yet been fit tested and she is looking into having them go through the process, as well.
Additionally, nurses have been availing themselves of online training on infection control and emergency preparedness, as well as how to put on PPE and take it off without contaminating themselves. This last skill can be challenging.
“They recommend that you put hand sanitizer on first, put your PPE on, go into the home, and then you take the PPE off once you’ve left the home,” she explains.
The VNA will ask patients to leave a trash can outside for the nurse to dispose of the used PPE. But that might not always happen.
“In that case, [nurses] would have to bring a bag with them to dispose of their used equipment,” she says.
Doing everything possible to protect nurses’ health is “extremely important because there really [aren’t] that many nurses available out there,” Carol says. “So we have to be careful to keep the nurses that we have healthy. They’re kind of vital because if we don’t have the nurses, we can’t take care of the patients.”
Background
Carol, a registered nurse with a bachelor’s degree in science and nursing, has been the VNA administrator since February 2017.
“I wasn’t the type of child that wanted to be a nurse from when I was young,” Carol recalls. “I didn’t realize until I was in high school and started to think about where I wanted to go to college and what I wanted to do.”
Born in Waterford, Carol and her family (she’s the youngest of five children) moved to Salem, New Hampshire, where she spent most of her childhood. They then moved back to Waterford, where she graduated from Waterford High School.
In retrospect, Carol thinks she might have chosen her college partly out of a yearning to go back to New Hampshire. Her sister and two of her three brothers graduated from the University of New Hampshire; Carol ended up at St. Anselm College in Manchester. She married soon after graduating and went to work at the nearby Catholic Medical Center.
From there, she worked at Falmouth Hospital on Cape Cod and then at the University of North Carolina Medical Center. When she and her husband moved back to Connecticut, she worked on the pulmonary floor of Hartford Hospital. She then transitioned into home care.
“One of the things I really liked about home care is that you spend more time with your patient instead of about 10 minutes in the hospital,” she explains. “You spend up to an hour and it’s a lot of teaching.”
With 17 years of home care experience—10 of it with Deep River Visiting Nurses, which closed—Carol was offered the lead role at Westbrook’s VNA.
“I will on occasion see a patient if a nurse is out sick and we don’t have any coverage,” she says. “It’s something that I’ve done for many, many years. I’ve been a hospital nurse and a homecare nurse a lot longer than I’ve been an administrator. So I’m very comfortable seeing patients.”
Westbrook’s Town Hall was closed for a week to allow for a deep cleaning, but Carol remained at work to receive and process referrals from hospitals and doctors. The town’s IT team arranged for faxes to be sent to her email, so she’s now prepared for the possibility of having to work from home.
Unprecedented
It’s almost become a cliché to state that the COVID-19 pandemic is unprecedented in our lifetimes. But while many are feeling out to sea, Carol and other nurses are using their years of training to guide them.
“We do have yearly training as nurses,” she says. “We have the blood-borne pathogens training. We do continuing ed every year regarding infection control, so it is something that we’ve always been mindful of.”
Nurses are also trained to be cautious about bringing equipment in and out of patients’ homes, taking equipment out of a bag, placing it on a barrier, and cleaning it before putting it away.
“So it’s something that we’ve learned on a yearly basis, we brush up on a yearly basis. Infection control has always been a big part of nurses’ training,” she says. “Nurses are out there caring for patients with wounds. Infection control practices are very important. We want to keep the wound clean; we don’t want to contaminate it.”
And considering that around 90 percent of the VNA’s patients are over the age of 60, nurses have had to be extremely cautious about the flu.
“We have to make sure that we use good infection techniques so we don’t spread the flu from one patient to another patient,” she says. “Of course, we haven’t yet had to take it to this level.”
COVID-19 is spread via droplet, Carol explains, and because experts are unsure how far droplets can travel, healthcare providers have to take both droplet and air-borne precautions.
“When we speak, sing, cough, or sneeze, little droplets come out and you can’t always see them,” she says. “That’s where the coronavirus is present, is in those droplets.
“That’s why the social distancing is very important,” she continues. Droplets “don’t travel that far; they may travel three feet. [If you maintain a] six-foot distance, you should not be contracting the coronavirus.”
Carol’s two children are grown and she has a nine-month-old granddaughter she’s used to seeing once or twice a week. Now, she and her family are practicing social distancing and communicating via technology is their temporary substitute.
“I do have one per diem RN who does not want to work presently because she’s taking care of her 95-year-old mother and she does not want to bring anything home to her,” she says. “If someone is a caregiver...for an elderly parent, then they have to be especially careful.”