Rebecca Hendren, for HealthLeaders Media, September 13, 2011
Nurses at NYU-Langone Medical Center didn't bat an eyelid when Hurricane Irene started barreling toward the northeast last month. The hospital is just steps away from New York's East River and Mayor Bloomberg ordered the hospital to evacuate, along with four others in harm's way.
NYU-Langone refused to move six of its ICU patients, warning they were so desperately ill that moving them threatened their lives. The ICU's nurses eagerly volunteered to stay with their patients through whatever the storm may bring.
After receiving permission for the six patients to remain, Elaine Rowinski, RN, MPS, CCRN, CEN, nurse manager of the medical ICU, found she had no shortage of staff volunteering to stay and care for them.
"Every day we're faced with life and death. Every day my staff are heroes," says Rowinski. "Maybe because we're New Yorkers, we're very resilient. Also we're critical care people. This was nothing unique. Just what they're faced with and you deal with it. I'm very lucky."
The preparations began on Friday, two days before the hurricane was expected to hit. The 18-bed medical ICU immediately made plans to transfer its patients to other hospitals. Transferring critically ill patients is extremely complicated and the staff had to complete a large number in a short time, but they made discharges and handoff transitions smoothly and successfully.
Due to the critical nature of their illnesses, many of the patients had to be accompanied in the ambulance by ICU nurses to ensure they did not crash during transfer. Rowinski says many patients and families didn't want to leave.
"It's a tribute to the medical and nursing care they get here," says Rowinski. "Some patients are with us for a while and they've been very sick for a long period of time. They develop relationships with physicians, nurses, and other members of the healthcare team. They have a comfort level and sending them out would change their comfort level."
Rowinski says the hospital practices patient- and family-centered care. Visiting hours are 24/7 and families are made to feel welcome. When families call for updates on their relatives, they don't have to call the switchboard, they simply dial their family members' nurse's line and speak to him or her directly.
"They talk to nurses constantly," says Rowinski about patient's families. "There's a relationship between families and the healthcare team."
The nurses worked to keep patients and their families informed and Rowinski made rounds to explain what would happen. As the hurricane neared, the staff made preparations in case they were cut off. They collected three days worth of medications for each patient and stocked each room with items such as flashlights and ambu bags.
Mass transit was due to be suspended at noon on Saturday and so nurses brought bags and prepared to stay at the hospital for an extended period of time.
"On Saturday morning, I had full complement of nurses," says Rowinski. "My whole unit was staffed, everyone came in for their normal shift. I had people who came in 18 hours before their shift so they would be here."
Christine King is a senior staff nurse on the medical ICU who was originally scheduled to work the weekend. After the evacuation notice decreased the need for as many nurses, she was told she didn't need to come in. Instead, she volunteered to stay the entire weekend to care for the handful of patients in the ICU.
"It was important for me to be here because our patients deserve the same quality of care even when times are difficult," says King. "Throughout the weekend the team of nurses and staff reassured patients they would continue to be cared for and were very supportive of the patients and their families who stayed with them. It was a blessing to be here and I would do it all over again."
Rowinski credits the hospital's disaster planning for the smoothness of the experience.
"In every hospital, you have tests and drills. We say sometimes they are stupid to do, but they really do prepare you for things like this," she says.
For example, the hospital's checklist included a provision to check whether patients were on dialysis. A few of the patients who were staying did need dialysis, so they provided the treatment on Friday in case they could not do it after the hurricane.
"It sparked ideas in our minds to get special therapies done early in case we couldn't do it afterwards," says Rowinski. "Teamwork makes all this work. Everyone talking to each other and listening to each other makes it work."
The blood bank made sure the ICU had the blood it needed and respiratory therapists stayed on the unit around the clock. In the end, the hospital evaded any major damage and everything was back to normal within a few days.
The experience has brought the unit closer together.
"I'm very fortunate to have them," Rowinski says of her dedicated nurses. "Everything ran very smoothly. There was a camaraderie we got from working through it together."