Editor’s note: The health sciences librarians and healthcare professionals we work with are responding to the COVID-19 pandemic in unique ways. We are honored to bring you their accounts of what those efforts look like. This month, we share with you the clinical adaptations and challenges of Tracey Wiese and Rachel Simmons, advanced practice registered nurses working on the front lines.

Tracey Wiese, DNP, FNP-BC, PMHNP-BC
Owner/Medical Director
Full Spectrum Health, LLC
www.fullspectrumhealthak.com

As a provider who is also the owner of a clinic, the hardest part of the pandemic has been maintaining stamina to recreate patient flow and to add four telemedicine portals. Changes require resources, time, and money. Supporting vulnerable, complex patients while also managing a clinic – including training and supporting staff, working with patients, and ensuring billing and coding is accurate – has been tough. This is a very difficult time for health providers.

Rachel Simmons, PhD (candidate), DNP, MSN, RN
Clinical credentials: WHNP-BC, ANP-BC, IBCLC, MSN
Southwest Orlando Family Medicine

Providing clinical care as an advanced practice registered nurse (APRN) during the COVID-19 pandemic has been physically, psychologically, and socially demanding. With COVID-19 as the imminent risk for all patients, my care has been augmented as I consider varied clinical presentations, screening and diagnostic methods, education, treatment, management, health promotion, and risk factors for patients and the community vastly different from the pre-COVID-19 era. Further, I must consider the variables of age, race, and economic status that contribute to the severity of pathology for COVID-19 in the individual’s clinical experience. There is a great deal of heterogeneity in the clinical presentation of individuals in the COVID-19 era.

Providing care for patients aged 65 and older and those with comorbidities such as diabetes, hypertension, kidney disease, and depression has been especially challenging. I spend extra time helping these persons reach optimal health and utilize telehealth as a safe and viable alternative in lieu of in-person visits when applicable. Many elderly patients in my practice are not comfortable with technology; therefore, I seek creative ways to engage and remain personable, including active listening, empathy, and maintaining dignity, especially when they are insecure about technology. I end each face-to-face or virtual visit with mitigation strategies for COVID-19, such as staying at home, wearing masks when out in public, and handwashing, due to elevated risks in the elderly.

As an African American provider with many clients from this ethnicity, I have a heightened awareness of the need to control comorbidities during this pandemic. This population has additional challenges surrounding access, quality, and timeliness of care, which are essential for optimal health. My lived experiences with this group, including more than a decade of service to underserved and uninsured minority populations, have given me the authenticity and credibility to provide COVID-19 care and education. The health education I provide during a clinical visit is an essential element of my care and the best way to effect positive change in the COVID-19 era.