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The evolution of hospitalist advanced practice providers
Throughout the chaos of the COVID-19 pandemic, advanced practice providers (APPs) – physician assistants (PAs) and nurse practitioners (NPs) – have become an integral component of the hospitalist response. As many physicians began shifting into telemedicine and away from direct patient care, APPs have been eagerly jumping in to fill the gaps. Their work has been changing almost as dramatically and quickly as the pandemic itself, bringing with it expected challenges but bestowing hugely satisfying, often unanticipated, rewards.
APPs on the rise
As the coronavirus pandemic evolves, the role of APPs is evolving right alongside it. With the current relaxation of hospital bylaw restrictions on APPs, their utilization has increased, said Tracy Cardin, ACNP-BC, SFHM, a nurse practitioner and vice president of advanced practice providers at Sound Physicians. “We have not really furloughed any advanced practice providers,” Ms. Cardin said. “In fact, I consider them to be, within hospital medicine, a key lever to finding more cost-effective care delivery models.”
Ms. Cardin said APPs have been working more independently since COVID-19 started, seeing patients on their own and using physician consultation and backup via telemedicine or telephone as needed. With the reduction in elective surgeries and patient volumes at many hospitals, APP-led care also saves money. Because one of the biggest costs is labor, Ms. Cardin said, offering this high-quality care delivery model using APPs in collaboration with physician providers helps defray some of that cost. “We’re hoping that advanced practice providers are really a solution to some of these financial pressures in a lot of different ways,” she said.
“COVID … forced us to expedite conversations about how to maximize caseloads using APPs,” said Alicia Sheffer, AGAC-AGPC NP, a nurse practitioner and Great Lakes regional director of advanced practice providers at Sound Physicians in Cincinnati. Some of those staffing model changes have included using APPs while transitioning ICUs and med-surg units to COVID cohort units, APP-led COVID cohorts, and APP-led ICUs.
“At first the hospital system had ideas about bringing in telemedicine as an alternative to seeing patients, rather than just putting APPs on the front lines and having them go in and see patients,” said Jessica Drane, APRN, PhD, DNP FNP-C, a nurse practitioner and regional director of advanced practice provider services and hospital medicine at Sound Physicians in San Antonio. In Texas at the beginning of the pandemic, hospital numbers were so low that Dr. Drane did not work at all in April. “We were all afraid we were going to lose our jobs,” she said. Then the state got slammed and APPs have been desperately needed.
Ilaria Gadalla, DMSc, PA-C, a PA at Treasure Coast Hospitalists in Port St. Lucie, Fla., and the PA program director at South University, West Palm Beach, Fla., noted that many of her APP colleagues have pivoted fluidly from other specialties to the hospitalist realm as the need for frontline workers has increased. “Hospitalists have shined through this and their value has been recognized even more than previously as a result of COVID-19,” Dr. Gadalla said.
“I don’t think it’s any surprise that hospitalists became a pillar of the COVID pandemic,” said Bridget McGrath, PA-C, a physician assistant and director of the NP/PAs service line for the section of hospital medicine at the University of Chicago. “There are just some innate traits that hospitalists have, such as the ability to be flexible, to problem solve, and to be the solution to the problem.”
Building team camaraderie
Ms. Cardin says that the need for APPs has led to an evolving integration between physicians and APPs. The growing teamwork and bonding between colleagues have been some of the most rewarding aspects of the pandemic for Dr. Gadalla. “We rely even more on each other and there isn’t really a line of, ‘I’m a physician versus an NP or PA or nurse.’ We’re all working together with the same goal,” she said.
Ms. McGrath said she has been learning what it means to lead a team during a challenging time. It has been gratifying for her to watch mentors get down to the bare bones of patient care and see everyone unify, putting aside roles and titles and coming together to care for their patients in innovative ways.
“This pandemic has really opened up a lot of doors for us because up until now, we were used almost like scribes for physicians,” Dr. Drane said. She has seen even the most resistant hospital systems beginning to rely on APPs as the pandemic has progressed. “They have become pleasantly surprised at what an APP can do.”
Work challenges
Obviously, challenges abound. Dr. Gadalla listed hers as visiting restrictions that invariably lead to slower patient visits thanks to obligatory phone calls, constantly fluctuating patient censuses, sporadic elective surgeries, watching colleagues become furloughed, and trying to balance external perceptions with what’s actually happening in the hospital.
Overall, though, “There have been a lot more rewards than barriers,” added Dr. Drane.
One of the biggest obstacles for health care workers navigating a pandemic is balancing work and home life, not to mention having time to unwind while working long hours. “Finding time for my family has been very limited. My kids feel really neglected,” said Dr. Gadalla. Some days, she gets up extra early to exercise to help clear her head, but other times she’s just too exhausted to even move.
Dr. Drane agreed that the work can get overwhelming. “We’re changing the way we practice almost every week, which can make you doubt yourself as an educator, as a practitioner. You constantly feel like you’re not sure what you’re doing, and people trust you to heal them,” she said. “Today is my first day off in 24 days. I only got it off because I said I needed a moment.”
Ms. Sheffer’s crazy days were at the beginning of the pandemic when she had to self-quarantine from her family and was working nonstop. “I would come home and sleep and work and wake up in the middle of the night and double check and triple check and go back to sleep and work, and that consumed me for several months,” she said.
The biggest challenge for Ms. Sheffer has been coping with public fear. “No matter how logical our medical approach has been, I think the constant feeling of the public threat of COVID has had this insidious effect on how patients approach their health,” she said. “We’re spending a lot more time shaping our approach to best address their fears first and not to politicize COVID so we can actually deal with the health issue at hand.”
Complications of COVID
With all the restrictions, caring for patients these days has meant learning to interact with them in different ways that aren’t as personal, Ms. McGrath said. It has been difficult to lose “that humanity of medicine, the usual ways that you interact with your patients that are going through a vulnerable time,” she noted.
Additionally, students in the medical field are being held back from graduation because they cannot participate in direct patient care. This is particularly problematic for PAs and medical students who must touch patients to graduate, Dr. Gadalla said. “All of this is slowing down future providers. We’re going to have trouble catching up. Who’s going to relieve us? That’s a huge problem and no one is finding solutions for that yet,” she said.
At the University of Chicago, Ms. McGrath explained, they created virtual rotations so that PA students could continue to do them at the university. Not only has the experience reminded Ms. McGrath how much she loves being a medical educator and fighting for the education of PA students, but she was surprised to find that her patients came to appreciate the time they spent with her students on the virtual platform as well.
“It’s isolating for patients to be in the hospital in a vulnerable state and with no support system,” she said. “I think being a part of [the PA students’] education gave some meaning to their hospitalization and highlighted that collaboration and connection is a human need.”
Despite everything, there’s a noticeable emphasis on the flowering buds of hope, unity, compassion, and pride that have been quietly blooming from the daily hardships. As Ms. Cardin puts it, “It’s so cliché to say that there’s a crisis. The other word is ‘opportunity,’ and it’s true, there are opportunities here.”
Taking care of each other
Creating resources for providers has been a priority at the University of Chicago, according to Ms. McGrath. “As hospitalists, we’re used to taking care of a variety of patients, but our section leadership and providers on the front lines quickly realized that COVID patients are more akin to trauma patients with their quick changes in health, as well as their isolation, fear, and unexpected deterioration,” she said. Her facility has implemented wellness initiatives to help prevent burnout and mental health problems in COVID providers so they can continue to give the best care to their patients.
Both Ms. Sheffer and Dr. Drane say that they have a peer network of APPs at Sound Physicians to call on for questions and support. And it’s encouraging to know you’re not alone and to keep tabs on how colleagues in other states are doing, Ms. Sheffer noted.
“The peer support system has been helpful,” Dr. Drane said. “This job, right now, takes pieces of you every day. Sometimes it’s so emotional that you can’t put it into words. You just have to cry and get it out so that you can go be with your family.”
Getting back to basics
The changes in patient care have turned into something Ms. McGrath said she appreciates. “This pandemic has really stripped away the extra fluff of medicine and brought us back to the reason why many of us have gotten into the field, because it became about the patients again,” she says. “You quickly learn your strengths and weaknesses as a provider and as a leader, and that flows into the decisions you’re making for your team and for your patients.”
Ms. Sheffer acknowledged that it is difficult to deal with patients’ family members who don’t understand that they can’t visit their sick relatives, but she said the flip side is that frontline workers become surrogate family members, an outcome she considers to be an honor.
“You step into the emotion with the family or with the patient because you’re all they have. That is a beautiful, honorable role, but it’s also tremendously emotional and sometimes devastating,” she said. “But to me, it’s one of the most beautiful things I’ve been able to offer in a time where we don’t even know what to do with COVID.”
Limited resources mixed with a healthy dose of fear can stifle creativity, Dr. Drane said. Right away, she noticed that despite the abundance of incentive spirometers at her hospital, they were not being utilized. She came in 2 hours early for 3 days to pass one out to every patient under investigation or COVID-positive patient and enlisted the help of her chief nursing officer, CEO, and regional medical director to get everyone on board.
Dr. Drane’s out-of-the-box thinking has enabled people to go home without oxygen 2 days earlier and cut the hospital’s length of stay by 5%. “It’s something so small, but it has such a great end reward,” she said. “I’m proud of this project because it didn’t take money; it was getting creative with what we already have.”
Renewed pride and passion
Dr. Drane is intensely proud of being an NP and working on the front lines. She sees that the pandemic has encouraged her and other APPs to expand their horizons.
“For me, it’s made me work to get dual certified,” she said. “APPs can be all-inclusive. I feel like I’m doing what I was meant to do and it’s not just a job anymore.”
Ms. McGrath is even more passionate about being a hospitalist now, as she has realized how valuable their unique skill sets are. “I think other people have also been able to realize that our ability to see the patient as a whole has allowed us to take care of this pandemic, because this disease impacts all organ systems and has a trickle-down effect that we as hospitalists are well versed to manage,” she said.
Ms. Cardin’s work involves communicating with APPs all around the country. Recently she had a phone exchange with an APP who needed to vent.
“She was weeping, and I thought she was going to say, ‘I can’t do this anymore, I need to go home,’ ” said Ms. Cardin. “Instead, she said, ‘I just want to make a difference in one of these people’s lives.’ And that is who the advanced practice providers are. They’re willing to go into those COVID units. They’re willing to be in the front lines. They are dedicated. They’re just intensely inspirational to me.”
The evolution of hospitalist advanced practice providers
The evolution of hospitalist advanced practice providers
Throughout the chaos of the COVID-19 pandemic, advanced practice providers (APPs) – physician assistants (PAs) and nurse practitioners (NPs) – have become an integral component of the hospitalist response. As many physicians began shifting into telemedicine and away from direct patient care, APPs have been eagerly jumping in to fill the gaps. Their work has been changing almost as dramatically and quickly as the pandemic itself, bringing with it expected challenges but bestowing hugely satisfying, often unanticipated, rewards.
APPs on the rise
As the coronavirus pandemic evolves, the role of APPs is evolving right alongside it. With the current relaxation of hospital bylaw restrictions on APPs, their utilization has increased, said Tracy Cardin, ACNP-BC, SFHM, a nurse practitioner and vice president of advanced practice providers at Sound Physicians. “We have not really furloughed any advanced practice providers,” Ms. Cardin said. “In fact, I consider them to be, within hospital medicine, a key lever to finding more cost-effective care delivery models.”
Ms. Cardin said APPs have been working more independently since COVID-19 started, seeing patients on their own and using physician consultation and backup via telemedicine or telephone as needed. With the reduction in elective surgeries and patient volumes at many hospitals, APP-led care also saves money. Because one of the biggest costs is labor, Ms. Cardin said, offering this high-quality care delivery model using APPs in collaboration with physician providers helps defray some of that cost. “We’re hoping that advanced practice providers are really a solution to some of these financial pressures in a lot of different ways,” she said.
“COVID … forced us to expedite conversations about how to maximize caseloads using APPs,” said Alicia Sheffer, AGAC-AGPC NP, a nurse practitioner and Great Lakes regional director of advanced practice providers at Sound Physicians in Cincinnati. Some of those staffing model changes have included using APPs while transitioning ICUs and med-surg units to COVID cohort units, APP-led COVID cohorts, and APP-led ICUs.
“At first the hospital system had ideas about bringing in telemedicine as an alternative to seeing patients, rather than just putting APPs on the front lines and having them go in and see patients,” said Jessica Drane, APRN, PhD, DNP FNP-C, a nurse practitioner and regional director of advanced practice provider services and hospital medicine at Sound Physicians in San Antonio. In Texas at the beginning of the pandemic, hospital numbers were so low that Dr. Drane did not work at all in April. “We were all afraid we were going to lose our jobs,” she said. Then the state got slammed and APPs have been desperately needed.
Ilaria Gadalla, DMSc, PA-C, a PA at Treasure Coast Hospitalists in Port St. Lucie, Fla., and the PA program director at South University, West Palm Beach, Fla., noted that many of her APP colleagues have pivoted fluidly from other specialties to the hospitalist realm as the need for frontline workers has increased. “Hospitalists have shined through this and their value has been recognized even more than previously as a result of COVID-19,” Dr. Gadalla said.
“I don’t think it’s any surprise that hospitalists became a pillar of the COVID pandemic,” said Bridget McGrath, PA-C, a physician assistant and director of the NP/PAs service line for the section of hospital medicine at the University of Chicago. “There are just some innate traits that hospitalists have, such as the ability to be flexible, to problem solve, and to be the solution to the problem.”
Building team camaraderie
Ms. Cardin says that the need for APPs has led to an evolving integration between physicians and APPs. The growing teamwork and bonding between colleagues have been some of the most rewarding aspects of the pandemic for Dr. Gadalla. “We rely even more on each other and there isn’t really a line of, ‘I’m a physician versus an NP or PA or nurse.’ We’re all working together with the same goal,” she said.
Ms. McGrath said she has been learning what it means to lead a team during a challenging time. It has been gratifying for her to watch mentors get down to the bare bones of patient care and see everyone unify, putting aside roles and titles and coming together to care for their patients in innovative ways.
“This pandemic has really opened up a lot of doors for us because up until now, we were used almost like scribes for physicians,” Dr. Drane said. She has seen even the most resistant hospital systems beginning to rely on APPs as the pandemic has progressed. “They have become pleasantly surprised at what an APP can do.”
Work challenges
Obviously, challenges abound. Dr. Gadalla listed hers as visiting restrictions that invariably lead to slower patient visits thanks to obligatory phone calls, constantly fluctuating patient censuses, sporadic elective surgeries, watching colleagues become furloughed, and trying to balance external perceptions with what’s actually happening in the hospital.
Overall, though, “There have been a lot more rewards than barriers,” added Dr. Drane.
One of the biggest obstacles for health care workers navigating a pandemic is balancing work and home life, not to mention having time to unwind while working long hours. “Finding time for my family has been very limited. My kids feel really neglected,” said Dr. Gadalla. Some days, she gets up extra early to exercise to help clear her head, but other times she’s just too exhausted to even move.
Dr. Drane agreed that the work can get overwhelming. “We’re changing the way we practice almost every week, which can make you doubt yourself as an educator, as a practitioner. You constantly feel like you’re not sure what you’re doing, and people trust you to heal them,” she said. “Today is my first day off in 24 days. I only got it off because I said I needed a moment.”
Ms. Sheffer’s crazy days were at the beginning of the pandemic when she had to self-quarantine from her family and was working nonstop. “I would come home and sleep and work and wake up in the middle of the night and double check and triple check and go back to sleep and work, and that consumed me for several months,” she said.
The biggest challenge for Ms. Sheffer has been coping with public fear. “No matter how logical our medical approach has been, I think the constant feeling of the public threat of COVID has had this insidious effect on how patients approach their health,” she said. “We’re spending a lot more time shaping our approach to best address their fears first and not to politicize COVID so we can actually deal with the health issue at hand.”
Complications of COVID
With all the restrictions, caring for patients these days has meant learning to interact with them in different ways that aren’t as personal, Ms. McGrath said. It has been difficult to lose “that humanity of medicine, the usual ways that you interact with your patients that are going through a vulnerable time,” she noted.
Additionally, students in the medical field are being held back from graduation because they cannot participate in direct patient care. This is particularly problematic for PAs and medical students who must touch patients to graduate, Dr. Gadalla said. “All of this is slowing down future providers. We’re going to have trouble catching up. Who’s going to relieve us? That’s a huge problem and no one is finding solutions for that yet,” she said.
At the University of Chicago, Ms. McGrath explained, they created virtual rotations so that PA students could continue to do them at the university. Not only has the experience reminded Ms. McGrath how much she loves being a medical educator and fighting for the education of PA students, but she was surprised to find that her patients came to appreciate the time they spent with her students on the virtual platform as well.
“It’s isolating for patients to be in the hospital in a vulnerable state and with no support system,” she said. “I think being a part of [the PA students’] education gave some meaning to their hospitalization and highlighted that collaboration and connection is a human need.”
Despite everything, there’s a noticeable emphasis on the flowering buds of hope, unity, compassion, and pride that have been quietly blooming from the daily hardships. As Ms. Cardin puts it, “It’s so cliché to say that there’s a crisis. The other word is ‘opportunity,’ and it’s true, there are opportunities here.”
Taking care of each other
Creating resources for providers has been a priority at the University of Chicago, according to Ms. McGrath. “As hospitalists, we’re used to taking care of a variety of patients, but our section leadership and providers on the front lines quickly realized that COVID patients are more akin to trauma patients with their quick changes in health, as well as their isolation, fear, and unexpected deterioration,” she said. Her facility has implemented wellness initiatives to help prevent burnout and mental health problems in COVID providers so they can continue to give the best care to their patients.
Both Ms. Sheffer and Dr. Drane say that they have a peer network of APPs at Sound Physicians to call on for questions and support. And it’s encouraging to know you’re not alone and to keep tabs on how colleagues in other states are doing, Ms. Sheffer noted.
“The peer support system has been helpful,” Dr. Drane said. “This job, right now, takes pieces of you every day. Sometimes it’s so emotional that you can’t put it into words. You just have to cry and get it out so that you can go be with your family.”
Getting back to basics
The changes in patient care have turned into something Ms. McGrath said she appreciates. “This pandemic has really stripped away the extra fluff of medicine and brought us back to the reason why many of us have gotten into the field, because it became about the patients again,” she says. “You quickly learn your strengths and weaknesses as a provider and as a leader, and that flows into the decisions you’re making for your team and for your patients.”
Ms. Sheffer acknowledged that it is difficult to deal with patients’ family members who don’t understand that they can’t visit their sick relatives, but she said the flip side is that frontline workers become surrogate family members, an outcome she considers to be an honor.
“You step into the emotion with the family or with the patient because you’re all they have. That is a beautiful, honorable role, but it’s also tremendously emotional and sometimes devastating,” she said. “But to me, it’s one of the most beautiful things I’ve been able to offer in a time where we don’t even know what to do with COVID.”
Limited resources mixed with a healthy dose of fear can stifle creativity, Dr. Drane said. Right away, she noticed that despite the abundance of incentive spirometers at her hospital, they were not being utilized. She came in 2 hours early for 3 days to pass one out to every patient under investigation or COVID-positive patient and enlisted the help of her chief nursing officer, CEO, and regional medical director to get everyone on board.
Dr. Drane’s out-of-the-box thinking has enabled people to go home without oxygen 2 days earlier and cut the hospital’s length of stay by 5%. “It’s something so small, but it has such a great end reward,” she said. “I’m proud of this project because it didn’t take money; it was getting creative with what we already have.”
Renewed pride and passion
Dr. Drane is intensely proud of being an NP and working on the front lines. She sees that the pandemic has encouraged her and other APPs to expand their horizons.
“For me, it’s made me work to get dual certified,” she said. “APPs can be all-inclusive. I feel like I’m doing what I was meant to do and it’s not just a job anymore.”
Ms. McGrath is even more passionate about being a hospitalist now, as she has realized how valuable their unique skill sets are. “I think other people have also been able to realize that our ability to see the patient as a whole has allowed us to take care of this pandemic, because this disease impacts all organ systems and has a trickle-down effect that we as hospitalists are well versed to manage,” she said.
Ms. Cardin’s work involves communicating with APPs all around the country. Recently she had a phone exchange with an APP who needed to vent.
“She was weeping, and I thought she was going to say, ‘I can’t do this anymore, I need to go home,’ ” said Ms. Cardin. “Instead, she said, ‘I just want to make a difference in one of these people’s lives.’ And that is who the advanced practice providers are. They’re willing to go into those COVID units. They’re willing to be in the front lines. They are dedicated. They’re just intensely inspirational to me.”
Throughout the chaos of the COVID-19 pandemic, advanced practice providers (APPs) – physician assistants (PAs) and nurse practitioners (NPs) – have become an integral component of the hospitalist response. As many physicians began shifting into telemedicine and away from direct patient care, APPs have been eagerly jumping in to fill the gaps. Their work has been changing almost as dramatically and quickly as the pandemic itself, bringing with it expected challenges but bestowing hugely satisfying, often unanticipated, rewards.
APPs on the rise
As the coronavirus pandemic evolves, the role of APPs is evolving right alongside it. With the current relaxation of hospital bylaw restrictions on APPs, their utilization has increased, said Tracy Cardin, ACNP-BC, SFHM, a nurse practitioner and vice president of advanced practice providers at Sound Physicians. “We have not really furloughed any advanced practice providers,” Ms. Cardin said. “In fact, I consider them to be, within hospital medicine, a key lever to finding more cost-effective care delivery models.”
Ms. Cardin said APPs have been working more independently since COVID-19 started, seeing patients on their own and using physician consultation and backup via telemedicine or telephone as needed. With the reduction in elective surgeries and patient volumes at many hospitals, APP-led care also saves money. Because one of the biggest costs is labor, Ms. Cardin said, offering this high-quality care delivery model using APPs in collaboration with physician providers helps defray some of that cost. “We’re hoping that advanced practice providers are really a solution to some of these financial pressures in a lot of different ways,” she said.
“COVID … forced us to expedite conversations about how to maximize caseloads using APPs,” said Alicia Sheffer, AGAC-AGPC NP, a nurse practitioner and Great Lakes regional director of advanced practice providers at Sound Physicians in Cincinnati. Some of those staffing model changes have included using APPs while transitioning ICUs and med-surg units to COVID cohort units, APP-led COVID cohorts, and APP-led ICUs.
“At first the hospital system had ideas about bringing in telemedicine as an alternative to seeing patients, rather than just putting APPs on the front lines and having them go in and see patients,” said Jessica Drane, APRN, PhD, DNP FNP-C, a nurse practitioner and regional director of advanced practice provider services and hospital medicine at Sound Physicians in San Antonio. In Texas at the beginning of the pandemic, hospital numbers were so low that Dr. Drane did not work at all in April. “We were all afraid we were going to lose our jobs,” she said. Then the state got slammed and APPs have been desperately needed.
Ilaria Gadalla, DMSc, PA-C, a PA at Treasure Coast Hospitalists in Port St. Lucie, Fla., and the PA program director at South University, West Palm Beach, Fla., noted that many of her APP colleagues have pivoted fluidly from other specialties to the hospitalist realm as the need for frontline workers has increased. “Hospitalists have shined through this and their value has been recognized even more than previously as a result of COVID-19,” Dr. Gadalla said.
“I don’t think it’s any surprise that hospitalists became a pillar of the COVID pandemic,” said Bridget McGrath, PA-C, a physician assistant and director of the NP/PAs service line for the section of hospital medicine at the University of Chicago. “There are just some innate traits that hospitalists have, such as the ability to be flexible, to problem solve, and to be the solution to the problem.”
Building team camaraderie
Ms. Cardin says that the need for APPs has led to an evolving integration between physicians and APPs. The growing teamwork and bonding between colleagues have been some of the most rewarding aspects of the pandemic for Dr. Gadalla. “We rely even more on each other and there isn’t really a line of, ‘I’m a physician versus an NP or PA or nurse.’ We’re all working together with the same goal,” she said.
Ms. McGrath said she has been learning what it means to lead a team during a challenging time. It has been gratifying for her to watch mentors get down to the bare bones of patient care and see everyone unify, putting aside roles and titles and coming together to care for their patients in innovative ways.
“This pandemic has really opened up a lot of doors for us because up until now, we were used almost like scribes for physicians,” Dr. Drane said. She has seen even the most resistant hospital systems beginning to rely on APPs as the pandemic has progressed. “They have become pleasantly surprised at what an APP can do.”
Work challenges
Obviously, challenges abound. Dr. Gadalla listed hers as visiting restrictions that invariably lead to slower patient visits thanks to obligatory phone calls, constantly fluctuating patient censuses, sporadic elective surgeries, watching colleagues become furloughed, and trying to balance external perceptions with what’s actually happening in the hospital.
Overall, though, “There have been a lot more rewards than barriers,” added Dr. Drane.
One of the biggest obstacles for health care workers navigating a pandemic is balancing work and home life, not to mention having time to unwind while working long hours. “Finding time for my family has been very limited. My kids feel really neglected,” said Dr. Gadalla. Some days, she gets up extra early to exercise to help clear her head, but other times she’s just too exhausted to even move.
Dr. Drane agreed that the work can get overwhelming. “We’re changing the way we practice almost every week, which can make you doubt yourself as an educator, as a practitioner. You constantly feel like you’re not sure what you’re doing, and people trust you to heal them,” she said. “Today is my first day off in 24 days. I only got it off because I said I needed a moment.”
Ms. Sheffer’s crazy days were at the beginning of the pandemic when she had to self-quarantine from her family and was working nonstop. “I would come home and sleep and work and wake up in the middle of the night and double check and triple check and go back to sleep and work, and that consumed me for several months,” she said.
The biggest challenge for Ms. Sheffer has been coping with public fear. “No matter how logical our medical approach has been, I think the constant feeling of the public threat of COVID has had this insidious effect on how patients approach their health,” she said. “We’re spending a lot more time shaping our approach to best address their fears first and not to politicize COVID so we can actually deal with the health issue at hand.”
Complications of COVID
With all the restrictions, caring for patients these days has meant learning to interact with them in different ways that aren’t as personal, Ms. McGrath said. It has been difficult to lose “that humanity of medicine, the usual ways that you interact with your patients that are going through a vulnerable time,” she noted.
Additionally, students in the medical field are being held back from graduation because they cannot participate in direct patient care. This is particularly problematic for PAs and medical students who must touch patients to graduate, Dr. Gadalla said. “All of this is slowing down future providers. We’re going to have trouble catching up. Who’s going to relieve us? That’s a huge problem and no one is finding solutions for that yet,” she said.
At the University of Chicago, Ms. McGrath explained, they created virtual rotations so that PA students could continue to do them at the university. Not only has the experience reminded Ms. McGrath how much she loves being a medical educator and fighting for the education of PA students, but she was surprised to find that her patients came to appreciate the time they spent with her students on the virtual platform as well.
“It’s isolating for patients to be in the hospital in a vulnerable state and with no support system,” she said. “I think being a part of [the PA students’] education gave some meaning to their hospitalization and highlighted that collaboration and connection is a human need.”
Despite everything, there’s a noticeable emphasis on the flowering buds of hope, unity, compassion, and pride that have been quietly blooming from the daily hardships. As Ms. Cardin puts it, “It’s so cliché to say that there’s a crisis. The other word is ‘opportunity,’ and it’s true, there are opportunities here.”
Taking care of each other
Creating resources for providers has been a priority at the University of Chicago, according to Ms. McGrath. “As hospitalists, we’re used to taking care of a variety of patients, but our section leadership and providers on the front lines quickly realized that COVID patients are more akin to trauma patients with their quick changes in health, as well as their isolation, fear, and unexpected deterioration,” she said. Her facility has implemented wellness initiatives to help prevent burnout and mental health problems in COVID providers so they can continue to give the best care to their patients.
Both Ms. Sheffer and Dr. Drane say that they have a peer network of APPs at Sound Physicians to call on for questions and support. And it’s encouraging to know you’re not alone and to keep tabs on how colleagues in other states are doing, Ms. Sheffer noted.
“The peer support system has been helpful,” Dr. Drane said. “This job, right now, takes pieces of you every day. Sometimes it’s so emotional that you can’t put it into words. You just have to cry and get it out so that you can go be with your family.”
Getting back to basics
The changes in patient care have turned into something Ms. McGrath said she appreciates. “This pandemic has really stripped away the extra fluff of medicine and brought us back to the reason why many of us have gotten into the field, because it became about the patients again,” she says. “You quickly learn your strengths and weaknesses as a provider and as a leader, and that flows into the decisions you’re making for your team and for your patients.”
Ms. Sheffer acknowledged that it is difficult to deal with patients’ family members who don’t understand that they can’t visit their sick relatives, but she said the flip side is that frontline workers become surrogate family members, an outcome she considers to be an honor.
“You step into the emotion with the family or with the patient because you’re all they have. That is a beautiful, honorable role, but it’s also tremendously emotional and sometimes devastating,” she said. “But to me, it’s one of the most beautiful things I’ve been able to offer in a time where we don’t even know what to do with COVID.”
Limited resources mixed with a healthy dose of fear can stifle creativity, Dr. Drane said. Right away, she noticed that despite the abundance of incentive spirometers at her hospital, they were not being utilized. She came in 2 hours early for 3 days to pass one out to every patient under investigation or COVID-positive patient and enlisted the help of her chief nursing officer, CEO, and regional medical director to get everyone on board.
Dr. Drane’s out-of-the-box thinking has enabled people to go home without oxygen 2 days earlier and cut the hospital’s length of stay by 5%. “It’s something so small, but it has such a great end reward,” she said. “I’m proud of this project because it didn’t take money; it was getting creative with what we already have.”
Renewed pride and passion
Dr. Drane is intensely proud of being an NP and working on the front lines. She sees that the pandemic has encouraged her and other APPs to expand their horizons.
“For me, it’s made me work to get dual certified,” she said. “APPs can be all-inclusive. I feel like I’m doing what I was meant to do and it’s not just a job anymore.”
Ms. McGrath is even more passionate about being a hospitalist now, as she has realized how valuable their unique skill sets are. “I think other people have also been able to realize that our ability to see the patient as a whole has allowed us to take care of this pandemic, because this disease impacts all organ systems and has a trickle-down effect that we as hospitalists are well versed to manage,” she said.
Ms. Cardin’s work involves communicating with APPs all around the country. Recently she had a phone exchange with an APP who needed to vent.
“She was weeping, and I thought she was going to say, ‘I can’t do this anymore, I need to go home,’ ” said Ms. Cardin. “Instead, she said, ‘I just want to make a difference in one of these people’s lives.’ And that is who the advanced practice providers are. They’re willing to go into those COVID units. They’re willing to be in the front lines. They are dedicated. They’re just intensely inspirational to me.”