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Rural Nurses On What It's Like To Fight Pandemic Within Smaller Health Care System


One of the frustrating parts of Danielle Pendergrass' job is convincing sick people to come in for a COVID-19 test.

DANIELLE PENDERGRASS: Nobody ever thinks that they have it.

CORNISH: Pendergrass is a nurse practitioner. She owns a women's health clinic in Price, Utah - population 8,000; number of ICU beds in the county, six.

PENDERGRASS: And I'm like, how do you know it's not COVID? Oh, I just know it's not COVID. There's no way I can have it. And our numbers are growing steadily, too. Now I can tell people, well, 34% of people that got tested last week were positive.

CORNISH: Another issue health care providers in rural areas face - keeping staff healthy with COVID running through the community, especially when everyone kind of hangs out at all the same places.

TESSA JOHNSON: If you have a positive, that's a disaster.

CORNISH: Tessa Johnson, president of the North Dakota Nurses Association. She also heads a long-term care facility in Dickinson, North Dakota, population 23,000; number of ICU beds in the county, four. Just two of her residents got COVID in the last few months. Both survived. She says at least eight of her staff did, including her.

JOHNSON: I exercise every day. I walked out to the garage to get something, and I couldn't catch my breath. And so then I thought, you know, this is the real thing.

CORNISH: And that's where we started our conversation with these two rural nurses. How do they keep their staff safe?

JOHNSON: I think the most taxing part on our staff - it's the testing process. I check my phone 16,000 times a day for results. I panic about what's going to happen and how are we going to quickly change that and what's going to happen when we get the results. And if there's a positive, how are we going to get them isolated? Then I worry constantly about, what if floor staff come back positive? How am I going to staff my building? And so I have that constant stress. And then you get the results, and then you deal with that. And then you have about a day of breathing room, and then you test again.

CORNISH: Danielle, you were nodding during Tessa's comments there, which were, like, making my heart beat just listening to you describe the stress of it. Since you're a nurse practitioner and you're at a clinic, are you still face-to-face with patients at this point? And what does that mean in the midst of a COVID surge?

PENDERGRASS: Yes, we're still face-to-face with patients. We try and do as much as we can telehealth, but then people still come in. So what that looks like for patients is sometimes, if they're not safe enough but need to be looked at, we are doing visits out in their car. So I will gown up. We have the goggles. We have the masks. We have our hair covered. And we go out to their vehicles. We're very careful on who comes in, so we do the whole screening questionnaire. They're required to wear masks. And I have had actual patients come in without a mask. We've asked them to please put their mask on, and they have gotten so upset, told us we were infringing on their rights and left our office, saying they will never come back because we asked them to protect theirselves (ph) and us.

CORNISH: Can you talk about the idea of fatigue, of burnout, of these other issues that are affecting kind of nurses in the state?

PENDERGRASS: Our nurses are pushed to the very brink. We have nurses out that are sick, nurses that are quarantined, nurses that have worked continuously. I am very concerned. And we are in a nursing shortage. And what message are we sending to nurses or people who want to be nurses when we're saying, oh, I'm sorry, we don't have protection for you to protect you against COVID; now go to work?

CORNISH: We're hearing more and more news about vaccines. How do you feel about the idea of health care workers being first in line or first among those to get a vaccine? And, Tessa Johnson, maybe I'll start with you because I know long-term care facilities have come up.

JOHNSON: As far as long-term care, I'm excited that we're in the first tier. I've been told, again, that we could potentially get it in the next couple of weeks. Our patients, they need something. They need something to give. They need to be able to see their families again. Our staff need to be able to not be scrutinized when they go to a local restaurant with their family or loved one for a meal or a drink after work. You know, we need something to be able to bring our life back to a little bit of normalcy.

CORNISH: Danielle, for you, embracing a vaccine is - do you think there might be reluctance among your staff or community? Where are you with it?

PENDERGRASS: I don't think there will be reluctance among my staff. As far as the community goes, I mean, if we compare it to the uptake of even flu vaccines this year, we had the lowest uptake we ever had because they are saying that it's a conspiracy theory. You're giving us COVID with the vaccine. They're putting something in this. This is from the government. We don't want that. So if that's any indication of what the uptake's going to be for the actual vaccine, then it gives me pause.

CORNISH: How are you both feeling about the next couple of months?

JOHNSON: I think I have mixed feelings. Let's start with that. I continually am just appalled by the way people behave in our state. We've heard our whole lives that we're North Dakota nice. But this morning on Facebook, there's a girl I know that had a post that said, I'm just so heartbroken that our kids have to wear masks during sports. And I just thought, I just can't take it anymore. And someone commented, you should see how heartbreaking it is to see a COVID patient in the hospital. If it doesn't affect people personally, they just don't get it. And whether that's my husband, who is a welder who thinks - he's never taken a flu shot in his life, and it's politicized, he thinks. I think after he saw me a little sick and he knows what I go through, he may understand a little more.

CORNISH: You're saying he may have a better sense? So even in your own home, you've got a skeptic.

JOHNSON: Yes. For somebody who - he, too, thought it was politicized. He, too, thought that it would be gone on November 4. He sees my stress. He sees what we do. It doesn't personally affect his day-to-day life, and that's what it boils down to.

CORNISH: Danielle, in Utah, where you are, what are you seeing that either makes you hopeful or concerned about the next few weeks?

PENDERGRASS: I'm more concerned as opposed to hopeful. And the reason why I'm more concerned is some things that Tessa actually touched on. Our town, our community prides itself in taking care of one another. Somebody falls down. We'll be the first ones there to lift you up. We bind together. We make sure we're all taken care of. But people will not do the simplest things as wearing a mask, social distancing. And I feel oftentimes rural is left out of the conversations. And as far as the vaccine goes, I mean, we can be prepared all we want, but we don't have the numbers to where the vaccines are going to go first. So even if we are excited, even if we are ready, are we really, even as health care providers, going to be in that first tier? I think rural's going to be last.

CORNISH: Well, Danielle Pendergrass, thank you so much for speaking with us.

PENDERGRASS: Thank you. I appreciate the opportunity.

CORNISH: And, Tessa Johnson, thank you for talking with us.

JOHNSON: Absolutely. Thank you.

CORNISH: And they are both nurses serving rural communities.

(SOUNDBITE OF EMPRESARIOS' "SIESTA") Transcript provided by NPR, Copyright NPR.