In Their Own Words: How COVID-19 Changed the Nursing staff at a Hawaiian Nursing Home

Studies show that the potential for moral injury to health care workers working with COVID-19 is relatively high, leading to burnout and impairing mental health. I asked my clients at a nursing home in Hawaii to tell me how the pandemic had affected them. They wrote this article.

March 2020 is a date that is forever imprinted on our minds, hearts, and the history books. Those of us who dedicate our lives to the world of long-term care and caring for our kupuna [elders], we all shared a heightened sense of fear and anxiety, as we watched the introduction of SARS-CoV-2 (COVID-19) to long-term nursing facilities. A virus that changed the landscape of what we do. COVID-19 continued its relentless spread throughout the world, nation, and facilities, infecting millions and killing hundreds of thousands more. The long-term care industry was facing its fiercest challenge yet: to protect a population burdened by frailty.

For all of us in long-term care, work increased exponentially, with expanded regulatory compliance, health care staffing shortages, personal protective equipment shortages, and an unknown coronavirus. We found ourselves immersed in the stresses and fears of working in a crowded facility, asking ourselves and each other, "How do we survive each day, each shift, each hour, and keep our residents and ourselves safe?” It is difficult to put into words the hardships we faced and the relentless burden we endured. Only those who were, and are, in it, can understand the painstaking tasks we accomplished to battle this historic pandemic.

Two years later, we continue to fight COVID-19. We still face the challenge to protect our residents and staff. We still endure stress, fear, and surges of new variants among our population. All of this has become part of our daily routines and changed the way we view our work and our lives. Recently, our team took a step back to reflect. A common thought: “I can’t believe it’s been 2 years already.” A common question: “How did we get through this?” There is no simple answer, but to put it simply, teamwork and revising the way we view and approach the work we do.

It difficult to say that there is a silver lining, especially when hundreds of thousands kupuna lost their lives. But it is this silver lining that will save many more. As our team reflected, many positives surfaced to realization. First, we truly learned the meaning of teamwork. We broke down walls, silos, and the division of duties among departments to become 1 team, 1 facility. As Pam Calilao, medical records manager, put it, “During the outbreak, you’re not just 'medical records' anymore. You quickly learn how to do patient care, test your fellow co-workers for COVID-19, correctly wear your PPE. You become a member of the COVID-buster team to promote cleanliness in the facility.” Rachel McKean, Admissions Coordinator, added: “Our team worked so well together and put in so much work to get COVID-19 out of the building. Teamwork literally makes the dream work.”

Secondly, we all felt an increased responsibility about the work we do, and had a different perspective with how we approach it. Lindsey Oroku, a registered dietitian, shared her thoughts: “COVID-19 was a rude reminder to be grateful—grateful to have a job, grateful to have a job that helps others, grateful for health. Many people lost their jobs and the ability to live carefree, lost loved ones, and went through—and continue to go through—tough times. I feel like it’s better to go through tough days than tough times.”

Christina Seto-Mook, another registered dietitian, noted, “We knew so little about this virus and how much chaos it would create in our professional and personal lives. We learned how to be more flexible. It was great to see everyone working as a team and really putting in the effort to keep our residents safe. It wasn’t just about getting our own work done but about helping each other and taking that extra mile. Adaptability was another crucial aspect of managing COVID-19, as we were all experiencing and learning how to get through this unforgettable time together.”

Two years of this pandemic has developed strength, belief, and courage within all of us. We carry ourselves, our team—our ohana [family]—with pride, owning the hand we’ve been dealt, and conquering the adversity we have faced. Our accomplishments have strengthened our bond, cemented our goals, and taught us the true meaning of ohana. COVID-19 has forever changed the landscape of what we do. But the bond we have built during this pandemic— the team, the support, and empathy, will last forever. It has guided us through an adversity, unlike any other, and we believe that we can continue to conquer any challenge before us.

The words of Leina’ala Pilares, registered nurse and staff educator, sums up our pride, “Two years of unknowingness. I look into their [patients’] eyes, and I see hope. I go on for another day. Why? To protect the things I love. I have no fear when I choose to love and protect. I kept myself safe, isolated, and clean to protect my people and the residents I care for. Why do I work so hard? Because when I go to work, the next day I want to see the same faces I saw the day before. And then I tell myself, 'COVID-19, you will never be welcome in my home. I have no aloha [love] for you. I stand proud to have kept you out of my homes for another day. E ku kanaka!” (We Stand Tall!)

We have struggled, endured, battled, and wept. But we have also empathized, bonded, rejoiced, and overcame. We found courage and strength within ourselves that we did not know existed. We continue to grow, to be grateful, and to be committed to health care, long-term care, and our kupuna. The lessons we learned hardened our foundation to overcome any adversity to provide the best care for them, and we look forward to doing this for many years to come.