Erin McCaffrey, Radiology Department Nurse Manager, New York City
PDS alumna Erin McCaffrey '00 set her sights on nursing after PDS, graduating in 2004 from the University of PA Nursing School and staying on to work at U Penn Hospital's trauma surgical ICU for the next few years before doing some travel nursing around the country, first in New York and then San Diego. In 2010 she moved to Sydney Australia, working part time as she earned her Master's in Public Health and Health Management from the University of New South Wales.
"I came back to New York from Australia in 2012 and started working at New York University Hospital in the radiology department, took on the department's Nurse Manager role in 2013, and have been doing that ever since," Erin reflects.
Radiology is a critical hospital care department, encompassing imaging, including CT scans and MRI, but also a large and active procedural component, which makes up the majority of Erin's nursing team at her hospital. "Interventional radiology covers a vast array of patient care and treatment that typically involves sedation for patients as we carry out minimally invasive procedures," Erin explains. "We typically work with many oncology and transplant patients, as well as stroke patients. For example, we emergently remove blood clots from stroke patients. We stop the blood flow and fix the vessels of patients who are bleeding, typically by going in through the groin or wrist. Similarly, we cut off blood supply and deliver targeted chemotherapy to patients via vascular routes."
The radiology department's typical routines were turned upside down this spring, along wit the rest of the hospital, due to the severity of the COVID-19 pandemic in New York City. "We went through the most intense and difficult environment I've seen in my professional career," Erin recalls. "Given our location in the thick of things in Manhattan, the hospital went very quickly from a few patients admitted with COVID-19 to being virtually filled with COVID-19 patients. Two thirds of my nurses had to shift to help with patient care in the ICUs and acute care floors, while I was tasked with opening one of the first surge units to accommodate the inflow," Erin continues. "We were very fortunate that we had a brand new hospital building that we had just opened two years ago. We filled it completely with COVID-19 patients. Because of the need and the speed at which new patients were being admitted, we had to open new surge units in a remarkably short amount of time. We opened some de-commissioned areas of the hospital and I staffed my surge unit with nurses mostly from procedural areas, such as post-anesthesia care units, where volume was down, and nurses from pre-admission testing. Most of us were nurses who had been away from direct bedside care for several years."
If you know any nurses, you will also know that most nurses are perfectionists who are committed to giving the highest level of care. As a nurse manager, Erin was used to managing large teams, but this was a very different and challenging scenario. "The surge team was nervous about whether they would be doing everything right and giving the best of care" as they dealt with the highly infectious virus and lack of data on the trends and complications of the novel disease, Erin explains. "It was difficult to switch the mindset to adjust to the numbers and emerging realities of COVID patients—all of us had to commit to doing the best we could and focusing on the most urgent care and safety, medicine and oxygen support priorities. It was a huge challenge for all of us.
The feeling of all being in it together was one of many factors that helped the team through the intense first wave of the pandemic. "The fact that most of us had been away from the bedside for a long time was one of the struggles, but it also helped pulled us through. Everyone was out of their comfort zone and out of their element, even the on-call doctors, who ranged from rheumatologists to plastic surgeons. Everybody was put into action on teams and everybody was in the same boat. It was very humbling and also a growth experience," she reflects.
Their experience with so many patients helped them learn quickly over the past two months, as Erin's hospital admissions alone outpaced the volume of the COVID-19 patients that some states have experienced in total. "Because of the patient numbers, we started to really learn the patient population, observe trends and better know what to expect and what to look for," she explains. "We observed some complications that had not really been discussed yet in the press or literature, including some clotting abnormalities and GI bleeds due to blood thinners. The very complex nature of this disease started to emerge as we realized it was not just about respiratory attack."
As of the end of May, the volume of cases is definitely calming down, according to Erin. "At the peak we had at least five full ICUs. We've now moved down to two ICUs dedicated to COVID-19. We've closed all of the surge units that were opened in de-commissioned areas of the hospital. We're able to discharge patients, though some of my nurses are still staffing the remaining COVID-19 ICUs, because there are still some very sick patients who need intense care. For the staff, we are finally having a chance to breathe and start processing things. Thankfully, the hospital realized how traumatizing this would be for staff and have provided numerous services along the way," Erin adds.
"Even not being able to see family outside of my hospital 'family' has been tough, " Erin says, "and I can't imagine missing key milestones like graduation for the PDS seniors." At the same time, Erin has a message for her fellow Panthers: "As difficult as it is to lose or have to postpone those things, it's worth it to stay safe and not be in this tidal wave of COVID-19 destruction. It's really tough for people to grasp when there is not some tangible thing in front of you and it has not hit close to home. But it becomes very real when a family member falls ill. And it is vital to remember that those who are infected are of all ages, and including those who were previously very fit and healthy. We still have some young patients who have been battling this for some time and are still on ventilators and heart-lung bypass machines."
While she is relieved that the first wave has peaked, she remains wary. "Opening up can be safe if people are taking the proper precautions," Erin says. "It's triggering for me and a lot of healthcare workers to see people not being safe as they access things they have not been able to enjoy this spring. We've seen how bad it can get and how destructive this disease is. And you don't want to see anybody else in that situation. All it takes is one person at church or one person at the office, or the air flow going in a certain direction, and it can lead to excessive infection and even deaths. One encouraging thing, at least in the New York area, is the number of people wearing masks and taking proper precautions. I still take the train in every day from Jersey City and it is reassuring to see commuters wearing masks. Culturally it requires a big shift, even for those of us in healthcare. We are not used to wearing PPE for our entire shifts. It's also strange not to be seeing people's faces, whether you are a patient or staff. Part of therapeutic communication is going in and sharing a smile."
When she thinks back on her time at PDS, Erin is clear about the biggest takeaway. "The thing I value most about how PDS has helped prepare me for my professional and personal life is the great job they did of gathering a really diverse community and how they cultivated an appreciation of that diversity," Erin recalls. "I so appreciate that students were given the room to think and problem solve creatively, and given the opportunity to fail and to try again to turn things around without feeling badly about themselves. That ethos has helped me prepare for my whole career, and especially this spring I've put it to critical use thinking outside of the box and developing a strong and diverse nursing team with different attributes, experiences, styles and personalities. We were able to cultivate a team in which everyone was valued and supported, making contributions and problem-solving in diverse ways."
Asked if she had any shout-outs to friends and teachers, she says, "Definitely Chris Ordowich, my brother Michael McCaffrey, Paris McLean and Alex Koerte; Paris and Alex have been amazing about checking in and seeing how I'm doing. And I always love the opportunity to acknowledge my favorite advisor and teacher, Harvey Lee. I think of Harvey especially when I think of how PDS allowed people to make mistakes and try again. He went out of his way to support and not judge. He would say, 'You're teenagers. You are going to get some things wrong before you get them right!'"
Princeton Day School has been sharing stories this spring from alumni around the country and the world who are doing their part to help on the front lines and behind the scenes during the COVID-19 pandemic.