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Every Front Line Has a Back Line: What Nursing Can Learn from Rugby

Feury, Tess BSN, RN

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AJN, American Journal of Nursing: October 2020 - Volume 120 - Issue 10 - p 45-46
doi: 10.1097/01.NAJ.0000718648.34409.e2
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Have you ever had a day at work that could only be fixed by an ice cream from your favorite creamery or by a hug from your best friend? Every shift during the height of the COVID-19 pandemic felt like this.

Unfortunately, because I work as an RN in a pediatric ICU at a large hospital in northern New Jersey, social restrictions that coincide with COVID-19 forestalled my usual comfort measures. After the start of the COVID-19 pandemic and during my reassignment in the COVID-19 ICU, I could no longer truly “leave” work. Work came home and walked with me throughout my day.

Dozens of IV pumps lining hallways; countless boxes of gowns, gloves, masks, and rubber shoes scattering the unit; ventilator alarms sounding; coworkers with surgical caps and masks, only identifiable by their eyes. The once medical–surgical unit transformed into a critical care unit equipped to care for COVID-19 patients.

After donning and doffing personal protective equipment, giving medication, adjusting ventilators, and updating families, you leave your 12-hour-plus shift wondering if you did your best. In the chaos of an unfamiliar unit, caring for patients with an unfamiliar virus, did I do everything to create the best outcome for my patients?

Missing patient contact in a necessarily dehumanizing environment. Because of personal risk of contracting COVID-19, nurses carefully coordinated care to minimize exposure. I controlled patients' medications, IVs, and ventilators from outside a hospital door. Because I clustered care, I entered patients' rooms minimally. The patient contact that was one of my favorite parts of being a nurse had been taken away. It was difficult having to conquer the fear of going to work . . . but then to also go without the part I enjoyed most? This was especially disappointing and hard.

Positive moments presented in different ways. One evening, the unit received a package that included a CD player and Frank Sinatra CDs. A note explained that the patient in room 14 loved Sinatra and often listened to him. This touched a special place in my heart because my grandpa, who died a few years ago, also loved Sinatra. I know that, for him as for the patient in room 14, listening to this music would have brightened his day. That evening, the family reached out to thank me for making it a priority to play the music for the patient. This experience made me realize that the connection I build with patients was still there and was more important than ever.

It's time to talk about the back line. When I think of a front line, I think of the first line of defense in sports. Playing rugby since age four, and now a member of the USA Women's National Rugby Team, I understand the importance of the front line—those who are most visible and put themselves at personal risk for their teammates. The front line is something or someone that protects.

There's been an outpouring of support for front-line health care workers; however, it's time to talk about the back line. The back line is every person who supported the front line during COVID-19. Without the back line, the front line would have fallen. It's the back line whose essential role supports the front line.

COVID-19 coping is not easy. I've watched a wife sit outside her husband's hospital window for days. I've watched a family video chat with their loved one for the last time. I've watched a child draw chalk on hospital sidewalks outside her dad's window. I've looked patients in the eye as they asked if they were going to be okay before we put a breathing tube in. I have watched this virus take the lives of previously healthy people.

A different kind of hero. Without typical coping outlets, some nights I crumbled. I sat in my car unable to drive because I couldn't keep my emotions together. The outpouring of love from my back line kept me going. Notes, coffee pick-me-ups, friends reaching out, and countless dinners I didn't have to cook all contributed to getting me through. I cannot thank my back line enough for their acts of strength that allowed me to focus on patient care.

Growing up, I had role models. But I never truly had a hero, until now. My heroes are in hospital gowns. My heroes are waiting outside hospital windows wondering if their family member will be okay. My heroes are at home, deciding to distance from loved ones to avoid spreading this deadly virus. Heroes are around us, but it took a worldwide pandemic and two years of being an RN for me to realize this. Oddly enough, I need to thank COVID-19 for opening my eyes to what was in front of me.

COVID-19 has profoundly affected each of us. Whether you were the front line, the back line, or one of my heroes, thank you. I encourage everyone to thank your own personal back line and to broaden your perspective to see heroes around us. Like me, you may realize you're surrounded by heroes every day. COVID-19, and actions taken by many, made a difference for me and reminded me why I am, and always will be, a nurse.

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