PINEDALE – Nurses deal with all kinds of trauma. Vicky Marshall, director of nursing at the Sublette County Rural Health Care District, learned early to expect new surprises, even after she thought that she had seen it all.
“I never say never in the medical field – ever,” Marshall said. “Because as soon as I do, something is going to happen.”
Marshall chose to go into nursing out of necessity, as a way to support her family, rather than to fulfill a childhood dream. She was accepted into a nursing school program offered by the Wyoming State Hospital and decided to enroll.
Nursing grew on Marshall after nearly 23 years in the field, including over 12 years at the SCRHCD.
“I don’t always think that I have that bedside manner that some of the other nurses do,” she said. “I’ve received angels from patients and thank-you cards, though, so I know that I make a difference somewhere.”
Marshall’s nursing background is diverse, including stints in behavioral health, medical-surgical nursing, home health and oncology. During a storied career, Marshall has seen nearly everything – the 2009 H1N1 flu pandemic to dog bites to an active-shooter situation.
This varied and versatile background served Marshall well in a setting like Sublette County, where anything could walk through the emergency doors.
“You have to be flexible to work in this type of environment, because it’s never a status quo day,” she said. “Something always comes up that you weren’t planning on, and you have to roll with it.”
Then COVID-19 came smashing through the door, completely unprecedented, wreaking havoc and shutting down the world for several months.
In November and December, COVID-19 cases spiked across Wyoming, overwhelming the health-care system, including the Pinedale and Marbleton Clinics.
“We had patients stacked up in the parking lot, two or three deep, waiting to come in, to be seen,” Marshall said. “We were triaging out in the parking lot.”
Marshall and the nurses under her supervision had to make quick decisions to determine where to prioritize care.
“We had patients where we’d start their vital signs – we’d put the oxygen (monitor) on their finger and the stats would read 70 percent. At that point, we knew we were in trouble, that we had to move. We sent quite a few patients to the hospital in the initial phase and they were there for a long period of time.”
Nurses battled an unknown, contagious and rapidly spreading disease.
“I can guarantee you that the thought (of catching COVID-19) was in the back of everybody’s mind when they went home each night and got that tickle in the back of their throat,” Marshall said. “But you would just jump in and help the patient.”
Through her role as director of nursing, Marshall took on new responsibilities that did not line up with a nurse’s traditional role. She coordinated internal incident command meetings and established workflows that included managing traffic in and out of the clinic, establishing guidelines for greeters and disinfecting masks.
Marshall was also tasked with researching and purchasing equipment and maintaining inventories, a staggering task as CDC and state public health guidelines shifted as the disease spread, causing nationwide shortages.
The item list needed for providers to safely care for COVID-19 patients and prevent cross-contamination was enormous. Marshall had to locate and purchase gowns, face shields, hair bonnets, shoe covers, hand sanitizer, IV pumps and N95 masks. Prices shot up with scarcity.
“A box of gloves has gone from 3 cents a pair to around 80 cents a pair,” Marshall said in February. “Surgical masks never used to have an expiration date. Now, they have an expiration date.”
Sublette County lacked a hospital to care for critically ill patients if regional facilities became overwhelmed. Marshall and clinic staff organized the purchase of two self-contained isolation units developed by Enviremedial Services to house COVID-19 patients at the Marbleton and Pinedale clinics.
Established hospitals received priority over clinics, even though Sublette County’s facilities essentially provided emergency room care.
“We went to the bottom of the list because we weren’t a hospital,” Marshall said. “It didn’t matter that we were taking care of sick patients just as well as every hospital out there. We were classified as a physician’s office.”
The challenges forced Marshall to get creative. She worked with state agencies and a regional health care coalition, where she serves as clinical advisor, to find ways to climb the priority list or locate out-of-the-way stockpiles.
Help in community
Marshall is used to dealing with stressful situations and developed coping methods during her career. Rising through the ranks, Marshall increasingly stepped up to solve logistical problems. COVID-19 compounded the situation, adding new demands. The constant meetings and phone calls to suppliers translated into many extra hours beyond Marshall’s regular workload.
COVID-19 was an evolving beast, and keeping on top of the pandemic meant plenty of trail and error to find the right fix.
“I will admit that a lot of times, plans didn’t work the first time, and we had to go back and revamp things because we didn’t know what (COVID-19) was and how to deal with it.”
Marshall put in long days and long nights.
“I guess I just did it,” she said. “I didn’t do anything special. I know I was more tired – I could see on Zoom meetings, where you can see your face, that I had big bags under my eyes. In the beginning, people would look at me funny and I would start to cry because I was so overwhelmed.”
A supportive husband who frequently had dinner ready after a long day and a close network of friends helped. Teamwork between SCRHCD employees also made Marshall’s job easier.
Clinical staff increasingly stepped outside their comfort zones to help where and when they were needed, Marshall explained. Nurses manned the front desk and helped with phones. Housekeeping came to the rescue numerous times through the simple act of taking on all the extra laundry.
“It took the whole team to get us through this thing,” Marshall said.
During the spike in cases, Marshall worked closely with Sharon Rutsch, SCRHCD director of laboratory services.
“Sharon was a ton of help,” Marshall said. “We put our heads together many nights.”
Agencies and first responders across Sublette County collaborated closely from day one. The cooperation alleviated stress.
“You had a partner that you could call,” Marshall said. “I called (emergency management coordinator) Jim Mitchell at one point and said, ‘I cannot get this UV light meter to test the N95s.’ He came in and helped take care of the problem.”
EMS stepped up and provided paramedics to mix or pull medications in a pinch, Marshall said. Public Health Officer Dr. Brendan Fitzsimmons and Public Health Nurse Manager Janna Lee worked closely with the clinics, Marshall said.
“The things that (Lee) had to deal with were just unbelievable. She and her team kept everything in check and on track, made sure we all knew what was going on and are running the vaccine clinics. That’s a ton of work, and they are doing an amazing job.”
Ordinary people across the community reached out, Marshall added. People bought lunches for the nurses. Sewing groups organized by Joan Mitchell in Big Piney and Marbleton and Cindy Van in Pinedale provided Marshall with hundreds of reusable masks and gowns. Mindi Crabb kept volunteers coming when needed, Marshall said.
“We have been extremely lucky that we are all able to work together and had plans in place for many years,” she added. “I think that is unique to our county.”
Marshall credited the nurses and clinical staff for being the real heroes.
“They deserve a lot more credit than they get. I try to tell them what a good job they’re doing, but it doesn’t always mean as much coming from inside as it does from the outside.”