May 9 2013
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Nurse On-Call: The Boston Marathon Bombings

Carolyn Hayes, PhD, RN, NEA-BC, is associate chief nurse for Adult Inpatient and Integrative Oncology at Dana-Farber Cancer Institute and Brigham & Women’s Hospital (BWH) in Boston, MA. She is a Robert Wood Johnson Foundation Executive Nurse Fellow (2012). Here, Hayes reflects on how nurses provided quality care to patients and others traumatized by the bombing at the Boston Marathon. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.

I remember a brief report on television, just after the Newtown shootings, when an emergency department (ED) physician in Connecticut said his emotional pain started with his realization that his ED was not getting any victims. It clearly overwhelmed him not to be able to help. At the time I felt for him but on Monday, April 15, after the Boston Marathon bombing, I truly understood him. I, along with other highly-skilled members of the health care and support teams at Brigham & Women’s Hospital, had the privilege of making a difference for the victims of that tragic event.

That Monday, I was the operations section chief—the role designed to ensure staff, materials, supplies, and systems are in place to address whatever is occurring. On Friday the 19th, the day that Boston and surrounding towns were instructed to “shelter in place,” I was incident commander.

We saved lives and limbs in our ED that day. But we also tended to the anxiety, fear, and confusion created by an attack on our city. We addressed with patients, their families, family members of unidentified marathon victims, and ourselves, the existential gap created by the “why” of it all. We lived out what we had trained for, yet couldn’t comprehend. And we did it all as a community.

We did it not knowing if someone we loved was among the injured or still on the streets of Boston. We didn’t know why the bombings happened, so we didn’t know if it was over. Yet we strived to do what we could to create a safe haven.

As nurses, we are well-trained to adapt with little notice or information. On that day, we emptied our ED by paging nurse directors to check the bed system and move patients to other parts of the hospital. They provided safe passage during the hand-offs. Nurses throughout the institution managed the anxiety of patients watching televisions repeatedly showing the bombings. Those among us who specialize in mental well-being encouraged other nurses to discourage the television viewing.  

We moved to identifying patients in any way possible. Our systems are dependent on two identifiers. Yet, we had none for many victims. One nurse colleague identified a patient by the store receipt in his pants pocket. Pictures of tattoos were taken.

Throughout the day, we gathered as nurse leaders for information, reassurance, strategy, and comfort. We acknowledged with and for each other that we would spend not just that day, but months to come healing from what we saw.

Nurse executives ended Monday by making rounds to each inpatient care unit to check in with staff and see what we could do to meet patient and staff needs the next day. We had employee assistance experts, chaplaincy, social work, psychiatry and integrative therapies gather to plan wellness days and debriefings.

Unexpected Challenges
By Wednesday, we had to evacuate one of the hospital buildings because a suspicious car was abandoned nearby. On Thursday, we mourned the victims together at a healing service. On that day, I learned that no matter your politics, our President is a very impressive presence. Friday was just surreal. Boston’s streets looked apocalyptic. The phrases: "person of interest" and "shelter in place" were added to our lexicon. 

One of our biggest issues that week was the information culture clash between law enforcement culture and health care. There were armed guards everywhere. The media were also camped outside the hospital looking for any story.

From a law enforcement perspective, everyone is on a “need to know” basis or they or whomever they are trying to protect will be at risk. Nurses, on the other hand, manage the anxiety of patients with transparency and information. Family members of nursing staff were texting our staff saying BWH had a bomb threat and a “person of interest” (POI). CNN was sure of it. 

Our role was to refocus nurses so they could calm patients by letting them know that POI was a law enforcement term. In health care, we talk about patients. We did so mindful of our code of ethics—to respect all people regardless of their situation. Whether or not we had the perpetrator was not going to change his or her care.

Our Work has Just Begun
By Saturday, I sent this email to my RWJF Executive Nurse Fellow (ENF) colleagues: “Boston update: Monday was sad, but had purpose as we dealt with mass casualties. Tuesday it started seeping in that we were in danger, as we began discovering friends, family and colleagues who had been injured.”

I now realize that from nursing’s holistic perspective, we have just begun to “treat” the victims of the Boston Marathon bombings, the ranks of which, we acknowledge, include ourselves.

As nurse executives, we are expected to serve as administrators. As preparation for that role at a level one trauma center, we have all gone through Hospital Incident Command Systems training—a well-established set of roles for health organizations in a crisis. It creates a situational chain of command that overrides normal roles.

From our experience, and the feedback we all received, nobody doubts the effectiveness of our training or that nursing leaders are more than capable to perform in these roles.

My second email to my ENF colleagues said: “The good news about nursing is we have the privilege of being able to help and to combat violence with compassion and skill. Literally saving lives in some cases, but mitigating harm by caring for the injured, the families, the community, and ourselves. The week of the Boston Marathon bombings was as inspirational as it was exhausting.”

For weeks now I have been avoiding talking to my closest friends because I wanted to sit a bit with what I experienced the week of April 15. I saw the worst and the best of humanity in one week. I want to make sure my nurse colleagues know how proud I was to be among them and how grateful I am to be a nurse. That week, I was especially proud to be a Boston nurse.

Read more about the Boston Marathon bombings and lessons learned from RWJF Clinical Scholar Jeremiah Schuur, an emergency physician at Brigham and Women’s Hospital.

Tags: Emergency Care, Emergency care, Emergency preparedness and response, Executive Nurse Fellows, Human Capital, Massachusetts (MA) NE, National Nurses Week 2013, Nurses, Nursing, Voices from the Field