May 18, 2020

Nurses step up in crises

Kaiser Permanente nurses have been saving lives on the front lines since 1942.

Laboratory personnel at Kaiser Permanente San Francisco Medical Center listening to AIDS training by Barbara Lamberto, RN, infection control coordinator. (The Reporter, September 1983)

The COVID-19 pandemic is not the first time Kaiser Permanente nurses have stepped up to meet extreme health emergencies. Time after time throughout the organization’s 75-year history, nurses have met crises with skill, compassion, and courage.

When the Permanente Health Plan was formed to serve Henry J. Kaiser’s shipyard workers at the beginning of World War II, our founding nurses found themselves dealing with an ever-growing patient load, an overwhelming number of industrial injuries, and limited resources. During the home-front challenges, the Richmond Field Hospital and the main Permanente Foundation Hospital in Oakland  were constantly jammed and expanding. Registered nurse Clair Lisker recalled that, even after the war ended and the health plan opened to the public, we were so busy we would have patients out in the hallways, lined up, because we didn’t have enough bed space in the patients’ rooms.

Until COVID-19 appeared, unquestionably the organization’s biggest challenge was the AIDS epidemic of the late 1980s and early 1990s. AIDS was a mysterious and terrifying disease that traumatized patients and caregivers alike. No one knew what protocols to follow. Nurses were crucial to our effective and culturally competent response.

In 1983, Marianne Bond was an infection control nurse at Kaiser Permanente San Francisco Medical Center. Frustrated by the lack of protocols, she developed a 30-minute in-service training on patient-caregiver precautions based on what she’d learned about hepatitis B transmission. Registered nurse Barbara Lamberto, infection control coordinator at that facility, was quoted in the employee magazine Spectrum: "As health care workers, it's important to put things in perspective — to educate ourselves about the realities of the disease and then to replace our fears with compassion." 

Before more progressive visitation policies were established during the AIDS crisis, significant others did not have the same rights as family members. Nurses were the  gatekeepers who controlled visitation rights for dying patients without blood relatives or family, and they made allowances. Their actions informed the creation of updated policies that expanded hospital visitation rights for significant others.

AIDS taught many lessons. In the summer of 1987 the Kaiser Permanente employee magazine Spectrum published a summation by Neil Schram, MD, an internist at Southern California's Kaiser Foundation Harbor Hospital "This virus won't conform to our rules, and we'd better face that fact by finding new ways to adapt and cope. Because it's not going away."

Not to be lost in the impact of the AIDS epidemic was the handling of another public health challenge, hepatitis.

Hepatitis A blossomed into an epidemic in 1985, and by the fall, 75 people in Sacramento County, California, had died of this virus. The crucial step of tracking the community spread was baffling epidemiologists. But Angie Merrill, an infection control nurse at the Kaiser Foundation Hospital in Sacramento, collaborated with a counterpart at Sacramento’s University Medical Center, a location which had also experienced an outbreak. Frustrated at failing to find links between cases at the 2 facilities, Merrill had a “Eureka!” insight. She later recounted, "They're doughnut people. They eat doughnuts with coffee every morning in the cafeteria." And yes, the both facilities shared a common doughnut vendor. Her finding solved the case.

These health crises were followed by others: anthrax in 2001, H1N1 in 2009, Ebola in 2014, and now COVID-19 and its impact in 2020. In every instance — from 1942 through today — Kaiser Permanente nurses have been on the front lines saving lives, innovating, and demonstrating extraordinary leadership.  


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