Two years ago, when COVID-19 patients began arriving in her hospital in St. Cloud, MN, Lisa Kilgard, BSN, RN-BC, raised her hand to move full-time to that unit, where she thought she could learn something new and take care of vulnerable members of her community. For Lisa’s co-workers, Amanda Shank, BSN, CMSRN, and Nicole May, BSN, RN, the decision was less straightforward, as both were moved to the COVID-19 unit when patient numbers dictated the need for greater nursing support. Understandably, both were apprehensive about the transition, as there were still so many unknowns. Yet as COVID-19 continued to spread and the number of patients in their care increased, they felt their initial apprehension transformed into pride. Fairly quickly into their time in the unit, they felt like they were doing the right thing, in the right place, with the right team.

The bond between Lisa, Nicole and Amanda existed before the pandemic, but all three agree that going through the pandemic together only made it stronger. From knowing when a peer is cranky because they need lunch to lending a shoulder when things get heavy, these three nurses have built a natural chemistry. That bond has been incredibly important throughout the pandemic, as they have leaned on each other in the most challenging days and stood together when they could celebrate a victory. Even when on some days, Nicole explained, clocking-in was the only victory.

When you’re a nurse on the COVID-19 unit, Lisa explains, you might be the patient’s only contact with the outside world. In turn, the nurses become very attached to each patient, as they are sometimes the only ones allowed in the room. Nurses in the COVID-19 unit are often alone at the patient’s bedside, holding their hand, even when—especially when—that person’s condition is worsening.

Even with the support of the other nurses, after months of grueling days and nights, where she recounts crying non-stop until she had to pull it together for her next shift, Lisa knew that she had to do something. One serendipitous day, about a year into the pandemic, Lisa was walking the halls when an administrator in their hospital mentioned a book that he was reading, which read like the author’s personal journal. This sparked an idea for Lisa: what if she could give the nurses of their unit a simple, similar outlet to heal from their stress and trauma? That’s when she connected with Nicole and Amanda, and they decided to document what they were experiencing and asked other nurses to donate their stories as well. What began as a small project for the nurses in their unit blossomed into a full-length book of nearly 100 stories from nurses and other frontline healthcare workers (FLHW) from the CentraCare hospital system. The book, Just Breathe, will be published in March. Tapping into the collective pain that they all were experiencing, Lisa, Nicole and Amanda crafted an innovative way to help nurses deal with the trauma that they were facing every day, through sharing their words.

“How we approached this book is kind of like how we approached COVID in our unit,” said Nicole. “We didn't really know what we were getting into, but we got this idea in our minds, and then we had to figure out what we were going to do to accomplish our goals.”

The stories that they received truly captured all the emotions from the pandemic: sadness and defeat, sarcasm and humor, anger and disappointment, hope and inspiration. At the end of the day, they needed something to bring them together and, the three nurses agreed, writing down how they were feeling was the best way to process these emotions. Amanda noted the healing properties of writing down her trauma, as the nurses in their unit had built up so much stress, emotion and pain, but had nowhere for it to go.

Journaling provided Lisa, and her fellow nurses, with an outlet to move forward and continue to have hope for the future. She shared that even her 15-year-old daughter wrote a piece for the book, which helped both mother and daughter work through the uncertainty, fear and anxiety they had felt. A lot of the entries they received used expressive language to describe their experience and—while the language was often colorful—it was truthful, the three nurses agreed, and resonated with how they all felt.

“The stories made me realize that I'm not the only one that held a patient's hand while they were intubated but couldn't save them,” said Lisa. “I’m not the only one who tried to do everything possible, and it still didn't work.”

“Like I’m not alone,” Nicole agreed.

As the project kept growing and more frontline healthcare workers wanted to share their stories, Lisa, Nicole and Amanda decided, with encouragement from their hospital administration, to turn the stories into a book. The trio then had to work through various logistical difficulties, Amanda shared. The process was tedious and time-consuming, taking nearly a year to complete, but the three of them leveraged their entrepreneurial mindset and to bring the book to the finish line.

“The book was by nurses and for nurses. In every story, they were entrusting us with their thoughts, their feelings and their story,” said Amanda. “All three of us took that very seriously, because we know the emotion that goes with it.”

The nurses partnered with their health system to launch the project, working with hospital lawyers on consent forms and administration on approvals, funding and publishing. After reading some of the stories, administrators and lawyers at the hospital volunteered to shadow the nurses, so that they could fully understand what they were reading. Some of these administrators, as well as other healthcare workers who weren’t in the COVID-19 unit, but were inspired by these nurses, wrote entries for the book which said a simple—but meaningful—thank you. As this was the trio’s first foray into publishing, Lisa credits a large portion of the success of the project to the support received by their health system, who helped them turn a seed of an idea into a fully formed and tangible product. The three nurses have discussed a second book, as many of the stories in Just Breathe were written over a year ago—at the height of the pandemic—as they are so much more hopeful now than they were back then. In the meantime, Lisa, Nicole and Amanda are all still at the bedside full-time, and they look forward to holding a copy of their book, and sharing it with participating nurses, families and those who just want to know what they experienced in the COVID-19 unit.

“We can look back at these stories and say, you know, look at what we’ve been through, but also how we have been able to move forward together,” said Lisa.