If You Can Do More, You Should Do More. Lessons from the Front Line

By Erika Fehrenbach Prell

If you can do more, you should do more.  This is the mantra of Bethli Zgraggen, wife, mother of 5, and family nurse practitioner, and why she felt the pull to take a travel nurse position in one of the United States Covid-19 disease hot spots on the East Coast. Most people say they want to help or wish they could, then there are the people that make it happen. Those that know this amazing woman are not surprised that she took action, leading by example for her children and all around her what it means to do more when you can.

The Unexpected Nursing Path
Bethli grew up in New Glarus, Wisconsin. Besides being home to the New Glarus Brewery, New Glarus is the Swiss capital of North America. Bethli, pronounced “bade ee”, comes from a strong Swiss heritage and actually has family that live in Switzerland. Bethli reports that she fell into nursing; her journey started and progressed naturally. Along the way, however, it became a perfect fit!

She worked as a certified nursing assistant (CNA) while getting her associate degree in nursing. She confesses she went this route because it was less expensive and had no waitlist. She began working in the Cardiothoracic Surgery Intensive Care Unit following graduation. Two years into her nursing career, she completed her Bachelor’s of Science in Nursing. She realized she wanted to continue her studies with an advanced practice nurse degree. Initially, she thought she wanted to go become a nurse anesthetist, which is a specialty in anesthesia. After working in the cardiothoracic surgery and the pediatric post-anesthesia unit, she found increased interest in learning how patients got to the point of needing surgery and how she could help from the frontline. She turned her sights on becoming a Family Nurse Practitioner. She is slowly but steadily working towards her Doctorate in Nursing. She reports she is doing this mostly for herself, as she has always had the goal of achieving a terminal degree, but also wants to show her kids that you can accomplish anything with perseverance and determination. 

A Calling to Do More
In January of this year, Bethli started to get the sense that Covid-19 was posing a huge health threat. She thought she would be needed at UW-Madison Hospital and Clinics in Madison, where she had previously worked as an ICU nurse prior to becoming a nurse practitioner. Since it had been a while since she had worked at the bedside, she began refreshing her knowledge on ventilator setting and intravenous medications. Leading with her mantra in mind, she had the mindset that if I can help, I should help.

Like many other places around the state and nation, she experienced job-related changes as her patient load decreased significantly and switched to telehealth. She kept thinking she had other skills that she could offer in this health care crisis. In March, she started thinking about taking a travel nurse position and helping in a high need area. She had a conversation with her husband as well as her mother and sister about whether or not she should do this; all of them were supportive of this idea, particularly her husband who never hesitated in his support of her.

She didn’t want to take her skills elsewhere if Wisconsin would end up needing her so she held off for a while. As March faded into April, it became clear that Wisconsin was successfully keeping case numbers contained, and the hospitals and ICUs were not overcrowded. Bethli approached her clinic regarding her desire to take a travel position to help on the East Coast and if this would be possible. Again, she was met with nothing but support and encouragement from her employer; they came up with a plan for her to work remotely via telehealth to see her family practice patients. Bethli and Joe discussed her desire to help with their 5 children, Madeline (11), Lily (7), Isaac (5), and twin boys, Fritz and Wally (3). Initially, Madeline was hesitant and didn’t want her to go. During the discussion, however, the entire family came to the conclusion that she had to go and help. Now, Madeline has told Bethli how proud she is of her.

Bethli contacted a nursing recruiter on a Friday. She decided on a position in Edison, New Jersey, which is about 1 hour from New York City. She would be going to the JFK Medical Center, which was a large neuroscience rehabilitation facility that was temporarily converted to an over 80 bed intensive care unit for Covid-19 patients. Her decision was not based on case severity, on the contrary, she wanted to go where her extensive ICU skills could be utilized to the fullest. Rather, her decision fell on not having to learn a different electronic medical record; for you health care providers reading this, you will completely understand that! (For you non-health care providers, learning a new electronic record is tedious at best.) She was granted an expedited nursing license 24 hours later. She packed up and left the following Tuesday, arriving in New Jersey that same day, and started her first shift the following day.

The Frontline Experience
Bethli was thrown right into the fray. She had two orientation shifts, then was started with patient assignments. When she arrived, there were 84 critically ill, ventilated patients. She was assigned 4 ventilated patients each shift; to put in perspective, a typical patient assignment would be 2 ICU patients as critically ill as these were for 1 nurse. Bethli said she felt very welcome and appreciated by the core staff; if it wasn’t for the travel nurses, the core staff would have had a 6 to 7 patient assignment. This would have been disastrous on two fronts; the core staff would have been stressed and overworked while patient safety and outcomes would have suffered.

Bethli recalls that she had to retrain herself on how she performed her nursing duties. One of the first things was on how she reacted. For example, when a ventilator alarms, her instincts were to go and help the patient. However, in the case of Covid-19, she had to learn to suppress this instinct and take the necessary steps to protect herself with personal protective equipment first. The emphasis was for health care providers to take care of themselves first before helping the patients, otherwise, they are no help to anyone. Another big change was maximizing her efficiency. The process of getting on the personal protective equipment was so laborious that she learned to do as much as she could at one time during each patient interaction. She had to shift her mindset to doing the necessary tasks only. Nurses often bring the human experience back to the hospital experience; they bathe the patient, give back rubs, hold hands, do all the little things. These patients were so critical and a staff stretched so thin that these had to be foregone most of the time. This was very hard for the nursing staff but necessary.

Initially, Bethli reports patient outcomes were very poor. There were multiple codes and patient deaths per shift. As the weeks passed, however, outcomes improved as providers started learning successful ways to combat the illness. As the critical cases of covid decreased, the hospital started shifting back to scheduled surgical cases. Since Bethli’s intention was to help with the crisis, and the crisis was starting to wane, she cut her assignment to 7 weeks instead of 8. It was time to head home and get back to her family!

While Mom was Away
Bethli is so proud of how her husband and kids stepped up while she was away. Between her
shifts at the hospital and duties as a family nurse practitioner via telehealth, Bethli worked close to 72 hours per week. Her East Coast colleagues couldn’t believe she was working that much. Bethli laughed at this and had two funny responses. First, this was a highly unusual time; since everything was closed and most people were quarantined, her only option was to hang out at her extended-stay hotel room. And, here’s the funny one all parents will relate to, she has 5 children ranging in age from 3 to 11; this is the best, uninterrupted sleep she has gotten in over a decade! 

When she wasn’t working, she spent time on Zoom with family and friends. She had breakfast every morning via Zoom with her kids as well as other chats during other times. She was amazed that her kids stepped up and took on more responsibility to help out while she was gone; however, she is skeptical it will continue once mom is back on the scene. It was definitely a team effort to coordinate all of this! They had the help of two sisters who had nannied for them in the past that alternated days during the week for child care, and Joe was allowed some flexibility of his schedule while he was gone. Bethli reports that she and Joe are a great team. They have been through several hard and challenging times during their marriage, including raising twins with a 1 ½ and 3 year old at home. She is grateful for her family’s support and love while she pursued this drive to help out. 

Life Lessons from the Frontline Experience
Another principle Bethli has always lived by is life happens, things get shitty, change the narrative. This perspective to change the narrative came front and center in her life just over a year ago when her husband, Joe, was found to have a life-threatening but benign chest tumor. He underwent life-saving surgery, which really highlighted this mindset that awful things happen in life but you choose the narrative. Instead of being scared or asking “why me”, they chose to be grateful that the tumor was found and the surgery successful. This is a principle that she and Joe want their children to live by as well. From the minute Covid-19 came on the scene in full force, she made the decision to find the good in these times.

She chooses to feel fortunate for the path her life has taken, to particularly change the narrative on the unexpected things that take us by surprise in life. In her experience, these end up being the biggest blessings. A great example is she never thought she would have 5 kids but she can’t imagine life without them! She remembers when she found out she was pregnant with the twins. Being the oldest, Madeline was starting to get into all the activities...sports, Girl Scouts, gymnastics, dance. Bethli kept thinking to herself, “how will I be able to do all these things with 5 kids?!?”. Her dad gave her an awesome perspective that has served her family well; he said simply that kids do not need to do all of those things to be happy and that it is okay to slow down. She realized that having a tight family circle with a few meaningful activities was the way to go. Awesome advice!

This experience has highlighted the people that truly matter in her life. As often happens during a big life event, people showed their true colors-support came from and was absent from unexpected places. She realized the importance of taking time to maintain the relationships that add value to her life; that this was a piece missing prior to this experience. She has learned it’s important to prioritize who and what are the most important!

She is also grateful that this experience has helped focus her life purpose. Prior to her front line experience, she was starting to wonder if family practice was following her purpose and considering going back to bedside nursing. These 7 weeks gave her a glimpse back into that world. She came to the realization that she went into family practice to help people on the path to health before health becomes an issue, to focus on prevention. This is the opposite perspective and influence of a bedside nurse. She realized that most of the critically ill patients had other medical conditions, which put them at higher risk. This solidified her purpose of helping people intervene earlier in their health to prevent this path from unfolding, to be their catalyst of health change. Along with this, she is interested in exploring per diem ICU shifts a few times per month to keep her skills fresh and satiate her desire for bedside nursing.

The final principle that Bethli believes strongly in is that do good and good things come your way. What a fantastic example of a positive mindset combining the power of the Law of Attraction! Bethli, you are an amazing example for others on taking action to make the world a better place, whether through your children whose lives you are positively molding, the patients you help in your family practice, or doing what others are not willing to do by going to the frontline of a pandemic. Keep leading by example and showing the world what kindness in action looks like!

Shine on!​