Sometime starting in March 2020, registered nurse Daniel J. Smith’s entire work life changed. Only one crucial aspect stayed the same: his dedication to serving vulnerable refugee and immigrant populations and completing valuable research while earning his Ph.D.
In the weeks before, Smith was balancing shifts as a charge nurse at Clarkston Community Health Center and a hard-hitting study schedule. He is pursuing a doctorate at Emory, with research focusing on issues that impact Latinx health in the Southern United States.
Then COVID-19 started its assault on Georgia, and Smith’s day-to-day life shifted almost completely. The research group, for example, made an immediate move to refocus on COVID-19, assisting with serosurveys that help establish how many people have COVID antibodies.
Smith works with doctor of nursing and postdoctoral researcher Valerie Mac at Emory University Nell Hodgson Woodruff School of Nursing. "Everything now has a COVID lens," Smith explains. "We were supposed to have a mobile clinic to assess the impact of heat on Latinx construction workers in Georgia. However, the need for social distancing put that study on hold, and now the group is looking at the impacts of COVID-19 on farmworkers in Florida, where we have a cohort of workers recruited for a study on renal health in farmworkers."
Ready or not, Smith was thrown into COVID-19 research and was even tapped to work with the CDC on serosurveys. "I was in the field for a week and a half and was able to bring back what I learned to both the clinical and academic arms of my life," he says. "It was really interesting."
The situation changed even more swiftly at CCHC, increasing the challenge of serving the ethnically-diverse small Georgia city, known as a hub for refugees and immigrants.
"The clinic had to move to telehealth in an effort to try to protect the health professionals that volunteer there and the people who present for care," Smith explains. "And now, every Sunday when we would have had a clinic, we run a COVID testing site."
This development has made things harder on groups already struggling to receive even the most basic health care pre-pandemic. “The biggest problem the refugees and immigrants have faced in my practice has been the switch to telemedicine,” he says. “Telemedicine is great for privileged populations, but it requires a fairly advanced infrastructure. Patients have to have a solid data plan and an expensive smartphone or computer in order for telemedicine to work most effectively. The COVID transition has also opened up larger cracks that refugees and immigrants can fall through when trying to navigate the United States’ overly complex health system.”
But Smith had no time to grieve over this development. Instead, he got to work. "People do expect nurses to keep going on, no matter what," he says.
Even with his altruistic mission and "I'm on it!" attitude, Smith says he gave up trying to be perfect long ago. Instead, part of weathering this particular storm is recognizing that sometimes the stress will get the best of him.
"I get frustrated and have to take my breaks," he says. "Sometimes I know it's not going to be a good week with this stressful schedule and I have to find a nurse to replace me at the clinic."
One tactic that helps him keep working amidst all the need and chaos: He insists on downtime, and self-care. He took a road trip in August, for example, and is hoping to "really take a break" when fall semester concludes.
"And I know it's a cliché, but we can only give from our buckets if our buckets are full. We have to work on actively replenishing our buckets through self-care, even though it's hard. The rug has been pulled out from under all of us."
For Smith, "me time" takes the form of binge-watching television. "I really like Netflix," he says. "Anything and everything."
And he cooks, enjoying the ritual of preparing comfort foods he knew growing up. Favorites? "I love to make chicken pie and country ham biscuits," he says, "though not necessarily at the same time! I'm still a nurse, and I try to eat healthy. The key thing for all nurses during this pandemic is to take time to not work! Those things you liked before the pandemic hit? Make sure you're still doing them."
Smith did have an aunt who was a nurse, but he came to the profession himself in a roundabout way. He was pursuing a dual major in biology and applied Spanish at University of Carolina-Charlotte and scored a study abroad trip to Cuba, coincidentally led by one of the school's nursing professors.
The two got to talking, and by trip's end Smith said he knew what he had to do. "I knew nursing science and nursing research is what I wanted," he remembers.
Throughout that journey, his parents in particular were there to support him. An only child, he was raised on a dairy farm in North Carolina, where his folks still live. "My mother worked so hard to set me up," he says. "I'm a first-generation college grad, and both my parents are just so supportive. They still live on the farm, but any time I publish or present research, my parents come to see or they request to read it. Even though my father said a lot of it goes over his head, he reads all my papers."
He says he recognizes that his has been a life of white privilege, and his role at CCHC has reinforced his heartfelt view that all nurses should work to be more aware of the health care challenges faced by immigrant and refugee populations, along with other people of color.
"I have to continuously remember that the health care system often failed them," he says. "As nurses, it's up to us to learn and educate ourselves about the beliefs and the struggles these groups have encountered, and to actively work at anti-racism and decolonizing our nursing practices."
For a first step, he also recommends that his fellow "non-BIPOC nurses start by recognizing that they are racist in one way or another and then they can begin to educate themselves on the historical traumas that have been inflicted on the populations they work with."
Smith's immediate goals haven't changed much at all. Between now and the end of December, he'll be aiming to "successfully survive my first semester of nurse practitioner clinicals," he quips. "After that, I hope to find a job that allows me to work with disenfranchised communities to build health equity, either through research, teaching, or clinical practice."
And those whole-life upheavals that began March 2020? “It’s fine,” he’s quick to assert. “It’s all good. I’m a nurse, and these past months have been a true testament to the ability of nurses to pivot.”
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