INTERVIEW: Abortion Care Network's Nikki Madsen on How to Care for Clinic Staff During Coronavirus

Nikki Madsen (left) with friend Emma Schubert

Photo courtesy of Nikki Madsen

Name: Nikki Madsen

Pronouns: she/her/hers

Digital: abortioncarenetwork.org, @abortioncare, /abortioncarenetwork, @abortioncarenetwork

Email: info@abortioncarenetwork.org

Give to: your local abortion clinic

At the Abortion Care Network, a network of independent abortion providers, you’re keeping a pulse on how “indies” are responding to all sorts of things like anti-abortion restrictions, violent attacks, and more. Can you tell us a bit about how indies are faring amid the COVID-19 or Coronavirus pandemic?

Providing safe and clean environments for patients, staff, community, and colleagues have always been a priority for independent clinics. Abortion is healthcare, and we affirm independent abortion clinics as integral, experienced, local, and available community healthcare. Independent providers have shown a deep commitment to upholding health and safety standards. Clinics are Open! Indies are resilient, they operate in the most politically hostile environments and are used to providing care during times of crises. Indies right now are focused on continuing to provide patient-centered abortion care and ensuring the safety of patients and staff. 

Of course, Coronavirus is a public health issue, but it’s also a workplace issue. How do you suggest clinics adjust to ensure their workers stay healthy and patients are able to get the care they need in a timely manner?

Abortion clinics already operate with significant protective measures in place. We know independent abortion care providers, like all frontline health care workers across the country, are adjusting protocols right now. We believe that people should be able to get abortion care as soon as they are ready, and that unnecessary delays can have serious impacts on patients lives, health and wellbeing. 

ACN supports clinics in communicating confidence in care, availability of services, and commitment to high-quality healthcare service delivery for their communities. We know any disruption to care can indicate closure, and we encourage clinics to communicate with patients and communities about safety precautions and any temporary closures and/or remote access to clinic services.

Furthermore, what makes independent clinics so excellent is their ability to meet their communities where they are at. More than ever, staff at clinics should build connections with their colleagues on the ground as a community health strategy and to reduce professional isolation. We suggest that our members:

• Work closely with their local abortion funds to understand if they are adjusting any protocols.

• Get to know who in their community is screening COVID-19.

• Make sure you know about healthcare and public health emergency planning and response activities in your community.

• Learn about plans to manage patients, accept transfers, and share supplies.

• Have an active referral list of providers for patients calling in and/or presenting with acute respiratory illness.

And finally, it’s essential that clinics are places where all people feel welcome and where stigma and discrimination related to the spread of COVID-19 is not tolerated. To that effect we encourage clinics to communicate internally and externally that:

• Coronavirus doesn’t recognize race, nationality, or ethnicity. Coronavirus (COVID-19) started in Wuhan, China. Having Chinese ancestry –– or any other ancestry –– does not make a person more vulnerable to this illness.

• Wearing a mask does not mean a person is ill. People wear masks for a variety of reasons, including to avoid pollen and air pollution and for cultural and social reasons. We should not judge someone for wearing a mask or assume they are sick. Many communities are already living with impacted immune systems and/or disabilities.

• Speak up if you hear, see, or read discriminatory comments. Correct false information and remind the person that prejudiced language and actions make us all less safe. 

• Show compassion and support for those most closely impacted. Listen to, acknowledge and, with permission, share the stories of people experiencing stigma, along with a message that oppression is not acceptable in our community. Supplies, accessibility, and convenience in healthcare should not be a privilege.

For additional recommendations, we want to uplift the expertise of our ally the National Abortion Federation regarding COVID-19 specific clinical policy guidelines. 

Providers who travel to perform abortions and front line clinic staff have the most contact with patients. What are your suggestions for clinics to keep those staff safe and healthy?

Clinic staff are balancing extra protective measures with continuing to provide warm compassionate abortion care to their patients. We know clinics are limiting non-essential travel for staff; however, providers are essential to abortion care provision. A few simple adjustments clinics are making to ensure the health and well-being of their staff include: screening patients, staff, and volunteers in accordance with CDC recommendations and their individual state’s Department of Health for COVID-19 symptoms; limiting guests to the clinic; changing patient flow so fewer patients are in the waiting room at any given time; and having all administrative staff work remotely in support of social distancing recommendations. ACN is not an organization that issues clinical guidelines; however, we are uniquely focused on frontline staff and clinical sustainability, therefore ACN shares these tips as matters of practicality, guidance and collective thought:

• Encourage sick employees to stay home. 

• Employees who develop respiratory symptoms should be instructed not to report to work; 

• Protect vulnerable staff and staff with vulnerable families by assigning remote work if possible, and provide the tools needed for telework such as forwarded phone lines, mobile appointment logs, access to laptops, etc.; and 

• Ensure that your sick leave policies are flexible, consistent and inclusive and minimize employee hardship during this crisis; 

Additionally, this pandemic has real financial implications for clinics owners and for staff. Clear and frequent communication is essential at times like this. We encourage our members to:

• Work with your staff to understand and find creative and community supports for childcare and other caretaking responsibilities resulting from childcare and school closures;

• Ask about food and housing concerns they may be facing and how that might impact their schedule, health and wellbeing.

• Ask for help. You don’t have to do this alone. There are so many people in the world who want to use their skills and talents in support of abortion care and access. Don’t underestimate all the ways your friends, family, colleagues, coworkers, and foundations are able to step-up to help you out. Often they don’t know how they can be of service other than making a donation and they are just waiting for you to ask and provide insights or some direction. 

We also encourage people who have insurance to check to see if that insurance covers teletherapy. If you don’t have insurance or if your insurance does not cover teletherapy, ACN has a vetted list of therapists for the staff at our member clinics to reach out to ensure the health and well-being of our staff during this time. And don’t forget free online supports! We love this healing circle from Tea Time with Sandra and these meditations from calm.com.

We’ve heard that cross-training staff can help ensure clinic flow continues in the event that staff members are out sick. Can you explain what that means and how a clinic can start doing that?

There are several aspects of care a patient will obtain the day of their visit, like checking vitals (i.e., blood pressure, heart rate, and temperature), an ultrasound, talking with a counselor, the abortion procedure, and aftercare instructions. Having cross-trained staff means that staff can fill in for each other without interrupting service provision. This is a common practice for independent providers and a place where independent clinics could provide learnings to other organizations during this pandemic. 

Many states have passed ridiculous medically-unnecessary laws designed to make operating a clinic difficult on a daily basis, but in particular in moments of crisis. What is your best advice to abortion clinic workers? 

There is much our entire movement and the world can learn from the resilience of independent abortion providers. Rather than advice, I’d like to give some words of encouragement. To all the independent providers out there, you got this! You are more prepared for this than most. ACN and your community is here to support you. Know you are not alone and please don’t hesitate to reach out to us if you need support by emailing Angelica Perez at angelica@abortioncarenetwork.org 

If a clinic is thinking about making sure their staff has paid sick days or increasing their paid sick days, where do you suggest they start? 

Start with a conversation with your staff. I recommend supervisors have one-on-one conversations with each staff person about their specific needs during this time and then as a management team figure out the places where you have more flexibility as well as those where you have less. And continue the conversations and assess how you can both support staff and your community’s needs as this pandemic evolves. 

And keep up to date with the state and federal resources that may be available to support expanded paid sick days. Early this week, we anticipate the Senate passing the “Families First Coronavirus Response Act” providing paid family medical leave, paid sick time and unemployment insurance to companies with under 500 employees -- which means all independent clinics in the U.S. should qualify. In the meantime, we are already seeing some states adopt a series of emergency rules to relieve the burden of temporary layoffs, isolation, and quarantine for workers and businesses as well as emergency grants for small businesses. It’s important to closely follow your state’s Employment Security Department and Office of Economic Development to stay updated on all of the additional benefits and grants that might be available to independent clinics to support the financial realities that impact small businesses during a pandemic and support the health and wellbeing of staff. 

Things can get stressful in times like this as staff and patients are worried, and a lot of information is uncertain. Can you share your tips for making it through turbulent moments like this?

Remember that providers’ number one priority is patient safety and this has always meant the health and safety of staff. Independent providers are always navigating turbulent times but depend on their communities' support. During particularly stressful times, sometimes the most simple of actions can have the biggest impact. It can be hard to remember to find those moments throughout the workday. We encourage our member clinics to take brief moments to center their nervous systems throughout the day. Some examples include: before you walk into an exam room pause and take a few deep breaths; create some visual cues throughout the clinic (an image you like, a sticker, a few post-it notes) that will put a smile on your face; center your attention on a something that is visually pleasing for you like a piece of artwork or a color you like for a few seconds; and have a plan in place for when a co-worker needs to step away for a few minutes. At ACN we say we are stronger together, please know independent providers will be there for their communities at this moment and ACN will be there for our members at this moment.

What would you say to people who want to donate masks, hand sanitizer, and food to clinic workers? What can we do to support abortion clinics at this moment?

First and foremost, spread the word that clinics are open. Next, reach out to the health care providers in your life and ask how you can help. Some suggestions might include: can you deliver dinner to them (or a gift card for a restaurant), support them with childcare, pick up groceries or supplies when you go out, help with house chores, etc. Those of us who have the flexibility to work from home need to step up to support health care workers in every way we can to ensure the health and well-being of us all. We know that our members have a lot going on right now. Feel free to reach out to our member clinics directly at their contact emails for donating items or gift certificates to support frontline staff during this time -- every independent clinic is different. It’s important that you talk with them before sending unexpected packages or showing up to help. Please be patient with how long it may take for them to respond. They really do need and appreciate your support but are under the same pressure as all health care providers at this time which might delay their response time to email. 

How do you handle stress? Any tips for others?

I laugh. Sometimes it’s just so much that there is nothing else you can do. Acknowledge how ridiculous the pressures can be and make a joke about it. Laughter is truly the best medicine.

How do you wind down your workday?

I really try to not schedule meetings past 4pm so I can close out the day responding to emails. I also try to pick up my son from school because conversations in the car are my absolute favorite. I swear kids share more about their feelings, friends and ideas in the car than anywhere else. 

What’s a delicious meal you ate recently?

My husband, Mike, has been really caring for my son and me by baking homemade bread and making meals from scratch lately. Last night he made burritos with homemade guacamole and there wasn’t a leftover to be found. 

Tell us about the last really good book you read.

I’m reading The Witches are Coming by Lindy West right now. There is a great chapter on abortion called, “What is Abortion Anyway” where she highlights a visit at independent abortion care provider, Emma Goldman Clinic, on the day after the 2016 election. She states “I believed, naively, that I had flown there to comfort them. What I found was exactly the opposite: a group of people not drowning in shock and despair, as I was, but putting one foot in front of the other with grace and good humor, just as they had the day before and would the day after.” These few sentences really get to the heart of the resiliency of independent providers.