Coronavirus. COVID-19. The virus. Regardless of the name, this year brought something most of us have never experienced in our lifetimes: a pandemic. We watched as our nation was essentially locked down and daily life as we knew it came to a screeching halt in hopes of slowing the spread of this contagion. All but essential businesses were forced to close, and dental offices were restricted to emergency patients only. This meant dental hygienists were not needed. Our employers were faced with some very difficult decisions.
My own boss struggled with what to do, and on April 2, I listened as my employer of nearly 20 years choked out the words I never thought I’d hear. We were all laid off from our jobs. It was heartbreaking to see her so distraught at informing us of her decision, but we all knew it was what had to be done to save the practice we’d all played a part in building. It was the only way to have a job to return to. But when would that be? There were no answers and so much was unknown. I felt gut-punched and numb.
Help! I’m unemployed!
My first reaction was regarding our family’s finances. How would we make ends meet? I’ve worked my entire married life, and we depended on my contribution to the budget. Should I file for unemployment? And if so, would it even be enough to matter? Should I try to get a job at a business that was considered essential? Thankfully, my employer, Dr. Brooke Porter, urged us all to file for unemployment benefits right away as there was a concern that this shutdown would overwhelm the system and we wouldn’t be able to collect benefits. This was new territory for me. The doctor made sure, via weekly Zoom meetings, that we’d all filed for benefits, and she answered any questions for those who were having trouble navigating the system. Those meetings kept us connected as a staff, and we were able to discuss what we were learning in the online CE we were watching. We also discussed how to move forward as recommendations changed. It was very reassuring knowing we were all in this together. She went above and beyond to take care of us, her work family.
This was the beginning of three months of unemployment. I’d never had that much time off from work, and it was unsettling. Having a plan has always been my comfort zone, and this time there wasn’t one. Initially, I spent several days navigating through feelings of anger, frustration, uncertainty, and fear. I dealt with those feelings by remaining quiet and emotionally distant from my immediate family and close friends. It took several days to process it all and come to grips with what was happening. I formulated a plan of things to accomplish around my house, and I stayed busy, even planting a small garden. I determined to accomplish at least one productive task a day to keep me focused, and that gave me the “plan” that I needed.
Keeping in touch and finding support
Like so many others, social media became a way to stay in contact with people and gather information. But the internet also quickly became a source of anxiety and stress. Along with the humorous postings came content from nonexperts with conflicting reports regarding COVID-19 and how it behaves. There seemed to be many overnight authorities with their take on the contagiousness, treatments, who was at higher risk, and so many other theories. Taking all of this into consideration, would we ever be able to practice elective dentistry again? Would my career choice put me in a dangerous environment if I continued to practice? Every day there were new questions with very few answers. I turned to the many online continuing education courses that were now offered, educating myself to the best of my ability, to give me direction. With all the emerging information surrounding COVID-19, the presentations often conflicted with one another, but at least I could start to wrap my brain around what was happening in the world. I sought out social media resources as a way to engage in a community, and I turned to a couple of the Facebook pages for dental hygienists, specifically one referred to as the “Listers.”
The Listers is a group I became part of in the mid-’90s. It was a small email group of hygienists that was started by Amy Petrillo as a class study page. Over time, it morphed into a supportive and encouraging community of RDHs from all over the United States and a few from overseas. I heard of this group at a continuing education course, and I turned to them years ago for support and advice in the midst of leaving one office and searching for another. It was a difficult decision, but with the encouragement of these hygienists, I was able to define what I wanted from my career moving forward. The annual RDH Under One Roof conference became a way for the Listers to meet one another in person, and friendships grew. Over time, the group became less active but never completely went away. Fast forward to several months ago, and that email group became a Facebook page. There are many new names in the group, but still a lot of the familiar ones that I had connected with all those years ago.
This page became a safe place for many hygienists to vent their anxieties and frustrations during this time. Unlike some of the other RDH pages, rude or degrading replies and comments are not tolerated. Disagreements are civil and spur some really productive discussions. The first post I made that seemed to hit a nerve were about the questions in my head that were unanswered pertaining to returning to work and the future of dentistry. How would we see patients back-to-back and still have time to filter the air and disinfect the operatory? How would we filter the air? How would we juggle all the new PPE? Would there even be enough PPE? How would our employers afford this? Would the cost be passed on to the patients? How would exams be possible when the doctors couldn’t leave the treatment room once a procedure was started? Would I even have a practice to return to? There were so many questions. It turned out that there were others feeling the same way, and it helped to have comments, suggestions, and just plain old positivity in almost every response. Their encouragement was so valuable to me in such an uncertain and scary time.
Is it time to retire?
As a hygienist of almost 33 years, I seriously considered retiring. The reports of what I’d face when returning to practice caused me to rethink what I really wanted at this stage of my career and life. I wasn’t sure I had it in me to start over and struggled to find motivation. Prior to being furloughed, I’d grappled with a heavy sense of dissatisfaction; not with dental hygiene, but with my work environment. When I was hired, the practice was just a few years old and we were a staff of six. We were all very close and supported one another on so many levels. My employer and I formed a deep friendship through practicing together and through the ups and downs of each raising two daughters. It was definitely a once-in-a-career environment. Fast-forward about 20 years and that practice is now three dentists, five hygienists, four assistants, and five business office employees! While I was so proud of what our team had built and grown, the connections to one another were tenuous at best. My days often felt like I was working in an anthill that someone had kicked over—controlled chaos.
All the changes that were needed seemed so daunting, but I eventually decided that I didn’t want to go out this way. Next March will be 20 years at my office and I really want to reach that milestone. There were also financial considerations, but discovering that we could manage without my income if necessary was really freeing. There is a huge difference, I found, in having to work and wanting to work. I decided I’d return to work when needed and see how it went.
My boss opened the practice in stages after the ADA and Texas State Board of Dental Examiners (TSBDE) decided on new protocols. The assistants and associate dentists came back first, and over the next month, the hygienists returned. Our first couple of days were spent learning new protocols and procedures instead of seeing patients. Learning how to “get dressed” for work was all new, as was the new equipment and layout of our sterilization area. Supplies had been moved and one of our operatories was now a PPE room where we changed our jackets (a contracted uniform company now supplies our scrubs and jackets) and scrub caps between patients. The office has a washer and dryer, but with a staff of nearly 20, it was impossible to launder all the needed uniforms on site. Another hygienist and I had put our sewing skills to work and made quite a few scrub caps while on break, and we launder those daily.
The day finally came for me to jump back into seeing patients. I was anxious about a new routine, but also about the public’s lack of care and concern in my state (Texas) regarding safe practices to prevent further spread of this virus. Our numbers were at an all-time high, and here I was stepping back into what is arguably a high-risk environment for contracting COVID-19, while many of my friends and fellow humans were arguing against safe practices on the basis that their political or personal rights were at stake! Once again, I turned to the Listers for encouragement and support and received it in spades. Knowing I could safely voice my fears, concerns, and frustrations to a group who really knew where I was coming from was invaluable.
Coping with changes
The biggest change made by the TSBDE was the restriction of ultrasonic scaler use on all but periodontally involved patients. I’d been using a USI manually tuned ultrasonic unit for almost 20 years and did 90% of my scaling with that, following up where needed with hand instruments. Turning back the clock and hand scaling seemed daunting. My wrists are definitely not what they once were, and I’m still concerned about how they will feel after months of this type of work. Thankfully, in February of this year, I shortened my workweek from three days to two due to a unique opportunity to use my paramedical tattoo training for several local plastic surgeons.
Aerosol containment is the big issue of the day since we know that COVID-19 is a virus transmitted in respiratory droplets. Finding devices that are effective and that work for us has been a challenge and is still a work in progress. We are currently leaving 20-30 minutes between each patient and staggering patient appointment times to allow suspended particles to settle. However, the biggest change in returning to work is the mental and physical fatigue at the end of the day. Nothing is routine any longer, so my brain is constantly spinning. And let’s talk about wearing all the new PPE! From headaches to dehydration to severely dry nasal passages resulting in sores, it is a big adjustment.
But I have found many positives. Change is scary, but there are always good things that come from it. My morning routine has been shortened because I no longer wear much makeup. I’m wearing a mask all day except when eating lunch. Besides that, the higher filtration level masks coupled with a face shield are hot, and makeup would sweat off very quickly. A quick brush of mascara and I’m good to go! Styling my hair for work is also a thing of the past, thanks to scrub caps. Before this, during my entire dental hygiene career, I never went to work without either of these things. My mindset was to always present myself how I wanted to be perceived, and I wanted to be thought of as a knowledgeable professional who took her work seriously. A sad little ponytail and a host of bobby pins and clips are my hair accessories these days, and leaving work in a baseball cap is a daily occurrence. The abbreviated routine has also allowed me to keep up with the morning exercise schedule I’d started while home.
The change in scheduling has brought another unexpected positive. Not only is the hygiene schedule different, but the doctors’ schedules are, too. The atmosphere and pace of the office has slowed, and we are all reconnecting as a team. There are usually a couple of us in the PPE room at the same time, allowing for a little breather, and the spacing between patients has allowed the whole office to feel the positive change. Despite this lighter patient load, our production has surprisingly remained at a very acceptable level.
Personal reflection and soul-searching while not working gave me new insight into my career and future. I’ve drawn my individual “line in the sand” regarding working in a fast-paced, high-stress environment for the duration of my dental hygiene career. I simply won’t do it. Period. Being able to make that statement provides me with such peace and confidence as I return to the career I’ve loved for so many years.
Cappy Snider has been a practicing dental hygienist for 32 years. She has written several articles for RDH in between homeschooling her two now grown daughters. She is also certified in paramedical/reconstructive tattoo and uses those skills to help breast cancer survivors complete the final step in their reconstruction process. She, her husband, and her pet pig, Stella, live in Texas.
