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Excelling, leading, and innovating

By: Susan Trossman, RN

Nurses share efforts on COVID-19 planning and response

In addition to providing direct care to patients, nurses around the country are using their professional expertise to lead, support, and innovate around the response of healthcare systems and communities to the COVID-19 pandemic. The American Nurses Association (ANA) is sharing nurses’ efforts widely throughout the year and has created a section within the COVID-19 Resource Center to showcase nurse innovators.

“We want to highlight nurses leading innovative efforts and creating new possibilities for care delivery amidst the COVID-19 pandemic,” said Oriana Beaudet, DNP, RN, PHN, vice president for nursing innovation, ANA Enterprise. “Our goal is to build the agency of nurses across our country to effect positive change across every population and community they serve.”

Here are the stories of four nurses interviewed a few weeks ago.

Creating sites for patient surges

Last year, Sarah Francis, MSN, RN, NEA-BC, EDAC, stepped into a newly created role as the clinical lead and director of planning, design, and construction, where she literally helps bridge the needs of nurses and other clinical “end-users” with the plans of architects, engineers, and others involved in building projects throughout the Atrium Health system in North Carolina, primarily in Charlotte and surrounding areas.

With the emergence of COVID-19 in the United States, Atrium Health began planning and implementing a range of strategies to ensure the healthcare system had the capacity to meet the needs of its patient population, according to Francis, a North Carolina Nurses Association member. She has been serving on the alternative care locations task force, where she has helped evaluate potential healthcare sites in the Charlotte area, including existing ambulatory health clinics, a former school of nursing building, and tent set-ups, and redesigned them to meet inpatient demands if a surge of cases occurs.

“We really were looking at spaces where we could create a ward-style model to care for patients without needing too much uplift and cost [and] that could be staffed safely and efficiently,” Francis said. “My efforts focused on creating additional beds outside of our traditional hospital walls.” One of the locations she and the team identified was a building that until recently housed Carolinas College of Health Sciences. Eventual demolition of that building is part of a multi-year construction project, which Francis is helping to lead. “Because we had partnerships with contractors, designers, and vendors from ongoing building projects, they were able to mobilize fast to create the new space, which includes walls with a bank of outlets, bathrooms, and handwashing stations,” she said.

Francis also thought through what’s needed—such as medication dispensing systems, critical medications, and portable X-ray machines—to care for patients in a self-contained site. And she wanted to ensure patient privacy, appropriate supplies, and a process to clean patient areas.

Francis noted that moving into her design-focused role required her to think in new ways, which has helped her surge-planning efforts for patients with COVID-19. She also pointed out that nurses, in general, are skilled at coordinating and responding to needs.

“This is what nurses do through their training and innate passion,” she said.

Francis also spoke of other ways Atrium Health has been innovating to support staff and provide effective care. For example, a grab-and-go grocery store has been set up in the cafeteria at many hospital campuses in the system for employees to use, and nurses and other staff can get their meals from roving carts that come up to units. And Atrium Health nurses have even found ways to reduce personal protective equipment use by implementing video baby monitors, which allow nurses to check on patients and gather needed supplies before entering patient rooms.

Francis said that so far, Atrium Health has been able to meet patient demand at its regular facilities in North Carolina, but the organization continues to plan so it’s ready if circumstances change. The alternative care locations task force also includes representatives from the county and other local healthcare systems, so the response is collaborative and effective.

Bringing people together

Lauran Hardin, MSN, CNL, FAAN, FNAP, is at the forefront of building and strengthening collaborative efforts to help communities across the nation meet the complex needs of vulnerable populations. This extensive experience during nonemergency times is enabling her to help healthcare professionals, facilities, and community partners as they grapple with effective outreach and services to vulnerable groups during the COVID-19 crisis.

“Many of the communities I work with already have been deeply involved in the medical side, such as hospital preparedness and shifting onsite care to telehealth,” said Hardin, senior advisor for the Camden Coalition’s National Center for Complex Health and Social Needs. Much of her focus, however, is to assist these community partners, which include healthcare and social services groups, police, and EMS, in working together to more quickly meet critical social needs of vulnerable populations. She accomplishes that by sharing best practices, coaching communities in identifying and building broader partnerships, determining funding and other resources, and ensuring they focus on what matters most to the population they’re serving.

“There is a real urgency out there, and my role is to help them see what’s possible, how to solve immediate problems, and support their efforts,” Hardin said. Recently, she began working with the leaders of several large, multi-state, nonprofit health systems, including Kaiser Permanente, Providence Saint Joseph Health, Adventist Health, and CommonSpirit, which are looking at ways to provide more services in their communities as part of their COVID-19 response.

Ongoing concerns include finding safe shelter for people who are homeless, addressing food insecurity, providing internet access and computers to isolated children, and finding safe pathways for anyone experiencing domestic violence and abuse.

Some communities have opened transitional housing units, created safe parking lots, and procured hotel rooms for people who are homeless where they can receive wraparound services and maintain critical physical distancing. In East Los Angeles, Adventist Health White Memorial leveraged its community partnerships to rapidly address food insecurity. A coordination hub was created at the YMCA, and community partners came together to find unemployed workers who could deliver meals to older clients and process food donations. They also collaborated with businesses and restaurants, which created 4,000 grab-and-go meals a day. Within 3 weeks they developed a system to serve the homeless, isolated seniors, undocumented community members, and unemployed families.

“The National Center for Complex Health and Social Needs has really tried to help organizations accelerate their response to COVID-19,” said Hardin, a member of the Kentucky Nurses Association. “It’s not about one individual agency doing some good. It’s about tapping into all groups that can respond and getting creative, so you can share resources, accelerate efforts, and solve complex problems together.”

From convention center to field hospital

When a nurse colleague called Debbie Gregory, DNP, RN, asking her to lend her expertise in transforming Nashville’s Music City Center into a 1,600-bed surge facility for patients with COVID-19, Gregory didn’t hesitate.

The project was a collaborative effort involving state officials, administrators from Vanderbilt University Medical Center and other healthcare systems, construction experts, and additional key stakeholders who wanted to ensure enough capacity to safely provide care to patients with COVID-19 who needed to be hospitalized. The plan was to get the facility up and running within 6 to 8 weeks after the first team meeting on April 5, just as the number of COVID-19 cases began an upward trend.

As an experienced nurse and healthcare designer with the national engineering firm Smith Seckman Reid, Inc. (SSR), Gregory is skilled at addressing workflows, looking at space needs from a clinical perspective, and determining how technology (such as nurse call systems, equipment location systems, beds, key card badges, and computers) is effectively incorporated into the work environment.

“This is the work I do every day. And when I first learned about plans to convert convention centers into field hospitals around the country, I began collecting resources and best practices on how that can be accomplished, which proved useful on the first day of the Music [City] Center project,” said Gregory, a member of the Association of periOperative Registered Nurses, an organizational affiliate of ANA, and co-founder of the Nursing Institute for Healthcare Design.

Gregory said that she and team members discussed a wide range of issues, from addressing staffing needs and workflows to looking at processes related to safety and infection control.

“We knew we wanted the equipment to be portable and not part of the infrastructure,” she said. “We also had to look at creating different types of rooms for isolating patients and air-handling systems, how to transform public restrooms into patient and staff restrooms, where to locate electrical and data sources, and how to safely control entries and exits into the facility.”

An often-asked key question, noted Gregory, was: “How can we make this work?”

And although Gregory is well-versed in the various factors that must be considered when designing a new hospital or renovating an old one, she did find herself facing some challenges. One was determining whether families who were all infected should be housed together or isolated from each other. In other words, should areas be designated for male and female patients and for adults and children?

Another challenge involved creating a space for staff to shower and change clothes safely before they went home, so they wouldn’t worry about potentially infecting their families.

Because a surge of patients hasn’t occurred, efforts to complete the field hospital have been put on hold. However, Gregory and the team have laid the groundwork for whatever may come next.

Redesigning healthcare spaces

When it comes to preparedness planning and responding to COVID-19, Misty Chambers, MSN, RN, reports that nurses’ clinical knowledge on infection control and prevention, understanding of processes and needs, and ability to problem-solve are invaluable.

Chambers, a Tennessee Nurses Association member, serves on the crisis management leadership team of the national architectural firm Earl Swensson Associates (ESa), headquartered in Nashville, where she also works as a clinical operations and design specialist. Eighty percent of ESa’s business is focused on designing hospitals and other healthcare facilities, and Chambers uses her clinical and evidence-based design knowledge to contribute to developing concepts and design solutions that respond to operational goals.

In terms of the COVID-19 response, she and other crisis management team members initially put into motion a preparedness plan, which was finalized last year, to address the safety and needs of staff and clients in the event of significant emergencies. ESa professionals also fielded calls from healthcare clients, advising them on how to safely convert nonpatient spaces to patient spaces, create units with higher air exchanges, and add negative pressure rooms.

“The number one discussion point has been determining how to safely manage patients—from increasing capacity to choosing appropriate materials and making design recommendations that support infection control and prevention,” Chambers said.

Chambers primarily focuses on collecting data on design best practices and innovations from architects and designers involved in the COVID-19 response so that information can be shared with other healthcare facilities. She also has helped organize the distribution of 3-D printed face shields manufactured by ESa architects and other local partners to help meet the PPE demand at local healthcare facilities.

On a personal note, Chambers said that she witnessed first-hand the compassion and inventiveness of nurses on the frontlines after her husband was recently hospitalized and she couldn’t be with him at the bedside.

“The nurses knew I was a nurse, so they gave me detailed information on his condition. However, they also provided me with ways to connect with him visually,” she said. “Nurses find ways to ensure family-centered, compassionate care—even in times like these.”

Susan Trossman is a writer-editor at ANA.

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