Home Focus on. . . Expected response to an unexpected year

Expected response to an unexpected year

Author(s): Julie Cullen, BA

When American Nurse Journal launched All Pro Nursing Teams in 2018, we never anticipated a year like 2020—a year in which a global pandemic created so much fear, anxiety, and uncertainty. However, if we had seen it coming, we would have predicted nurses’ (and nursing teams’) response. Stories from around the world have described the relentless and compassionate work of nurses caring for patients, adapting to updated guidelines, innovating in the midst of supply shortages, and supporting each other.

For this year’s All Pro Nursing Teams awards, in addition to questions about communication, leadership, and responsiveness, we asked nursing teams to tell us how they’ve been caring for patients and each other during the COVID-19 pandemic. We worried that given these busy times, we would receive only a handful of submissions, but we were wrong. We had the highest number of submissions since we launched the award, which tells us that nurses want to share their stories and want their colleagues to be recognized for the sacrifices they’ve made to keep their communities safe.

This year’ All Pro winners exemplify nursing teams that jumped into the fray, created policies and procedures in response to a novel virus, delivered excellent care, acted as surrogate family to isolated patients, and responded to their colleagues’ needs. The American Nurse Journal team members applaud all who submitted their stories (and the many who simply did not have the time to do so) and celebrate the winners, whose stories appear on the following pages.

Julie Cullen is the managing editor of American Nurse Journal.

Winner

Montefiore Medical Center Clinical Faculty/Montefiore Learning Network

all-pro-expected-response-year-montefiore

This year’s All Pro Nursing Team winner, Clinical Faculty/Montefiore Learning Network at Montefiore Medical Center in Bronx, New York, put their already strong communication skills, professionalism, and responsiveness to work when the pandemic began in March 2020. The Bronx was particularly hard hit by the virus (the hospital had two patients with COVID-19 on March 11, 2020, and 2,000 one month later), so in addition to their usual nursing education duties (which they quickly adapted to meet social distancing requirements) this team of educators was tasked with developing a safe, rapid training plan to meet surge capacity.

The educators created mandatory redeployment training days that involved “skilling up” over 600 nurses within 1 month. In addition to essential skills, the training included education specific to COVID-19—respiratory and cardiac care, strict infection control practices, and proning. They also provided socially distanced skills sessions related to central line dressings, patient-controlled analgesia pumps, indwelling urinary catheter insertion, peripheral I.V. insertion and line management, phlebotomy, and personal protective equipment. When the team’s classrooms and learning center conference area were turned into COVID-19 facilities, team leadership found alternate locations—many off-site—that met Centers for Disease Control and Prevention recommendations.

In the team’s words

“We all agree that this has been the hardest months of any of our professional lives. To the outside world, all clinicians seem to display a brave face…but the truth is we faced the same fears as everyone else. To reduce the emotional toll, we invested time in each other, each day, simply by asking ‘How are you today?’ The daily communication provided us with mental health stability, which can never be overestimated. Oddly enough, despite its challenges, this pandemic brought a renewed sense of solidarity and continues to be an enriching personal and professional experience.

“As clinical faculty, we’re not direct patient care providers, at least not by job description. However, when not teaching, we were on the units assisting our nursing colleagues on the frontlines…bringing them food and providing encouragement. We may have been the extra hands needed to position and turn a patient or assist them with an unfamiliar skill. We had many roles during the pandemic, but as nurses, undertaking many roles is who we are and what we do best.

“The education we provided and reinforced was evidenced by the excellent care our nurses provided. Thousands of patients were admitted to the Montefiore Health System over a 3-month period. There is much to be thankful for and much more gratitude on the horizon. Once the vaccine has conquered the coronavirus and terms such as ‘quarantine’ and ‘resurge’ fade from our daily vocabulary, we’ll take a few deep breaths and reflect on what this past year has taught us. We’ll continue to take pride in knowing we did our best and hope that some good has come out of all of this. 2020, without doubt, was the year of the nurse!”

First Runner-Up

University of Maryland Medical Center COVID-19 Screening Hotline

all-pro-expected-response-year-maryland-medicalThe PREP Center, which under normal conditions performs histories and physicals for pre-operative patients, was redeployed as an employee screening hotline when all elective procedures were halted. In addition to creating standard policies and procedures for sick and exposed employees, the team built a 24/7 schedule to support the hotline within 2 days.

To ensure cohesion, the team used a variety of communication tools, including virtual group meetings and an encrypted texting-type app that meets Health Insurance Portability and Accountability Act requirements. Team members texted each other throughout the day to ask questions, provide updates, and share fun stories.

The hotline’s success led hospital leadership to request expanding it to include the entire University of Maryland Medical System of 15 hospitals and clinics. Within 2 weeks, the team established a system-wide hotline.

As elective surgeries returned, leadership requested that the PREP Center reopen. The resilient team re-configured its schedule to allow for joint staffing of both the PREP Center and the hotline. The team continues to support two different workflows.

In the team’s words

“These team members had to create a workflow from scratch in a compacted time period. Many similar processes would take months; this team did it within days. We became fond of the saying ‘perfect is the enemy of good.’ The team was determined in working toward this goal.

“The response [to the COVID-19 screening hotline] from employees (who were our patients in this workflow) was overwhelming. Many cried because they were so happy to reach someone who could provide them answers. Some team members stayed on the phone for long periods listening to patients talk, cry, or vent. The team excelled at using empathy and therapeutic listening.”

Second Runner-Up

Methodist Mansfield Medical Center ICU Team

all-pro-expected-response-year-methodist-mansfield-medicalWhen the pandemic hit Methodist Mansfield Medical Center, the ICU nurses were instrumental in creating the COVID-19 unit. Because containing the pandemic meant keeping patients’ loved ones out of the unit, the ICU nurses became surrogate family members, comforting patients and sharing information about care.

Several ICU nurses began tracking the latest COVID-19 research on testing and trends and disseminated best practices, and the unit formed mentoring teams to share patient care. The nurses work to anticipate treatment plans and necessary safety precautions, and they haven’t missed a beat while learning and adopting new care approaches.

At the height of the pandemic, many nurses worked 6 weeks without a weekend, but the team camaraderie lifted their spirits. All nurses have had access to a serenity room, aromatherapy, chocolate snacks, short meditations, stretching, a massage recliner, relaxing nature sounds, guided mindfulness, and inspirational videos to help them re­charge and clear their minds. In addition, a 24/7 professional assistance hotline is available so nurses can share their concerns and be listened to and reassured.

In the team’s words

“The ICU nurses worked together to protect each other. They stepped up to be assigned to the special COVID-19 unit so that other staff members who had vulnerable family members at home could be kept safe from being exposed to the virus. Some of the nurses opened their homes to staff members to quarantine so they didn’t have to pay to stay in hotels. They also offered financial assistance to those whose spouses lost their jobs, offering gift cards, food, and essential items.

“When our hospital was one of the first to receive the Pfizer-BioNTech COVID-19 vaccine, these nurses were among the first in the state of Texas and nationwide to receive it and then volunteered to administer this vital vaccine to frontline staff who worked directly with patients diagnosed with or at high risk for COVID-19. They took the lead by setting the example for others to follow.”

Third Runner-Up

Chesapeake Regional Healthcare Clinical Coordinator Nursing Team

all-pro-expected-response-year-chesapeake-regional-medicalCollaboration is key to this team’s success. To address increased staffing demands, the hospital created in-house contract positions and former employees were invited to return for designated periods. Their plan for overflow capacity extended to the hospital’s ambulatory surgical center, which prepared to serve as a tertiary ICU. Two campus locations and a community center were identified for lower-acuity patients.

To address safety concerns for staff participating in resuscitation efforts of patients with COVID-19, the Difficult Airway Response Team (DART) was created. DART is responsible for distributing, collecting, reprocessing, and fit testing N95 masks. When responding to Code Blue calls, they fit team members with PAPRs and supply them with LUCAS Chest Compression devices.

Nursing and respiratory therapy partnered to ensure proning for patients with COVID-19 throughout the hospital. Nurse educators teamed up with the respiratory therapy manager to create and disseminate staff and patient education on the practice.

In the team’s words

“As our staff worked tirelessly to care for patients, we wanted to find a better way to care for them. The idea for a Zen room blossomed into a full-fledged research project called the Me-15 Room. We transformed an abandoned office space into a place of quiet relaxation with massage chairs, lavender aromatherapy, salt rock lamps, music therapy, and a virtual reality set for mindfulness and meditation. Over 400 employees have enjoyed its benefits.

“Encouraged by the positive response, we took another step toward enabling more mindfulness and personal well-being by establishing a partnership with doctoral psychiatry students from Old Dominion University. These externs rounded with members of the Employee Wellness Committee to lead frontline workers in 1- to 3-minute mindful meditation sessions. Feedback indicated this was a successful tool to help with coping skills.”

Honorable Mention

Advocate-Aurora Lutheran General Hospital 4th Floor Cardiac Telemetry Unit

“Our unit, like many, experienced difficult times during the pandemic. Our teamwork and collaboration have made us what we are today—a stronger, better unit. At the beginning of the pandemic, transporters and phlebotomists weren’t allowed to enter isolation rooms, so nurses and nursing care technicians (NCTs) took on those responsibilities. In addition, if simultaneous rapid responses were called on multiple floors, our team assisted ICU nurses and ran our own rapid responses with a medical officer of the day and respiratory therapist at the bedside. We were the first unit in the entire hospital to get the very first positive COVID-19 patient. We came together and asked, ‘What are the next steps? What can we do to be prepared?’”

Honorable Mention

Buena Vista Regional Medical Center Medical/Surgical Department

“Two words come to mind when describing the medical/surgical department: relationships and gratitude. The department spent 4 years participating in the Institute of Healthcare’s Joy in Work collaborative, which emphasizes positive psychology interventions, teamwork, and having conversations that matter. The pandemic has been exhausting, but it’s frightening to consider where we’d be without this work. Burnout and compassion fatigue frequently appeared, but the department was able to mitigate issues with the tactics we learned. Patients who were entrusted to us received excellent care and we saved lives, while helping the community at large. Courage, gratitude, and relationships are the key to success and they kept us all going. We responded to a need and exceeded even our own expectations.”

Honorable Mention

Hospital of the University of Pennsylvania Medical Intensive Care Unit Nursing Team

“The data gathered from last spring on Hospital of the University of Pennsylvania (HUP) patients in the ICU with COVID-19 told a story of remarkable, skilled ICU nursing care. Third-party data from Vizient from April 2020 through August 2020 show a remarkable low mortality index for HUP. Our calculated index was a rate of .53 compared to the comprehensive ‘academic medical centers’ cohort at .87. During this time, HUP ranked #1 in the northeast region for its lowest mortality index and #11 in the nation. This rate is truly remarkable given how early and hard the northeast was hit with COVID-19 compared to medical centers across the country who didn’t begin to see surges until much later.”

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