Michelle Churches, MSN, RN, Staff Nurse — Kellogg Eye Center PACU

Crisis: “A stage in a sequence of events at which the trend of all future events is determined; a turning point”

2020, the International Year of the Nurse and Midwife. It has been an incredible journey so far.

I currently work as a PACU staff nurse at the Kellogg Eye Center (KEC) in Ann Arbor, Michigan (Michigan Medicine).

My 41-year hospital career is broad: ED Clerk, Phlebotomist, Pediatric ED RN, Pediatric Trauma Nurse Coordinator, ED Phone Triage, Adult Pulmonary ICU, Accreditation and Regulatory Readiness Staff Specialist, Expert Witness/Legal Nurse Consultant, Pediatric PACU Nurse, Adult PACU Nurse, Ophthalmic PACU Nurse. All of these honed skills would be reactivated during this deployment.

March 26, 2020, I volunteered to be deployed from the Kellogg Eye Center PACU (ASC) to help “on the hill” at the main hospital(s) covering 21 COVID ICUs/departments. Michigan Medicine (MM) has three hospitals: University Hospital (UH), The Cardiovascular Center (CVC), and Mott Children’s Hospital.

My deployment assignment: Team Coordinator, Safety Monitor Team…a team that never existed before the pandemic. Michigan Medicine’s in-house bio-containment unit was created from the ashes. Our role as Safety Monitors (SMs) was to keep MM’s staff and faculty safe by monitoring donning and doffing of PPE “in the moment” (like during codes when teams instinctually rush in to help save the patient, emergency tracheostomies, multiple codes on the same unit at the same time, etc.)

I would be responsible to train, orient, answer questions from staff and ICU Leadership, resource policies (ever-changing), schedule the continual onboarding and offboarding staff, and handle personnel issues (call-ins, emergencies, etc.) that arise with the daily functions of any hospital unit and any other issue from anyone that had my email, pager or mobile phone number.

My direct reports for deployment: UH OR Education Supervisor Valerie Marsh, DNP, MSN, RN. I would be working under Val and also taking lead from Gretchen Pagac, MSN, RN, Senior Director of Nursing and Associate Chief Operating Officer, University of Michigan Medical Group. I would work in the “old” Mott Children’s Hospital (near and dear to my heart) and repurpose someone’s abandoned desk and computer (furloughed employee) (ahem…I took over their office).

My past ED triage skills would quickly be put to use.

The challenge: We had no central meeting place (unit) (we were to cover 21 units in three hospitals 24/7). There was no central means of communication. Staff came from several of our off-site and main OR/PACUs/Procedural Areas—many of whom I had never met before.

In our home units (ASC) most of us work eight-hour day shifts, M–F. With the C-19 crisis, our CNE shifted nursing to work 12-hour shifts covering 24/7. Some would be assigned to work the 12-hour midnight shifts (many had not worked midnights in over 20 years) to cover the ICU needs (you know where I am going with this…).

I am glad there was no popularity poll sent out during this time.

I kept reminding myself that the focus of my role was to staff the units to support MM nursing and faculty, keeping MM employees and our community safe from the spread of C-19, and proceeded with daily operations. I would demonstrate compassion to my team of SM by allowing them to self-schedule as much of their work-life as possible during this crisis. I was also here to support them during this pandemic, too.

I knew this was not going to be a one-woman job. With Val’s approval, I quickly recruited help from a few of my KEC colleagues I knew I could trust and rely on. I quickly learned from Val that I had her full support. We knew we could trust each other’s decisions. We had each other’s back. This is imperative in a leadership role.

Kevin Dombrowski, RN (KEC OR), and Shelly Robbins, RN (KEC PACU), became the SM Team Charge Nurses. I was able to utilize the talents of Jillian Bowers, BSN, RN (ASC), OR Educator, to assist us in training the Safety Monitors. The amazing fact: We, the four of us, “stood up” 92 SMs (trained and oriented, staffed) covering 21 ICUs in less than 14 days. We worked closely with the Safety Management Team and the Infection Prevention Department. Collaboration was key to daily operations.

 

On New Team Development

Tuckman’s stages of group development: forming, storming, norming and performing. All necessary and inevitable in order for the team to grow, face challenges (there were many), tackle problems, find solutions, plan work and, most importantly, deliver results.

  • Forming: Team meets and learns about opportunities and agrees on goals; acts independently.
  • Storming: Group sorts itself out; members gain each other’s trust. This stage often starts when they voice their opinions and, as a result, conflicts may arise between members as power and status are assigned. It identifies a different hierarchy of status positions in the group.
  • Norming: Resolved disagreements and personality clashes result in greater intimacy and a spirit of cooperation. This happens when the team is aware of the competition and they share a common goal. In this stage, all team members take on the responsibility and have the ambition to work for the success and goals of the team. They tolerate the whims and fancy of other team members. The danger here is that team members may be so focused on preventing conflict that they are reluctant to share controversial ideas.
  • Performing: With group norms and roles established, members focus on achieving common goals, often reaching an unexpectedly high level of success. By this time, team members are motivated and knowledgeable. Supervisors of the team during this phase are almost always participating. The team will make most of the decisions. A change in leadership may cause the team to revert to storming, as the new people challenge the existing norms and dynamics of the team.
  • Adjourning: Completing the task and breaking up the team.

 

Communication

As with any crisis, clear, concise, sustained, up-to-date communication is of utmost importance. I created a new email group (central) communication (PPE-Safety-Monitor) including both Safety Management and Infection Prevention/Epidemiology Leadership, to keep all of the team informed. This email group allowed us to close the loop on many issues in a short amount of time. Our findings (safety breaches) were immediately communicated by the Director of Safety Management to the Command Center, the top leadership at MM.

Jillian, our Nurse Educator, quickly taught me how to navigate Google Docs to create live, online scheduling for the SM Team to view from their smartphones (remember, we did not have a brick-and-mortar SM unit). All of us extended ourselves to levels we never thought possible.

In turn, we were teaching the SMs how to access Google Docs from their phones to view their schedule. We were building the plane as we were flying!

Kevin and Shelly (charge nurses) created online assignment sheets so staff would know which ICU to report to. They emailed the assignment sheets out 24 hours prior (mostly…) to the next shift to keep staff informed and tame any anxieties. We frequently had to shift staff to various units based on the ever-changing hospital bed census. Constant flux. Rolling with it!

Hindsight: The disease process itself is just as stated on World News Tonight and every bit of what you may have read in your local paper. Same struggles, different places and faces. The pandemic exposed our vulnerabilities (globally/local) and the lens is focused on leadership and change.

 

Pandemic Leadership Perspectives

Leadership, Communication and Relationships

The C-19 pandemic has instilled lessons from the federal level all the way down to local levels. The highest leadership decisions are felt globally but were/are palpable at a granular level (in the ICUs and in public health—our communities). Some federal and global leadership decisions became painfully prominent during the pandemic (global PPE/C-19 spread). There was real hubris on the part of public health officials from the very start. The lack of federal leadership meant that states lacked a unified approach.

In the days and weeks that followed, politicians, public health officials and rival academics disparaged or ignored their colleagues. Some even worked to undermine the warnings at crucial moments, as the disease spread unnoticed.

Meanwhile, back at the Hall of Justice….

I would listen to NPR radio on my commute before and after my shifts, watched World News Tonight, and read anything I could get my hands on pertaining to the pandemic world events. I was trying to make sense of what I heard in the various forms of media and what I was observing clinically in the ICUs….

We live in a world that we cannot control. People defy our plans and let us down. Circumstances bring us to our knees. Planes fly into buildings. And it all happens without our permission.

Once we learn to bring all of that misdirected energy to what we can control, and learn to respond to both the good and the bad in a way that serves us, the meaning of our lives is enhanced and we find greater power, peace and success in our lives.

I have learned that most people believe learning and growth come from looking at something new and finding the familiar in it, but it is the opposite that is actually true. When we see the familiar world differently, we will behave differently in it, because it simply is not possible to respond in a way that is not congruent with what we see and still remain sane. If you have tried to change your behavior without first changing your perspective, you have probably met some form of failure.

We live in an out-of-control world, and there is nothing we can do to change that fact. But the success and happiness we all seek is not out of our control. And the key to finding it lies in our ability to know how to accept what we cannot control and bring all of our energy to what we can. This is when our energy turns to power. It is in the power of losing control. 

 

On Trust

Working together more effectively requires trust. It is not usually long until you hear someone say “Trust…has to be earned!”

Trust cannot exist until it is given. Trust is born of giving, not of earning. And the giving requires a leap of faith. Both faith and trust derive their ultimate power from the giving, not from the earning.

 

Historical Perspective and Fun Fact

(Because I Love Trivia!)

At home, to gain a better understanding of the pandemic, I began to read historical medical books. I love to read. My favorite medical history book was Pale Rider: The Spanish Flu of 1918 and How It Changed the World by Laura Spinney.

Much like COVID-19, the Spanish Flu exposed mankind’s vulnerability and put our ingenuity to the test. This overlooked catastrophe forever changed humanity.

 

Interesting Historical Facts: The Spanish Flu of 1918

In the global reshuffle post–Spanish Flu of 1918, many dependents found themselves deprived of their breadwinners. Many families went to the poorhouse.

However, among them were some lucky beneficiaries of life insurance policies: The U.S. life insurance industry paid out nearly $100 million in claims after the 1918 pandemic—the equivalent of $20 billion today.

Upon his death from the Spanish Flu of 1918, one German immigrant to America left his widow and son a sum of insurance money. They invested it in property, and today the immigrant’s grandson is a property magnate, purportedly worth billions. His name is Donald Trump.

 

Self-Reflection

Attaining wisdom is an ongoing process, one that will never be concluded so long as we live and grow. Both you and I will always live in a world that is beyond our control. That is the way things are—and the way they are supposed to be. Our power lies in recognizing how much of life is constructed of the choices we make, one moment, one thought and one response at a time.

That is all the power any of us has. It is all the power we need.

Accept, adjust, advance.

#StaySafe!