Thank you for reading the June 2020 edition of the Magnet® Newsletter from Tipton Health Communications. This edition features information on how to drive nursing excellence amid COVID-19, insights from our webinar series speakers, and tips from the experts at Tipton Health Communications.
- Q&A: How to Drive Nursing Excellence in the COVID-19 Environment
- Five Ways to Help Your Nurses Navigate COVID-19 PTSD and TSI
- Strategies for Leading from the Front Lines during the COVID-19 Pandemic
- Keeping Your Nurses Engaged Amid Layoffs or Furloughs
- Congratulations to Our Recent Magnet-Designated Clients
- For Us It’s Personal
How to Drive Nursing Excellence in the COVID-19 Environment
A Q&A with Nursing Leaders at Long Island Jewish Medical Center and Deaconess Health System
During the COVID-19 crisis, it can be hard to keep your shared governance councils focused on your journey to nursing excellence and Magnet® designation. These concerns can seem less important than the patients pouring through hospital doors. But nursing excellence is the foundation that many organizations are built on and the goal that drives nurses to deliver stellar patient care.
Jill Buttry, Director Patient Care Services at Deaconess Gateway Hospital and Chief Nursing Officer at Deaconess Gateway and Midtown Hospital; Kathy Reddy, Nurse Manager and Magnet Program Manager at Northwell Health – Long Island Jewish Medical Center; and Linda Vassallo, Senior Administrative Director Patient Care Services and Magnet Program Director at Northwell Health – Long Island Jewish Medical Center, weigh in on their strategies for keeping the focus on nursing excellence, even now.
What role has your shared governance councils played in your hospital’s response to COVID-19?
Jill: Shared governance councils have been instrumental in helping us develop protocols and guidelines. They have attended daily staffing forums through our Incident Command structure and taken information back to their units for education and communication. Councils have disseminated appropriate guidelines and garnered feedback from the nurses, ensuring the practices within the guidelines are correct and realistic when applied to COVID-19 patient care.
Kathy and Linda: Our Safe Patient Handling (SPH) Committee coordinated two major initiatives. They formed proning teams, especially useful for the night shift, to support the nurses in proning their patients and caring for their patients in prone position, and they taught SPH and assisted the morgue with SPH equipment due to the overwhelming volume of expired patients that needed to be lifted and moved.
Our Skin Care Council stepped in to share protocols with staff on how to care for themselves while using N95 masks. They were the driving force behind ordering cleansing cloths for staff, created handouts to share with staff focusing on assessment and documentation of pressure injuries, and created supportive skincare supply packets for proned patients.
Were you able to use the structure you have in place for mentoring new nurses to help your experienced nurses transition into new practice environments such as the ICU or ED? Can you give an example?
Jill: New graduate nurses have been a part of the COVID-19 experience and environment at Deaconess, caring for patients in the ICU as well as the emergency department. They’ve found this to be very rewarding. The more experienced colleagues mentored the new nurses, who have come up with very innovative ideas around care for COVID patients. The mentorship has allowed staff to establish evidence-based practice within these units, as they have networked with other organizations throughout the state to ensure readiness for an influx at Deaconess or in the Midwest.
Kathy and Linda: We had numerous staff that were redeployed. Our perioperative staff needed to become critical care nurses, as all surgeries were postponed. We had a tremendous amount of supplemental staff from travel agencies and other hospitals—especially Strong Memorial Hospital in Rochester, New York, and Intermountain Health Care in Salt Lake City, Utah—as we had a great need for nurses to care for the volume of critical COVID patients. We would first screen their existing clinical expertise and then provide education and shadow opportunities. We spread out our own established critical care staff into the new surge critical care units so that travelers and those redeployed were supported by our veteran critical care staff.
Can you think of an example where clinical nurses demonstrated autonomy in a new or different way as a result of the COVID crisis? Something your nurses are doing now as part of their practice that they didn’t use to do autonomously?
Jill: In the COVID units, our clinical nurses have established a practice where the IV poles are outside of the COVID patient rooms with extension tubing to ensure decreased exposure for staff, as well as conservation of PPE. We have ensured medication administration practice remains safe, since the Five Rights of Medication Administration continue to be part of this process. We have also collaborated with Pharmacy for bundled delivery of medications to the patient to ensure that we, again, can decrease exposure and the number of times staff must go into the rooms. Deaconess respiratory therapists and nursing worked together to assemble ventilators that would ventilate four patients at one time and designed unit layouts to safely accommodate this. With this, they demonstrated several scenarios of workflow and created a triad team approach to patient care. Each triad consisted of one ICU RN, one medical/surgical RN and one PCT to oversee the care of five patients.
Kathy and Linda: A critical care clinical nurse suggested to our senior administrative director of patient- and family-centered care that we give patients iPads to communicate with their families during this time when no visitors are allowed. LIJMC then purchased 20 iPads, and many more were donated. We developed an iPad communication team, as patients and families needed assistance in making this connection, and a centralized team provided additional support to the nurses on the units.
Can you think of an innovative approach to care that nurses helped implement in response to COVID? How was this approach developed?
Jill: Our nurses designed our COVID unit to ensure safe practices; for example, taping off pathways for ancillary staff to arrive on and depart the unit. A team of nurses and ancillary services (Laboratory, Radiology and Pharmacy) was developed to create safe practices and decrease exposure on these units.
Centralized COVID units were created that supported care for all levels—ICU, Medical/Surgical, Stepdown, Telemetry, etc. A core group of staff was dedicated to these units that were educated differently to ensure safe practices. We did extensive communication and education for medical/surgical nurses so they could care for ICU patients, in the event there was an influx in that patient population. The core group of nurses developed guidelines quickly and helped organize an infrastructure of communication though our intranet process to share guidelines not only with Deaconess employees, but with other organizations throughout the state as well.
Kathy and Linda: Our clinical nurses found a way to improve the experience of their fellow nurses by seeing a need to celebrate our successes during such a busy, sad time. They suggested celebrating each COVID-19 discharge patient through what we are now calling “Team Home.” When a patient is getting ready to be discharged, the nurse notifies his/her manager who reaches out to our Department of Patient- and Family-Centered Care. That department sends out an email to tell the entire hospital we will soon have another discharge. At the exact time, bells are rung overhead, and any available staff go down to our lobby to line the discharged patient’s path and clap in celebration of the patient and of our success. This led to also celebrating every extubation of a patient off a ventilator by playing the Beatles’ “Here Comes the Sun” overhead.
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Five Ways to Help Your Nurses Navigate COVID-19 PTSD and TSI
The COVID-19 crisis has taken a significant toll on healthcare providers across the country. For hospital staff already reeling from burn out, PTSD and other mental health conditions, the magnitude of the pandemic helped to exacerbate these serious issues.
To help educate healthcare leaders and bring further awareness around the effects of the COVID crisis, Tipton Health Communications hosted a webinar on the issue, S.O.S. Response: Solid Operational Strategies to Help Your Nurses Manage Traumatic Stress. Chrys Parker, EdD, JD, ECA-LM, a medical traumatologist, shed some light on how to understand trauma on a deeper, biological level and how healthcare leaders need to support nurses’ emotional wellbeing.
Nurses repeatedly exposed to stressful, emotionally draining situations – like caring for COVID-19 patients – are susceptible to traumatic stress injury (TSI) or post-traumatic stress disorder (PTSD).
Dr. Parker shared five ways you can save your nursing staff from the devastating effects of COVID-19 related PTSD and TSI:
Tip One: Take the problem seriously
Your nursing staff are so focused on caring for others that often times they forget to care for themselves. This means that nurses place their own wellbeing secondary – not only to their patients, but also their loved ones at home. As healthcare leaders, it is your job to take this problem seriously and take proactive measures to help them address any issues they may be facing.
Tip Two: Reduce factors that intensify TSI
The best way to reduce TSI-inducing factors is by enforcing an open and structured system with your nurses. This includes:
- Ensure your nurses are constantly supported and aware of your open door policy if they begin to experience TSI
- Insist that nurses develop a daily self-care plan tailored to their specific traumatic stress topology
- Invest in different resources to help them monitor their physical health, such as blood pressure cuffs
A key part of understanding the emotional stress your nursing staff deals with is to remember there may be past or present traumatic events impacting their daily lives. These steps can help you assist your nurses in their time of need.
Tip Three: Provide resources and referrals
Providing easily available, on-site access to an Clinical Pastoral Education (CPE) accredited staff chaplain or EAP counselor are resources that can help staff struggling with workplace and personal stress. Nurses are typically unable to step away from units during their shifts, now more than ever, so the inability to briefly escape from daily stress may be alleviated by having a trained professional to talk to whenever it is needed.
Tip Four: Employ simple but useful tools
There are easy ways to give your staff the tools they need to destress over the course of the day. Section off some space for a work out/cool off center that can help your nurses release their built up anxiety or stress from their shift. Sometimes there is not enough time in the day for nurses to go to the gym or mediate before heading home. Offering a space for them solely focused on reflection, relaxation and rejuvenation is a way to help nurses support themselves.
Tip Five: Ensure COVID is a turning point
Even though the pandemic has caused widespread chaos and fear, let the crisis serve as the turning point for your organization and staff to better recognize and address PTSD and TSI. Use the lessons learned over this time as an opportunity to focus on how you can help your nurses overcome traumatic events they may experience on the job. Dr. Parker explains that showing nurses they can better serve patients and the community, simply by supporting themselves, may help nurses to take steps to address their workplace stress.
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Strategies for Leading from the Front Lines during the COVID-19 Pandemic
Nurse leaders on the frontlines of the COVID-19 pandemic shared their experiences during Tipton Health’s May 12 Nursing Leadership webinar. The nursing leaders from around the country discussed the overwhelming nature of COVID-19, and credited nurses and staff for working collaboratively and nimbly to develop solutions that would have taken weeks or months to implement in normal situations. Panelists shared how the pandemic has likely forever changed the way healthcare is delivered.
The webinar panelists were:
How to Support Your Nurses Through the Chaos of COVID-19
Nurses were, and still are, overwhelmed by the realities of responding to the crisis. They’ve found themselves as surrogates for patient families, who were not allowed to visit their loved ones. Nurses with little ICU experience were working in the units with very little training, having to adjust quickly and think on their feet. Incredible stress and anxiety on nursing teams resulted. The panelists described some of the tactics they used that could help lower stress levels:
- Create a designated relaxation room or tranquility tent where nurses can escape for a moment and find information about self-care.
- Help your staff with daily chores, like grocery shopping. Phelps Hospital designated an area where staff members could access essential food and products they couldn’t get otherwise because of their shifts.
- Reach out to the community for support. The Phelps community set up a meal train, where community members and even staff members would donate meals for nurses to eat during shifts.
- Launch a confidential and anonymous outreach frontline call system. At Wellstar, nurses who were not on the frontlines were trained to take calls from their colleagues, partnering with internal behavioral health team members to ensure all needs were being met.
Technology and the New Normal
The nurse leaders provided some key takeaways as healthcare transitions to a new normal. A major point was the larger role technology has played in doctor-patient interactions. According to Jill Case-Wirth, over 50% of users for online doctors’ visits during COVID-19 were in their 70s. Now that we have seen the success of telehealth and how patients of any age can adapt, nurses should plan to see a shift from in-person appointments to seeing patients online. Implementing telehealth will change care models for good. Staff in the ambulatory setting should be prepared that moving forward they’ll be there in-person only for patients who need the most acute care, as well as for chronic disease management and preventative care.
In addition to telemedicine’s role in doctor-patient relations, Brad Lukas explained that telemedicine also opened the door for creative solutions to work around visitation restrictions and keep family and patient-centered care at the core of their work. His nurses turned to telehealth appointments to keep families informed of their loved ones’ conditions and give them the chance to visit when they weren’t allowed to be there physically.
Preparing for Our Next Crisis
Two critical aspects the five panelists mentioned while discussing how to prepare for another potential wave of COVID-19 were communication and training.
Transparency with your teams and open communication is how you can ensure everyone is on the same page, which is incredibly vital during a crisis. Kim Guesman also mentioned that giving your nursing teams the why is key – she found her team responded best when she was transparent about why she was making a decision. During a crisis, sometimes you may have to make decisions extremely fast and you won’t have the time you normally do to involve everyone on your team or discuss all of the options fully. But if you take your team on the decision making journey with you, even after the fact, it helps them understand your why.
Visibility and feedback are also two critical components of communication during a crisis. By being seen as a leader on the frontlines you are showing your nursing staff that you’re there to support them and help in any way you can. Asking your staff members what they need and seeing for yourself what their environment is like is critical to supporting them. Getting feedback after the worst has passed is also a great strategy for preparing to tackle crises better the next time around. The staff members at Grosse Pointe are taking part in multiple debriefing sessions to discuss the processes that worked well during the height of COVID-19 and what they can improve upon the next time they face a similar situation. Being open and honest about successes and failures, as well as making sure your nurses feel that their voices are heard, sets the foundations to make your organization even stronger.
Be Proactive Rather Than Reactive
Being proactive is an essential part of getting ahead of the worst of a pandemic. At Wellstar, they turned to case studies of SARS and MERS to understand what processes they could implement early before they reached peak capacity. Looking at other organizations that were hit earlier or harder can also give you a good idea of how to begin to plan for the next change in patient condition, resource shortage or staffing challenge.
Lukas also noted that training was a key factor in their preparation for COVID-19 and would be in the case of a re-surge. “You practice how you play,” he said. He encouraged redesigning your tabletop training based on what you have experienced, and don’t hesitate to throw in some curveballs. By learning from areas that were affected earlier on, like Wuhan and Italy, Lukas was able to prepare his team instead of having to rely only on coaching on the job. All of the leaders agreed that having crash course training prepared is important in the event of a crisis as well. Many of the organizations implemented bedside-to-bedside instruction on “how to become an ICU nurse in 20 minutes,” which included information on drips, proning and anything else that might apply to the patients they were expecting due to COVID-19.
The incident command training some of these leaders had taken through FEMA was another invaluable resource as they faced the brunt of the virus. Lukas plans to make it a requirement in the future to create a more formalized incident command training for his leadership team, similar to the FEMA training he went through.
Communicate Often and Openly
Opening up communication channels that are out of the ordinary can also lead to better results. Mary McDermott stressed that system communication and local communication were equally important during this pandemic. While they had many reoccurring calls occurring with their system-level medical director group, nurse executive group and CEO, sometimes everyone was not getting the same information because there were so many different messages being emphasized. Taking the key points from local communication and translating them at a system level was crucial to get one message across.
Collaborative communication outside of your hospital or system can be a valuable resource and you may find allies you never knew you had. Early on, Case-Wirth called on fellow CNEs in Wellstar’s competitor organizations in Georgia and proposed a weekly call to talk about the situations they’re facing, how they’ve tackled them, what they should do differently and how they could learn from each other.
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Keeping Your Nurses Engaged Amid Layoffs or Furloughs
Throughout the COVID-19 crisis, furloughs and layoffs have been a concern for nurses and healthcare executives alike. During Tipton Health Communication’s May 19 Nursing Leadership Webinar, Nikki Sumpter, senior vice president and chief human resources officer of Atlantic Health System, weighed in on strategies for avoiding furloughs altogether and keeping your team members supported and engaged.
Strategies for Avoiding Furloughs at Your Organization
Before you choose to furlough members of your staff, first ask yourself, “why would we furlough a nurse?” There has been a shortage of skilled nurses for decades. For reference, before COVID-19, the Bureau of Labor Statistics cited there would be a gap of 20,000 nurses just in the New Jersey market, where Atlantic Health System is based. It’s likely the gap will only grow, so it’s time to get creative with maintaining the nursing workforce that is so vital to our care delivery systems.
- Upskill and Retool: Take this time to train your nurses to provide care in a variety of settings. This not only helps support their professional growth but also helps your nursing teams become more agile. It’s critical to consider that there will always be retirees, even in a pandemic. Create programs to aid nurses in a smooth transition of knowledge as they move toward retirement. Retiring nurses can add value to their profession and organization in many ways, such as by delivering virtual education or precepting.
- Offer Redeployment: As focus moved away from perioperative and ambulatory settings during COVID-19, the staff in these areas had few options for work within their specialty. Allowing them to move to vacancies within the organization can help keep them employed. Don’t let go of your most precious resources.
- Don’t Contribute to Unemployment in Your Community: Nurses have the ability to adapt to several different roles, not just the specialty they were trained in. Offer opportunities in finance, recruitment, patient access or any job where they can still deliver and provide service to your organization.
Maintaining Team Member Engagement
- Provide Open and Honest Communication: When explaining furloughs and layoffs, it’s important to make sure your employees understand the reason behind them. Share the financials in a way that connects with your staff through a thoughtful process, drawing a clear line of why executives are faced with such a tough decision. Exhaust your whys and cascade these messages down from the organization, to the department level and to all team members.
- Engage with HR: Your Human Resources (HR) department should be able to partner with you to help share any important information clearly through message maps, leadership talking points, pre-planning communication, and creating visual cues to eliminate confusion and engage team members. Also, ask if they can reach out to organizations in the community who may be willing to donate and help support staff. Your community is invested in you and your workers now more than ever.
- Take Your Team on the Journey With You: It is well understood that right now we will not see a return to the pre-COVID environment and we will experience the “new normal” of healthcare. It’s time to reposition how your nurses define their roles. They are no longer an endoscopic nurse or a critical care nurse. They are nurses who are able to tackle many different tasks and specialties within your organization. You can partner with HR to help you communicate this new perspective and keep your nurses invested and engaged.
Make Sure HR Is Supporting Your Nurse’s Environment
- HR Can Support You in a Variety of Ways: Your HR department should be there to help you redesign roles, assisti with staffing support and benefit changes, and provide support as you have crucial conversations with other departments, such as finance. They can also assist with the redeployment process to make sure shifts are covered and work out how to offer hazard pay or “pandemic pay” for your staff.
- Listen to Your Nurses’ Requests: To ensure you’re accurately providing the self-care your staff needs to boost their resilience, you can use this model. The model contains multiple ways to understand your nurse’s requests, such as protect me, hear me, see me, etc. The model can serve as a filter to help leadership make meaningful changes to support their staff.
- Wrap Your Arms Around Your Team: Focus on the physical and mental health, as well as self-care, for your nurses. Also, continue to provide services to your team members who are exiting the organization at this time by giving them continued access to your EAP services. Losing your job or being furloughed, especially during this time, can be traumatic and it’s important to take care of your current and former staff. Remember that patients connect specifically with nurses, so when your nurses are healthy, happy and well cared for, so are your patients.
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Congratulations to Our Recent Magnet-Designated Clients
Tipton Health Communications is proud to congratulate and celebrate our clients that have received Magnet re-designation.
- HonorHealth Deer Valley (First)
- OhioHealth Riverside (Fourth)
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For Us It’s Personal
“I appreciated the dedication of the consultants, their honesty in communicating early and clearly when there were concerns, and their ability to instill confidence where appropriate. Being able to have an in-person connection with the team at the Magnet conference enhanced my experience even more because now I feel like we know you and you know us on a personal level, and that’s a great feeling to have.”
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