The COVID-19 Nurse Liaison Task Force Implementation at Monmouth Medical Center, Long Branch, NJ
The shared governance model warrants that clinical leaders on the frontline make empowered, team-oriented decisions at the point of care for the betterment of the organization. At Monmouth Medical Center (MMC), a needs assessment revealed an obligation to restructure the organization’s flow of communication during recent events in our nation’s history.
In light of the COVID-19 pandemic, the visitation policy was amended indefinitely, while continuing to protect MMC staff, patients, and the community at large. This proved challenging to the patients and their loved ones, who had been prohibited from visiting at that time. While patients were encouraged to utilize the telephone and video capabilities of available smart devices to communicate with their friends and family, part of the patient population remained at a disadvantage. Those with disabilities, sensory deficits, cognitive deficits, or language barriers did not benefit from such technology. To remedy this, staff nurse Lauren Fleming, MA, BSN, RN-BC, and other frontline nurses launched the COVID-19 Nurse Liaison Task Force to bridge communication between the healthcare team, the patients, and their loved ones with a new role and structure. Lauren is the former Chairperson of the Patient Care Coordinating Council (PCCC)—a shared governance steering committee—as well as former Chairperson and current consultant of the Medical-Surgical Shared Governance Council.
According to the Agency for Healthcare Research and Quality (AHRQ) Guide to Patient and Family Engagement in Hospital Quality and Safety, “Patient and family engagement creates an environment in which clinicians, hospital staff, patients and families work together as partners to improve the quality and safety of care” (AHRQ, 2017). This guide finds that in addition to the benefits regarding patient outcomes, patient and family engagement helps hospitals respond to Joint Commission standards that recognize the need for patients and families to be active and informed decision-makers throughout care. The nurse liaisons were tasked with championing this partnership while upholding MMC’s mission and vision amid dire circumstances.
Six professional registered nurses, who operated in a designated office with telephone and computer capabilities, while maintaining appropriate social distancing and infection control precautions, filled the liaison role in the medical-surgical division. They were assigned a telephone number in correspondence with their workstation and had access to the electronic medical record. They were expected to clock in for full eight-hour shifts, five days a week, and coverage spanned Monday through Sunday. Schedules were made in two-week increments and relayed promptly to their respective directors of patient care, the MMC Command Center, and the staffing department.
The nurse liaisons worked directly with the designated COVID-19 units. Each nurse liaison was assigned to an ongoing caseload of positive COVID-19 patients and persons under investigation for COVID-19 (PUIs) and remained with this group through discharge or until a change in the care plan. This continuity of care built trust and rapport with the patients and their loved ones.
Per HIPAA, a designated loved one (“point of contact” person) was determined for each patient. Once permission for the correspondence was obtained, the nurse liaison served as the main line of communication between the healthcare team and the point of contact. Nurse liaisons directly reported to the Magnet office and worked with directors of patient care, unit nurse leaders, physicians, advanced practice nurses, medical residents, case managers, social workers, other healthcare providers, dieticians, and Patient Satisfaction on the COVID-19 unit in which their patient was admitted. Predetermined topics of discussion with points of contact included: questions for the primary nurse, questions for the physicians, questions for the care team, plan of care, medications and side effects, discharge instructions. Nurse liaisons also followed up with the patients after discharge to ensure they were comfortable, their concerns were addressed, and recommended infection safety guidelines were understood.
Guide to Patient and Family Engagement in Hospital Quality and Safety also links evidence between communication, safety, and quality: “Communication is the foundation of partnerships between the patient, family and clinicians and affects the safety and quality of care received during the hospital stay” (AHRQ, 2017). It is noted in the guide that effective communication can improve standards such as patient outcomes, patient safety, and perceptions of quality. To bolster communication between the task force and frontline staff, a script was provided to the nursing stations and operators. Informational flyers on the initiative were handed to COVID-19-positive patients and PUIs on admission. By taking these actions, the nurse liaisons ensured that everyone worked together to achieve these standards. To further amplify communication, the task force’s accomplishments and family feedback through Patient Satisfaction were presented to the Patient Care Management Council (PCMC) and the PCCC as a model of best practice within MMC. The PCMC is one of the specialty councils of shared governance.
The main goal of this role was to enable open channels of communication in the best interest of the patient. In addition to this enhanced communication, the nurse liaison position permitted the interdisciplinary team directly caring for COVID-19 patients to spend valuable time in the isolation rooms instead of answering multiple phone calls throughout the shift, which helped to conserve personal protection equipment. The task force was so successful in the medical-surgical division that it was replicated in the Intensive Care Unit.
The COVID-19 pandemic and New Jersey–mandated visitor restrictions forced a chasm between the hospital and patients’ loved ones. By self-assessing the needs of the patients, their points of contact, and the interdisciplinary team, the nurse liaisons tailored the task force’s initiatives to meet MMC’s standards of care and exceed expectations. Through the utilization of teamwork and best practice, they adjusted the task force’s function to meet the ever-changing needs of the community. The COVID-19 Nurse Liaison Task Force acted as a conduit, thereby facilitating a partnership between the interdisciplinary team and the families for the betterment of the patient population.
For more information about this best practice, contact Lauren Fleming, MA, BSN, RN-BC, at Lauren.Fleming@rwjbh.org.
Information to Help Hospitals Get Started. Content last reviewed December 2017. Agency for Healthcare Research and Quality, Rockville, MD.