On March 11, 2020, the World Health Organization acknowledged the devastating reach of the coronavirus (COVID-19) by categorizing it as a pandemic.1 The severity of COVID-19's impact has changed the healthcare landscape worldwide. Accompanying the pandemic is an urgent and intensified demand for high-acuity levels of care that strain already overstressed healthcare systems. Surges of admissions to acute care settings have amplified staffing shortages, compromised the ability of hospitals to accommodate patients' healthcare needs, created unprecedented calls for organizational flexibility, and quickly depleted resources previously thought adequate.2 These circumstances pose a serious risk to frontline nurses, with media attention that's raising social awareness about the vulnerability of nurses' safety and well-being.
Amid crisis, the benefits of a positive practice environment on overall staff safety and well-being may be especially highlighted. The Pathway to Excellence® framework, which is applicable to a range of healthcare settings from acute care to home health to ambulatory, enriches the nurse practice environment by instilling six essential standards: shared decision-making, leadership, safety, quality, well-being, and professional development. These standards yield a culture of nurse advocacy and enable nurses to directly impact their work. Pathway-designated organizations strive to sustain a positive practice environment from which the organization, patients, and staff may benefit.3 When the Pathway framework becomes rooted in an organization's culture, it safeguards not only nurses, but all team members during times of unforeseen events.
In this article, healthcare leaders from Pathway-designated organizations share how they've used the Pathway framework in response to the COVID-19 pandemic.∗
Pathway standards in action
At Wellstar Douglas (Ga.) Hospital, Pathway program director (PPD) Elizabeth Berrier explained, “The standards have been a guiding force as we've made decisions and changes in care delivery and care processes due to the COVID-19 pandemic.”
Kaye Marie Rodriguez, PPD at St. Luke's Medical Center—Quezon City, Philippines, identified how the standard of shared decision-making specifically provided guidance to her organization, “Shared decision-making and interprofessional collaboration played an integral part in preparing for the COVID-19 pandemic. As the organization fosters a shared governance culture, frontline staff, managers, and different professionals from various disciplines contributed and shared their expertise to arrive at a shared decision. Through shared decision-making, St. Luke's—Quezon City worked as a team to ensure the delivery of the best possible healthcare experience to our patients and their families while safety of healthcare workers was made certain during this pandemic.”
Similarly, Lisa Keegan, PPD at Adirondack Health in Saranac Lake, N.Y., shared, “As a Pathway organization, we operate solely from a shared-decision based concept. Our employees know that their input is important, especially during a crisis.”
During this global crisis, leaders must evaluate many choices and unknowns when making decisions.4 The Pathway standards of leadership, shared decision-making, safety, and well-being provide guidance to organizations as they respond to the crisis and support frontline team members and the communities they serve. The following are examples of some of the Pathway standards currently in action.
Shared decision-making. According to Ms. Keegan at Adirondack Health, round-the-clock sessions are held with the CNO and vice president of patient care services, empowering employees to bring suggestions forward that have led to policy revisions specific to the care of patients with COVID-19 and staffing plans to meet the surge of admissions.
Dr. Angie Kamermayer, vice president and CNO at Integris Health Edmond (Okla.) explained, “During the COVID-19 pandemic, the American Nurses Credentialing Center's Pathway to Excellence framework provided a model integrating shared governance and leadership to promote the safety and well-being of frontline caregivers. Task cards were developed by medical-surgical and intensive care nurses. The cards would be given to reassigned caregivers and any other additional personnel available. The objective of the task cards was to create a user-friendly way to reassign and delegate care based on competency and skill level.” (See Figure 1.)
The Pathway standard of shared decision-making requires that safety practices across an organization are collaboratively developed involving an interdisciplinary approach. Newly designated Wellstar Douglas Hospital illuminated this standard when the organization developed a cross-training program between ICU and ED nurses in response to COVID-19. Wellstar Douglas PPD Ms. Berrier reported, “The charge nurses from the ED and ICU saw this as an opportunity to improve the relationship between the two departments and now they meet weekly to discuss issues and make improvements. This wasn't manager mandated, this was our nurses seeing an opportunity to improve, taking control, and making it happen.”
Well-being. During this dynamic time in healthcare, prioritizing a structure of support and resources for physicians, nurses, and frontline team members is imperative.4 An example of such a structure is indicated by the well-being standard, unique to the Pathway program, that entails both the physical and mental health aspects of caregiver health. This standard supports giving staff a voice in developing initiatives to encourage well-being. Pathway organizations implement health programs that promote assessment of and engagement in wellness, and staff are encouraged to take part in well-being initiatives to strengthen their resilience, among other things.5 Resilience is also nurtured by staff involvement through shared governance to decide on activities of volunteerism, recognition, and self-care activities.
Adirondack Health's wellness committee, comprised of frontline staff, has established a group support program offered at virtually no cost to the healthcare team. The committee has also acquired scholarships for staff members to participate in virtual yoga classes. Considering that volunteerism is another component of the well-being standard, Ms. Keegan proudly announced, “We're so grateful for the overwhelming support from our community during the COVID-19 pandemic. As a way to pay it forward, we initiated a food drive at all of our locations.”
At St. Luke's Medical Center—Quezon City, PPD Ms. Rodriguez stated, “Being a Pathway to Excellence-designated hospital, St. Luke's—Quezon City continues to foster a culture of care, as guided by the Pathway framework. Integrating shared decision-making and interprofessional collaboration, the organization continues to come up with initiatives that prioritize the safety of patients and welfare of its employees. These are sustained by the unwavering support of the St. Luke's Medical Center management, nurse managers, and nursing leaders who untiringly safeguard their teams during this health emergency.”
Ms. Rodriguez further remarked, “The Pathway standards, specifically safety and well-being, also guide the organization as it holistically recognizes and prioritizes the needs of nurses during this pandemic.” A staff-conceived initiative called Caring for Others with Positivity and Encouragement (COPE) provides an example. (See Figure 2.) The initiative was established in recognition that the pandemic will have emotional and mental implications for staff members who can turn to COPE for support when experiencing periods of emotional exhaustion.
We salute you
Through the dynamic and evolving COVID-19 pandemic, Pathway-designated organizations are recognizing the value of the Pathway to Excellence framework in supporting their response to the crisis. Most apparent are examples of leadership, a strong shared decision-making practice, and guarding the safety and well-being of healthcare team members, as well as the patients for whom they care.
According to Michelle Farris, CNO of West Marion Community Hospital in Ocala, Fla., her organization “looked at Pathway as a way to recognize the staff, and the COVID crisis shows just how wonderful our staff is. Pathway gave us the avenue to show how they shine.” The Pathway to Excellence Program salutes organizations and their teams for continuing to be at the frontlines to ensure the safety of their patients and communities.
1. World Health Organization. Timeline of WHO's response to COVID-19. 2020. www.who.int/news-room/detail/29-06-2020-covidtimeline
2. Hick JL, Hanfling D, Wynia MK, Pavia AT. Duty to plan: health care, crisis standards of care, and novel coronavirus SARS-CoV-2. National Academy of Medicine. 2020. https://nam.edu/duty-to-plan-health-care-crisis-standards-of-care-and-novel-coronavirus-sars-cov-2
3. Hume L, Hall M. Sustaining a positive practice environment after Pathway to Excellence®
designation. Nurs Manage
4. Sherman R. Leading in a time of chaos. Nurse Lead
. 2020. [e-pub April 15, 2020]
5. Hart PL, Brannan JD, De Chesnay M. Resilience in nurses: an integrative review. J Nurs Manag