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Think About It

A forum for discussion of the latest news and ideas in nursing management and healthcare.

Tuesday, May 12, 2020

By Peggy Collins, BSN, RN, CCRN

I'm tired as I write this. Exhausted in so many ways. Physically, mentally, and throughout my entire being. In my over 30 years of bedside nursing, I've never experienced anything like this. Not AIDS, not SARS, not Ebola, not H1N1. I'm scared. But my fear and exhaustion are nothing compared with what my patients feel.

The World Health Organization declared 2020 the International Year of the Nurse and Midwife. All over the world, nurses were planning to get together and celebrate. Plans change. Every day I go to work, and I'm sent to a different area of the hospital to fight this horrible virus. To wage battle against an unseen enemy in a war where we need more equipment and in which the soldiers themselves are becoming casualties. Nurses have gotten sick and become patients in the hospital; some have died. We're low on supplies. Masks are carefully handed out to nurses because there's a finite number of them left.

We strive to save every patient from this beast. Each patient is unique but fighting the same illness. We also search for equipment for our patients. There aren't enough feeding pumps to give nutrition, cooling blankets to treat fevers, suction regulators to clean mouths, and plugs to keep lifesaving I.V. pumps going. In some newly blocked off areas for COVID-19 patients, there's no sink. We aren't sure there will be enough ventilators tomorrow to keep airways open.

As nurses have throughout the centuries, we make do. We manually give our patients boluses of tube feedings hoping they tolerate it, we change out which pump gets plugged in as batteries run low, and we bring bottles of water into the room to bathe patients.

We implore our patients to survive. We will it with all our experience, skills, and prayer. We monitor their BP and regulate their breathing. We clean their faces and rub their backs. We hold our patients' hands and look into their eyes above our N95 masks and through our face shields and think of what more can be done to help save them. When a patient is taken off the ventilator, we celebrate. They beat the odds and got better. We won this battle. When a patient dies, we mourn for them and silently cry.

No visitors are allowed in the hospital. Our patients fight this virus without family. They die without their loved ones. Yet, they aren't alone. We become their family, their friends. We feel their frailty, we become their world. We tell them they'll get better, that they'll see their family again. We tell them to fight.

As experts and politicians go on TV and talk about events inside the hospital, a curious phenomenon is occurring. The public is learning about what it is to be a nurse. They hear about PPE, ventilators, exhausted nurses, and even sores on our faces from wearing N95 masks all day. We attempt to take the time to listen for the cheers every night at 7 p.m. It's an amazing experience. I've stood in the street and cried as feelings of gratitude overwhelm me.

Plans change, but one thing is certain. We share these cheers with our patients. We're in this war together and we fight on together. This isn't just the year of the nurse anymore, 2020 is also the year of the patient. 


Peggy Collins is a nurse clinician at NewYork-Presbyterian/Weill Cornell Medical Center in New York, N.Y.

Tuesday, April 28, 2020

Ellen Degeneres had a few suprises in store for Philadelphia nurses whose "Level Up" dancing video went viral amid the coronavirus pandemic


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A group of frontline nurses who went viral with a video of themselves dancing to Ciara's "Level Up" earlier this month were recently treated to an appearance on The Ellen Degeneres Show.

These nurses, who have dubbed themselves "The Swab Squad," run the COVID-19 testing center at Thomas Jefferson University Hospital in downtown Philadelphia, which was the city's first drive-thru testing center for the virus. The hospital posted the nurses' response to the "Level Up" dance challenge on its Instagram account on April 5, and the video has since garnered over 250,000 views on Instagram. 

The squad isn't just a one-hit-wonder, though. The hospital's Instagram account, @tjuh_pool,  is well stocked with videos of the nurses dancing to various hits in the last month. 

In the 10-minute appearance on "Ellen," Jeffrey Salvatore, a clinical nurse specialist at Thomas Jefferson, said the testing center's nursing team meets every morning before their 8 to 5 shift and discusses the importance of staying focused for the day during this "scary" time.

"'Level Up'" just has that message," he said.

The nurses were joined by Jeff Doucette, the hospital's chief nurse and a member of the Nursing Management Editorial Board, to talk with Degeneres about their work at the testing center and their experiences on the frontlines during the COVID-19 pandemic. 

"This team has come together and formed this amazing family that has really kept this community safe," Docuette told Degeneres. "We are so incredibly proud of them and everythign that they're doing."

A few minutes into the segment, Degeneres played a message from Ciara and the pop star's husband, Russell Wilson, who stars as quarterback for the NFL's Seattle Seahawks.

"You guys are doing something so amazing and so special," Ciara told the group. "You are giving the world joy in a time when we need it by dancing and "leveling up." Your Level Up challenge was amazing and I want to encourage you guys to keep on going strong because we're all in this together."

Watch the nurses' appearance on Ellen here, and stay tuned for an upcoming episode of the Nursing Management podcast with Doucette to discuss his team's work.

Tuesday, April 21, 2020

As a former hospital manager, I know all too well the effects of trauma and stress on nurses. Can nurses get post-traumatic stress disorder (PTSD)? Absolutely.

We, as leaders, know that great leaders understand that actions and supportive behaviors can positively influence staff. These leaders make their way through the muck of disastrous experiences to see the humanness of stress and respond to it.

Right now, we are all experiencing traumatic stress that can lead to PTSD.

In this time, more than ever, our staff needs us to understand that this coronavirus experience has rocked our world. Not only is our staff fearful, enduring equipment shortages and long work hours, they also are experiencing overwhelming stress and worrying about what is occurring in their personal world.

Nurse managers have a lot on their plates right now: disaster command center plans, daily briefings, and long hours dealing with patient flow and throughput, and stressful dealings with staffing plans, sometimes on an hourly basis. All of this work is vital to the operations of units and the hospital. As vitally important is helping staff through this stressful time.

Here are a few tips to help staff mitigate the stress:

• Acknowledge that all nurses are sharing this human experience together; with togetherness, we can create hope

• Maintain awareness and help staff to keep aware of stress – do not deny and help others to not deny

• Understand and empower nurses to have control over something. Encourage ways to have nurses support other staff in these stressful times. Refer to "Support Ideas From the Frontline - COVID-19" blog

• If possible, allow some recovery time from stress; seek help from your staff on how to implement a plan. One unit executed a “walk around the parking lot” break by creating break partners to join them from a safe distance. Nurses are very innovative!

• Allow the creativity of the staff to create ideas that will help mitigate daily stress. My suggestion is journaling. Will critical care nurses journal? Maybe. A good starting point would be to give all staff a small notebook to record at least one to three things that went well on their shift. Or use a whiteboard in the breakroom where the staff can share their good thoughts with the shift.

• Know that everything you do for your staff, you also need to do for yourself. Put your own oxygen mask on first!

For a great review of managing stress, view this video from a past NTI by American Association of Critical-Care Nurses (AACN) past president Vicki Good, “Resiliency Tips and Strategies to Manage Moral Distress and Burnout.” Vicki does a great job of showing us vital ways to tackle stress, not only for nurse managers but all staff, which is essential for nurses.

AACN has a host of additional resources related to moral distress on the website. Explore it for additional ideas or education on this topic.

Caryl Goodyear, PhD, RN, CCRN-K, NEA-BC, FAAN, is the practice excellence programs manager for the American Association of Critical-Care Nurses in Aliso Viejo, Calif., and a Nursing Management editorial board member.


Friday, April 3, 2020

During COVID-19 pandemic, take extra time to connect with your frontline nurses

By Alex Klotsche, BSN, RN-BC

It's time for clinical leaders to exchange business attire for scrubs as the coronavirus pandemic continues to disrupt the US. Every hospital leader, no matter their area of leadership, should go to a patient care area and spend 30 minutes with frontline staff members. That means for 30 minutes a day, no meetings and no answering emails or phone calls. Making time for unity and support is critical in a period of high stress and anxiety.

Dr. Cole Edmonson, chief clinical officer at AMN Healthcare and the 2008 Nursing Management Visionary Leader Award winner, created a strategy to increase nurse satisfaction when Ebola cases began appearing at his former hospital (Texas Health Presbyterian Hospital) and staff members became worried. He started a practice called the "Sacred Sixty"—every nurse leader put an hour a day toward spending time with frontline staff. Surveys measuring nurse engagement and job satisfaction showed a jump from the 55th percentile to the 98th percentile in just over 4 years.1

Multiple articles are being published regarding the mental stress this pandemic is causing healthcare providers. Historically, periods of high mental stress have been reported in times of war. During World War II, General Dwight D. Eisenhower, who later became President of the US, was noted for a select type of leadership. He didn't discuss the war with his frontline soldiers, but rather spoke about what they did back home and their families. He wanted to create a feeling of friendship and personalization for his soldiers. Eisenhower noted, "Morale is born of loyalty, patriotism, discipline, and efficiency, all of which breed confidence in self and in comrades…Morale is at one and the same time the strongest, and the most delicate of growths. It withstands shocks, even disasters of the battlefield, but can be destroyed utterly by favoritism, neglect, or injustice."

By wearing the same uniform as frontline staff, I believe leaders can help with morale during this vexing time. Leaders need to engage in the personalization of employees. Emotional intelligence—the ability to identify and manage one's own emotions, as well as the feelings of others—is of the utmost importance now.2 Talking to employees about their family, friends, and interests can help remind everyone for whom we fight. We're fighting to save lives, stop the spread of the virus, and find treatments to cure this pandemic.

I recommend that all leaders take 30 minutes out of their shift each day to visit a different area. Clinical leaders are heroes in business attire, and it's time to show their capes and join the superheroes on the frontline.

 

REFERENCES

1. Fabris P. Dr. Cole Edmonson's culture of engagement at Texas Health Presbyterian. American Healthcare Leader. 2018. https://americanhealthcareleader.com/2018/dr-cole-edmonsons-culture-of-engagement-at-texas-health-presbyterian.

2. Psychology Today. Emotional intelligence. www.psychologytoday.com/us/basics/emotional-intelligence.


Alex Klotsche is a Clinical Nurse at NewYork-Presbyterian/Weill-Cornell Medical Center in New York, N.Y.

Friday, March 27, 2020

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The COVID-19 pandemic has put much of the US in a standstill in recent weeks as healthcare professionals work to accommodate mounting cases around the country. COVID-19 seems to be everywhere—on social media, in the news, in the community, and in healthcare facilities. According to an online tracker of COVID-19 cases compiled by Johns Hopkins University, there were more than 90,000 confirmed cases and nearly 1,400 deaths in the US as of 2 p.m. on Friday.1

COVID-19 is caused by a specific virus called SARS-CoV-2, which has been colloquially referred to as "the coronavirus" by media outlets.2 Having originated in Wuhan, China, the virus was designated as a pandemic by the World Health Organization on March 11, 2020.3 It has affected many countries around the globe, including the US, where all 50 states are reporting cases.2

As healthcare facilities race to prepare and respond, there have been many headlines regarding public reaction, from retail business closures to supply hoarding.4,5 The practice of "social distancing" has emerged in a nationwide (if not, global) effort to curb the spread of COVID-19, with the White House issuing guidelines for limiting unnecessary exposures.6,7 These include avoiding travel, shopping outings, and social gatherings of more than 10 people, as well as working from home when possible.7

Twenty-three states have issued stay-at-home orders to date, asking residents to leave their homes only to buy food and medicine and for other "essential" reasons that vary by state, such as outdoor exercise while maintaining a safe distance from others.8  Some states had closed "non-essential" businesses but had not issued a statewide stay-at-home order as of noon Friday. However, many cities and counties around the country have issued stay-at-home orders, even if their states do not yet have a similar policy.

CDC efforts to reduce the spread of COVID-19 have focused on travel guidelines, resources for identification and tracking, and the development and production of diagnostic tests.2 Meanwhile, healthcare organizations and professionals continue to prepare, adapt, and provide care in uncertain times. Internationally, South Korea made testing notably accessible and efficient by opening "drive-thru" facilities, in which passengers were swabbed in their cars.9 Similar facilities have popped up in some municipalities and healthcare centers around the country as testing has ramped up in recent weeks after initial delays.10 Several clinical trials are underway to find a potential COVID-19 vaccine, and the WHO announced a major study last week that will compare treatment strategies in a streamlined clinical trial design in which doctors around the world can participate.11

The US is also among scores of countries facing a widespread shortage of personal protective equipment (PPE) for healthcare workers amid the pandemic. The WHO said in a media briefing on Friday that the PPE shortage is "now one of the most urgent threats to our collective ability to save lives."12

The Food and Drug Administration (FDA) released a guidance this week that outlines temporary policies to help curb the PPE shortage while a federal public health emergency declaration related to the COVID-19 outbreak remains in effect.13 The guidance is designed to increase the availability of general use face masks for the public and particulate filtering facepiece respirators (such as N95 respirators) for healthcare professionals. The new guidance can be found here.

The introduction of COVID-19 and subsequent efforts to contain the virus have resulted in societal changes both at home and abroad. The last few months have been chaotic and stressful around the world, especially for nurses and everyone in the healthcare workforce. Sharing knowledge and insights will be vital as the world fights this virus.

On behalf of Nursing Management, we would like to wish all our readers and their teams good health, personal safety, and the best of luck in the coming weeks. As such, we have provided the following additional resources:

• www.coronavirus.gov

• www.cdc.gov/coronavirus/2019-ncov/hcp/index.html

• www.who.int/emergencies/diseases/novel-coronavirus-2019

• www.jamanetwork.com/journals/jama/fullarticle/2762692

• https://tools.ovid.com/coronavirus/

• https://www.nursingcenter.com/coronavirus

Stay safe!


This is a developing story. Check back with our blog for updates in which we'll share guidelines and other helpful information for nurses.

 

REFERENCES

1. Coronavirus COVID-19 global cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. Coronavirus resource center. Johns Hopkins University & Medicine. 2020. www.coronavirus.jhu.edu/map.html.

2. Centers for Disease Control and Prevention. Coronavirus (COVID-19): situation summary. 2020. www.cdc.gov/coronavirus/2019-ncov/cases-updates/summary.html.

3. World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. 2020. www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.

4. Duffy C. Nike, Urban Outfitters and other retailers shuttering stores temporarily because of coronavirus. CNN. 2020. https://www.cnn.com/2020/03/15/business/retailers-nike-store-closures-coronavirus/index.html.

5. Frankel TC. The toilet paper shortage is real. But it should be brief. The Washington Post. 2020. www.washingtonpost.com/business/2020/03/13/toilet-paper-shortage.

6. Stevens H. Why outbreaks like the coronavirus spread exponentially, and how to "flatten the curve." The Washington Post. 2020. www.washingtonpost.com/graphics/2020/world/corona-simulator.

7. The president's coronavirus guidelines for America: 15 days to slow the spread. 2020. www.whitehouse.gov/wp-content/uploads/2020/03/03.16.20_coronavirus-guidance_8.5x11_315PM.pdf.

8. Secon H. Almost half of all Americans have been ordered to stay at home. This map shows which cities and states are under lockdown. Business Insider. 2020. www.businessinsider.com/us-map-stay-at-home-orders-lockdowns-2020-3.

9. Bicker L. Coronavirus in South Korea: how 'trace, test and treat' may be saving lives. BBC. 2020. www.bbc.com/news/world-asia-51836898.

10. Affo M. The US decided to make its own coronavirus test, but the process was plagued by errors and delays. Here's a timeline of what went wrong. Business Insider. 2020. www.businessinsider.com/us-coronavirus-testing-problems-timeline-2020-3.

11. Kupferschmidt K, Cohen J. Race to find COVID-19 treatments accelerates. www.science.sciencemag.org/content/367/6485/1412.

12. World Health Organization. "Media briefing on #COVID19 with @DrTedros. #coronavirus" March 27. 12:14 p.m. Tweet.

13. Food and Drug Administration. Enforcement policy for face masks and respirators during the Coronavirus Disease (COVID-19) Public Health Emergency: Guidance for Industry and Food and Drug Administration Staff. 2020. www.fda.gov/media/136449/download.