COVID-19: The Nurse Leader Perspective 6 Months Later

From Chief Caregiver Officer K. Kelly Hancock, DNP, RN, NE-BC, FAAN

Across the globe the COVID-19 pandemic has brought many challenges and uncertainty. However, it has also presented unexpected opportunities and ignited a change in the way care is delivered.

Shortly after the onset of COVID-19 in the U.S., I published these recommendations to nurse leaders on how to lead through the crisis, which included the following suggestions:

• Show strength in leadership.
• Communicate timely and accurate information to nursing caregivers.
• Ensure nursing caregiver safety.
• Clearly and precisely convey intended caregiver safety behaviors.
• Lean in and step up to the tough decisions.

Six months later, we have learned a lot – and, as we move forward together, we will continue to learn. In this article, I reiterate the above recommendations and present a few new lessons Cleveland Clinic’s nursing organization has since learned.

• Maintain leadership presence and communicate frequent, transparent and informative messages to nursing caregivers.

Not only do nurse leaders need to be present to promote confidence and show support for their nursing teams, they need to be ready and prepared to suggest new ideas, consider alternate plans of action, provide feedback on processes and workflows, and rapidly approve new tactics and strategies to keep moving forward. Additionally, nurse leaders must communicate. In this situation, overcommunication does not exist.

Throughout the crisis, Cleveland Clinic nurse leaders have continued to communicate around-the-clock. Many of the communication tactics we formed in the beginning, we’ve kept in place. For example, executive nurse leaders are present on all system-wide executive phone briefings and incident command briefings. We continue to hold daily nurse leader phone meetings and distribute nursing-specific e-mail updates for leaders to share with caregivers. We’ve added new communications, such as virtual Town Hall meetings. We hold these monthly web meetings with nurse leaders to discuss trending COVID-19 topics. We’ve also enhanced daily team huddles with additional communication tools that help caregivers keep up with ongoing changes. And, we created a COVID-19 toolkit, numerous caregiver resources and more.

Time and time again, the feedback received from our nursing caregivers is they appreciate the transparency. Our leaders are sharing information on staffing issues, coverage of nursing shifts, caregivers who are furloughed due to COVID-19, process/protocol updates in the organization and nursing unit/practice areas, daily census, and local, state and federal policy issues as well as local, regional and national coronavirus statistics.

• Keep caregiver and patient safety front and center.

One of the greatest fears of both caregivers and patients throughout the pandemic has been safety. At Cleveland Clinic, our goal is to ensure caregivers and patients know that our organization is still the safest place to work and to receive care.

When the pandemic began, our leadership team immediately aligned personal protective equipment (PPE) guidelines with those of the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC). We partnered with our supply chain department regarding resource needs and conservation strategies, encouraged telemedicine or virtual visits when possible, and implemented numerous new processes and policies for safe inpatient care. When we launched our reopening/reactivation strategy in early May for patient care areas that had been closed (outpatient, surgeries, procedures, etc.) per government mandates, safety was at the forefront of every conversation and communication with caregivers. Our President and CEO, Tom Mihaljevic, MD, began sending frequent email communications to patients outlining our reopening plan, what patients could expect, and expressing our commitment to safety. He continues sending safety communications to patients today.

Other ways we’ve learned to prioritize caregiver and patient safety are temperature scanning for caregivers and permitted visitors, a caregiver hotline, hand hygiene and masking, social distancing, environment-of-care checklists, thorough disinfection of all facilities and continued visitor restrictions. We update PPE guidelines through newly created PPE grids and communicate these via frequent webinars, emails and the Intranet. We also implemented new processes for proper and timely identification and isolation of patients with COVID-19 symptoms and began conducting caregiver safety drills. The drills ensure caregivers are prepared to identify and isolate COVID-19 patients to protect themselves and those around them.

• Evolve foundational strategies.

We’ve also found it imperative to continue to evolve the foundational COVID-19 strategies we initially set in place. For example, some of our initial strategies were: a) access to care, b) access to testing, and c) surge plan readiness. Keeping in alignment with our four care priorities: care for patients, care for caregivers, care for the organization and care for the community – these strategies have required evolution to meet our ongoing needs.

In recent months, we’ve taken action to prepare non-traditional patient care areas for patient care, we deployed emergency department tents, co-horted inpatient COVID-19 units and hospitals, developed and expanded effective patient screening processes across all care access points, increased telemedicine and virtual visits, created ‘drive-thru’ testing, outlined testing criteria priorities (i.e. standard versus expedited), converted non-traditional treatment areas for potential patient surges (i.e. Hope Hospital), and more.

We also upskilled and cross-trained nursing staff. For 11 weeks, Cleveland Clinic’s senior nurse education leaders and clinical nurse educators led an immersive cross-training effort for ambulatory and perioperative nurses to help care for COVID-19 patients. Additionally, our nursing leadership team has strategically enhanced our labor pool and enterprise staffing efforts to best care for areas in high need and continually prepare for potential patient surges.

• Encourage and embrace innovation and opportunity.

The pandemic has brought forth numerous creative and innovative nursing best practices – which nurse leaders should encourage and embrace. At Cleveland Clinic, nurses are finding new ways to use telehealth technology to communicate with patients, they’ve created ‘buddy systems’ for safely putting on and taking off PPE, and are continuously improving treatment protocols for patients with complex diseases.

In another example, Cleveland Clinic nurses in Florida and Ohio partnered to create and implement a new standardized practice for COVID-19 patient IV pumps. In less than 5 days, these nurses developed and rolled-out comprehensive nursing practice and safety guidelines for keeping COVID-19 patient IV pumps outside of patient rooms. Similarly, nurses suggested IV medication infusions be equipped with extension tubing that is compatible with the primary tubing. Adding the extension tubing allows nurses to access pumps without the need to enter the patient’s room each time an alert goes off. Nurses are able to efficiently change IV medications and more while reducing potential caregiver exposure and conserving PPE.

Practice innovations like these are inspiring nurses and their teams. Nurses are applying their clinical knowledge, skill and expertise in new and different ways and the positive results are showing through engagement, teamwork, quality of care, patient satisfaction and experience and more.

The next 6 months

The past 6 months have been an unprecedented time for nursing and all of healthcare, and no doubt the next 6 months will pose new challenges, strategical modifications, and so on. As we move forward together, I encourage nurse leaders to remember your nursing values and allow them to steer you during this time of adversity. We will continue to rise to the occasion in this incredible Year of the Nurse and Midwife!