A Future State of Readiness

By Meredith Foxx, MSN, MBA, APRN, NEA-BC, Executive Chief Nursing Officer

As another year closes, nurse leaders are reflecting on the events of 2021 and looking to the new year with hope and promise. We have more knowledge and understanding of what we are up against with COVID-19. We have better defense thanks to the vaccines. We also have the gift of experience. We’ve seen it, we’ve lived it and we know how to work through it.

In our reflection, we consider what we could have done differently to manage and lead through the pandemic. In doing so, we are thinking about crisis preparedness in new ways to ensure that we are equipped and ready for future disruptions.

A flexible and capable nursing structure

Cleveland Clinic’s executive nurses have been evaluating our health system’s state of readiness for crisis situations and conducting associated action planning to improve upon it.

Through our ongoing work this year, our primary goal has been to create a nursing structure that is flexible and capable enough to respond to future crisis scenarios: pandemics, patient surges, mass casualties, infrastructure or IT outages, mass caregiver absences and more.

When we began our work, we outlined a few guiding principles:

• Stay true to our mission and values
• Make safety a priority
• Ensure fairness and transparency
• Promote flexibility
• Have an open mind and be innovative

Our executive leaders participated in a start, stop, continue exercise, which prompted reflection on how nurse leaders and caregivers worked together during the pandemic and how they might improve or change that work in the future. Three nurse executive work groups were created to outline preparedness strategies with sustainable action plans.

While there are many ways to build flexibility into nursing for the future, what matters for any organization is making time for this rethinking to take place, and tying the new thinking to actions that will ensure good ideas have an opportunity to be tested.

Team-based nursing model

The first work group has been focused on developing a team nursing model that is ready for surges and staffing challenges. The model optimizes the skills of each nurse and highly trained acute-care staff.

The team-based model is designed to care for large numbers of patients by deploying nursing caregivers from one area to areas of greatest need. It includes cross-training, education and caregiver support, and pairs caregivers who are being brought in for support with experienced ones. Model roles are defined by nurses’ scope of practice and confidence in decision-making relative to the care area they will serve. The work group is defining specific responsibilities and duties of the roles in the model and reviewing enterprise staffing plans.

They are also taking a closer look at education and training to prepare nursing caregivers – which Cleveland Clinic excelled at during the pandemic, cross-training 4,100 nurses in just a few weeks. Key priorities of the group’s near-future work include outlining when to activate the model, how many models might be needed, considerations for float nurses and model sustainability.

Increase licensed and non-licensed caregivers

To assist with crisis staffing and workforce surge capacity, another group has been developing a plan to increase the supply of employed licensed and non-licensed caregivers. At the center of this plan are healthcare professionals who are quickly available for added caregiver support.

The plan includes three support levels for licensed caregivers: those who work in other care settings, such as the operating room or ambulatory surgery centers (not inpatient settings); those who work for the Stanley Shalom Zielony Institute for Nursing Excellence but not in a care setting; and those who don’t work in the Nursing Institute or a care setting. It also encompasses two non-licensed caregiver support levels: those with clinical experience and administrative workers. Based on employee experience and skill, work assignments might include nursing support duties, skilled clinical nursing or non-clinical unit support.

Nursing-specific crisis communication protocol

The third work group has been developing a nursing-specific crisis communication protocol to support nurse leaders. It is designed to reinforce communication with teams and enable nurses to receive streamlined and actionable information. The protocol includes communication devices and platforms, topics and standardized communication processes. It also aligns with Cleveland Clinic’s corporate communications crisis plan.

Key elements of the plan are status updates and debriefs, engagement/HR/caregiver resources, operations messaging and nursing practice and policy documentation.

In crisis situations, there will always be ups and downs and managing those variances is vital. Start 2022 off right by evaluating your current state of readiness and jumpstarting crisis preparedness planning so you can best manage the next major disruption that may come our way.