From Kelly Hancock, DNP, RN, NE-BC
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Throughout the past few days and weeks, I have witnessed remarkable levels of nursing care unfold, incredible displays of professional unity, and an amazing sense of commitment and dedication from all those who are fighting the coronavirus/COVID-19 pandemic from the frontline.
Day after day, nursing caregivers are rising to the challenge and showcasing the true essence of our great profession. During these uncharted and uncertain times, their hard work shines as a beacon of hope. Never before have we experienced a global health crisis of this magnitude, but I assure you, we are in this together.
While the situation continues to change and evolve every day, Cleveland Clinic’s Executive Nurse Leadership team currently advises the following recommendations to aid nurse leaders and nursing organizations through the COVID-19 pandemic.
Show strength in leadership.
Now more than ever, nurse leaders need to be present and collaborate and work together as a team — teamwork is key. Leaders should continually be engaged in all that is happening and have a strong in-person presence with their nursing teams.
At Cleveland Clinic, our leadership teams are communicating around the clock. The decision-making cycle is rapid – from resource preparation and planning to necessary improvements, process changes and more. Executive nurse leaders are present on all system-wide executive phone briefings and incident command briefings. Additionally, at least two nursing-specific e-mail update communications are sent to the nurse leadership team every day for sharing with caregivers, and a daily phone meeting is held at 5 p.m. Within 1 hour of the all-team nurse leader meeting, an executive debriefing and summary, complete with action items and deliverables, is distributed to all in attendance.
Communicate timely and accurate information to nursing caregivers.
Communicating in real-time and with transparency is the safest way to manage this situation. With new challenges emerging by the minute, it is especially important that nursing caregivers are made aware of the steps and actions being taken by their leadership team to remedy issues and maintain safety for themselves and their patients. Important items to communicate include staffing issues and coverage of all nursing shifts, caregivers who are furloughed due to COVID-19, current happenings or changes within the organization and nursing unit/practice area, and the status of local, state and federal policy issues.
Up-to-date and frequent communication to nursing caregivers by nurse leaders brings caregivers together, encourages confidence, helps clarify any confusion, ensures high-quality, safe care continues, and shows ongoing support and appreciation. At Cleveland Clinic, all of our COVID-19 messaging is appropriately aligned with our four care priorities: care for patients, care for caregivers, care for the organization and care for the community.
Ensure nursing caregiver safety.
In times like these, nurse leaders should be actively partnering with leaders from other health organizations, as well as state and local officials. We are all in this together and collectively, our messaging should be consistent and evidence-based. Specifically, with regard to caregiver safety, leadership teams should align personal protective equipment (PPE) guidelines with those of the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC). At Cleveland Clinic, we are continually updating our PPE guidelines, with the most current available to caregivers on our intranet homepage. The guidelines help keep caregivers safe, ensure proper and effective use of PPE, and conserve supplies.
Additionally, nursing organizations should work hand in hand with their hospital or health system supply chain department on resource needs and conservation strategies. Ensuring caregiver safety should also include restricting access to health facilities as needed and checking caregivers for fever when they enter patient care areas.
Clearly and precisely convey intended caregiver safety behaviors.
With a goal to limit exposure to COVID-19, appropriate caregiver safety behaviors (for interactions with patients, patient family members and other caregivers) should be reviewed with nursing caregivers daily and include: social distancing (at least 6 feet from other persons), proper sneeze and cough etiquette, avoid touching eyes/nose/mouth, frequent handwashing, regularly disinfecting surfaces, and encouraging telemedicine or virtual visits when possible.
Cleveland Clinic is currently utilizing numerous telehealth and virtual health strategies to provide care for patients – especially in primary care and home care settings. In the home setting, for example, patients who are able are being asked to step outside for their appointments so nursing caregivers can still physically see them, while maintaining proper social distance and conserving PPE.
In the inpatient setting, another strategy we’ve implemented is care bundling, which is intended to limit the number of times nurses, nursing assistants, care managers and other caregivers enter a patient’s room. Multiple tasks are being completed with one caregiver visit to the room; i.e. food is delivered, the patient is assisted to the restroom, vitals are taken, paperwork is completed, etc. Care managers have also started calling patients from outside patient rooms, developing more of a telephonic relationship with patients. They review discharge instructions via phone, email regulatory paperwork to the patient, and more. With this more streamlined approach to care, Cleveland Clinic is also seeing added efficiencies to care delivery and discharge processes, as well as reductions in patient length of stay.
Look ahead to continue providing safe, high-quality patient care.
Current data analysis predicts that in many U.S. areas, Northeast Ohio included, the peak of the COVID-19 pandemic will hit in mid-May. With this in mind, another important recommendation to nurse leaders is to actively use predictive modeling to prepare for future challenges so you and your teams can continue to provide patients with the safe, high-quality care they deserve.
Now is the time to take action – don’t wait!