by Maddie Langr and Carol Boston-Fleischhauer
Chief Nursing Officer
Last week, Carol Boston-Fleischhauer interviewed Michelle Curry, the CNO at Overlake Hospital, to learn about their response to Covid-19. Overlake Hospital, a 349-bed facility in Bellevue, Washington is one of a small but growing number of provider organizations that are progressing into Covid-management.
The organization saw their first Covid cases on February 28th and moved quickly to construct appropriate Covid care areas, cohort patients, and design intensive staffing models, which were complicated by Washington State Nurses Association (WSNA) union negotiations that were already in high gear. Overlake has now passed their Covid-19 apex, but are still figuring out the new normal. Below, Michelle shares her key lessons learned from leading through the Covid surge.
Lesson #1: Make decisions efficiently—and ensure you communicate them.
We had little warning when our first Covid positive patient entered the facility. Like many of you, we had to make quick decisions. There were two things that helped us do this: our Covid command center and rounding.
We immediately set up our command center, relying on nursing and medical leadership, as well as other C-suite executives. For the first month, it ran 24-hours a day, providing real-time data to aid our quick decision-making and respond to issues as they arose. Now, we’ve adjusted our schedule to running it 7am-7pm.
The other part was communicating Covid information and our decisions to staff. We relied heavily on rounding to achieve this, including 24/7 command center rounding. Nurse educators and nurse managers also rounded on all units to ensure questions were answered and staff had support. We used our intranet for staff-wide communications and reinforced messaging during daily huddles with managers.
Lesson #2: When it comes to staffing, be prepared for the unexpected.
We developed a nurse care pair/extender model to support intensive staffing needs, and planned to redeploy staff from low volume or closed service areas to work with Med-Surg and ICU nurses. No matter how strong your staffing surge plan looks on paper, be prepared for unanticipated reactions to occur, and get ready to adjust along the way. For us, we didn’t anticipate the following:
- Excessive, legitimate staff accommodation requests per CDC guidelines coming through early on. This complicated logistical and staffing placement decisions.
- Significant numbers of nursing staff without accommodation requests rejecting redeployment to Covid-units, and overall staff rejection of the staffing model we designed.
- Increased numbers of furlough requests with timelines and reinstatement provisions needing to be quickly negotiated.
- Receipt of an MOU from the WSNA regarding interim Covid-expectations, including increased PTO hours, hazard pay, and interim hourly wage adjustments.
- The need for travelers. We hope we wouldn’t resort to temporary staffing, but we ultimately contracted travelers for a four week time period to augment our critical care area where staff were emotionally and physically exhausted.
Lesson #3: You need extra staff to help with non-traditional work.
We experienced myriad unexpected tasks that required staff time and you need a system to deal with that. For example, we were surprised by how much additional data reporting was required by various state and federal agencies—time consuming but basic activities like duplicating documents and collating reports were needed. We also needed help delivering supplies to units and processing donations, including food and PPE.
To help with this, we created a labor pool of staff for non-traditional work, or last minute tasks where a department may need extra help. This labor pool is staffed by non-clinical leaders and staff, and is currently managed by the Directors of Patient Experience and Continuous Performance Improvement.
I recommend creating your labor pool as soon as possible. I wish we had opened ours sooner, but got delayed finding the right oversight due to time constraints. We started with the patient experience, then tried HR, and finally settled on the quality manager and marketing department for labor pool management.
Lesson #4: We are experiencing a pivotal moment as leaders—but we’re in this together.
As a leader and a person, this has been a challenging time. I’ve always been soft in nature. In the last 6 weeks, I’ve had to face that and make tough decisions that don’t make everyone happy—and it’s been hard for me. This is all while working non-stop since our first Covid patient was admitted, spending no less than 16 hours per day in the command center and trying to keep the rest of the hospital running.
That said, this has been the most dynamic six weeks of my professional career. For leaders facing your surge right now, I offer the following reflections:
- Fear is real, no matter how much scientific data or evidence you have to support the decisions you need to make. Recognize the fear you carry and identify a trusted executive colleague or two that you can routinely bounce concerns about.
- Stay very close to your senior nursing leadership team. They have the pulse of the entire nursing enterprise, which for me was key.
- Don’t underestimate the power of in-the-moment recognition at all levels of your organization. The time will come later for more formalized celebrations. For now, staff, managers, and leaders all need authentic and timely demonstrations of your sincere recognition of what they are doing.
I have many questions as we shift to our “new normal.” Top of the list for me include: what the long term Covid-care model will look like and how I will rebuild a strong culture with my frontline staff. I’m worried about the chasm between the staff that accepted interim assignments and those that didn’t (and were furloughed), as well as the exhaustion we all feel. As leaders, we must figure out how to heal ourselves and our clinical staff as we re-open services, while also reflecting on lessons learned, celebrating our achievements, and moving forward.