From March to June 2020, New York City was the epicenter of America's coronavirus epidemic. Over 200,000 cases were reported in this three-month span, with a quarter resulting in hospitalization. Health systems throughout the region struggled to accommodate a surge of this scale, leaving the clinical workforce overwhelmed.
Montefiore Health System, headquartered in the Bronx, was one of the New York organizations most impacted by the first surge. Montefiore hospitals increased bed capacity as mandated by the state, but a portion of Montefiore’s clinical workforce were unable to come to work due to Covid impact and caregiving responsibilities.
In response, leaders implemented their emergency team-based staffing protocol, originally designed for nursing strikes. While instrumental in helping the system respond to their first surge, these staffing plans lacked the specificity required to treat complex Covid-19 patients with long lengths of stay.
Montefiore’s approach to supporting staff during the first Covid-19 surge
During this first surge, Montefiore’s CNO and Director of Nursing Research found an article published by the Nursing Executive Center on Covid-19 nurse staffing. The article featured Baylor Scott & White's Covid-19 team-based staffing models, which outlined responsibilities for all nursing and allied health clinicians down to each clinical task.
This approach struck a chord with Montefiore leaders given their staffing and experience shortages, and it validated their current team staffing approach. Montefiore leaders then used the Baylor Scott & White (BS&W) model to further refine their staffing plan in three ways:
- Clearly delineated frontline roles and responsibilities. Using the BS&W model as a starting point, Montefiore leaders updated their own Covid-19 staffing plan to delineate clinical roles down to the tasks for which each team member was responsible. They added onto BS&W’s work by incorporating physician partners within the team model and updating the responsibilities of each team member to meet their current staffing needs.
- Adapted the model to staff needs. After they implemented their new team staffing model, leaders reached out to staff for feedback on the model and to gauge staff comfort with performing the clinical tasks assigned to them. Leaders conducted “hotwashes,” or post-shift debriefs with nurses involved in team staffing to see what could be improved. They also sent out a skills assessment survey to over 1600 ambulatory nurses who were deployed to the inpatient setting during the surge. Based on staff responses to the hotwashes and to the skills assessment survey, Montefiore created a training program over the summer to help staff better prepare for the next wave of Covid patients. Montefiore leaders are also considering using team-based care models (and their training) beyond the pandemic.
- Bolstered leadership resilience. Montefiore’s CNO attended an NEC workshop for nurse executives to discuss how leaders should support nurse manager resilience. This workshop reinforced the need for manager support, focusing on the emotional toll Covid-19 has taken on all levels of leadership.
Using the team-based staffing model, Montefiore cared for a high number of high-acuity patients during the Covid surges.
Feedback from staff indicates that the Covid team staffing model worked well, even when teams incorporated more novice nurses. Having the clearly delineated roles and an expert RN within the team model to turn to for guidance was key to supporting less experienced staff at a time when they were needed most.