Perservering Through COVID

By Heather West, BSN, RN-BC

Nursing Director Shares Lessons Learned During the Pandemic

During the COVID-19 pandemic, frontline health care workers throughout McLeod Health rose to every challenge, emerging resilient and heroic. Below is a firsthand account from Heather West, the Nursing Director of the McLeod Regional Medical Center Observation Unit, describing how her team has persevered with a relentless determination to keep patients and staff safe and healthy.

On March 27, 2020, I learned of the plan to convert our floor from an outpatient Observation Unit to the long-term COVID area for floor patients.

Relatively new in my role as Nursing Director, I did not know how I would lead my work family into something so unknown while also keeping them safe, motivated and positive. In the weeks that our unit was being converted, our staff began learning about the personal protective equipment (PPE) and protocols involved in caring for COVID patients. I vividly remember the first time we suited up as a group to go into these patients’ rooms. I can still see the fear in my staff’s eyes as they fought back tears and trembling hands. Despite the fear of the unknown, every single one of them made a choice to care for the patients who needed them.

It was in that moment, I realized that fear would be the greatest barrier to overcome in this journey.

After floor preparation was completed, we opened a hybrid unit with 24 Observation patients on one end and 28 COVID patients on the other. By this time, after working with COVID patients in the temporary area for several weeks, staff were less apprehensive.

The early preparation was a saving grace for us and what was about to come.

On June 26, 2020, the COVID census exceeded capacity, and we relocated Observation patients to other areas within the hospital to allow us to convert to a full 52-bed COVID floor.

We remained this way for three months until the first peak ended.

The first peak was brutal. It was unlike anything I have ever professionally experienced. We were truly just existing in survival mode. We battled full Tyvek suits and N-95 masks in the July and August heat. We felt vulnerable and isolated from everyone else in the hospital. Like the rest of the world, we did not have precedent or evidence-based practice to fall back on. The guidelines for COVID care changed almost daily and were difficult to keep up with. The patients were so much sicker than the Observation patients we typically cared for.

By September 20, 2020, we resumed our hybrid model with both Observation and COVID patients. We were both relieved and grateful to have pushed through those difficult months.

We did not want to think of the possibility of a second wave. We still struggled with the isolation from other areas of the hospital, but our staff was healthy, our confidence had improved, and our fears of the unknown had eased with time and experience.

We were now the experts on COVID patients, learning from the first wave and changing some of our original practices. We moved from survival mode to improving mode. Our increased collaboration with Hospitalists allowed us to identify areas of opportunity in care. Critical early intervention and ambulation of these patients proved helpful in preventing complications.

In late November, we were one of the first hospitals in the state to offer the outpatient drug Bamlanivimab to COVID patients. It played a vital role in keeping them out of the hospital. Because the drug was administered via IV infusion, finding a safe location to administer it while fulfilling staffing requirements was a challenge. On November 24, 2020, we initiated the outpatient COVID infusion service in one of our larger patient rooms.

We were now home to three populations of patients -- Observation patients, COVID patients, and COVID infusion patients. COVID numbers continued to rise and on December 7, 2020, we were forced to convert back to a 50-bed COVID unit and two COVID infusion rooms.

At the height of the second peak we were caring for 74 patients per day on the floor -- 50 inpatients and 24 infusion patients. This lasted until mid-February when the numbers finally declined enough for us to convert back to the hybrid for the third time.

Our entire team learned invaluable lessons from this experience, including the true meaning of teamwork which led to a greater level of trust and respect between nursing staff and providers.

In addition, we saw innovation at work. Even through the isolation we were experiencing, many colleagues throughout the hospital assisted us in unique ways.

• Engineering created the safest environment possible by replacing windows and installing equipment to place our floor under constant negative pressure. They installed UV lights to sterilize the air and massive air conditioners to help combat the heat from the PPE.
• Operational Effectiveness and Procurement planned early to conserve PPE and other critical supplies.
• We converted the sunroom on our floor to an area where Central Supply could sterilize N-95 masks.
• We created a new service with the infusion rooms and maximized our resources by thinking bigger. We used the availability of the Army National Guard Medics to fulfill the nursing need and increase the number of daily infusion slots.
• Patient Representatives called families to offer moral support. Even though they could not give clinical information, families felt more connected to us.
• Athletic Trainers from local schools helped ambulate patients. We found this to be critical in preventing complications during the second wave. Our trainers had never worked in a hospital, but they suited up beside us and brought a new burst of life to the team. They willingly stepped off the elevators with smiles on their faces, ready to work.
• We received donations from the McLeod Health Foundation so we could distribute gifts to our 50 patients who were in the hospital alone on Christmas without their families.

What I am most proud of is how hard this staff has fought for our patients. They did so much more than just show up every day and provide nursing care to COVID patients. Because we were isolated from other areas we relied on, we had to take on many additional tasks to meet the needs of these patients, including but not limited to: microwaving and distributing 50 meal trays three times each day; making multiple trips daily to the lobby or elevators to collect deliveries for patients; troubleshooting computer issues over the phone; hand-delivering all COVID swabs to the Laboratory and picking up COVID medication from the Pharmacy.

I see a team who found a way to push through barriers of isolation and fear to care for more than 3,000 COVID positive patients in their community. My team has taught me that resilience is not about one person, and it is not simply effective leadership. For us, resilience was a team effort -- a conscious choice that we made to overcome our fears. It took all of us, fighting every single day to take care of those patients in the way they deserved. We had to take what initially felt like an impossible circumstance and turn it into an opportunity to grow and learn -- and ultimately succeed -- as a team.