Selected Podcast
Taking the Sting Out of Nursing Redeployment
Jeannette Bronsord and Kathy Baker explore redeployment strategies during the COVID pandemic and best practices in re-skilling nurses to alternative practice settings.
Featuring:
Kathy Baker, Ph.D., RN, NE-BC, Associate Vice President and Associate Chief Nursing Officer of Patient Care Services. Dr. Baker is an accomplished executive with a history of leading improvements in clinical performance. Dr. Baker is also nationally known for her research on leadership and workforce issues. Since 2018, Dr. Baker has served as the Associate Chief Nursing Officer for VCU Health. Previously she served as Nursing Director at VCU Health for Emergency Services and Resource Management. Several of her accomplishments in her 30-year tenure at VCU Health System include implementation of strategic staffing models and a benchmarking system in Patient Care Services; redesign of Emergency Services; and expansion of critical care air and ground transport. As a prolific author, Dr. Baker’s most recent manuscripts have focused on the importance of registered nurse as advocates, innovators, and collaborators; elimination of barriers to RN scope of practice; and, the influence of leadership on empowerment. She is also a Nurse Scientist at VCU Health System with a research focus in work environments, patient safety, and workplace satisfaction. Dr. Baker received her Master’s and Doctor of Philosophy Degree in Nursing from Virginia Commonwealth University. She also holds an affiliate faculty position at the VCU School of Nursing where she teaches in the Graduate Nursing Leadership program.
Jeannette Bronsord, RN, DNP, NEA-BC | Kathy Baker, Ph.D., RN, NE-BC
Dr. Jeannette Bronsord is Executive Director Surgical Services at Yale New Haven Hospital, a 1541 bed academic medical center and level 1 trauma center. She oversees nursing practice and operations in the inpatient general surgery units, surgical intensive care and stepdown units as well as has administrative oversight for the Trauma program. In addition she leads strategic workforce initiatives in collaboration with the nurse executive team. Her Yale New Haven Health System responsibilities include the standardization of products and patient care equipment within the YNHHS system hospitals. Born and raised in Connecticut, Jeannette often comments that she has worked at the smallest hospital in the state, the largest one, and also ones in-between, many of which are products of mergers and acquisitions. She believes this experience has helps her understand various organizational perspectives when integrating practices and standards across the 5 hospitals in the YNHHS system. Jeannette has over 35 years of experience and has held a variety of leadership positions with oversight of nursing and clinical operations. Jeannette enjoys leading in the complex and ever-changing healthcare environment and her areas of expertise include change management, quality improvement, and she has developed and implemented practices to recruit and sustain an engaged workforce. She received her BSN and MSN from Southern Connecticut State University; her Masters in Organizational Leadership from Quinnipiac University; and her Doctor of Nursing Practice from the University of New Hampshire. She is board certified as a Nurse Executive Advanced through the ANCC.Kathy Baker, Ph.D., RN, NE-BC, Associate Vice President and Associate Chief Nursing Officer of Patient Care Services. Dr. Baker is an accomplished executive with a history of leading improvements in clinical performance. Dr. Baker is also nationally known for her research on leadership and workforce issues. Since 2018, Dr. Baker has served as the Associate Chief Nursing Officer for VCU Health. Previously she served as Nursing Director at VCU Health for Emergency Services and Resource Management. Several of her accomplishments in her 30-year tenure at VCU Health System include implementation of strategic staffing models and a benchmarking system in Patient Care Services; redesign of Emergency Services; and expansion of critical care air and ground transport. As a prolific author, Dr. Baker’s most recent manuscripts have focused on the importance of registered nurse as advocates, innovators, and collaborators; elimination of barriers to RN scope of practice; and, the influence of leadership on empowerment. She is also a Nurse Scientist at VCU Health System with a research focus in work environments, patient safety, and workplace satisfaction. Dr. Baker received her Master’s and Doctor of Philosophy Degree in Nursing from Virginia Commonwealth University. She also holds an affiliate faculty position at the VCU School of Nursing where she teaches in the Graduate Nursing Leadership program.
Transcription:
Bill Klaproth (Host): Leadership Beyond the Pandemic, Care Delivery Innovations is supported by an unrestricted grant from the Johnson and Johnson Foundation in partnership with the Johnson and Johnson Center for Health Worker Innovation.
COVID unleashed what is perhaps the greatest movement to redeploy nurses from one setting to another, in the history of nurses. Organizations scrambled to determine ways of providing training and to create job roles that would accommodate varying skillsets. Especially impacted were nurses in operating rooms, ambulatory care and maternal child and pediatric settings.
So, on this episode, we'll talk about the multiple ways that nurses experienced redeployment during the COVID-19 pandemic, the different redeployment strategies and why they were successful and what lessons will be carried forward. Joining us today will be Dr. Jeannette Bronsord, Executive Director of Surgical Services at Yale New Haven Hospital and Dr. Kathy Baker, Associate Vice President and Associate Chief Nursing Officer of Patient Care Services.
This is Leadership Beyond the Pandemic, Care Delivery Innovations. I'm Bill Klaproth, Dr. Bronsord and Dr. Baker, thank you so much for your time. Dr. Bronsord, let's start with you. So, first off, what were the multiple ways that nurses experienced redeployment during the COVID-19 pandemic?
Jeannette Bronsord, RN, DNP, NEA-BC (Guest): Nurses experienced redeployment in several different ways. We had canceled our elective surgical schedule, so our peri-operative nurses and nurses from our PACU were redeployed based on their competency and skills to our med-surg and ICU settings. We also saw a marked decrease in our ambulatory volume. So, our ambulatory nurses from our various clinics were all redeployed to our med-surg areas to assist with patient care. And then we also had some specialized teams and we had dofficers. Those were nurses that were from our OR and peri-operative areas, and they were very specific in that they assisted with donning and doffing PPE.
So, masks and gowns for our staff when they were going in and out of COVID rooms. So, they would review with the staff, the proper way to take and put gear on and take it off. And also reinforce just in general, the PPE, because there was so many changes that we were experiencing, with the different products.
So, the dofficers were able to reinforce with the staff the proper methods to use those different equipment. And then we also had a team, a prone team. And the prone team was very specific to proning patients, which is positioning them on their stomach. So, that was a very successful, treatment for our COVID patients when especially they were on ventilators.
So, it could take up to four to six staff members to turn a patient who was ventilated on their stomach. So, it required a team. So, we developed the prone team. And then we also utilized our CRNAs, who are licensed and many of them had former ICU experience. They also were very comfortable at managing ventilators, especially when we were considering the possibility of using our OR ventilators as backup ventilators should we exceed the number that we had had, for what we would normally use in our ICUs. And they could also be advanced practice providers and actually manage care for some of those patients. So, we used them in many different ways.
Host: There was so much to learn in such a short time. And while on the go. A really daunting task, what everyone went through and Dr. Baker, how about your experiences? Can you share those with us?
Kathy Baker, Ph.D., RN, NE-BC (Guest): Yes, Jeannette, that was just such a great overview of all the many different roles that people had to assume and the different ways that people had to work. I think underpinning that is exactly what you characterized. It was, every aspect of the way people perform their jobs had to be rethought a little bit.
So, what had been routine on one day, was turned upside down the next. And so, we changed the way we worked. We changed who we worked with. We changed the populations of patients that we worked with. So, I don't think there was any aspect about a nurse's role, or way that their normal job functioned, that was not untouched by the pandemic and that spread across all areas of nursing. Our Ambulatory as Jeanette, stated, now those are really saw patients in a much different way. They became those virtual visits. Our ORs were shut down and so those patient populations disappeared. And then we had, you know, an evolving patient population that had new critical demands that really stretched our staffing in ways that really no one had really experienced before in their careers.
So, I would say, overall, as you know, the word unprecedented has been used many times, but I think it applies so well in this situation also is that every aspect of the way that nurses staff, the way they care for patients, required an unprecedented level of change.
Host: Absolutely. And the phrase unprecedented level of change certainly applies here. So, Dr. Baker, there were other models out there as well. What differentiated your model from the other models used during COVID 19?
Dr. Baker: The thing that I think was so important around our model is that we applied really the principles of nurse empowerment and staff engagement to ensure that we maintained the resiliency of our teams. And what I mean really specifically by that is that we all knew that we had job to perform and different needs that needed to be met. We really deployed our staff using a team model and we described the outcomes that we needed to get to and then we asked them to help us find the best ways to achieve those outcomes. Specifically, then instead of just randomly assigning people to move to a different unit like the OR for example. We took a team of people together and we said, how can we make this work?
We've got additional patients that need to be covered. We need to manage in this work setting and how can we best do that? And so that team of folks that were experiencing deployment, then moved together and they brought ideas to the table of how we could really make sure this coverage happened, how we could educate in the moment, what they needed to be successful.
So, at every onset of the process or every onset of change that we had to experience, we used the principles of change management and staff empowerment to guide us so that our teams would stay resilient throughout this. What we think that led to, was really a good solution from the start, so that we didn't have to do rework and that teams felt involved and empowered to tell us what was working and what wasn't. And we think that was really a game changer for us.
Host: Yeah. And a couple of things that stuck out with me from what you said, you talked about having a team model, a team approach and how that worked. Change management and of course empowering your staff. And Dr. Bronsord, what would you like to add into that on the model that you used and why it worked.
Dr. Bronsord: Very similar to what Kathy mentioned, staff involvement was critical. Our CNO was committed to preserving our nursing professional governance structure during COVID. And we were able to utilize several of the members of nursing professional governance and our staff in the design and the pilot of a team model that utilized ICU nurses, med-surg nurses, nurses that may have been currently in non-direct patient care roles, but we brought them back in based on their experience and competency. And were able to train them back up to be an extender, so to speak. We had a team model that we actually color coded the nurses to identify them.
So, for instance, a red nurse was a current ICU nurse. An orange nurse might've been, was a former ICU nurse, so that they were comfortable in the environment, but not expected to take an assignment independently. Pink nurse would be an ambulatory or a former med-surg nurse that was not expected to take an assignment, but would partner with a med-surg nurse to care for a larger number of patients.
So, that really helped people and to this day, they'll still refer to oh, I was a pink nurse or I was a red nurse during the COVID redeployment. We also developed a comprehensive toolkit. And I think Kathy, when you said we did it right at the beginning, so we didn't have to keep doing the rework. And I agree, that was critical. Staff needed to have the tools to be able to implement team nursing. Many of us probably utilized a form of team nursing in our careers, but from maybe the 19, late 1990s forward, nurses that have been practicing within that period of time, probably have not utilized team nursing.
So, we needed to actually do assignment worksheets and team assembly algorithms to help them understand how do I now assign this support nurse with one of the nurses on the units and how do I make an assignment that's safe and everybody feels comfortable with. So, those types of things, along with a reassignment etiquette, actual listing of what responsibilities would be performed on each shift and FAQ's, that were questions that the nurses had actually asked during the pilot. And so we put together FAQ's, so that tool kit was available and I think really helpful as well.
Host: Yeah, I love the attention to detail on all of this. So, Dr. Bronsord, if I could ask you to take the 30,000 foot view of all of this overlooking everything over the past year, were there a couple of key things that really made this model successful?
Dr. Bronsord: I think there were two key things. The first is it was patient-centered. So, similar to our values, our organizational values, there was the focus on patient safety, the deployment with planned and it was based on competency and ensured the safety of our patients and our staff. And the second was the teamwork and collaboration. So, the model allowed for a dynamic response to increase in our volume. We were looking for ICU volume, for instance, to go from anywhere from 193 to 338 beds in phase one. So, we needed to have a model that could help us flex to be able to do that. Another piece of it in the teamwork, was that we collaborated, and used a centralized process to deploy staff.
We also collaborated with our bed management staff so that we could understand where patients were going to be admitted to, what patients were waiting, potentially at other hospitals to be able to come in for therapies that only in our region that we would provide. So, that collaboration and coordination was critical. Evaluating, volume transfers, incoming acuity, and then our daily staffing decisions were aligned with those decisions.
Host: And then Dr. Baker, if we could get your thoughts on this is well, your 30,000 foot view level, everything that you've experienced over the past year. What made what you did successful? Give us your thoughts on that.
Dr. Baker: Yeah, I love what Jeannette said about the patient-centeredness of that. And I will just sort of put an exclamation point behind that. Here in Richmond, we had a job that we knew we needed to do, like every place across the country. And nurses were really willing to rise to the occasion to get this job done. So, it was that common purpose and knowing that this was really our time to stand up and respond to a very important need. I would say the other thing that Jeannette said that I think was extremely important is that we created these areas that really became the source of truth for people.
Right? If you needed to find out something about staffing, there was an identified place to do that. If you needed to find out something about a change in protocol, there was a different place to do that. So that there were support systems for that bedside team coming in, so that they could find their source of truth.
And we really reinforced that with weekly town halls for our nursing teams, so that they could dial in and make sure that they had the latest information of how we expected the census to rise. What there might be a change in protocol that people needed to be accustomed to. So, people really knew where to get the information they needed in order to perform their job well. Lastly, I would say, and I would be remiss in saying it's just the outpouring of support that we experienced here from the community was just unbelievable. The meals, the signs of gratitude were just touching. And so I think that fueled the team to know that the work they were doing was appreciated by the community and all of those signs of appreciation really meant so much to the people that were on the front lines. I think it truly made a difference.
Host: Yeah, it was great to see the communities supporting our local healthcare workers throughout the pandemic. So, you mentioned a few things, Dr. Baker. Support systems, weekly town halls, that sharing of information. I'm just curious, what will you carry forward? What have you learned from this that you will still apply in the future?
Dr. Baker: So, what was really reinforced for me, number one, was that frontline staff really do have the answers. And so at the end of the day, how important it is to engage the teams that are actually doing the work, and their involvement is just absolutely critical. Number two, is that staffing and deployment is more than just a numbers game, right? You need people, you need the right numbers, but you also need the teamwork. You need the comradery, you need the sense of trust that's built by having a familiar face when you show up to work. So, those pieces of teamwork are just as important as having the right numbers and that you have to pay lots of attention to that.
The third thing, is again, the importance of mechanisms for staff to build in some resiliency. The importance of leader presence, the importance of work-life balance and to understand that the stressors that people have at home, are bound to affect them in the workplace. So, to make sure that people are getting what they need to sustain themselves is also important to building community and resiliency at work. So, those are lifelong lessons that I'll never forget. And that were really, revalidated by this pandemic experience.
Host: Yeah. Really interesting to hear your thoughts on that and Dr. Bronsord, how about you? What have you learned and what will you carry forward throughout the rest of your career from what you've learned from the COVID-19 pandemic?
Dr. Bronsord: Oh, I've learned a lot. The first is we gave ourselves time with the model at the beginning. And granted we had that up and running within nine days, but we gave ourselves the time to make sure that our employees were involved, similar to Kathy had said. I think engaging them was critical. Also trusting our team to all work simultaneously towards the same goal. So, when we started, as I said, it was nine days, we knew that COVID was coming up the 95 corridor from New York through Connecticut and that we needed to be ready. And we had a window of about maybe two weeks before we expected to see a surge start.
So, engaging our employees at that time and making sure that we were educating and communicating was critical. We did a survey for our nurses who were deployed following the initial months of COVID and they scored training as the highest of any of the sections of the survey, that maybe they were scared, but they felt that they were prepared to be redeployed.
And that was so important for their safety, for their resilience, for the safety of our patients and for our teams. And the employees who were redeployed, 83%reported that they felt like they were helpful to the receiving unit. And that was important too, because we had made a decision, a commitment as an organization, not to furlough any staff.
So, we really wanted to create space for everybody to contribute, and everybody was able to contribute using the care model that we had in place. And then also the employees understood that they were, why they were being deployed. And I think the why is critical and they had a real sense of purpose. And after, they had a sense of pride and this was further validated for us on our engagement survey.
So, that was critical. Things that we're going to carry forward, a skills inventory. When we were initially planning the deployment and trying to identify which nurses had experience in critical care, and which nurses had experience in med-surg and how long ago, and who was competent to do different tasks; we didn't have a centralized database for that. And it took us a lot of time and manual processes to put that information together. So, our system had over last summer put together a skills inventory that was kept, and we will be updating on a routine basis so that if we ever had to do anything like this again, we would be able to immediately know who on our workforce is capable of being redeployed to an inpatient setting to an ICU.
Another thing I think that was critical is partnership across our service areas. Our ICU's all had to work together. Initially, all the leaders of the ICUs met and we talked about we were going to be resource sharing in a way that we never had before. And we started daily staffing calls, where we would really negotiate, how we're going to allocate our resources to ensure that all our patient care needs were met. And we are continuing to do those staffing calls to this day, as well as a daily call with our physician leadership around how we were going to best place patients in those critical care beds. So, I think the alignment of that bed placement and staffing piece is something that we're going to carry forward as well, just the partnership piece is critical.
Host: Some really good points there. I like how you talked about that skills inventory. And the partnership involved as well, bringing the different service areas together. So, we've talked about a lot of things on this podcast. Now let's talk about the nurse's point of view if we can. Of course COVID-19 unleashed what is perhaps the greatest movement to redeploy nurses from one setting to another. How did the staff feel about this redeployment? Did they feel successful in all of this?
Dr. Bronsord: It was stressful. I won't say that it wasn't. I think that initially they were scared. And we needed to really talk them through some of that. Their home departments and their home teams and leaderships kept in touch with them. And I think that really helped boost their morale and helped them make that transition. But overall, they felt good about what they did and were able to achieve. Some have said they feel like they made new friends on the inpatient units that they didn't even know that they had. They were able to for the most part, there was a core group, similar to what Kathy said, assigning teams together.
We didn't assign people together in their are complete teams, but we were able to, in many situations assign them to a location in a consistent manner, so they could integrate into that local team. And they really liked that. And some describe, I made friends for life. But I think the sense of purpose and sense of doing the right thing for our patients during a pandemic that none of us have ever experienced before, was extremely rewarding for many of them.
Host: Yeah, that's really good to hear and Dr. Baker let's wrap up with you. Same question as far as the nurses point of view, how do you feel the staff felt about all of this and do you feel they were successful in this redeployment?
Dr. Baker: Well, I like many other nursing administrators, really couldn't be prouder in what our staff were really able to accomplish. For those nurses that primary responsibility was caring for our COVID patient population, they really led that way in our organization to a patient-centered approach, to rising to the occasion, to care for a very complex patient population, that had lots of demands and they not only considered it their responsibility, they did it with a sense of pride and dedication that was really, inspiring.
And so they helped the rest of the organization get to a comfort level with knowing this was important work and showing us a positive way to approach this and to get the job done. I would say then as the deployment needs really increased, people faced this with a certain amount of uncertainty, right? Am I going to be put in a place that's unfamiliar or am I going to be able to do the job? The nurses that were on the units, will I have enough staff tonight? Will I be able to care for the patients? And so people found a way to ease those fears for staff.
And so what we found that happened is the nurses that normally would have resisted moving to other areas, really became very concerned about their colleagues. And so there was a level of comradery and I love the word partnership that Jeannette used that emerged, that really, I feel like is still evident in our health system today and I'm very hopeful that we never lose that. I can really tell that nurses really were able to rally and become resilient.
And these circumstances is that we redeployed people for only a short period of time. And so we thought we would rotate them so that wouldn't burn out in any particular area. And what we found is they wanted to stay. They said, nope, I'm settled. I want to be with my team. And so we found that that was a strategy we thought we would need to use, and then we didn't need to use it.
And then in early December, we were bequeathed the gift from an anonymous donor of some funds that came to us from the community to say, you know, I want you to make your life better for your nursing staff. And so we put out a call for what we called grant submission and we said what would you do to improve how we've responded to COVID, and the things that they wanted to improve were things for their patients.
They wanted to find a better way to connect with their families. They wanted to make a way for their families to be resilient. So, once again, our nurses just made us proud. They made us understand that from the beginning of the pandemic until where we currently are, their patients were their focus and that is what stayed front and center for them throughout the entire time.
Host: Yeah, that patient-centered focus obviously was very important to all of this. Well, thank you so much for your time, Dr. Baker and Dr. Bronsord. This has really been informative and we've loved hearing all of your thoughts on such an important topic. Thank you again.
Dr. Baker: Thank you.
Dr. Bronsord: Thank you.
Host: That's Dr. Jeannette Bronsord and Dr. Kathy Baker. And for more information, please visit aonl.org. And once again, this podcast is supported by an unrestricted grant for the Johnson and Johnson Foundation in partnership with the Johnson and Johnson Center for Health Worker Innovation. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Leadership Beyond the Pandemic, Care Delivery Innovations. Thanks for listening.
Bill Klaproth (Host): Leadership Beyond the Pandemic, Care Delivery Innovations is supported by an unrestricted grant from the Johnson and Johnson Foundation in partnership with the Johnson and Johnson Center for Health Worker Innovation.
COVID unleashed what is perhaps the greatest movement to redeploy nurses from one setting to another, in the history of nurses. Organizations scrambled to determine ways of providing training and to create job roles that would accommodate varying skillsets. Especially impacted were nurses in operating rooms, ambulatory care and maternal child and pediatric settings.
So, on this episode, we'll talk about the multiple ways that nurses experienced redeployment during the COVID-19 pandemic, the different redeployment strategies and why they were successful and what lessons will be carried forward. Joining us today will be Dr. Jeannette Bronsord, Executive Director of Surgical Services at Yale New Haven Hospital and Dr. Kathy Baker, Associate Vice President and Associate Chief Nursing Officer of Patient Care Services.
This is Leadership Beyond the Pandemic, Care Delivery Innovations. I'm Bill Klaproth, Dr. Bronsord and Dr. Baker, thank you so much for your time. Dr. Bronsord, let's start with you. So, first off, what were the multiple ways that nurses experienced redeployment during the COVID-19 pandemic?
Jeannette Bronsord, RN, DNP, NEA-BC (Guest): Nurses experienced redeployment in several different ways. We had canceled our elective surgical schedule, so our peri-operative nurses and nurses from our PACU were redeployed based on their competency and skills to our med-surg and ICU settings. We also saw a marked decrease in our ambulatory volume. So, our ambulatory nurses from our various clinics were all redeployed to our med-surg areas to assist with patient care. And then we also had some specialized teams and we had dofficers. Those were nurses that were from our OR and peri-operative areas, and they were very specific in that they assisted with donning and doffing PPE.
So, masks and gowns for our staff when they were going in and out of COVID rooms. So, they would review with the staff, the proper way to take and put gear on and take it off. And also reinforce just in general, the PPE, because there was so many changes that we were experiencing, with the different products.
So, the dofficers were able to reinforce with the staff the proper methods to use those different equipment. And then we also had a team, a prone team. And the prone team was very specific to proning patients, which is positioning them on their stomach. So, that was a very successful, treatment for our COVID patients when especially they were on ventilators.
So, it could take up to four to six staff members to turn a patient who was ventilated on their stomach. So, it required a team. So, we developed the prone team. And then we also utilized our CRNAs, who are licensed and many of them had former ICU experience. They also were very comfortable at managing ventilators, especially when we were considering the possibility of using our OR ventilators as backup ventilators should we exceed the number that we had had, for what we would normally use in our ICUs. And they could also be advanced practice providers and actually manage care for some of those patients. So, we used them in many different ways.
Host: There was so much to learn in such a short time. And while on the go. A really daunting task, what everyone went through and Dr. Baker, how about your experiences? Can you share those with us?
Kathy Baker, Ph.D., RN, NE-BC (Guest): Yes, Jeannette, that was just such a great overview of all the many different roles that people had to assume and the different ways that people had to work. I think underpinning that is exactly what you characterized. It was, every aspect of the way people perform their jobs had to be rethought a little bit.
So, what had been routine on one day, was turned upside down the next. And so, we changed the way we worked. We changed who we worked with. We changed the populations of patients that we worked with. So, I don't think there was any aspect about a nurse's role, or way that their normal job functioned, that was not untouched by the pandemic and that spread across all areas of nursing. Our Ambulatory as Jeanette, stated, now those are really saw patients in a much different way. They became those virtual visits. Our ORs were shut down and so those patient populations disappeared. And then we had, you know, an evolving patient population that had new critical demands that really stretched our staffing in ways that really no one had really experienced before in their careers.
So, I would say, overall, as you know, the word unprecedented has been used many times, but I think it applies so well in this situation also is that every aspect of the way that nurses staff, the way they care for patients, required an unprecedented level of change.
Host: Absolutely. And the phrase unprecedented level of change certainly applies here. So, Dr. Baker, there were other models out there as well. What differentiated your model from the other models used during COVID 19?
Dr. Baker: The thing that I think was so important around our model is that we applied really the principles of nurse empowerment and staff engagement to ensure that we maintained the resiliency of our teams. And what I mean really specifically by that is that we all knew that we had job to perform and different needs that needed to be met. We really deployed our staff using a team model and we described the outcomes that we needed to get to and then we asked them to help us find the best ways to achieve those outcomes. Specifically, then instead of just randomly assigning people to move to a different unit like the OR for example. We took a team of people together and we said, how can we make this work?
We've got additional patients that need to be covered. We need to manage in this work setting and how can we best do that? And so that team of folks that were experiencing deployment, then moved together and they brought ideas to the table of how we could really make sure this coverage happened, how we could educate in the moment, what they needed to be successful.
So, at every onset of the process or every onset of change that we had to experience, we used the principles of change management and staff empowerment to guide us so that our teams would stay resilient throughout this. What we think that led to, was really a good solution from the start, so that we didn't have to do rework and that teams felt involved and empowered to tell us what was working and what wasn't. And we think that was really a game changer for us.
Host: Yeah. And a couple of things that stuck out with me from what you said, you talked about having a team model, a team approach and how that worked. Change management and of course empowering your staff. And Dr. Bronsord, what would you like to add into that on the model that you used and why it worked.
Dr. Bronsord: Very similar to what Kathy mentioned, staff involvement was critical. Our CNO was committed to preserving our nursing professional governance structure during COVID. And we were able to utilize several of the members of nursing professional governance and our staff in the design and the pilot of a team model that utilized ICU nurses, med-surg nurses, nurses that may have been currently in non-direct patient care roles, but we brought them back in based on their experience and competency. And were able to train them back up to be an extender, so to speak. We had a team model that we actually color coded the nurses to identify them.
So, for instance, a red nurse was a current ICU nurse. An orange nurse might've been, was a former ICU nurse, so that they were comfortable in the environment, but not expected to take an assignment independently. Pink nurse would be an ambulatory or a former med-surg nurse that was not expected to take an assignment, but would partner with a med-surg nurse to care for a larger number of patients.
So, that really helped people and to this day, they'll still refer to oh, I was a pink nurse or I was a red nurse during the COVID redeployment. We also developed a comprehensive toolkit. And I think Kathy, when you said we did it right at the beginning, so we didn't have to keep doing the rework. And I agree, that was critical. Staff needed to have the tools to be able to implement team nursing. Many of us probably utilized a form of team nursing in our careers, but from maybe the 19, late 1990s forward, nurses that have been practicing within that period of time, probably have not utilized team nursing.
So, we needed to actually do assignment worksheets and team assembly algorithms to help them understand how do I now assign this support nurse with one of the nurses on the units and how do I make an assignment that's safe and everybody feels comfortable with. So, those types of things, along with a reassignment etiquette, actual listing of what responsibilities would be performed on each shift and FAQ's, that were questions that the nurses had actually asked during the pilot. And so we put together FAQ's, so that tool kit was available and I think really helpful as well.
Host: Yeah, I love the attention to detail on all of this. So, Dr. Bronsord, if I could ask you to take the 30,000 foot view of all of this overlooking everything over the past year, were there a couple of key things that really made this model successful?
Dr. Bronsord: I think there were two key things. The first is it was patient-centered. So, similar to our values, our organizational values, there was the focus on patient safety, the deployment with planned and it was based on competency and ensured the safety of our patients and our staff. And the second was the teamwork and collaboration. So, the model allowed for a dynamic response to increase in our volume. We were looking for ICU volume, for instance, to go from anywhere from 193 to 338 beds in phase one. So, we needed to have a model that could help us flex to be able to do that. Another piece of it in the teamwork, was that we collaborated, and used a centralized process to deploy staff.
We also collaborated with our bed management staff so that we could understand where patients were going to be admitted to, what patients were waiting, potentially at other hospitals to be able to come in for therapies that only in our region that we would provide. So, that collaboration and coordination was critical. Evaluating, volume transfers, incoming acuity, and then our daily staffing decisions were aligned with those decisions.
Host: And then Dr. Baker, if we could get your thoughts on this is well, your 30,000 foot view level, everything that you've experienced over the past year. What made what you did successful? Give us your thoughts on that.
Dr. Baker: Yeah, I love what Jeannette said about the patient-centeredness of that. And I will just sort of put an exclamation point behind that. Here in Richmond, we had a job that we knew we needed to do, like every place across the country. And nurses were really willing to rise to the occasion to get this job done. So, it was that common purpose and knowing that this was really our time to stand up and respond to a very important need. I would say the other thing that Jeannette said that I think was extremely important is that we created these areas that really became the source of truth for people.
Right? If you needed to find out something about staffing, there was an identified place to do that. If you needed to find out something about a change in protocol, there was a different place to do that. So that there were support systems for that bedside team coming in, so that they could find their source of truth.
And we really reinforced that with weekly town halls for our nursing teams, so that they could dial in and make sure that they had the latest information of how we expected the census to rise. What there might be a change in protocol that people needed to be accustomed to. So, people really knew where to get the information they needed in order to perform their job well. Lastly, I would say, and I would be remiss in saying it's just the outpouring of support that we experienced here from the community was just unbelievable. The meals, the signs of gratitude were just touching. And so I think that fueled the team to know that the work they were doing was appreciated by the community and all of those signs of appreciation really meant so much to the people that were on the front lines. I think it truly made a difference.
Host: Yeah, it was great to see the communities supporting our local healthcare workers throughout the pandemic. So, you mentioned a few things, Dr. Baker. Support systems, weekly town halls, that sharing of information. I'm just curious, what will you carry forward? What have you learned from this that you will still apply in the future?
Dr. Baker: So, what was really reinforced for me, number one, was that frontline staff really do have the answers. And so at the end of the day, how important it is to engage the teams that are actually doing the work, and their involvement is just absolutely critical. Number two, is that staffing and deployment is more than just a numbers game, right? You need people, you need the right numbers, but you also need the teamwork. You need the comradery, you need the sense of trust that's built by having a familiar face when you show up to work. So, those pieces of teamwork are just as important as having the right numbers and that you have to pay lots of attention to that.
The third thing, is again, the importance of mechanisms for staff to build in some resiliency. The importance of leader presence, the importance of work-life balance and to understand that the stressors that people have at home, are bound to affect them in the workplace. So, to make sure that people are getting what they need to sustain themselves is also important to building community and resiliency at work. So, those are lifelong lessons that I'll never forget. And that were really, revalidated by this pandemic experience.
Host: Yeah. Really interesting to hear your thoughts on that and Dr. Bronsord, how about you? What have you learned and what will you carry forward throughout the rest of your career from what you've learned from the COVID-19 pandemic?
Dr. Bronsord: Oh, I've learned a lot. The first is we gave ourselves time with the model at the beginning. And granted we had that up and running within nine days, but we gave ourselves the time to make sure that our employees were involved, similar to Kathy had said. I think engaging them was critical. Also trusting our team to all work simultaneously towards the same goal. So, when we started, as I said, it was nine days, we knew that COVID was coming up the 95 corridor from New York through Connecticut and that we needed to be ready. And we had a window of about maybe two weeks before we expected to see a surge start.
So, engaging our employees at that time and making sure that we were educating and communicating was critical. We did a survey for our nurses who were deployed following the initial months of COVID and they scored training as the highest of any of the sections of the survey, that maybe they were scared, but they felt that they were prepared to be redeployed.
And that was so important for their safety, for their resilience, for the safety of our patients and for our teams. And the employees who were redeployed, 83%reported that they felt like they were helpful to the receiving unit. And that was important too, because we had made a decision, a commitment as an organization, not to furlough any staff.
So, we really wanted to create space for everybody to contribute, and everybody was able to contribute using the care model that we had in place. And then also the employees understood that they were, why they were being deployed. And I think the why is critical and they had a real sense of purpose. And after, they had a sense of pride and this was further validated for us on our engagement survey.
So, that was critical. Things that we're going to carry forward, a skills inventory. When we were initially planning the deployment and trying to identify which nurses had experience in critical care, and which nurses had experience in med-surg and how long ago, and who was competent to do different tasks; we didn't have a centralized database for that. And it took us a lot of time and manual processes to put that information together. So, our system had over last summer put together a skills inventory that was kept, and we will be updating on a routine basis so that if we ever had to do anything like this again, we would be able to immediately know who on our workforce is capable of being redeployed to an inpatient setting to an ICU.
Another thing I think that was critical is partnership across our service areas. Our ICU's all had to work together. Initially, all the leaders of the ICUs met and we talked about we were going to be resource sharing in a way that we never had before. And we started daily staffing calls, where we would really negotiate, how we're going to allocate our resources to ensure that all our patient care needs were met. And we are continuing to do those staffing calls to this day, as well as a daily call with our physician leadership around how we were going to best place patients in those critical care beds. So, I think the alignment of that bed placement and staffing piece is something that we're going to carry forward as well, just the partnership piece is critical.
Host: Some really good points there. I like how you talked about that skills inventory. And the partnership involved as well, bringing the different service areas together. So, we've talked about a lot of things on this podcast. Now let's talk about the nurse's point of view if we can. Of course COVID-19 unleashed what is perhaps the greatest movement to redeploy nurses from one setting to another. How did the staff feel about this redeployment? Did they feel successful in all of this?
Dr. Bronsord: It was stressful. I won't say that it wasn't. I think that initially they were scared. And we needed to really talk them through some of that. Their home departments and their home teams and leaderships kept in touch with them. And I think that really helped boost their morale and helped them make that transition. But overall, they felt good about what they did and were able to achieve. Some have said they feel like they made new friends on the inpatient units that they didn't even know that they had. They were able to for the most part, there was a core group, similar to what Kathy said, assigning teams together.
We didn't assign people together in their are complete teams, but we were able to, in many situations assign them to a location in a consistent manner, so they could integrate into that local team. And they really liked that. And some describe, I made friends for life. But I think the sense of purpose and sense of doing the right thing for our patients during a pandemic that none of us have ever experienced before, was extremely rewarding for many of them.
Host: Yeah, that's really good to hear and Dr. Baker let's wrap up with you. Same question as far as the nurses point of view, how do you feel the staff felt about all of this and do you feel they were successful in this redeployment?
Dr. Baker: Well, I like many other nursing administrators, really couldn't be prouder in what our staff were really able to accomplish. For those nurses that primary responsibility was caring for our COVID patient population, they really led that way in our organization to a patient-centered approach, to rising to the occasion, to care for a very complex patient population, that had lots of demands and they not only considered it their responsibility, they did it with a sense of pride and dedication that was really, inspiring.
And so they helped the rest of the organization get to a comfort level with knowing this was important work and showing us a positive way to approach this and to get the job done. I would say then as the deployment needs really increased, people faced this with a certain amount of uncertainty, right? Am I going to be put in a place that's unfamiliar or am I going to be able to do the job? The nurses that were on the units, will I have enough staff tonight? Will I be able to care for the patients? And so people found a way to ease those fears for staff.
And so what we found that happened is the nurses that normally would have resisted moving to other areas, really became very concerned about their colleagues. And so there was a level of comradery and I love the word partnership that Jeannette used that emerged, that really, I feel like is still evident in our health system today and I'm very hopeful that we never lose that. I can really tell that nurses really were able to rally and become resilient.
And these circumstances is that we redeployed people for only a short period of time. And so we thought we would rotate them so that wouldn't burn out in any particular area. And what we found is they wanted to stay. They said, nope, I'm settled. I want to be with my team. And so we found that that was a strategy we thought we would need to use, and then we didn't need to use it.
And then in early December, we were bequeathed the gift from an anonymous donor of some funds that came to us from the community to say, you know, I want you to make your life better for your nursing staff. And so we put out a call for what we called grant submission and we said what would you do to improve how we've responded to COVID, and the things that they wanted to improve were things for their patients.
They wanted to find a better way to connect with their families. They wanted to make a way for their families to be resilient. So, once again, our nurses just made us proud. They made us understand that from the beginning of the pandemic until where we currently are, their patients were their focus and that is what stayed front and center for them throughout the entire time.
Host: Yeah, that patient-centered focus obviously was very important to all of this. Well, thank you so much for your time, Dr. Baker and Dr. Bronsord. This has really been informative and we've loved hearing all of your thoughts on such an important topic. Thank you again.
Dr. Baker: Thank you.
Dr. Bronsord: Thank you.
Host: That's Dr. Jeannette Bronsord and Dr. Kathy Baker. And for more information, please visit aonl.org. And once again, this podcast is supported by an unrestricted grant for the Johnson and Johnson Foundation in partnership with the Johnson and Johnson Center for Health Worker Innovation. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Leadership Beyond the Pandemic, Care Delivery Innovations. Thanks for listening.