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Scott Kelley: Hello. My name is Scott Kelley, and I'm the Director of Mission Integration at Loyola University Medical Center. I'm here with Peggy Norton-Rosko, who is the Regional Chief Nursing Officer for Loyola Medicine and the Interim President of MacNeal Hospital. Welcome, Peggy.

Peggy Norton-Rosko: Thanks, Scott. Thanks for having me today.

Scott Kelley: Could you tell us a little bit about your professional journey and your current responsibilities?

Peggy Norton-Rosko: Sure. Well, I've been a nurse for 33 years, which was highlighted this week when I wrote my Nurses' Week message to our staff. Nursing has offered me so many opportunities that I never would've dreamed of when I first finished my bachelor's degree in nursing many, many years ago at Northern Illinois University. I truly love being a nurse and I believe it's a calling.

I stayed in a clinical role for a really large portion of my career, moving from a clinical nurse at the bedside to an advanced practice role for many years. And I even did some teaching along the way at various universities. I finished my Master's Degree at Loyola University many years ago, and completed a Doctor of Nursing Practice in Health System Leadership in 2018.

I've held various leadership positions over the last 16 years and I'm thrilled to be back working at Loyola. I worked here early in my career at the medical center as an ICU nurse and as one of the lung transplant clinical nurse specialists. And when the opportunity presented itself to come back to Loyola, I jumped on it. And I really love being here and I really love my role in serving our nurses and other colleagues.

Scott Kelley: And we're very glad to have you in a leadership role. You said in the communication that you mentioned that the last year was one of the most challenging you've ever had in your career. So I wanted to reflect a little bit about looking back on the past year, but particularly through the lens of two of our values, two of our core values, which is the commitment to serve those who are poor and marginalized and of our commitment to justice. Was there a moment in the last year that really highlighted for you how different populations have very different healthcare outcomes?

Peggy Norton-Rosko: It's really hard to pinpoint one moment that highlighted the differences we saw in how communities were impacted, because we saw it from the very beginning. The neighborhoods surrounding our hospitals were hit really hard. I think Berwyn and Cicero were some of the most heavily impacted areas, certainly in the state of Illinois and maybe even in the country.

We frequently heard stories from our staff and our providers about how many members of the same family were being hospitalized and about the challenges that created beyond just the healthcare crisis they were facing. Our teams heard stories about the economic challenges getting worse for some of the low income families we serve either because their jobs were closed down or because they were afraid to go to work in fear of bringing home COVID, which was certainly some of the same challenges that our own colleagues faced.

Our communities were also worried about the availability of testing in their neighborhoods. Normal access points to the healthcare system were largely shut down. Many of the communities we serve, some of the citizens don't have access to primary care and they oftentimes use our emergency rooms as, you know, their primary access point for healthcare and people were afraid to come to the emergency rooms.

People were fearful that they didn't have testing available. So one of the things that we were able to do, because of our commitment to those who are poor and commitment to those who are underserved, is partner with many of our community partners to provide services outside the traditional setting. We partnered with Loyola university of Chicago to help provide drive-up and walk-up testing, so people have better access in the neighborhoods surrounding our hospitals.

In a sense, the biggest struggle throughout the pandemic has been related to justice and trying to decide how we'll allocate the scarce resources in the acute care and the community settings. It's been a struggle to serve all that presented in poor health and with poor resources. And our commitment to partner with others to understand and serve the needs of our community has aligned really well to our values.

The other thing I think about as a pivotal moment for me early in the pandemic is the thought that in a sense, our colleagues, our nurses, our doctors, our EVS colleagues, our lab techs and others were the ones we really had to focus on serving. In a sense, our own colleagues were the ones who were poor. We were poor in knowledge about the new disease we were treating. We were afraid we were going to be poor in resources. And we were all poor in the sense that we were learning how to respond and keep everyone safe and needed to understand what resources we had each day and would we still have those resources tomorrow.

Throughout the pandemic, but certainly within the first several weeks, I was really worried about not only the service to our communities and patients, but also to our colleagues. And I still worry about that every day and definitely want to continue our commitment to listen and respond to the challenges that they continue to face. So it was really kind of in my mind, you know, multilevel view of how are we defining our commitment to those who need us most? And at many times during the pandemic, it was our colleagues and providers that needed us as much as our patients.

Scott Kelley: I wanted to return to something that you said earlier that oftentimes the emergency room becomes a space where people are receiving primary care. Can you help paint a picture of what that means? So not having access to good primary care, what does that mean for a person who has an illness or, say, coronavirus? What does that look like from a clinical perspective?

Peggy Norton-Rosko: Well, you know, there's many reasons someone might not have access if they don't have insurance and they have difficulty getting into a physician's or provider's office, or if they aren't aware of some of the other resources in the community or the other resources like federally-qualified health centers and their clinics are full.

What it looks like is, you know, you really show up to what should be reserved for kind of the last resort care, right? Emergency care. But when you don't have access to those other community-based resources, people show up sometimes because they're really sick and don't have any other option or, prior to COVID, they'd show up for things that you might be able to go to immediate care for or you wouldn't normally go to the emergency department for.

But for those who didn't have access from a payer or an insurance coverage standpoint, think it was even more difficult if they were fearful that they had COVID, if they were fearful that they had COVID and they were going to come to the emergency department and be admitted and didn't have any way to pay for their care. I think it definitely played into some probably delaying care, delaying coming for care and seeking treatment because they were afraid of that financial impact. So I think we definitely saw a lot of that with our patients as well.

Scott Kelley: that plays out in the data, right? So the different outcomes based on, geographical ZIP codes and race. So there's a disproportionate impact. So is the delay in care one of the primary causes of those disparities?

Peggy Norton-Rosko: think it's a result of the disparities that exist ahead of that. certainly disparities with lower income families who don't have access to good insurance coverage or fearful of that from an economic standpoint, I think that it's an outcome of the other disparities.

When neighborhoods don't have access to simple things like healthy food, it obviously is one of the social influencers of health that causes health disparities. When there's a language barrier and, the health system might only be putting things out in English and people have a lack of information, that causes another disparity.

You know, all the social influencers of health impacted how our communities were impacted by COVID. We know that those areas that are lower in income have lower access, don't have access to good food, are those neighborhoods that also have higher comorbidities, many other health conditions and, obesity, diabetes, high blood pressure. And we also know that those were the patients who had worse outcomes, higher risk for hospitalization, hospitalization in the ICU and death. So all of those social influencers impacted how we saw each community impacted by the coronavirus.

Scott Kelley: You had mentioned that our partnership with Loyola University in terms of getting testing out there and potentially some earlier intervention, are there, other initiatives that sort of illustrate how we're trying to address some of those social determinants?

Peggy Norton-Rosko: as Loyola medicine, we have, our community health and wellbeing departments that partner with the communities that we serve, are out in the communities, understanding the resources that are there, helping us identify partner organizations. As an organization, we also are out in the community with some of our own resources. Like we have a mobile peds unit that we've been using throughout COVID. And we've been able to deploy that for the normal care it provides for the kids in our communities and have the ability to use it for other things like testing and even vaccines when we get to that point.

Other things that we've done to partner with our communities, I know as we've gained expertise first in testing, so we helped roll that out, you know, partnered with Loyola University as I mentioned to roll out testing in the communities. Now, we've gained a lot of expertise in vaccines for COVID and how to roll out a vaccine clinic and how to store those vaccines and really sharing that information with some of the local city governments, as they start to set up community-based vaccine centers.

So we've really done a lot as we've learned throughout the pandemic to share that information with the communities around us those providing resources in the community.

Scott Kelley: So thinking broadly about the last year, what were some of the biggest challenges that nurses at the bedside faced?

Peggy Norton-Rosko: From the very first coronavirus patient, our nurses faced the reality that no matter what happened on the frontline, they would be the ones in the patient's rooms. Oftentimes they could and would share information with other clinical disciplines to minimize the exposure for others. The nurses were the frontline.

And I think back even many, many years ago, when we were all across the United States, doing a lot of training in case Ebola patients came through our doors. And at that time, it was loud and clear that we were going to minimize exposure and the person that would be in patient room would be the nurses. So the nurses really are the frontline and I think they knew that from the beginning. And that's pretty daunting when you aren't really sure about what you're facing. I had a lot of concern about that for them.

Initially though, we were all challenged with learning as we went through the pandemic and with the frequency of the changing information, and I'm sure some of our frontline were wondering if we really knew what we were doing, and if we were really doing everything we needed to do to keep them safe. Of course, we were and, of course, that remains our number one priority. But as time wore on, the challenge of seeing so much loss and devastation for the patients and family and for being the surrogate family members for the patients who died so that the patients wouldn't die alone, that's been really, really hard for nurses.

Many nurses probably go through a whole year or maybe longer without having a patient die in their care, that was a much more rare thing over the last year. Nurses knew they were working really, really hard and despite their best efforts there were patients they were going to lose. The providers felt the same. All of our colleagues felt the same. But the nurses really had to step in very often and be that surrogate family member. And I think that took a toll.

Scott Kelley: So thinking about the last year, what have you learned about yourself as a leader, as a nurse? What have you learned about how we deliver healthcare or even perhaps about the larger social fabric that, has to be in place in order to deliver healthcare? So what what are some of the things you've learned as you think about the last year?

Peggy Norton-Rosko: think I always knew this, but it certainly became much more apparent from the first hours of the pandemic. We absolutely have to, especially in a crisis, go to the frontline, find out what's working, find out what's not and listen to the suggestions of the nurses, the providers, the EVS workers, the lab techs. The people doing the work know the barriers and know the challenges and we need to seek that information as often as we can, so we make the right decisions as quickly as we can for them.

Early on, we all recognized the need to communicate frequently and consistently, so people had the information that they needed as soon as we have it. So, just overemphasis on the importance of communication. I think the other thing that I learned is, it's, relatively, I wouldn't say easy to be a leader in " normal times," but when so many elements become out of your control, you have to focus on the things that you can and communication was one of those things that we had to continuously work on to try to get better.

As far as the larger social fabric and the larger kind of healthcare system, I think what this absolutely highlighted is we have to start focusing on a much more robust public health structure and public health infrastructure.

In the United States, we're perfectly designed, I guess I would say, to get the results we're getting in healthcare. And we largely focus on acute care in big hospital and healthcare systems. So we focused on these, big, impactful episodes of care and get patients through that. But then what? a lot of situations, there's not a lot of good community resources to link them to and had we had better public health infrastructure to respond more quickly. Things like testing and vaccines and, the community-based response would have been much more consistent no matter what neighborhood you lived in, no matter what state you lived in and it certainly wouldn't have been so based on the politics of our times.

So I think, if we all can come out of this doing anything different as we educate the next generation of healthcare workers and healthcare leaders is how do we look at the public health infrastructure and what needs to happen in the community because the center of our healthcare system, shouldn't be our big acute care hospitals.

Scott Kelley: Chaplains often use the framework of grief and gratitude to help make meaning of a difficult time, a difficult event, difficult experience. Was there a moment or two in the last year where you felt a sense of grief or gratitude about what was happening?

Peggy Norton-Rosko: Yeah. I will remember one night that I went home from work and I'm not really typically crier and this was early on and I crawled into bed and I started crying. And my husband's first response was, "Did someone die?" I said, "Yeah, just too many people and too many more people I'm afraid of will die."

But felt grief for all the people we lost. And for the toll the pandemic was taking on our colleagues and providers. From the time our first patient presented, I was worried about our team and I felt a lot of anxiety about, like I mentioned earlier, not being able to control everything that we needed to do and have to keep them safe. And I still worry about that.

The gratitude I felt is also for our colleagues and providers and their relentless commitment to how they care for our patients and for each other. And I'm even more grateful that they keep teaching all of us that are here to support them what we need to do to be better at that. And despite the difficulty of the pandemic, one of the other things that I think has been a positive outcome for us is that our three hospitals are working better together and sharing resources like they never have before. We've even created some different and new structures. So we understand how we can share just our beds across three hospitals differently and how we might share staff differently. And, the collaboration that has come out of this has just been amazing. And I'm really grateful for that because it makes our work going forward that much easier.

Scott Kelley: So considering all the challenges that we faced in the last year and you know, this is by no means in the rear view mirror, it's still very much with us. What gives you hope?

Peggy Norton-Rosko: Well, think I've said a lot who I admire most through all this, and it's our colleagues and providers. They really give me hope. They faced a storm that I couldn't even imagine really, you know, in my whole career. And they keep showing up every day. You don't do that unless you're truly called to make a difference, not only for the patients that we serve, but for each other. And that's really hopeful. They're amazing people. And, you know, my hope, other hope is that, we can continue to support them and do an even better job of supporting them as we move forward and hopefully out of pandemic, but continuing the important work we do to serve our communities.

Scott Kelley: Peggy, thank you for sharing your insights and reflections with us, and we really appreciate your witness and your leadership and your wisdom.

Peggy Norton-Rosko: Well, thanks for asking me to have the conversation today, Scott. Thanks.