Outcomes-Based Nurse Staffing During Times of Crisis and Beyond.

Nurse staffing is linked to safety, quality, and experience outcomes. In the context of the COVID-19 pandemic, staffing has become more critical as overwhelming demand has met diminishing supply of healthy nurses, capacity for care, and the innovation necessary to deliver optimal quality and experience to patients and the people who care for them. Press Ganey data scientists, along with industry experts, sought to evaluate staffing before the pandemic and its effects on clinical quality, experience, and nurse engagement. Furthermore, interviews with expert nurse researchers and nursing leaders helped to identify the kind of innovation necessary to accommodate the variable demand in patient volumes, acuity, nurse availability, and teamwork. Valuable insights from this work will help healthcare leaders in their quest to optimize nursing care.

Forever Changed: RNs Speak of their COVID-19 Experiences through a System-Wide Nursing Web Site.

A COVID19RNStories website allowed RNs in this integrated health system to "tell their stories" during the recent pandemic. From April to August 2020, approximately 100 items were posted with 4 themes emerging. COVID19RNStories had no preconceived hypotheses or specific questions to answer: RNs shared whatever they felt was relevant to their experiences. This approach provided real-time information on issues and concerns of RNs during the 1st wave of COVID-19. This article discusses the identified themes with recommendations for nursing leaders to support staff during the pandemic and future unexpected emergency situations.

The Impact of COVID-19: Nurses Occupational Stress and Strategies to Manage It.

OBJECTIVE: The aim of this study was to explore the occupational stress perception of nurses and how they manage it during the COVID-19 pandemic. BACKGROUND: The management of occupational stress is a key factor in promoting nurses' well-being. METHODS: A descriptive cross-sectional study was conducted. RESULTS: The top occupational stressors from the nurses' perspectives (N = 236) as measured by using an updated version of the Nursing Stress Scale (NSS) included wearing a face mask at all times in the hospital, unpredictable staffing and scheduling, not enough staff to adequately cover the unit, feeling helpless in the case a patient fails to improve, and being assigned to a COVID-19 patient. The mean stress score was 31.87. The updated NSS Cronbach's α was 0.92, and the interclass interclass correlation coefficient was 0.914. CONCLUSION: Nurse administrators are in a strategic position to develop interventions (eg, open door policy, meetings, and employee assistance programs) to assist nurses in effectively managing stress.

Novel Deployment of Pediatric Biocontainment Unit Nurses in Response to COVID-19.

ABSTRACT: Most existing biocontainment units (BCUs) in U.S. hospitals are designed to care for a limited number of patients infected with epidemiologically significant pathogens. The COVID-19 pandemic presented substantial challenges to hospital preparedness and operations because of its high incidence rate and the high risk of transmission to staff members. This article describes a novel practice innovation: a hospital-wide deployment of nurses on a trained BCU team to support hospital staff in safely caring for patients with COVID-19. Their responsibilities included assisting in the development of guidelines and providing training on safety protocols and the appropriate use of personal protective equipment. The authors show how this deployment contributed significantly to staff education and support during the pandemic.

Clinical Nurse Specialist Expands to Crisis Management Role During COVID-19 Pandemic.

PURPOSE: Emergence of the COVID-19 crisis into the healthcare system challenged existing roles and shifted organizational priorities and staff responsibilities. Operating within the spheres of impact, clinical nurse specialists (CNSs) adapted to the needs of the organization and expanded their responsibilities to provide crisis leadership. DESCRIPTION OF PROJECT: The CNSs used advanced practice nursing skills and leadership to implement hospital rounds, identify issues, make decisions, collaborate with stakeholders, disseminate new and emerging information, and evaluate processes in an ongoing pandemic. Using the health crisis management framework, the CNSs demonstrated authentic leadership throughout the prevention, preparedness, response, recovery, and rehabilitation phases. OUTCOME: Data analysis of CNS handoff and meeting communications generated these areas of focus involving the CNSs: (1) clinical practice, (2) supplies, (3) workflows, and (4) people. CONCLUSION: The CNS played a vital role in the planning, training, and evaluation of crisis preparation. New and emerging infectious diseases may continue to confront the healthcare system. Thus, healthcare systems need to remain prepared for public health threats. In the crisis leadership role, the CNS helped the transition to learn and relearn practices. As authentic leaders, CNSs instilled calmness, confidence, trust, and resiliency to the staff during the COVID-19 pandemic.

Nursing Orientation During the COVID-19 Pandemic.

Traditional in-person delivery of nursing orientation programs at a large academic hospital could not occur because of the COVID-19 pandemic, with the need to limit group sizes and adhere to physical distancing guidelines. A nurse educator team pivoted the orientation program to a virtual model combined with the review of select clinical skills and buddy shifts. This model effectively met the nurses' needs required to practice safely on an inpatient environment.

An Academic Health Sciences Centre's Strategy to Enhance Nurse Resilience and Psychological Safety.

The rapid cadence of change and the fear of acquiring and spreading COVID-19 - coupled with moral distress exacerbated by fulfilling one's duty to care under extremely challenging conditions - continue to impact nurses' coping ability, resilience and psychological safety globally (McDougall et al. 2020). This paper provides an overview of how an academic health sciences centre (AHSC) has responded to the evolving waves of the COVID-19 pandemic. Specifically, we share our context and the strategies we used to build and enhance nurse resilience and psychological safety at the organizational, clinical team and individual levels. This is followed by a description of our nurses' achievements amid the pandemic.

Nursing organisation during COVID-19: experiences of an unaided, not-for-profit quaternary care teaching hospital in India.

India reported its index case of coronavirus disease 2019 (COVID-19) in January 2020 and since then there has been an alarming rise in cases. In response to the worsening pandemic and the challenge presented by COVID-19 for hospitals in the public sector, the Government of India asked the country's private hospitals to reserve a percentage of their beds for COVID-19 patients. This article describes how nursing services at the Christian Medical College, Vellore - an unaided, not-for-profit quaternary care teaching hospital in Tamil Nadu, India - addressed various challenges to ensure a sustained, high-quality nursing care response to increased patient load. The main challenges included changing COVID-19 policies, ensuring the hospital was prepared to care for COVID-19 patients, and ensuring the availability of nurses. The article demonstrates how proactive planning, empowered involvement of nursing leaders and collaborative efforts resulted in deployment and training of 1,400 nurses, and ensured coordinated care for more than 10,000 patients with COVID-19.

[COVID 19: Nursing Leadership and innovations on the field to face the pandemic]. / COVID 19: Leadership infermieristica e innovazioni sul campo per affrontare la pandemia.

INTRODUCTION: In the Italian and European literature there are still few studies describing the impact of the COVID-19 pandemic on the organization of nursing care in hospitals, on the actions taken by nursing leaders to contain it, and on the outcomes of these interventions. AIM: To describe nursing leaders' experiences with reorganizing healthcare pathways, through management data and personal accounts. METHODS: A retrospective quali-quantitative observational study was conducted at the Mauriziano Hospital in Turin, with 484 beds and over 1,700 workers. Quantitative data were analyzed through descriptive statistical indices and integrated with qualitative data collected through semi-structured telephone interviews. The analysis of the quantitative and qualitative data provided an objective and experiential representation of the implemented interventions. RESULTS: We described the impact of interventions introduced by the nursing leadership during the pandemic on hospital services. In particular, the reorganization of the emergency department and of the prevention and psychological support services for the hospital's health workers. In addition, specific initiatives to support the discharge of COVID-19 positive patients, and to support and manage contacts with family members both during the hospitalization of their loved ones and following death are described. DISCUSSION AND CONCLUSION: This study contributes to the discussion on some crucial issues: the increasingly clear relationship between adequate staffing and safety of patients and professionals, the importance of a good working environment and a solid leadership, the importance of continuing education for professionals and adequate skill mixes; all highlighted by the pandemic.

A mixed methods study of an organization's approach to the COVID-19 health care crisis.

BACKGROUND: Healthcare emergency can increase work-related stress and reduce nurses' job satisfaction and quality of life. Managerial decisions and proactive interventions implemented to react to the emergency ensure the best patient outcomes. PURPOSE: The purpose of this study was to verify whether a proactive organizational approach can limit nurses' work-related stress and help preserve their job satisfaction and quality of life during a health emergency. METHODS: A longitudinal mixed methods study was conducted. Data were collected before and after the transformation into a SARS-CoV-2 Hospital and the implementation of organizational interventions. Focus groups were conducted to investigate quantitative data. FINDINGS: After the implementation of interventions and as the pandemic progressed, work-related stress decreased and job satisfaction and quality of life increased. DISCUSSION: Through proactive organization, even during an emergency, nurses are prepared for working, and work-related stress due to changes is reduced. Nurses are motivated and satisfied with their organization and management, and quality of life increases.

COVID-19: An Italian Hospital Response From the Nursing Perspective.

Novel coronavirus disease-2019 (COVID-19) is a new respiratory disease that has spread widely throughout the world. On February 20, 2020, the first Italian case of COVID-19 was reported. The infection rapidly spread across the country, and by August 11, 2020, a total of 250 566 official cases with 32 205 deaths (12.8%) were reported in Italy, counting a total of 96 884 positive cases and 16 833 deaths (17.3%) in the Lombardy region only. A huge demand to handle the COVID-19 outbreak challenged both the health care providers and the ordinary work in the hospital. From the beginning of the crisis, San Raffaele Scientific Institute, a 1318-bed tertiary care university hospital located in Lombardy, Northern Italy, has played a major role in supporting the national health care system for the treatment of COVID-19 cases, and a significant reorganization of the hospital was immediately required. The reorganization was carried out both structurally and with regard to the distribution of medical and nonmedical staff. This article aims to highlight the management strategies for the health care staff subsequent to the pandemic intense workload in San Raffaele Scientific Institute.

Has the COVID Pandemic Strengthened or Weakened Health Care Teams? A Field Guide to Healthy Workforce Best Practices.

During the 2020 global pandemic crisis, some health care teams pulled together while others fell apart. The teams who pulled together put aside their differences and became stronger, putting their patients first and then each other. Those teams grew stronger, but some teams completely fell apart. They spent their days nitpicking, complaining, and arguing-making decisions based on what was best for themselves, not patients or their coworkers. The common denominator in determining how well teams performed was the leader. Employees looked to their leaders to successfully lead them through crisis, whether it was on a small or global scale. Depending on leader behaviors, the leader strengthened or weakened the team; trust was built or broken. That is a heavy burden to carry knowing that employees were so dependent on them and how they showed up every day. What lessons can leaders learn from the coronavirus-2019 (COVID-19) pandemic that can help them strengthen and sustain a healthy, professional, and supportive workforce culture during a crisis and beyond?

COVID-19: A Personal and Professional Perspective.

The COVID-19 pandemic has affected millions of Americans, including health care staff. This article traces the experience of 1 nurse leader as she falls ill, only to learn that she has, indeed, been infected with the virus. She describes her 4-week quarantine, including the impact on her family and her attempts to continue to support her staff. As she recovers from the acute onslaught of COVID, the focus shifts back to her nurse leader role. In this role, she and her colleagues manage the logistics of caring for more than 150 COVID-positive patients a day in the 719-bed academic medical center. This included staffing the hospital, given the extreme challenges of staff availability limited by concerns such as school closings and at-risk family members. Now with the hospital's daily volume of COVID-positive patients greatly reduced, there is an opportunity to reflect on lessons learned, including what went well during the peak of the crisis and where there were opportunities. Leadership and staff are experiencing a sense of pride at their exceptional care of this complex population, even while exploring opportunities to be even better prepared should COVID erupt once again.

Leading Through Chaos: Perspectives From Nurse Executives.

The COVID-19 crisis created unique and interesting challenges for health care systems and changed how health care professionals delivered care. Evidence suggests that leadership skills remain of utmost importance during crises as it is the leader who often determines the response of the follower. A descriptive qualitative approach was used to ascertain the essence of nurse executive leadership and innovation during the COVID-19 crisis. Nurse executives were recruited via personal invitations to participate in the study. Participants were asked about their current challenges of COVID-19 on health care delivery, their leadership style, and what innovative processes their teams deployed. Using a thematic analysis approach, 3 themes emerged and resonated from the interviews: the importance of communication; the need for leadership presence; and mental toughness. With any health care crisis, leadership is essential to guide followers. As demonstrated by these findings, communication, leadership presence, and mental toughness are 3 key components to promoting and providing quality care in an austere, complex, and changing health care environment. Further understanding of the roles of these key concepts may add insight into nurse leaders and leadership development.

Signposts on the road to recovery.

Sam Foster, Chief Nurse, Oxford University Hospitals, reflects on ways in which nurse leaders can help their staff recover from the stresses of working during the COVID-19 pandemic.

A nurse staffing model for an unprecedented event.

Lessons learned from one hospital's COVID-19 experience.

Optimizing Nurse Staffing During a Pandemic.

This article describes how a health care organization optimized staffing during the COVID-19 crisis by capitalizing on the expertise of nursing professional development practitioners to create a rapid deployment onboarding plan. The rapid onboarding training plan provided Riley Hospital for Children at Indiana University Health with a sense of stability in an uncertain time. Designing a plan that easily could be modified allowed the organization to be prepared during the pandemic and at a point where staffing needs must meet surge capacity. [J Contin Educ Nurs. 2021;52(3):109-111.].