At the same time many services and industries were shutting down due to COVID-19, hospitals and health care systems were ramping up to meet the challenge head on in the safest ways possible. Sibley’s existing infrastructure and support system allowed the hospital to accomplish what would have been an unbelievable feat a year ago—completely converting an existing medical/surgical unit into a fully-functioning isolation unit capable of delivering multiple levels of care—in less than one month.
Nursing Director Christine Inglisa says that the keys to Sibley’s success were twofold: 1. An established and ready structure designed to activate in a crisis, and 2. A collaborative team with strong leaders on the front lines of patient care all the way through hospital administration.
Designing safe infrastructure at top speed
Medical Surgical Nurse Manager Matt Brown oversaw the structural changes to the hospital’s medical/surgical unit when it became clear the pandemic was on its way. That meant coordinating with the leaders of the physical facility supports, including construction, maintenance, environmental services, and information technology, to map out how a 25-bed medical care unit could quickly become capable of caring for extremely sick and likely contagious patients, while keeping the staff protected from infection.
The physical changes required creating a system of double negative pressure to keep air inside the unit separate from the rest of the hospital, while also keeping air in each patient room separate from the rest of the unit.
The team also set up designated clean spaces for donning personal protective equipment (PPE) and for removing it. Each area was staffed by a designated “safety officer,” a staff member who monitored each person entering and leaving the unit to make sure they followed the proper process for putting on and taking off PPE every time.
According to front-line nurse Abdul Sheriff, throughout it all, Brown kept the staff nurses’ voices in all the infrastructure conversations, bringing their needs and their worries to the table.
“Communication was really open between the staff and leadership,” says Sheriff. “We’d share what we could do and what wasn’t possible, and it would be relayed to the [hospital’s] COVID-19 team.”
“Building the plane as we fly”
Once the unit was operational as a medical care COVID-19 unit, Nurse Manager Deb Jenkins, a retired Navy nurse, took over day-to-day management. As with everything related to this pandemic, when patients started to arrive in the unit, it became easy to see what was working and what wasn’t, and the hospital stood ready to make the necessary changes.
As Jenkins put it, together they had to “build the plane as we fly.”
One big challenge was patient and supply transfer. Without proper precautions, moving a patient on and off the unit, even for a discharge, could pose risk.
Very rapidly, the staff met with nursing leaders and changed the process. COVID-19 unit staff stayed with the patient and moved them off the unit when needed, where they were met by security staff to clear hallways and specially outfitted transfer staff to assist with the move.
This challenge was especially great for patients who needed to move to the intensive care unit (ICU). The nurses worked with leadership to bring 10 ICU beds to the COVID-19 unit instead and trained some of the medical unit’s front-line nurses to read telemetry and cardiac monitoring so they could help follow patient progress more closely.
“Really, it was an ideal unit to work on,” Jenkins says. “We got everything we needed to deliver safe and effective care while keeping the staff safe.”
Leadership communication and support
Throughout the surge of COVID-19 patients, Sibley’s nursing and hospital leadership actively worked with the staff on the unit to make sure their needs were met, including both psychological support and physical support like PPE.
Sheriff staffed the unit for five months and remembers that constant presence and support from the leadership made a big difference in team morale. “If you’re hearing something from your chief nursing officer about the plan, it gives you confidence that people are listening and respect your input as a worker.”
Jenkins says leadership made scrubs available for all the unit’s nurses, so they had the option to leave their work clothes at the hospital at the end of each shift.
Both Sheriff and Jenkins note that after the staff started to experience the impact of long hours wearing N95 masks, the hospital invested in powered air purifying respirator (PAPR) systems as alternatives.
Throughout the surge, occasional catered meals and donated supplies helped keep the team’s spirits up, too.
A team like no other
Sheriff looks for the positive in his pandemic experience and says the medical/surgical unit team is stronger than ever before. “We are all in this together,” he says. “We all come together to make a decision, and then, we go ahead and do it.”
Inglisa sums up what brings Sibley staff together in times of crisis like this. “We all have this deep commitment to Sibley. Everybody is looking out for everybody’s well-being, whether it is patients or employees. We are true to who we are, an incredible community hospital within this large, incredible academic system.”