June 17, 2020 Nursing – A Team Sport – Part 1

I Am a Nurse

Quinn Kostman, RN and Customer Success Manager, LaudioMy clinical background includes six years as a bedside nurse in a medical intensive care unit at a huge, magnet-designated, academic medical center.  It was the highest level of care you can imagine ­- every therapy from ECMO to solid organ transplant, cutting-edge immunotherapies, really complex, high-risk surgeries. We handled all kinds of atypical illness presentations where a patient needs to be evaluated by providers that have “seen it all.”   

Patients would be transported to our hospital from everywhere you can imagine. We had the only hyperbaric chamber in the region that could take multiple patients at a time. So, when there were hurricanes and other natural disasters where people were using generators in their homes and getting carbon monoxide poisoning, we would take care of lots of those patients from all over the region. The overall mortality of this population is extremely high, and while we were able to provide an impressive quality of care, many patients passed away in the unit, or shortly after their stay because of the severity of their illness. 

A Passion for Team Environments 

Over the years, I developed a passion for clinical nursing and learned that team as well as policy and processes are vital in enabling clinicians to provide high-quality care. After six years as a frontline nurse, I went back to school for an advanced nursing degree and became a Nurse Manager. I loved working in a team, and I knew that in the role I would have the opportunity to address system issues that would support the functioning of the clinical team as well as drive engagement, improve staff wellness and decrease burnout. When I left the hospital setting last year to join Laudio, it was again for a role where I could influence patients by supporting teams – enabling managers to drive team engagement and improve workflows.   

Nursing in the Midst of Crisis 

Quinn Kostman, RN and Customer Success Manager at Laudio as a volunteer RN in Philadelphia COVID unit

In March, I watched the COVID crisis unfolding in the media. I found myself imagining the incredible stress that nursing teams must be experiencing and how vital those team dynamics would be to supporting clinicians, both from leaders and between colleagues.  So, when the opportunity arose to volunteer. I signed up at a hospital that needed additional critical care RNs to staff their ICU and overflow areas due to the surge of Covid-19 patients. This hospital is in an area that serves a disproportionately high-risk population, so they really saw a tidal wave of need especially at the time when Philadelphia hospitals experienced peak hospitalizations – mid to late April.

I am not new to pandemic infectious disease response. In 2014, I volunteered to be a part of my hospital’s Special Precautions Unit, a group of critical care nurses who would care for any patients sent to us with Ebola Virus Disease, or who were being ruled-out for EVD because of specific symptoms and recent travel to an affected area. Our institution had been selected to receive these patients and received federal funding for, among other things, supplies of PPE that would enable us to care for patients safely.

We spent weeks developing procedures for donning and doffing PPE in multiple layers, with observers who would help ensure we didn’t self-contaminate. We learned skills outside of our normal scope, like cleaning protocols and how to change settings on the ventilator, to minimize the number of staff entering patient rooms. We planned to support patients and their family members in communicating since family wouldn’t be allowed to visit and had to discuss the challenging topics of whether and when we would withhold specific treatments due to the risk to providers and medical futility. 

Ultimately, I decided to take the personal risk to volunteer in these clinical areas not because I am a hero, but because I knew that we were prepared – we had enough PPE and that my organization would be able to keep me safe. I had the proper training in infection control, care of patients with contagious illnesses, hot and cold zones, and procedures to don and doff without self-contaminating. So, I made an informed decision on how to act, which is what nurses do. We are trained to look at a challenging, rapidly deteriorating situation and decide how to act based on the resources we have and our assessment of the situation. While complicated, exhausting, and honestly pretty terrifying, the circumstances were much more controlled than those today. Because of the nature of the transmission of Ebola, it was far less likely to spread the way that COVID has, and we only cared for a few PUIs. All of which were negative in the end. Of course, this situation is different for many reasons. So many hospital workers are now faced with this burden because, some say, “they signed up for it.” They have been given no choice, and we have no other option. 

Crisis or No Crisis – Nursing is Fundamentally the Same 

Hearing stories in the media of the care bring provided in ICUs across the world, and reflecting on my own experience caring for patients during this crisis I realized that, while clinicians are being stressed like almost never before, nursing during COVID is fundamentally the same – providing safe, high quality, patient-focused care. I don’t mean to downplay the intensity of this moment. Nurses (and all healthcare workers) have been put in unacceptably extreme circumstances, often at risk to their own health and safety, and certainly experiencing higher levels of burnout than ever. What has struck me is that, despite these conditions, nurses are continuing to exercise their training and skill – safely, providing unbelievably compassionate care for their patients – as always. 

Final Thought – Nursing Teams Are More Important Than Ever 

Now, nurses are working with an interdisciplinary team to adjust the plan of care minute-by-minute. They are sitting with patients who are dying, playing music, and reading words selected by family members that can’t be there in person. They are using every tool in their arsenal to balance comfort with hemodynamic stability. The fact that the pandemic has played out on TV globally, means that the public is finally realizing what it means to be a nurse, what nurses do every day for our patients.  Most days we do not feel like “heroes.” We are working as a team, doing what we are trained to do. The COVID crisis must now renew our focus and investment in frontline clinicians and the resources necessary to support those teams. 

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