August 28, 2020 Nursing – A Team Sport – Part 3

In my last blog posts, I talked about my nursing experience working as part of a team, and how different that has looked for nurses and hospitals in the face of Covid-19. Trust in leadership and in our teammates is key for job satisfaction. We know that one reason nurses leave their roles is because of a perceived lack of support from their managers. And, that staff who feel unsupported are more likely to burn out. What we’ve learned from healthcare teams across the globe during this pandemic is that a collaborative team dynamic is vital to successfully addressing the many challenges of Covid-19.

Blending Tradition with Innovation

As Nurse Leaders, protecting and supporting our healthcare workers is one imperative that we must figure out now, and team dynamics are central to that goal. In this post, I’ll begin to talk about ways we can drive the development of strong teams through information sharing and rapid cycle tests of change. As I mentioned in my last post, sometimes this requires us to become “comfortable being uncomfortable.”

Healthcare has such a blend of tradition and innovation. Nurses are known to be innovators – first and foremost problem-solvers, always finding a “workaround.” In the two decades since The Institute of Medicine’s To Err is Human” brought focus to decreasing harm in healthcare settings, so much has improved. Probably by orders of magnitude. Although a shift toward lean process improvement and incentives-based drivers of outcomes has been growing, still, when someone says, “Why are we doing it this way?” the frequent response is, “Oh, well, that’s the way we’ve always done it.” That mindset is pervasive and a huge barrier to change.

“Because that’s the way we’ve always done it,” is clearly inadequate when you’re responding to an unprecedented event. If the Covid-19 crisis has made anything certain, it’s that the ability to pivot, to quickly update and change our processes in the face of new challenges, is vital to ensure the outcomes we expect, including supporting and protecting healthcare workers. This pandemic represents a seismic shift for healthcare, illuminating so many opportunities to improve care delivery, infection control, supply chain, post-discharge planning. We have an opportunity now to be really intentional about how we use current learnings to inform the way we practice in the future.

Let’s learn from organizations and teams that have made dynamic operational changes very quickly and develop some industry best practices that can be used in future situations like this, or in other resource-constrained settings. Let’s create a nationwide initiative to identify successful initiatives and COVID-driven experiments at specific organizations and disseminate that information to others who are facing similar challenges.


A great opportunity for sharing experience and information should focus on systems being developed to communicate and coordinate about transferring patients based on resource availability. New York State utilized a “Central Coordinating Team” beginning in early April to help public and private hospitals coordinate and strategize as the surge grew. In Boston, in March, a small startup developed a bed management system in just 48 hours to allocate post-acute resources for homeless patients in facilities all over the city.

Right now, in Arizona, hospitals can call a “COVID Surge Line” to coordinate the transfer of patients between hospitals, a resource rapidly developed and deployed by the state department of health and a local health system as cases were spiking across the state beginning last month.

So, what can we learn from these models that we can apply for more common situations like the yearly spike in patient volumes due to seasonal flu, not to mention any future unprecedented events that may come?

Innovative care delivery team models have become a way to respond to staffing constraints in acute care hospitals with high acuity and high patient volumes. Team nursing, a model that leverages multiple individuals with different roles, skills, and levels of training to care for a group of patients, was popular in the 1980s and 90s. Because many hospitals have too few ICU nurses to care for the volume of high acuity patients with Covid-19, many are revisiting this model.

Staff from other areas are being redeployed to work in teams with a critical care nurse in an ICU setting. While this won’t be permanent, there’s a lot to gain from reflecting on this experience, capitalizing on the elements that worked well, and using these learnings to address similar situations, such as a seasonal surge in volumes due to flu, when we often flex in similar ways.

While an innovative solution to an immediate problem such as, redeploying staff to new practice areas with unfamiliar team members, has been common in the last few months, it is acutely stressful for clinicians who often feel underprepared and unsupported. Let’s find specific examples of “in the moment” training that was effective and helped staff feel better prepared.

What’s Needed

We must develop plans to meet future needs while supporting staff and preventing stress and burnout. We need to combine the rapid-cycle innovation with more ingrained models like cross-training and preparation for all team members with effective communication (such as TeamSTEPPS®—Team Strategies and Tools to Enhance Performance and Patient Safety or the PEEER model).

This is important not only for patient care but so that nurses know they’ll have adequate help, as well as training and supplies to safely do their jobs. We must ask the providers who are there now, making changes, and learning what works, what other factors have helped providers feel “comfortable being uncomfortable” in such a challenging environment. Then we must use this knowledge to make a change.

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