The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant challenges for nurses, both professionally and personally. In these unprecedented times, new opportunities to reflect on practice have emerged. Through reflection, whether individually or with others, nurses can explore areas of their practice that could be developed and improved. This article outlines the types of reflection and discusses its benefits and challenges, explaining how it is linked to nurses’ regulatory revalidation processes. It also details various models and activities that nurses can use to reflect on their practice during the COVID-19 pandemic and beyond.
The COVID-19 Pandemic has presented nurse leaders with unique conditions to think and move more freely to create rapid, impactful change. As our health systems have grown, they have also hardened their structures to create predictability, efficiency, and stability. A crisis like COVID-19 has upended much of our traditional thinking. When a crisis hits, it forces us to look at the vulnerabilities in our systems and acknowledge some practices that don’t serve us well in emergency situations. It creates space to think differently in the words of the Apple corporation.
I thought about this as I listened to a webinar presented by AONL last week titled Pandemic Surge Staffing: Insights from the Front Lines in N.Y. One of the nurse leaders who was presenting mentioned that her organization had changed their delivery system to team nursing to meet the surge staffing needs in critical care. I glanced at the chatbox right after she put the slide up and began to see leaders asking for information on team nursing. It is a nursing care delivery that has not been widely practiced for decades. Many of our younger staff and probably many leaders know little about it. And yet, the COVID-19 pandemic presents a unique opportunity for nurse leaders currently struggling to staff their ICUs to try something different.
What is unique about the COVID-19 pandemic is how it has rapidly changed the patient population that most health systems routinely see. COVID-19 patients are primarily acutely ill medical adults with co-morbidities. A higher percentage require critical care including ventilator management. Their lengths of stay are far longer than typically seen in hospital settings. Because of their need for isolation, most come in without family members to help care for them. Communication with family is often through technology.
In response to the crisis, most health systems have stopped all elective surgeries and procedures. Many visits now take place via telehealth. These changes have presented some unique challenges around nurse staffing. Nurse leaders have been asked to double, triple or even quadruple their critical care beds. From a staffing perspective using a traditional model of care delivery, many more critical care nurses would be needed. At the same time, volumes are down in areas such as surgery, pediatrics, and behavioral health. These areas are staffed with RNs and other personnel who are often excellent clinicians albeit not critical care nurses.
For many health systems, it is probably impossible to staff up using only critical care staff. So at this point, nurse leaders have a choice – do we stick with our traditional model of care and RN-Patient ratios in ICU or do we change the model and redeploy staff using a different model and rapid upskilling of staff. In a blog on Avoiding the Status Quo late last month, I discussed the staffing tiered model recommended by the Society of Critical Care Medicine which essentially recommended a team approach using non-critical care staff to care for ICU patients that aligns with a team nursing model of care delivery.
It is interesting that team nursing was originally developed during a time of crisis during World War II when there was a nursing shortage. To combat a shortage of nurses, the military began to train ancillary healthcare staff including medical corpsman and 91 Charlies to work with nurses on a team. After the war, the VA Health System was the first to move to this model of care delivery. Team nursing was studied in the late 1940’s and early 1950’s by Dr. Eleanor Lambertsen at Teachers College Columbia University with a grant awarded by the Kellogg foundation. It was found to be efficient and effective in producing good patient outcomes when executed well.
One of the most positive outcomes so far from this crisis has been the high level of teamwork and collaboration. Crises have a funny way of forcing all of us to focus on a purpose and work together more harmoniously. We don’t worry as much about power and control because we have so little against this virus. It could be the exact right time to revisit team nursing. I have prepared a short Youtube video to help you learn more about team nursing. There are not that many resources out there but I had the great fortune to have Dr. Lambertsen as my mentor while a doctoral student at Teachers College where I did my dissertation on team nursing. As I made this video – I could picture her smiling at me and reminding me as always did that timing is everything.