Me First to We First: Working as an Interim Assistant Nurse Manager on a COVID-19 Unit

By: Susan Benson, BSN, RN-BC

I recently signed up with HCT and was accepted as a local traveler as an Interim Assistant Nurse Manager on a designated COVID-19 unit.  I was hired to help enforce PPE policy/procedures in place on the COVID unit and to support, educate and train staff.  At the time, the CDC was coming out with new guidelines for practice every day that needed to be implemented as quickly as possible.  Nurse float policies between the two telemetry units were established and bedside travel RNs were hired to meet projected long term staffing needs.  New Grad RNs had their orientations placed on hold and worked as nurse aides and as “runners” on the COVID units.  Needless to say, it was an intense and exciting time to be working as an Interim.

The COVID unit is like another world in the hospital.  There is red tape on the floor throughout the unit designating the “warm zone” area in each corridor for staff in PPE to stay behind.  Everyone is in full PPE including face shields or PAPR.  The Charge Nurse sets up hourly rotating schedules including RNs and CNAs to cover the warm zone so there is always a 4:1 ratio inside the warm zone ready to meet patients’ needs.  There is also a Resource RN or “runner” assigned every shift  who provides staff in the warm zone with whatever they may need from the clean areas, such as clean supplies, medications, linen and pantry supplies.  It’s obvious that a system like this cannot work without teamwork.

When I arrived, this hospital was a month into treating COVID patients.  Policies were changing daily and staff were floating in and out of the unit.

One of the things I was asked to do was to come in early and assist the Charge RN with assignment making decisions.  I support them when challenged by oncoming staff for decisions made on floating and the assignment.  To reduce tardiness I start the COVID unit huddles on time at the beginning of the shift and praise staff who are there on time dressed in their hospital-provided scrubs.  I have ensured that everyone knows the warm zone and the PPE policies/procedures at the beginning of their shifts.

I also provided staff education on COVID policies including staff going in and out of patient rooms.  I check whoever is assigned to a restrained patient is familiar with documentation practices and travelers know how to care for vented patients.  The Charge Nurse and I review situations that happen and discuss strategies for better results.  Both units are very fast paced requiring critical assessments, planning and interventions.

With each day, I have noticed that our new staff are becoming more independent and more confident. Each shift I lead mid-shift huddles on both units and coach the Charge RNs to do the same.  During these huddles we cover findings from safety rounds, and I’m proud to say that our staff has gone from several things needing improvement in every room to close to no findings in many rooms.  I give them kudos at the huddles and praises when RRTs go well.  We talk as a group when there are things that could have been done differently.

Over the weeks I have seen this staff begin to change from a culture of “me first,” to “team first” and it is especially rewarding.  We often speak about empowerment and critical thinking, taking initiative and being advocates for their patients.  They are taking pride in their work, understanding the importance of what they do and how their individual actions play a huge role in patient safety overall.  They are even having fun as trust builds.

I am enjoying this assignment immensely.  I have an opportunity to experience the world of the night shift and provide leadership directly in a setting I have always loved.  The Director and managers are very supportive and the other Interim Assistant Manager and I keep up so we are operating on the same page.  I also have to give a shout out to my very supportive HCT Management Team who have been very helpful every step of the way.

Susan is licensed in CA and has worked over 25 years in Nursing Management.  She has been employed as both a Clinical Manager and Director for Med/Surg, Telemetry, Orthopedics, and Oncology in acute care settings and also as a Clinical Manager for hospital-based outpatient clinics.  She is ANCC Certified in Med/Surg Nursing.

 


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