I am a nurse leader and manage acute care hospital units. The 103 staff members who directly report to me and I are living through the COVID-19 pandemic crisis. We are on the front lines, and have cared for more critically ill and dying patients than we ever imagined in our professional lives. We are tired and scared but we are nurses, and we are

• incomparable
• unparalleled
• decreasing barriers and transforming practice
• leading innovative strategies to improve the healthcare system, and
• adapting to change.

Nurses serve as the clinical backbone in modern healthcare. We are voted America’s most trusted profession year after year, and there is no legacy as rich in trust. There is a reason nurses are the most trusted: It’s not by chance but by design. Nurses are caregivers. They embody the psychosocial and physical wellbeing of patients. They provide care and support to patients and families. Nurses educate patients about their illness in their effort to restore health. They serve as advocates by representing the patients’ wishes and ensuring their rights are protected.

Role of nurse leaders

In an instant, COVID-19 became the leading focus of the nation. The rapid spread of the disease led to state quarantines, businesses closing, and above all, social isolation. Nurse leaders play a critical role in their team’s health and safety. They must apply their knowledge to manage crises and bring order to chaos. Maintaining an adequate healthcare workforce requires communication, clear vision, motivation, and a sense of perspective for the frontline nursing staff. These fundamental elements will equip the nurse to provide care for themselves, patients, and the patients’ families.

Communicator

Leadership requires use of the basic tenets of effective communication. The nurse leader must provide accurate and current information through clear, comprehensive, and concise language. The information provided must be correct, timely, well-designed, and bring a positive reaction from the receiver. Nurse leaders also should be empathetic and maintain a calm demeanor to the challenges experienced by the team, based on the information they received.

A pandemic has the potential to increase the anxiety and fear of the clinical staff. They are fearful for themselves, families, colleagues, and their patients. Therefore, transparent and thoughtful communication is essential to help the clinical nurse maintain a sense of control/ Nurse leaders should unremittingly pull on the unique strength of the frontline clinical team, irrespective of how understated or bold.

Visionary 

Seldom does a pandemic end abruptly, yet nurses crave for the immediate end to the COVID-19 pandemic. The critical aim during this crisis is triumph and success for the team, patients, and overall success despite all obstacles. Nurse leaders need to analyze the scope of the crisis and explore processes to address them. They should operationalize the vision of the organization, set directives, and mobilize the nursing team to the most vulnerable areas within the healthcare system.

While it’s important not to alarm the team, it is critical for the nurse leader to discuss the magnitude of the crisis. Nurse leaders model the way; however, during a crisis, they are most helpful if they maintain the organization’s vision and utilize content experts to accomplish each goal.

Motivator and supporter 

Nurse leaders are visible, engaged, and well positioned to influence, motivate, and support clinical nurses. Their fundamental responsibility is to support the well-being and meet the basic requirements of the healthcare team and the patients. Nurse leaders must maintain composure, adapt rapidly during a crisis, and use critical thinking skills to investigate and analyze the complexity of the crisis. Nurse leaders’ first decision; however, might not be the final one because they might revise and change assessment quickly, based on up-to-the-minute information. Nurse leaders must therefore provide perspective on the ambiguities of the crisis and continuously motivate the team.

COVID-19 highlights the role of nurse leaders to support and motivate the clinical team. They should recognize the moral dilemma that the team might encounter, and with adequate resources, create a supportive infrastructure, that includes the following:

Create a safe space for the team to verbalize feelings and fears. Nurse leaders should ensure that the organization creates accessible toolkits and resources for staff’s mental hygiene. However, asking is the best tool for understanding the nurse’s key concerns. The organization should refrain from creating generic toolkits that are not tangible or meet the team’s specificity.

Create a simple tool (survey) to assess the team’s stress level and any long-term impact generated by the crisis. Nurse leaders should create an innovation platform that promotes visibility. They should routinely connect with the care team through huddles, and schedule meetings; and thus, offer up-to-date information and provide an opportunity to answer pressing questions and address concerns. Leaders should inquire about what the team needs, and try to make reasonable accommodations. Sensible non-evidence-based topics to explore during the COVID-19 crisis are, protecting oneself at home, such as separation of living spaces and developing rigid protocols to follow when arriving home from work (Adams & Walls, 2020).

Redistribute workload evenly across all service lines. A fast-track nursing gap analysis should be completed to address the immediate organization needs. Education should be accelerated and tailored to retrain and enhance the needs of the nursing staff. Learning can be accomplished in different modalities such as a classroom setting or just- in-time training directly on the units.

Ensure paid time off are unaffected by illness related to the crisis. However, rational processes must be implemented to prevent system abuse. Co-workers that abuse the system can decrease the morale of the staff who work tirelessly throughout the crisis.

Shanafelt, Jonathan and Trockel (2020) stated that the overwhelming requests from healthcare professionals during the COVID-19 pandemic were:

• Hear me—acknowledge my expertise on the frontline.
• Protect me—help me reduce the risk of getting myself or my family infected.
• Prepare me—provide the training that I need to care for the patients adequately.
• Support me—I am human, I have limitations, therefore, be there and if you can’t, provide the resources that I need to decrease my fear.
• Care for me—I am self-isolated from friends and family, care for me.

Strengthening healthcare professional benevolence helps clinicians overcome anguish and trepidation to deliver care under extraordinarily demanding restrains.

Dewi DeVeaux is a nurse manager at NYU Langone Health – Brooklyn in New York.

 References

Adams JG, Walls RM. Supporting the health care workforce during the COVID-19 global epidemic. JAMA. 2020;323(15):1439–1440.

Edmonson C, Sumagaysay D, Cueman M, Chappell S. The nurse leader role in crisis management. J Nurs Adm. 2016;46(9):417‐419.

Fee E, Garofalo ME. Florence Nightingale and the Crimean. Am J Public Health. 2010;100(9):1591.

Rath T. Strengths Finder 2.0. New York: Gallup Press; 2007.

Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA. April 07, 2020.

Singer T, Klimecki OM. Empathy and compassion. Curr Biol. 2014;24(18):R875‐R878.

Weiss RP. Crisis leadership training. Training and Development, 2002:56(3):28-3