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A student nurse in the MICU: Leveraging unexpected

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leadership on the frontlines of COVID-19

Emily G. Newell*

Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA

rresponding author: Emily G. Newell, E

ail address: [email protected] 554/$ -see front matter � 2020 Elsevier //doi.org/10.1016/j.outlook.2020.04.014

A R T I C L E I N F O

Article history: Received 8 April 2020 Accepted 29 April 2020 Available online 8 June 2020

Keywords: BSN Nursing leadership Student nurse COVID-19 Crisis response

mory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA

m Inc. All rights reserved.

The early days of the COVID-19 response were char- acterized, for me, by a feeling of ominous restlessness: a subtle symptom each nurse has been trained to rec- ognize as an early indication of hypoxia. The inability to act was suffocating. Nursing students had been dis- missed from clinical locations across Georgia in a mat- ter of hours; Emory’s classes were delayed, and then moved online, forcing me into the silence of my studio apartment. I was cornered between directives from my family and professors to stand down and a visceral need to do something. On the morning of March 21st, I biked the empty

mile to Emory University Hospital and reported to the Medical Intensive Care Unit—my first shift back as a patient care technician following Spring Break. I had spent nearly a year in this role and many overtime hours on the Unit Practice Council, but my return did not feel like coming home. The usual bustle of collabo- rative learning that fills the teaching hospital was

replaced with the sound of nervous breaths through wrinkled masks. COVID-19 had just infiltrated the hos- pital, and our unit was already overwhelmed. As a stu- dent care tech, one of my key responsibilities is stocking every room and patient cart with the neces- sary supplies; but when I reached for the supply closet handle, it did not turn—the masks, gloves, and gowns had been locked. In that moment, I could not help but wonder how the next 12 hours would impact my con- cept of nursing and the vision I had for my career. Florence Nightingale, whose 200th birthday happens

to be the day after my May graduation, once said, “I attribute my success to this—I never gave or took any excuse.” What I discovered during that shift was the army of

unexpected frontline leaders, redeploying their skills, and leaning into the crisis—no excuses. Patient care technicians were tracking personal protective equip- ment (PPE) reserves, vetting protocols, and clustering

Nur s Ou t l o o k 6 8 ( 2 0 2 0 ) 3 8 8�3 9 0 389

care with registered nurse (RN)s to preserve lifesaving supplies. Unit clerks were explaining Emory Health- care’s no-visitor policy to family members with shared heartache and empathy, and requesting exceptions when appropriate. Chaplains were mindful of patient loneliness amidst the no-visitor policy, becoming a calm voice of support for health care workers and call- ing (instead of visiting) COVID-19 patients to offset PPE demand. Nursing students were stepping into leader- ship roles remotely, acting as call center technicians, packing medical kits, donating blood, and delivering supplies to community members in isolation. While the current demands on nursing leadership are

profound, deans and nurse executives must not over- look the natural leaders, emerging around us, through unexpected ranks. Among nursing students, care techs, and support staff, there are untapped solutions to COVID-19 challenges. At this moment, many of these individuals are taking initiative to consolidate and repurpose limited resources to solve problems. Leaders who act swiftly can leverage this energy to improve work flow, reduce cost, and ease stress during this crisis and beyond. For instance, nursing leadership could:

� Integrate crisis management training into nursing course- work and continuing education. Emory BSNs undergo a professional development series and an evidence- based practice course, which emphasize clinical lead- ership skills, and have served me well during this time. This training in delegation, communication, and calm under crisis has enabled me to remain poised and work strategically on one of Emory Healthcare’s hardest-hit units. There are countless crisis manage- ment modules appearing online now, which health systems and nursing schools could share with stu- dents and nurses, including the free COVID-19 mod- ules offered by Emory Nursing Experience.

� Deploy a team of student nurse researchers to help the organization keep pace with COVID-19 developments. Emerging nurses who are adept in synthesizing liter- ature, clinical practice guidelines, and news sources could help the school or health care facility to develop policies as new COVID-19 evidence unfolds. These updates could inform important curricular changes as well, given that the American Associa- tion of Colleges of Nursing (AACN) has recom- mended nursing schools integrate curricula on COVID-19-related topics, such as PPE, quarantine, and isolation protocols (AACN, 2020).

� Employ nursing students in nursing assistive person- nel roles when possible. As of March 30th, a policy brief set forth by National Council of State Boards of Nursing (NCSBN), AACN, and other organiza- tions recommends employing student nurses when appropriate (Policy brief: U.S. nursing lead- ership supports practice/academic partnerships to assist the nursing workforce during the COVID-19 crisis, 2020) Employment of US-educated interna- tional nursing students nearing graduation is especially pertinent because student visas will

likely expire before the crisis is over. Utilizing final-year nursing students as assistive personnel will not only ease systemic burden, but will expose emerging nurses to unit flow, foster self- efficacy, and demonstrate crisis management strategies at a time when nurse residency precep- tors may have limited time for teaching.

� Ask nursing students and employees how their roles can be adapted during the COVID-19 response. Emory Health care has instituted a series of surveys requesting that employees submit free-text ques- tions and concerns, which are being promptly addressed in daily email updates. This survey could be expanded to ask how workflow and division of responsibilities could be improved at the frontline. Other options for conducting this sort of dialogue could include virtual open forums, staff meetings, and/or post-lecture Q/A sessions.

Last, remember that even the most determined and tireless individuals on your team are facing extenuating circumstances right now. Your people will perform bet- ter—on the unit and in the classroom—if you institute support services and policies of flexibility. Alongside their 12-hr shifts, many frontline leaders must now navigate home schooling for their children. Studentswith learning disabilities must grapple with taking tests remotely or on screen, which may not meet their Americans with Dis- abilities Act (ADA) requirements. People are coping with the loss of loved ones to the virus, family hospital separa- tions, visa expirations, eviction notices, and the list con- tinues. In their guidance for institutes of higher education, the Centers for Disease Control and Preven- tion recommends recording all lectures, initiating digital counseling services, and coordinating reliable housing and meals, among other suggestions (CDC, 2020). Con- sider the unique challenges and needs of your nurses and students, away from the bedside or outside the class- room, andworkwith them to customize solutions. During what is arguably the biggest health crisis in

the last century, it is more important than ever for nursing leaders to set new expectations for themselves and their teams, rather than pushing to meet old ones. Let us not give or take any excuse, nor squander our best resources during this fight.

Acknowledgments

I would like to thank Dean Linda McCauley, RN, PhD, FAAN, FAAOHN for supporting early career leaders, even at the undergraduate level. I am grateful for your guidance and the example you set for our school. Rose Hayes, RN, BSN, MA, Senior Manager of Execu-

tive Communications, for her availability and editorial support throughout the pre-publication process. Roy Simpson, DNP, RN, DPNAP, FAAN, FACMI for his

mentorship and for submitting my name (within our program), for this opportunity.

390 Nur s Out l o o k 6 8 ( 2 0 2 0 ) 3 8 8�3 9 0

My Unit Director, Ray H. Snider, DNP, RN, CCRN-K, NEA-BC, and all of the Medical Intensive Care Unit team at Emory University Healthcare for consistently modeling extraordinary patient care, regardless of cir- cumstances. This research did not receive any specific grant from

funding agencies in the public, commercial, or not-for- profit sectors.

R E F E R E N C E S

American Association of Colleges of Nursing. (2020a, March 20). Considerations for COVID-19 preparedness

and response in U.S. schools of nursing. Retrieved from https://www.aacnnursing.org/Portals/42/Academi cNursing/pdf/Considerations-for-COVID19-Nursing- Schools.pdf.

Centers for Disease Control and Prevention. (2020, March 23). Interim guidance for administrators of U.S. institutions of higher education. Retrieved from https:// www.cdc.gov/coronavirus/2019-ncov/downloads/ guidance-administrators-college-higher-education. pdf.

National Council of State Boards of Nursing. (2020, March 31). Policy brief: U.S. nursing leadership supports practice/ academic partnerships to assist the nursing workforce dur- ing the COVID-19 crisis. National Council of State Boards of Nursing. Retrieved from https://www.ncsbn.org/Poli cy_Brief_US_Nursing_Leadership_COVID19.pdf