Promoting Resilience During a Marathon: Q & A with Novant Health’s Vaccaro
Health care organizations have learned much about promoting and supporting resilience during the pandemic. Michael Vaccaro, MHA/MBA, RN, is senior vice president for acute care nursing at Novant Health, a health care system with 15 hospitals based in Winston-Salem, N.C. AONL talked with Vaccaro to learn more about the practices his organization developed—encompassing financial, technological and emotional support—during this difficult time.
AONL: Inpatient nurses often care for critically ill patients. What made the pandemic different in the ways it caused fatigue and burnout?
MV: Although our organization had done work on resiliency and well-being, a number of factors were at play that intensified stress and burnout. The number of patient deaths that we saw, especially in the beginning, was unusual. There were days when our intensive care unit (ICU) nurses experienced as many as six patient deaths in one day. The sheer burden of additional personal protective equipment (PPE) was huge. Donning and doffing all shift long is exhausting.
Another factor was the pace of change. A lot of information was coming out, not just from Novant Health, but also from the Centers for Disease Control and Prevention and other government agencies. In addition, nurses were worried about their own health and were asking these questions: What do we know about COVID-19? What’s happening at home with my loved ones? Is my spouse out of work now as a result of the pandemic? Are my kids going to be in school or having school at home? How do I care for them? There was uncertainty about what was going to happen.
AONL: In what ways did Novant Health seek to support staff?
MV: Some of the burdens and stresses that our team were feeling were not related to providing care. We set up the Hope for Remarkable Team Aubergine Fund, which was a resource for team members in need. It was funded with more than $11 million to support team members with resources to make a house payment or help pay for childcare, among other needs created by the pandemic.
But we also had to get help to the bedside. We had to figure out ways to redeploy team members whose areas had shut down because of the pandemic. We needed to retrain team members who were rusty in their clinical skills so they could provide hands-on care in an assistive role. We designed new roles, like runners and refreshment cart rounders to provide nonclinical support for those on the front lines. We coordinated all of this through an effort we affectionately called Operation All In.
AONL: Were new communication routines developed?
MV: Because of the rapid pace of change, we were trying to do a number of things to support our teams. Our internal communications team started a daily newsletter, COVID-19 Update, as the source of truth for new information and rumor control for all team members and leaders. We dedicated the front page of our intranet to tiles that would direct team members to our COVID-19 dashboard, policies, resources, vaccine information and other key communications. These messages were cascaded in a number of ways including daily huddles with our nurse managers, nurse directors and CNOs. I met with all of the CNOs. For the first couple of months in the pandemic, every day we had a 30-minute huddle. We discussed updates with PPE and changes related to aerosol-generating procedures, among other topics.
Our clinical education team rounded 24/7 in all acute care facilities to check on the clinical teams, monitor practice and answer questions.
AONL: Did ideas to help manage the surge come up from hospital staff or down from system leaders?
MV: Both. On the system level, our IT department developed an app for us, in the midst of COVID, which we could use to assess the availability of staff. Where did nurses in our organization work and what were their skills sets? We created lists of staffing needs so that team members could opt in to help us manage additional patients. The app allowed us to call on resources across the health care system. We had nurses who worked in utilization review, quality improvement and ambulatory settings; we recruited them utilizing this technology to support our nurses at the bedside. So, in turn, it supported well-being and resilience.
One idea that came up from the hospitals was creating A and B teams of nurse leaders, so one team could leave work and recharge. We needed to make sure that leaders rested because this pandemic was both a marathon and a sprint. It’s not sustainable to have all nurse managers working seven days a week. We needed to have a process and a structure to make sure that people were taking time off and caring for themselves.
But clinical staff bubbled up great ideas as well. They asked for specific training before cross-training to work in departments that were new to them. They needed particular knowledge of clinical systems before they showed up to work with a preceptor. These classes boosted their confidence tremendously.
AONL: What proved to be most helpful practices for nurses who were providing acute care?
MV: There were a lot of things, large and small. Making sure that we had financial support for childcare and other needs for our team members who needed it was important. But small things helped, like putting IV pumps outside the room to reduce the burden of constantly donning and doffing PPE to go in the room and reset an IV pump. We also used runners to be able to grab items for nurses in the rooms. These small things had a profound impact in lessening the burden for those team members.
AONL: Did the pandemic change any of the wellness practices Novant Health had in place?
MV: We were already working on resiliency and well-being before the pandemic. We provided a three-day off-site session for our leaders. We extended that practice and offered a daylong session for clinical nurses. During the pandemic, our chief well-being officer conducted some virtual sessions with our ICU staff. That’s something we’re going to continue to do.
The other practice that took off during the pandemic was the use of emotional health advocates. We identified people in the organization that had some skill in supporting individuals emotionally and provided those people additional training. If I’m a team member who is having some struggles, I can go onto our internal webpage and click to connect with an emotional health advocate. If I need some additional resources, whether it’s an employee assistance program or something else, the advocate can connect me to those resources.
AONL: What practices developed for the pandemic is Novant Health going to keep in place?
MV: Communications have definitely changed. We now have leadership huddles more frequently, once a week instead of every two weeks. We also learned how to be more efficient and effective with our meeting time. So now we do this huddle very efficiently via a video meeting platform. We also used a virtual platform for our annual education symposium for nurses last year and it worked well, so that’s something we are going to carry forward. And there are other technologies. The emergency staffing app, which gives us visibility on skill sets of individuals in the organization, is something we will continue to use. If we have a disaster or emergency situation lasting more than a couple of days, it’s an application that can help us mobilize staff from across our footprint. I hope we never manage care for another pandemic, but if we do, we’ll be prepared in that regard.
We also recognized that nurse managers could occasionally work from home, and we are continuing that as we moved forward. They have to coordinate remote work with their leader, but it is encouraged. This remote work helps their well-being, allowing them time to be a bit more strategic and giving them space to work uninterrupted.
AONL: What did you learn about resilience?
At the end of the surge peak for us in late January, our organization came up with steps to HEAL from the COVID experience. HEAL stands for being honored, expressing empathy, appreciation and love. We need to honor the staff’s service and sacrifice and acknowledge our experiences. We’ve produced some podcasts with nurses telling their stories and had forums for staff to discuss them. As leaders, we need to be thoughtful about well-being and bring that into the conversation when we are rounding. It is part of our mission to care for one another and ourselves.