key: cord-0716511-s4vvfdnu
authors: Albert, Debra; Gruebling, Nicole; Nuss, Suzanne L.; O’Shaughnessy, Kathryn; Patton, Harold “Pat”
title: The Power in Coming Together
date: 2021-09-09
journal: Nurse Lead
DOI: 10.1016/j.mnl.2021.08.010
sha: ede033c87c87009bfd1675f1989a694a1069699b
doc_id: 716511
cord_uid: s4vvfdnu

The role of the chief nursing officer is multifaceted and complex. These complexities can be exacerbated during times of turbulence, specifically the COVID-19 pandemic. Understanding communication and collaboration are core to achieving optimal outcomes, this article outlines the experience of 3 chief nursing officers through the COVID-19 pandemic and the value of a structured platform for peer shared learning and support.

The role of the chief nursing officer is multifaceted and complex. These complexities can be exacerbated during times of turbulence, specifically the COVID-19 pandemic. Understanding communication and collaboration are core to achieving optimal outcomes, this article outlines the experience of 3 chief nursing officers through the COVID-19 pandemic and the value of a structured platform for peer shared learning and support. C hief nursing officers/chief nurse executives (CNOs/CNEs), by nature of their career trajectory, have varying experiences that often mold their leadership style, influenced by those leaders who have come before them as well as those they serve. Essential competencies for the CNO/CNE are the ability and willingness to communicate, to promote patient-centered decisions, and to collaborate. 1 Although collaboration is imperative to ensure optimal patient and staff outcomes, it can occur in a variety of venues. Specifically, collaboration and sharing of experiences from veteran to less experienced CNOs can occur locally, regionally, and nationally via professional organizations and networking. Such was the case for CNOs/CNEs from Academic Medical Center (AMC) systems from across the nation through the Vizient AMC CNO Network.

The AMC CNO Network has been working together virtually and in-person for 20 years, with varying degrees of engagement and activity. Fortunately, early on in the pandemic, the AMC CNO Network leaned on each other to share information, and support and learn from each other as they struggled to protect their patients and families, colleagues, and society as a whole. Despite the wealth of knowledge of many successful nurse leaders across the United States, nothing could have truly prepared us for what to expect from the COVID pandemic.

In reflecting on the past year, it is apparent that this process of information sharing was perhaps less spontaneous than originally thought and more accurately demonstrates nurse leader's dedication and operationalization of the American Nurses Association's (ANA) Code of Ethics With Interpretive Statements, which speaks to the need for collaboration to include mutual trust, respect, transparency and open communication among those who share concern and responsibility for health outcomes. 2 Positive results of collaboration and knowledge sharing have been described. However, these reports are primarily within the same organization. [3] [4] [5] Outcomes of on-line knowledge sharing confirm the listserver method to collaborate. 4 The openness of information that was shared on the listserver demonstrated an increased level of trust within the group and was similar to reports from others. 6, 7 In addition to the high level of trust, the shared goals, comparable to those shared by dedicated project teams, focused the CNOs/CNEs and supported open knowledge sharing. 8 Some participants were affiliated with competing health care systems and could easily have partaken in "knowledge hoarding," 9 that is, not sharing valuable information, regarding the care of COVID-19 patients or protection of colleagues. This group had a high level of trust and altruism prior to the pandemic, which allowed members to seamlessly share policies, procedures, and practices with one another. Altruism has been identified as a key predictor for collaboration and knowledge sharing, which was evidenced by the KEY POINTS Transparency, trust, and communication provide an effective support structure through times of turbulence. Common goals or interest in supporting patient outcomes and staff accelerate intersystem collaboration. Developing a network of professionals who have the same interests in a time of noncrisis helps build community to support the whole in a time of crisis.

CNOs/CNEs sharing all information regardless of hospital affiliation for the greater good of the patients and staff they serve. 10 The development of a shared team culture of open communication and collaborative learning facilitates efficient coordination within interdisciplinary teams, leading to a better implementation of innovative solutions. 5, 11 This collaborative group of CNOs/CNEs verified this tenet and shared best-practices during a very difficult time in health care history.

The Vizient AMC CNO Network included 195 executive leaders from 95% of AMCs across the nation. This esteemed network of executives was established 20 years ago, and over this time, has developed into a collaborative and trusting resource. Communication and discussion between the executives have been facilitated via a listserver where questions can be posed and answers delivered via e-mail.

Although always active on their dedicated networking channel, the COVID pandemic brought new and greater opportunities for CNOs/CNEs to share processes and plans with one another. Communication on the listserver increased more than 7-fold in March 2020, compared to the prior year. Members rapidly sought the counsel of their peers to maintain staffing and operations, as well as share emerging practices during this unprecedented time. Over 40 COVID question threads originated during March, generating nearly 650 responses, including sharing over 25 policies, procedures, plans, and supporting documents for topics including screening staff and visitors, restricting visitation, and staffing for patientvolume surges.

CNOs/CNEs in areas with large numbers of COVID-positive patients transparently provided information and guidance to peers who were still planning for when their local areas would achieve peak volumes. These responses and sample documents allowed them to validate current practices as well as to create policies for emerging practices "without reinventing the wheel." Vizient staff then aggregated, summarized, and redistributed information on each COVID query that received more than 1 response and ensured that these data were captured in an emerging practices document for further aggregation and analysis. The posts generating the highest volume of conversation are noted below (Figure 1) .

Each summation provided insight and guidance for those receiving them. How the receiving executive incorporated the information and utilized this resource varied as each needed to adapt the information to their specific organizational culture and resources. In an effort to provide insight into translating information and communication received in a trusted environment, 3 CNOs shared their experience.

Suzanne (Sue) Nuss, MBA, PhD, RN, CENP Living in the middle of the United States, seeing from news reports what was happening on the East coast (most especially New York City) was like waiting and watching for a tsunami to hit. We pulled together working groups to address issues that were being reported by our NYC colleagues. These included appropriate levels of personal protective equipment (PPE) and ventilators, facilities (creating negative airflow units), redeployment of staff (all disciplines), restricting visitors, and cancelling "elective" surgical procedures, just to name a few. Since we have some of the country's best known epidemiologists at our facility who forecast numbers of cases, we continued to prepare for the worst. Our teams rallied and were ready for whatever might come our way. This was in April, May, and June of 2020. Fortunately, we did not experience the same magnitude as NYC in this time period. In retrospect, the decision to stop elective surgical procedures was made too soon, and we were then concerned with the financial impact to our organization.

By July 2020, it became apparent that we needed to restart surgical procedures and send deployed staff back to their home units. We cautiously reversed some changes that had been made. It was at this time that the "we've got this" attitude started to wane. We purposely discussed that things were not going back to "normal" as we were not sure what a post-pandemic normal would truly look like. Then, in November 2020, we experienced our peak. Just about everything that we had implemented in spring 2020 that had been reversed in July 2020 had to be reimplemented. By this time, it took much stronger leadership to rally the troops and keep the morale high. Throughout most of 2020, the support of our Vizient CNO colleagues is what made it possible to guide, mentor, and lead through the pandemic. As we were all working to survive each day, there was little time to reinvent any wheels. The sharing of ideas, processes, and policies was a tremendous help. The camaraderie of the group and the openness to share was as unprecedented as the pandemic itself. I am extremely thankful to this group for coming together to help assure the safety of our nurses! Pat Patton, DNP, MSN, RN Working in a big system on the West Coast where the pandemic had not yet hit full force in early 2020 was an experience like no other. We were watching our colleagues on the opposite coast get inundated with patient after patient to the point their hospitals were overflowing, and outside tent hospitals had to be constructed. Planning for that type of scenario was underway as we heard about what was going on in NYC. The issue we had was we had limited supplies of N95 masks, regular surgical masks, and gowns. We knew we had to conserve in a different way just to survive with the small numbers we were seeing then as well as protect our staff.

The advantage of working in a large academic health system is we were able to touch base with our colleagues at our sister facilities to see what they were doing. We worked together during the pandemic to decide when we would go to full use of N95s, how we were going to recycle our N95s and face shields, what we were doing to cohort, just to name a few. All of the CNOs in our system are on the Vizient CNO Network listserver, and we relied on it heavily, not only at the beginning, but all the way through the pandemic to see what our colleagues were doing across the country. We learned many lessons from what had happened at places that were overrun with COVID patients so we didn't make the same mistakes. The West Coast system also shared with colleagues in our areas as to what was happening on local list server that we had in each of our areas so they could take advantage the learnings we had with the Vizient Network. The power of being able to communicate real time through e-mail without having to get on yet 1 more Zoom call was great. It gave us a sense of being able to keep up with the "latest" without having to do much searching on our own. Debra (Debi) Albert, DNP, MBA, RN As the first wave of the COVID pandemic hit in the early spring of 2020, I had just transitioned into my role at NYU Langone Health in NYC. Although I was a wellexperienced nurse leader moving into this role, it quickly became clear that much of my experience was not directly applicable, given all we did not know at the time. During that stage of the pandemic, we were continuously learning about the disease and how it presented. Almost every day, we faced new and complex issues that ranged from resource allocation, equipment, personnel, and training to evolving almost every workflow in the organization. We needed to review and change how we handled visitors, and take steps to ensure our staff were healthy and safe to work as they entered the building every shift. We evaluated every aspect of patient care interactions to reduce these to the vital few to conserve PPE. We were forced to develop virtual interactions of patient family members with their loved ones and the clinical team. And, given the pace and number of admissions every day, we were forced to look at our patient care models, redeploy staff from almost every area of the health care system into the inpatient hospital system. Although we relied on a formal emergency management structure to respond to these examples and so many more daily changes, we had no playbook. We had no peerreviewed literature for evidence-based practice to refer to as we made these changes. What we did have was the power of the Vizient Network.

The network gave me a platform to reach out to peers across the country in a timely, convenient, and effective way. I was able to pose questions and get insights from others dealing with the same issues. Because of the high level of trust within the group, we all shared openly and honestly. We told each other what we were struggling with, what worked, and what didn't work. On occasion, just the questions that were posed served to provoke thought within our nursing team if a peer asked about a topic that we had not yet encountered or considered. The power of this type of knowledge sharing is that it helped to validate the issues we were seeing and either reinforce or challenge our thinking. Personally, I appreciated the notes of support and encouragement that often accompanied the posted queries and responses. I have no doubt our local response was enhanced by what was shared in the listserver network conversations.

CONCLUSION COVID served as a great equalizer, placing CNOs/ CNEs from across the nation in unchartered places. The AMC CNO Network provided a platform to build upon trusting relationships manifested over the course of 20 years. Although each nurse executive experienced this pandemic differently, all were able to lean in and benefit from knowledge being shared as they needed it. This led to more informed and faster decision-making, undoubtedly impacting the care of patients and staff across the nation. Through open communication, transparency, and an altruistic mindset, CNOs/CNEs were able to face their largest adversary to date and are prepared to face the next challenge together.

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Nicole Gruebling, DNP, RN, NEA-BC, is Associate Vice President, Member Connections, at Vizient Inc., in Irving, Texas. She can be reached at nicole.gruebling@vizientinc.com. Suzanne L Nuss, MBA, PhD, RN, CENP, is Chief Nursing Officer at Nebraska Medicine, Nebraska Medical Center, and Associate Dean for Nebraska Medicine Nursing