key: cord-0956660-zb4dk53m authors: Prestia, Angela S. title: The Remote Influence of Nursing Leadership date: 2020-07-15 journal: Nurse Lead DOI: 10.1016/j.mnl.2020.06.005 sha: ab6b489f470cd069243d864732778173a4fd8d4a doc_id: 956660 cord_uid: zb4dk53m Maintaining connection and support of staff amid the unprecedented challenges of the coronavirus pandemic (COVID-19) was difficult. One nurse leader conscientiously sent “Monday morning messages” to assure consistent inspirational communication with staff. Although remote work caused the leader to be separated from the staff, these messages helped support them through adaption, change, progress, and promotion of resiliency. The ability to inspire is an essential leadership trait, invaluable in times of crisis. T he coronavirus pandemic (COVID-19) abruptly diverted the attention of every nurse leader in the United States. Many health care settings were forced to reduce office staff, moving some to remote sites to minimize exposure. The Trustbridge Hospice and Palliative Care organization was no exception. Trustbridge is a not-for-profit care provider serving over 1700 patients daily in Broward and Palm Beach counties of South Florida. Divided into 5 regions, the company's model is one of hub and spoke, with offices strategically located in each county. Hospice and palliative care are provided in homes, assisted living facilities, skilled nursing facilities, and inpatient care centers. The coronavirus pandemic , to date, has forced a 2-month closure of Trustbridge Hospice's north regional office. The interprofessional team of over 75 patient care directors and managers, registered nurses, certified nursing assistants, chaplains, social workers, physicians, and administrative support staff, responsible for the care of over 350 patients, has been dispersed. Lost is their touchstone for communication and comradery. How does cohesiveness prevail when remoteness is a reality? Fortunately, the staff continue to provide compassionate quality care for those at end of life. Foundational to assuring patient-centric care, the weekly intradisciplinary care group meetings are now conducted remotely. 1 Technological connectivity issues often cloud sound quality. Conveyance of meaning and nuanced cues can be missed. This causes rework, and frustration follows. Adding to this are mounting feelings of social isolation as team members work telephonically and travel alone. The tools of compassionate connection, caregiver to patient, are weakened behind masks that hide a smile, human touch altered by gloves, and sincere eyes shielded behind protection. The team, the patients, the families, and the facilities served are fearful of the silent transmission of this virus. This article shares how 1 nurse leader worked to connect and inspire staff through the utilization of "Monday morning messages" during this time of little precedent and undeniable fear. The caring domain of nursing's body of knowledge provided the framework for these efforts. Nurse leaders are inherently responsible to create environments of care that focus on nurturing their staff. 2 Astute leaders will recognize the tenor of their staff and intentionally act in accordance. 3 Sometimes this means providing comfort. It was this nurse leader's intention to provide words of inspiration, continued connectedness, and a snippet of relief for staff. They might not see the leader, but through these messages, they would somehow know that they were not alone. They would know that someone cared. In the face of the COVID-19 pandemic, the leader-staff connection can be strengthened despite a challenging/ changing work environment. Inspirational messaging that reflects caring values can influence staff, providing comfort and support even in times of remoteness. Expressions of care and concern by the nurse leader is of paramount importance to the well-being of staff and patients. Wheatley describes the power of leadership influence existing in the invisible. 4 Fill "all of space with messages we care about." 4(p.56) Through this endeavor, relational harmony between leaders and staff is strengthened. Additionally, Kouzes and Posner's 5 The Leadership Challenge, was resourced. Their 5 practices of exemplary leadership were reviewed. The efforts to be described best fit with the first 2 practices, modeling the way and inspiring a shared vision. Modeling the way is described as the leaders exhibiting behaviors that in this case reflect caring values. 5 In the face of the COVID-19 pandemic, building staff nurse confidence through inspirational messaging exemplifies this practice. The practice of vision sharing may not be clearly evident as the pandemic spirals with no attainable endpoint identified. Inspiring a vision may be limited to short-term goal attainment. As the pandemic continued, the following short-term goals became evident: adaptation, change, forward momentum, and continued resiliency. The leader's vision becomes the support of staff towards and through each goal, with the hopes of maintaining a sense of purpose and staff selfpreservation. What follows are some examples of the Monday morning messages shared with the staff. Adaptation-April 7, 2020: The Cactus Flower As we continue to work together in this time of uncertainty, my goal is steadfast. I want to be sure we minimize the negative impact of this virus and maximize our success as a team. What does this mean? It is important to me that you all reduce your exposure to the virus. How do we do this? Social distancing is the recommended way. This is accomplished by minimizing in-person visits, and maximizing telephonic visits when possible. All team members, RNs, CNAs, social workers, chaplains, and doctors will continue using masks, eye protection, gloves, hand washing with antibacterial soap, and of course, using lots of handsanitizer. Prior to any in-person visit, please utilize the screening tool to ensure the patients do not have a fever, cough, or sore throat. If you are aware that out-of-state family members are visiting in the home without proper quarantine time, speak to your manager. How do we maximize our success? We work for the good of the whole, not the good of the individual. This means everyone keeps working for as long as we have work. This may mean helping patients on another team, or helping patients at the care centers if you choose. It may mean taking a vacation day to make up your 40 hours. These are very difficult times, not just for us, but for the whole world. I read that drought is a recurring feature of the climate in most parts of the world. The adaptability of certain plants helps them to sustain in times of drought. The cacti have drought tolerance adaptations, such as reduced leaf area and waxy cuticles to enhance their ability to tolerate drought. What ability do you have to weather the drought ahead of us? Think about it: how can we adapt, and how can we help each other? Due to drought, there are some species of cacti that bloom once every 30 years. But when they do, the flower is amazingly gorgeous. Let's work together to minimize risk and maximize success in our fight against COVID-19. We can weather this drought together as we await the blooming of the gorgeous flower in all of us. Change-April 20, 2020: The Pivot My father worked as a basketball referee to supplement the family income. My brother and I spent many a Friday night or Saturday afternoon in high school and college gymnasiums watching our Dad. It gave my Mom a much-needed break. We would sit on the sidelines with our bag of chips, forbidden to move. We watched, asked a lot of questions, and learned the rules of the game. One basketball rule I learned was you must always dribble the ball when you are moving. If you do not dribble, a "walking" foul is called. I do not see this enforced much in the pros; however, it is a foundational element of the game. Offensive players sometimes get stuck by heavy defense that prevents them from forward motion and dribbling. So, what do these players do in these situations? They pivot. The pivot allows you to keep 1 foot planted, and move to the right, left, trying to pass, or make a play, or take a shot, without walking. You hear this word used a lot lately in reference to our government and health officials plans for combatting COVID-19. The virus keeps us closely guarded and unable to move forward. Just when we think the curve is flattening, we realize we cannot make a play and have to pivot. Many of us learned to pivot this weekend with the news that schools will remain closed through the end of May. Just when we thought we might have a shot at "normalcy," we learn that ventilators are not the best course of treatment and that hydroxychloroquine reduces inflammation, but does not cure. We learn of another person infected and another life lost. Honoring the severity of this virus is important, but thank goodness we humans can pivot. The pivot assists us to recognize our options. If we pivot right, we might see how best to help a patient. If we pivot left, we might learn to understand our colleagues a little better. If we take that "shot," we might appreciate our own resiliency in this time of uncertainty. So, next time you feel that the COVID-19 virus is keeping you from forward motion, remember to pivot, giving thanks for the choice of options. Moving Forward-April 27, 2020: Ground Hog Day Life can sometimes become mundane and boring. The stay-at-home order that Florida is currently under due to COVID-19 can make us feel as if we are trapped in an endless time loop. Wake up, drink coffee, realize we still can only see our loved ones from afar, read the headlines, look at the statistics, wonder if any one we know will come down with this awful virus, shower, dress, do our work, talk on the phone, make our notes, come home, think about taking a walk, undress, eat dinner, repeat. Sort of like that silly 90's movie, Ground Hog Day, you know the one with Bill Murray. 6 His character relives the same day over and over. His alarm goes off at 6 a.m., the same Sonny & Cher song, "I Got You Babe," comes on the radio. 7 He moans and groans as he goes about his day, feeling stuck. Finally, he realizes the importance of each day. He begins to understand that each fresh start is an opportunity to learn something new, find out about someone else's struggles, cherish the good he sees in others, and to love more deeply. Only then can he break the spell and move forward with his life. It takes him a while to figure this out, despite the clue the cosmos sends him every morning; "I got you babe!" Think what you may about Sonny Bono, but I'd say, "then put your little hand in mine, there ain't no hill or mountain we can't climb," is a pretty powerful lyric. 7 We are not alone. If you are trapped in the loop, hold someone's hand, stand on someone's shoulders, no, let them stand on your shoulders to see the beautiful vistas that lie ahead. Let's work together to build back our world. Let's move forward. Resiliency-May 4, 2020: Bricks I would like to think that my house is built of bricks, not straw or sticks. So, when the Big Bad Corona Wolf comes to "huff and puff," he will find a fortress mighty and strong. Although my house may have cracks and may be in need of some repairs, I know from experience it can withstand even the most challenging of forces. The reason is simple: my home, our homes have a secret security system. It's called resiliency. Resiliency is learned. It is described as a behavioral trait of adaptability, where there is an antecedent, how we were before, adversity, that Big Bad Corona Wolf, and an outcome of positive adaptation, how we are on the other side of this. 8 Positively adapting to this unprecedented event is not done in isolation. In fact, it can only be accomplished with the support of others. Ask for what you need. Maintain an optimistic attitude as you engage in mindful decision making about what is right for you, your families, and your patients. Refresh your energy levels. Learn new skills and competency that will serve you in the face of the Big Bad Wolf. Most importantly remember, you did not build your house by yourself. Others helped advise, guide, and mentor you along the way. You are who you are because of them and because of the resiliency you developed along the journey. The feedback received from the messages was positive. Individual e-mail responses conveyed appreciation. Some respondents shared that "it was just what they needed to hear at that particular time." One nurse connected with the message in the pivot story. She shared that this in particular resonated with her. She added that her high school coach taught the players to use their "peripheral vision" to continuously scan the playing field. Yet another nurse expressed her thanks for the caring and continued support. The messages initially meant just for the regional staff began to be shared with others. Positive responses were received from other patient care areas and departments. The chief medical officer asked if he could share the messages with the medical staff. Several physicians emailed their thanks; for the perspective, and the encouragement. I heard the chief executive officer refer to Ground Hog Day during a conference call. The ability to inspire is 1 of several valuable leadership traits. [9] [10] [11] Cultivating this ability results in increased staff engagement. This is especially important in times of uncertainty. Research supports that inspirational leaders make an emotional connection with staff. In turn, the staff are better able to connect with others more aptly offering collegial support. In the invisibility of remote leadership, benefits from the cascading effect of staff-to-staff beneficence is invaluable. Inspirational nurse leaders are emotionally grounded, recognize employee mood, rely on evidence, and authentically speak the truth. Crafting a weekly message takes time, but it is time worth spending. An inspirational leader can remain ever-present, guiding, encouraging, and supporting staff, even in remote invisibility. An interdisciplinary framework for palliative and hospice education and practice Nursing as Caring: A Model for Transforming Practice Executive Presence Leadership and the New Science The Leadership Challenge Ground Hog Day search?q=i+got+you+babe+lyrics&form=EDGSPH&mkt=en-us &httpsmsn=1&msnews=1&rec_search=1&plvar=0&refig=8923 9da8e1c842ce9fb3672942fce0be&PC=DCTE&sp=1&qs=LS&p q=i+got+you+babe&sk=PRES1&sc=8-14&cvid=89239da8e1c84 2ce9fb3672942fce0be&cc=US&setlang=en-US. Accessed Creating a positive work-place culture What Inspiring Leaders Do How to Be an Inspiring Leader How Leaders Inspire: Cracking the Code. Bain & Company is director of patient care at Trustbridge in West Palm Beach, Florida, and adjunct faculty at Christine E. Lynn College of Nursing