CNO Roundtable 2021

The New Normal

Q: What changes that your hospital made in response to COVID-19 will remain in place?

Raye Burkhardt

Kaiser Permanente Fontana Medical Center

The pandemic has brought a heightened focus on infection control practices, which have long been part of hospital practice, but are now more closely monitored. Staff and managers have had positive feedback about the switch to virtual meetings, which allow frontline staff to be part of shared governance and leadership without having to add a commute to their already-grueling clinical schedules.

Lori Burnell

Valley Presbyterian Hospital

Our post-pandemic normal will likely include continued screenings to ensure that everyone who enters the hospital is wearing a medical-grade mask, is normothermic and has scrubbed their hands. Patients and staff will be required to keep their masks on unless it impedes their breathing or they are alone in a room, and unrestricted patient visiting hours will remain a thing of the past.

Our new normal may also include the purchase of an electronic hand-hygiene-monitoring system, whose cost will ultimately be offset by a reduction in hospital-acquired infections.

Karen A. Grimley

UCLA Health & UCLA School of Nursing

Technological changes have forever altered many traditional routines. In the past, I ran from meeting to meeting; now, I can join a meeting in a moment’s notice to acknowledge someone, weigh in on a decision or host a town hall. Technology has also given me better access to the nursing staff through virtual chats called “Conversations with Karen” that even allow for anonymous questions and comments.

I am certain that face-to-face meetings will resume, but isn’t it nice to know we have found other ways to keep in touch?

Katie Hughes

Casa Colina Hospital and Centers for Healthcare

Physically, we have seen the hospital footprint change to accommodate social distancing, including limiting the number of people in the breakrooms, repurposing nonclinical areas for occupational and physical therapy, and placing barriers in lobby and reception areas. I imagine many of these changes will remain in place for some time.

One change I hope will not last long is the temporary meeting area created for rehabilitation patients to visit with their loved ones.

Glenda Luce

Foothill Regional Medical Center

I am excited to see how the lessons learned during this time will affect our new normal. A few examples include testing all admissions, rapid turnaround on tests, and now vaccinations.

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We have also become proficient at holding meetings via Zoom and Microsoft Teams, social distancing when we do have in-person meetings and being more selective in deciding when and how we need to meet. This has reduced travel time for meetings and provided more on-site time, which I truly treasure.

Deborah McCoy

Methodist Hospital of Southern California

Two areas that stand out are increased workforce communication and interdisciplinary collaboration. Early on, we realized that the frontline staff might not have easy access to the same information leadership was discussing during our daily conference calls, so IT offered to create an intranet dashboard that would give staff ready access to information such as PPE/supply status and now vaccination status.

Supporting staff communications in this way will be an ongoing effort. Additionally, interdisciplinary rounding, which we began early, appears to increase protocol compliance, and has been embraced by the patient care team.

Robyn Nelson

West Coast University

In academia, we have found that students do not check their email as conscientiously as they should, but they do check their texts, even in a crisis — that is the communication mode we will continue to use with students post-pandemic!

There are apps available to us that allow you to have everyone in the organization on the roster. They support two-way encrypted and documented communications, and of course they use our phones.

Jinhee Nguyen

Adventist Health Glendale

COVID-19 will be with us for a while, which means hospitals have to become adept in managing the acute care, outpatient and post-acute phases. We need to have infection prevention and testing procedures hardwired, with surge management plans ready to be executed.

We really don’t yet know about the recovery phase or how long it will take to fully rehabilitate patients, so outpatient and follow-up care will be important aspects of post-acute care. The new normal may be that COVID-19 will become a service line in the hospital.

Sherry Nolfe

Loma Linda University Children’s Hospital

One change that will be a new normal for us is our daily leadership huddle. At the onset of the pandemic, we established a morning huddle that includes nursing, physician leadership and administration, enabling us to solve problems in real time and ensuring consistency in communications across the hospital.

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Melanie Patterson

CHOC Children’s Hospital

When schools closed, we knew we needed to provide childcare support for our staff. Our child life team took over our largest conference center and three adjacent rooms and swiftly set up an onsite daycare, including food and snacks from dietary and a computer lab for school-age kids doing distance learning. Knowing that their children would be well taken care of gave our staff tremendous peace of mind. Employer-provided daycare will likely be part of our new norm going forward, although it may look different than it does right now.

We also launched a free, 24/7 nurse helpline to address COVID-19 questions from parents, including referrals to telehealth appointments where appropriate. This has become another new norm for us.

Darlene Scafiddi

Pomona Valley Hospital Medical Center

During the pandemic, we have broken down the silos between departments and disciplines. This cross-team collaboration has allowed us to move fast and respond to rapidly changing guidelines. I hope we can sustain that, because we have benefitted so much from bringing different perspectives into our problem-solving. We are truly better together!

Lauren Spilsbury

Redlands Community Hospital

While many of the hospital’s physical changes will eventually be removed, I think our use of telemedicine will continue. Greater use of telemedicine to assess and treat patients from afar has been a positive development in this uncertain time.

Patricia Vasquez

Adventist Health White Memorial

It was interesting to see how our lines of communication had to change. Implementing Microsoft Teams enabled us to meet and make decisions while maintaining social distancing and respecting stay-at-home orders. Meetings were shorter and structured differently, which made them more efficient, and meetings were recorded so people who missed them could get up to speed. We also piloted a “team nursing” structure for patient care, providing collaboration between med-surg and telemetry nurses along with the resources to support them.

Ron Yolo

Glendale Memorial Hospital and Health Center

Several innovative practice changes emerged during the pandemic, including our nurse- driven COVID-19 pathway. This is a treatment “road map” using the latest evidence-based practices to improve not only survivability, but also patient quality of life. There were a lot of unknowns on how to treat this disease early on, and we wanted to be sure we were delivering the best possible quality of care to our patients.

Our nurses took the lead on developing our COVID-19 pathway, which is derived from elements of the models and order sets developed by EvidenceCare and the University of Chicago. The nurse activates the pathway upon admission in the emergency department or COVID-19 unit (unless declined by the M.D.), and then ensures that the daily order sets are followed during the entire hospitalization.

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