UCLA Health’s Chief Nurse Executive Karen Grimley keeps a rock on her desk, brightly painted with rainbows and hearts, the word HOPE emblazoned across its face. For Grimley, the rock — given to her by the MICU nurses caring for COVID-19 patients — symbolizes the unending optimism and resilience demonstrated by nurses and nursing leadership in 2020.
In a year like no other, nursing leaders throughout the health care system stepped up to meet the demands of the pandemic with courage and compassion. They worked tirelessly, on the front lines and behind the scenes, leading, listening to and advocating for the 4,200 nurses in the UCLA Health system.
“I’m really proud of them all,” says Grimley, PhD, RN, NEA-BC, FACHE, who also serves as vice dean of UCLA’s School of Nursing. “I appreciate the way they honored each other and our nurses by showing up, by being the leaders they needed to be. I think their resilience was amazing.”
Much of the leadership success in 2020 can be summed up in a single word: presence. For many nurse leaders that meant rounding mornings and nights, taking evening and weekend shifts, and being readily available to their teams seven days a week for months on end.
“The constant changes and the unknown created such chaotic times during the first surge that we spread our leadership team out around the clock,” says David Bailey, PhD, RN, MBA, CCRN-K, NEA-BC, FACHE, chief nursing officer at UCLA Santa Monica Medical Center. “We sat down and said this is a critical juncture and our teams need us – they’re worried about their families, they’re worried about catching COVID-19, they’re worried about dying. My team didn’t bat an eye; they said let’s do it. One or two of my leaders and one of our clinical nurse specialists or educators were here 24/7 for several months, and when we did that there was an added level of comfort in the building.
“To have that physical presence, to go out on rounds so our teams could see us, that we were here with them,” went a long way, Bailey says. “Nurses were scared, and how do you help them overcome that? You have to be with them to do that.”
“We’ve had leadership coverage seven days a week on both shifts,” says Coleen Wilson, DNP, RN, NEA-BC, director of adult inpatient nursing at UCLA Santa Monica Medical Center. “I don’t know how many hospitals did something like that across the country, but that was pretty spectacular, because that’s what helped get us through a lot of challenges in the beginning.”
Leadership presence was essential at COVID-19 testing sites, too, where Quanna Batiste-Brown, DNP, MSHCSM, RN, NEA-BC, FABC, chief nursing officer of ambulatory care at UCLA Health, oversaw the testing of more than 1,000 patients a day during the height of the pandemic.
“Bringing nurses into a situation they had not been in before, it was essential to have leadership presence and visibility to let them know we were standing together and we were going to get through it together,” Dr. Batiste-Brown says. “I was onsite every day with our leaders, our directors of nursing and our clinical nurse specialists to be able to troubleshoot and to alleviate the fears of the patients and also the staff. That was something really helpful in making sure everybody felt cared for.”
For Dr. Grimley, presence often meant donning sneakers and scrubs to visit a COVID-19 unit, being present for critical meetings, facilitating informational Zoom calls with nurses or working with the leadership team to ensure nurses had a voice and a place at the table.
“It’s not only about showing up, it’s about representing,” Dr. Grimley says. “You have to represent that group that you lead, and you have to support that group you lead. You have to walk into COVID units and not be afraid to be out in front, or behind, or with that group whenever you’re needed. That was part of it, too; not only showing up, but showing up for nurses and as a nurse.”
Dr. Grimley says her visibility — rounding, being present to give out awards on the units, writing thank you notes — has made a difference in the nurses’ receptivity to change. “And I think it helped us through some tough spots during COVID,” she says.
One of the early challenges of the pandemic was disseminating current, clear, actionable guidance to nurses and others on the front lines. That effort was headed by Lee Galuska, PhD, RN, NE-BC, director of the Center for Nursing Excellence, who quickly mobilized a team of educators to collaborate with infection-prevention experts in the production of educational materials that could be distributed in a variety of modalities to some 15,000 employees across the health care system.
During the first few months, her team helped create and disseminate roughly 200 guidance documents related to patient care and treatment, emergency response, and staff and patient safety, which included such things as testing, PPE, screening processes, urgent supply changes, patient education and communication. A web-based repository was created to house the documents and links to the materials were provided on a newly created COVID-19 webpage.
“It was like this mad flurry to communicate with staff to provide the necessary education they needed to keep themselves and their patients safe,” Dr. Galuska says. “We really leveraged all hands on deck and got it done.”
Dr. Galuska says her team learned a lot during that period.
“One of the keys to our success was that we reached out for feedback — what’s working and what’s not working, the pace and clarity of communications — and then listened to the feedback to make modifications we needed to have it be more effective.”
Frequent communication from the pandemic Command Center team, headed by Dr. Grimley and Robert Cherry, MD, chief medical and quality officer at UCLA Health, was critical.
“They were out and about all the time,” says Ellen Pollack, MSN, RN, chief nursing informatics officer at UCLA Health. “I was very cognizant they were connecting with frontline staff, sharing information, answering questions. It helped us to make sure there was a two-way communication. We needed to push information on what we were doing, but just as important, we needed to collect information and to know what their challenges were so we knew what to work on.
“We had this cadence of active, daily management meetings,” Pollack continues. “We started our day with management huddles and ended our day with management huddles so everyone knew where we were going every single day, seven days a week. I felt like in those early days we really nailed it for communication.”
The Command Center put out daily emails and facilitated frequent Zoom calls linking groups of nurses with a variety of people, from physicians and infection-prevention experts to emergency preparedness experts and Human Resources representatives.
“We essentially set up real-time panel discussions with these audiences, not only to better inform them but to put them at ease, which had tremendous impact on our staff, and that goes back to presence,” Dr. Grimley says. “I think one of the things we had to do was create an environment that ensured that nurses and other members of the care team could actually be present with their patients and focused on caring for them, not worried about where their next mask was coming from.”
As UCLA Health began shutting down nonessential services as a safety measure, nurses were redeployed to work in other areas of the health care system, including the ICU.
“That was over 100 nurses that we had to retrain, but everybody got on board with it,” says Elizabeth Maister, MBA, BSN, RN, NE-BC, senior director of Nursing Business Systems.
“It was a very collaborative time for us; everybody was encouraged to share their point of view,” Maister continues. “While it was stressful, we had the attention of every single person in the hospital, and that’s something we don’t always have. Everyone was driven and focused on what we had to do.”
Leading with empathy
Dr. Grimley recalls walking into the Command Center one day early in the pandemic and hearing a conversation about a clinician who was afraid to enter a room. That’s when it hit her: We have to be kind.
“That person, despite years of education and experience in health care, was scared to death, and berating them is not going to help the situation,” she says. “Their fear is real and we need to help them own it so they can get control of it. That’s empathy.”
Empathy was recognizing the limitations of others and knowing how to tap into their strengths, Dr. Galuska says.
It also was understanding when a team member needed to take time off; protecting vulnerable staff by finding ways for them to work from home; providing scrubs and places to shower and change at work; and providing nurses with vulnerable family members places to stay on campus.
“We had to be attuned to the needs of our staff and how we could support them not only keeping themselves but their families safe,” Dr. Galuska says.
For Ronald Perez, JD, MSN, RN, NEA-BC, CNOR, senior director of Operative Services at UCLA Health, coming to that realization wasn't always easy.
“Especially as nurse leaders, we tend to want to just hold our heads high and forge ahead. Because we’re so patient-centered we forget about self-care and the care of our colleagues,” he says. “So, for me it’s about doing a check, and not just check on how’s your unit running or how’s your staff satisfaction and how’s your nursing sensitive indicators, but how are you doing, how can I help you, how can we help you?”
Many nurse leaders described 2020 as the most difficult year of their career. Still, most say the pandemic resulted in better efficiency, innovation and collaboration between leadership and nurses.
“I think the silver lining is that we all learned something new, we all have new skills, and they’re not skills we ever thought we’d have,” says Meg Armbruster, MSN, RN, executive director of emergency and trauma services at UCLA Health. “We train for this, we talk about infectious diseases and we drill for them, but this was the real thing. We’ve been through a pandemic and survived it. Every day we learned and did something new, and it’s important to reflect on that.”
Dr. Grimley agrees. “I think we established a better rapport. I think we learned our strengths as a team, and I know where I need to focus this year on helping my team get stronger,” she says. “I think the pandemic has been a great teacher for me. It’s been a hard topic, but a great teacher.”
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Jennifer Karmarkar is the author of this article.