In Hawaii, where I’ve worked as a Chief Nursing Officer for almost two and a half years, the phrase ho‘omau aku means perseverance. It means to be constant, immovable, and to endure. Those who possess ho‘omau aku do not give up, especially when the going gets tough. This phrase eloquently sums up what the last two years have been like for nursing departments worldwide.

Faced with a myriad of challenges never encountered—Hawaii in particular faced some unique issues as the most isolated land mass on earth—nurses and nursing leaders stayed focused and steadfast for patients and for each other. They cared for acute patients, administered vaccines, and answered patient calls with care, concern, and a smile. I am privileged and humbled to be a part of this esteemed group of professionals, and what better time than National Nurses Week to celebrate and acknowledge their many heroic contributions?

Although it highlighted the ho‘omau aku of our nurses, COVID also forced several significant changes to our healthcare system, especially in the nursing department. Changes often overshadowed by the many issues this unrelenting virus still throws at us. Here are five shifts I’ve seen that have changed healthcare for the better.

Embracing Better Leadership Styles in the Nursing Department

“Courage starts with showing up and letting ourselves be seen.”

The quote by author Brené Brown is one of many she has made on the need for humans to be transparent and vulnerable. As a leader, I realized that if I wasn’t willing to open up and share how I was feeling, how could I ask others to do that? Being open and honest about the fact that I was tired and taking time off to recharge gave others the license to do it.

In nursing, there is a lot of fear over letting your colleagues down, looking like you’re unable to carry your weight, or appearing less capable. But the reality is that if you’re not okay, you can’t bring your whole self to your job. That applies to leaders, too.

I asked myself, “Why do I keep coming back?” Others on my team asked me the same question.

My answer was ho’omau aku. Life is all about showing up. It is part of who I am. As leaders we must show courage, share our truth, and let ourselves be seen.

Being Better Prepared for the Next Healthcare Crisis

Suggesting we may be forced to deal with another virus may be unpopular, but it’s necessary. The good news is that while our healthcare system was not well-prepared for this pandemic, much has been learned that will help us in the future.

Most hospitals, including my own, had to act quickly to create new strategies and processes to test and treat patients while keeping everyone safe. With six surges behind us, my team is now a well-oiled machine. We’ve worked hard to strengthen and build our internal relationships, and cross-train our nurses so they can fill in wherever there is a need. At first, everyone was outside their comfort zone, but the investment in training and relationship-building with physicians and other departments has paid off.

We’ve also improved our operational processes and redesigned how we manage patients. Dedicated med surg, telemetry, and intensive care units have been identified to cohort patients rather than admit them to multiple units across the hospital. If volume increases, we can act quickly to mobilize those units, providing efficiencies for the nursing staff, food and nutrition services, environmental services, and our physicians. We also adopted a process for sequentially opening units so we cohort and maximize our staff and our patients in those units. And we now have a consistent, documented process for escalating requests for visitor exceptions that everyone knows and follows.

Finally, we’ve strengthened our data collection, analytics, and reporting capabilities to better project future demand and capacity. This includes monitoring community positivity rates, testing volume, advice calls, inpatient admissions, supplies, staffing data, and more. Today, our goal is to always know what’s coming so we can be ready for what’s next.

Meeting Patients’ Needs on their Terms

Let’s be honest. Nobody wants to be in a hospital. Patients sleep better and are happier at home. Even getting to a doctor’s appointment can be challenging, if not impossible, for many. Before COVID, demand for outpatient management (e.g., home healthcare) was already growing. Fueled by more baby boomers choosing to age in place and providers incentivized to reduce inpatient stays and emergency department visits, the healthcare industry was slowly making advances.

But COVID accelerated the adoption of virtual provisions, like telehealth services, almost overnight.

Today, we’re exploring more ways to expand virtual care services. This includes investments in care strategies that enable our medical teams to monitor and provide care to acutely ill patients in their homes, such as telehealth, remote monitoring, and regular in-person visits by nurses. We’re working with pharmacists on remote medication management programs and using technology to provide smart medication alerts to patients. Additionally, Bluetooth-enabled devices enhance our ability to remotely monitor patient health, such as blood pressure levels and weight, daily.

This shift is more focused on the patient’s needs and helps them live the best quality life they can while living with a chronic disease. And it is a positive approach to reach underserved communities and address health disparities, particularly in Hawaii, where many of our patients who need hospital care require transportation from outer islands.

Using More Technology to Support Patients

Beyond adopting technologies to support outpatient care and telehealth, I found our nurses quickly embraced other technologies to help their patients. We used our iPads or patient’s devices and features like FaceTime to connect them with their families who were unable to visit in person or discouraged from visiting due to safety issues. Seeing an opportunity to conserve Personal Protection Equipment (PPE), particularly when we faced a shortage, nurses began checking in and communicating with patients using the same technology.

This example demonstrates the value our nurses provide in identifying and solving patient care issues, and why we continually seek nursing input at all levels to improve patient care.

Working to Combat Nurse Burnout

Many are drawn to the nursing profession out of a desire to care for and serve others. Unfortunately, caregivers too often neglect their own health in their passion for providing for the health of others. They will set their issues—worry, exhaustion, dread, sadness—aside and put their game face on for patients. It is a tendency that makes nursing a mentally taxing profession.

This mental drain, coupled with staff shortages and longer shifts, was causing many to leave nursing before the pandemic hit. But COVID exacerbated the mental strain, turning difficult jobs into unbearable ones. In my 46 years of nursing I’ve never experienced anything like the last two years.

With COVID, everyone, not just nurses, began facing some level of worry, exhaustion, sadness, or personal loss. The result was a shared experience that opened everyone’s eyes to mental health concerns and encouraged people to get comfortable talking about their struggles.

At my hospital, we began with our leadership team helping managers identify and articulate what they were going through. Then we encouraged them to have those same conversations with their staff and determine what support was needed. We also took a hard look at meetings and eliminated non-essential ones so leaders could be more present with staff. We partnered with our Employee Assistance Program and engaged our chaplains to enhance how we support our employees.

Beyond letting employees be heard and getting them help, we encouraged team members to take time to recharge. I often remind my team that self-care is a priority because you must be your best self to effectively care for others. Whether spending time with others or getting some alone time, it is essential to do what you need to recharge.

In October 2021, I flew to the Big Island for a long weekend, and at midnight I was sitting in Volcano National Park watching the lava flow. As I sat and took in both the beauty and power of nature, I realized for the first time in eighteen months that I was tired. I realized that I needed to recharge so I could continue to be an effective leader.

Feeling connected is another piece of this puzzle. Remote work, social distancing, masks, and the elimination of company luncheons and staff parties have made it challenging for coworkers to create closer bonds. This has been particularly challenging in Hawaii where ohana (family in the broader sense) is very important, and dining together and sharing food is a part of the culture. We’ve hosted virtual staff meetings and delivered prepackaged food to units to help our nurses stay connected, but I admit this is a COVID condition I hope will not remain.

As an Emergency Department nurse for many years, I was used to running towards the crisis and triaging to prioritize in a rapidly changing and chaotic environment. Leading during the Covid pandemic brought back many of those experiences, as you had to be present every day to help your team manage and prioritize change. Along with caring for others, we cannot underestimate the importance of caring for ourselves and making sure to put our own oxygen masks on first so we can continue to care for others.

In celebration of the nursing profession, I thank nurses around the world for their contributions and unwavering focus on the patients and families we serve. With your leadership, innovation, and courage, we will continue to advance patient care and discover more ways to take us into the future.

Kathleen Roche is a Vice President and Chief Nursing Executive at Moanalua Medical Center – Kaiser Permanente in Honolulu, HI.

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