Nursing staff played a pivotal role during the challenging times. In particular, oncology nurses have needed to exhibit a high degree of resilience by “coping while caring.” They simultaneously managed equipment shortages as well as the physical and emotional demands of extended nursing shifts. Noticing the dearth of literature in this area, Regina Duncan, BSN, RN, OCN, CNML, and colleagues described the clinical practice changes and innovative approaches to care they instituted at the Winship Cancer Institute at Emory University. The goal of publishing and disseminating their experience is to enhance patient care and assist nursing personnel with coping and resilience strategies.
The hospital utilized a management framework to quickly adjust to the daily clinical challenges caused by the pandemic. This method uses rapid cycle tests to evaluate ideas, identify and mitigate waste sources, standardize protocols, and improve quality, while ensuring buy-in from stakeholders and personnel.
Timing was critical, as the oncology team grappled with adapting to the rapidly evolving environment precipitated by the COVID-19 pandemic. Improving care and procedural efficiency and optimizing quality and safety initiatives for patients and healthcare team members was critical to success.
The institution’s leadership committed to involve all team members when developing innovative solutions in the midst of the pandemic. Nurses, doctors, advanced practice providers, and administrative leaders regularly convened as a united oncology healthcare team, focusing on the primary goal of creating, executing, and supporting necessary practice changes to meet the shifting needs of patients, their family members, as well as staff.
The cooperation, support, and engagement of the entire team of oncology nurses, providers, and administrators was key to the success of this program, which allowed ongoing process changes to occur in response to new guidelines and available information. Oncology nurses demonstrated a remarkable ability to shift their practice based on updated information.
Social distancing guidelines were established, and caseloads were balanced to provide an environment that would enable social distancing. The day prior to their appointments, patients were contacted and prescreened for fever and COVID-19 symptoms. Communication between patients, family members, and providers was facilitated using virtual technology, and this became standard practice. Visitor restrictions and infection-prevention measures were employed. One primary entrance to the facility was established, and signage was hung to heighten awareness about social distancing in staff lounges, common areas, and patient care stations. For patients lacking support systems, oncology nurses became surrogate family members.
Personal protective equipment (PPE) conservation and related safety issues were significant concerns, so based on new Centers for Disease Control and Prevention guidelines staff were educated on safe mask protocols regarding donning, doffing, and reuse. Community members and staff donated cloth masks to provide additional resource support.
Telehealth visits were used for routine follow-up care visits by oncologists and oncology advanced practice providers (ie, nurse practitioners and physician assistants). Using this technology, the staff were able to deliver care to up to 150 oncology patients per day. Despite the hospital never having used telehealth prior to the pandemic, patient reported feedback indicated satisfaction with the new technology.
Personal safety guidelines were established, including masking, PPE, and facility cleaning for all staff. Nurses committed to “choosing care above fear.” Having the ability to openly communicate, team members helped allay their overriding fears and anxiety. Policies were instituted for daily checks of temperature and symptoms, with instructions for staff to notify a supervisor and go home if symptomatic.
Standardized policies and guidelines were established so telecommuting could be used to reduce unnecessary exposure; this option was made available for all appropriate staff. As needed, computer equipment was provided for employees who were working from home; with the option to work from home, staff expressed increased levels of satisfaction.
Nurses and staff were redeployed based on census and competency and were encouraged to reassign to COVID-19 areas. This allowed them to remain employed and prevented furloughs. Despite the challenges, nurses reported feeling rewarded by their work and being honored to minister to these ailing patients.
A systemwide resiliency education program was provided to staff, which promoted transparency. Staff were encouraged to send inspirational e-mails to each other, and 24/7 online systems were set up for mental health counseling and spiritual support. Oncology leadership facilitated employee recognition and staff actively adopted self-care, which improved morale.
Source
Duncan R, Szabo B, Jackson QL, et al. Care and coping during COVID-19: practice changes and innovations in the oncology setting. Clin J Oncol Nurs. 2021;25:48-55.
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