It was late March 2020. Covid-19 had landed in the US, had washed through Seattle and ventured into the Big Apple, though as yet had only killed a few hundred New Yorkers. As the month drew to a close, Covid also made its debut in Philadelphia. Scientists around the world were playing catch-up with the little data that was available. And Temple University Hospital now opened its Boyer Building as a dedicated ICU for Covid-19 patients.
When Nurse of the Week Marissa Pietrolungo, BSN, MSN, CCRN, a 29-year-old cardiac care ICU nurse at Temple, arrived for her shift, she could see that her manager was troubled. More was awry than the usual headache of a shift being short one nurse. Much more. With the Boyer Building opening their doors for SARS-CoV-2 patients, the nursing staff was suddenly in need of 14 additional qualified nurses.
“The first time I went in the room, I was like, ‘Oh my gosh, trying not to breathe.’”
Pietrolungo automatically volunteered, and that same shift, she embarked on her first-hand experience with the soon-to-be-called “unprecedented event.”
During those initial Covid patient encounters, she knew enough—in the abstract, at least—to be well frightened. Pietrolungo told Temple’s Narrative Medicine Program (NMP), “The first time I went in the room, I was like `Oh my gosh, trying not to breathe.’ But there’s no way you can do that. And I’m in that room so much that I just honestly hope that my protective gear is protecting me.”
Marissa Pietrolungo, BSN, MSN, CCRN, ANN Covid Courage Leadership honoree, on CBS Philadelpia
At first, things could be a bit surreal, but it wasn’t overwhelming. Pietrolungo says she started with an essay at preventive dentistry: “The first day, I did something simple like help my patient brush her teeth. She’d been in there for three days, but we were all so worried about transferring the disease that I don’t think anyone had thought about brushing her teeth. I brought in a toothbrush and toothpaste and mouthwash, and I set her up on the end of the bed. She was a Spanish speaker and we couldn’t really communicate, but she kept blowing me kisses.”
The lull was over quickly. As the Temple NMP’s writer described it, “Things in Boyer changed fast. The hospital filled with extremely sick COVID patients, many on ventilators. Normally, a cardiac intensive care nurse at Temple will care for one patient, sometimes two. Pietrolungo was soon caring for three ICU patients at a time – and quite often three to a room.”
But as things got worse, something seemed to compel her to fight harder to care for each of her patients and do whatever had to be done to help everyone through the long ordeal. Pietrolungo took initiative in devising ways to optimize the ward to function in worsening crisis conditions. She recalled for one interviewer that “We transitioned the rooms from holding one patient per room to holding two to three patients per room with makeshift curtains. We also turned the operating rooms into suites that would hold up to four patients on ventilators.”
She emptied trash, mopped floors, recruited fellow nurses to take shifts in Boyer, held terrified patients as they struggled to breathe, and tended to the care and final comforts of the dying.
When she was not strategizing or tending to a patient, Pietrolungo did whatever else had to be done. She emptied trash, mopped floors, recruited fellow nurses to take shifts in Boyer, held terrified patients as they struggled to breathe, and tended to the care and final comforts of the dying. In fact, she was the bedside nurse for 15 different Covid patients as they drew their last breaths, holding a mobile phone screen up so they could see their families one last time.
Looking back, she’s still not sure whether she contracted Covid herself during that insane spring, but there is no uncertainty in her description of her experience. The masks hurt. Wearing PPE for 12 hours is stifling. You have to confront fear before and during every shift, and every time you go home. You lose an unbearable number of patients, and it’s hard each time. What kept her going?
Pietrolungo says, “I go back to our responsibility to the patients… [who] are very sick and can take a turn for the worse in an instant.” And you have to marshal your fears; it’s the only way to get the job done. “Each time you enter the room, you are coming into direct contact with the disease, and you have to be okay with that risk to perform your job. If all I focused on was contracting the virus, I would not have been able to be the best nurse for my patients … I took care of my COVID patients like I would have taken care of anyone else.”
Congratulations, Marissa, for setting such an outstanding example of nurse leadership—and for the exceptional patient care, of course!
For a list of all ANN Covid Courage Award winners, click here.
Kids at Yreka High School in Siskiyou, California know that one teacher is really looking out for their health. Our Nurse of the Week, BSN Amy Gaither, is a nurse-educator who tends to a very important patient demographic: Yreka High’s teens.
Since early 2020, of course, her purview has broadened well beyond the usual adolescent cases of asthma, gym injuries, and Pop Quiz Flu. Gaither still handles those things, naturally, but she has also been disseminating pandemic safety policies and planning logistics with the Siskiyou Department of Health and Board of Education. Then, somehow, she teaches four Health Occupations classes each day (kids probably knock on her classroom door at odd moments). And, she sometimes exercises her persuasive powers to recruit students to help out at the vaccination clinics at the local fairgrounds.
Gaither herself is quick to laud her colleagues, telling the Siskiyou Daily, “I couldn’t have done this without them,” but acknowledged, “It’s a challenging year for nurses. In my 32 years as a nurse, this has been my most difficult year yet.”
Yreka High is well aware of her value. Assistant Principal Rhoda Dawes says, “Amy is amazing,” and reflected that their school nurse’s leadership qualities helped sustain them during the long Covid ordeal: “[Amy] still comes to work with a smile on her face. This has been a tough year for her because of Covid, but she has been such a trooper, and I can’t say enough about how blessed we are to have her on staff.”
Dawes is far from being the only one to hold Amy Gaither in high esteem. In fact, last week, staff members bearing tributes crashed what Gaither had been told would be a student meeting. Tributaries from the Yreka High staff then presented gifts to the teary-eyed nurse:
The Yreka High Horticulture class created a floral bouquet in her honor
Yreka’s Shop teacher made a pen for the BSN
Staff brought personal notes
All of Gaither’s co-workers also pitched in to give her a much-needed vacation on the Oregon coast.
Colleagues were eager to show their appreciation for the responsibilities she has shouldered so well over the past year—and for her graceful management of the accompanying stress. As Vice Principal Dawes remarked, “Her job has been difficult. People don’t always want to hear they have to quarantine, but again she is so kind, she is genuine, and she truly cares about every staff member and student.” A deeply moved Gaither told a reporter, “They are the best here. I just cried. It meant so much to me.”
(DailyNurse respectfully suggests that ALL schools pay their nurses a similar tribute this year. It would be the right thing to do : ).
For more on Yreka High’s Amy Gaither and what we might call the Amy Gaither Appreciation Day Event, visit the Siskiyou Daily.
DN: The judge commented that “What I loved about this book is that the authors made complex leadership and business topics accessible and interesting by sharing leaders’ personal stories… Provides actionable and practical strategies students can use to further their own development… Readable and clear, it is sure to be a favorite among students.”
TR: “I love hearing that, by the way. I’m so grateful for the comment about the book. Because you know, when I went into academia, I committed to never writing a book, because I don’t learn particularly well through reading books. It’s just how my brain is wired.
And two, I’ve never, I have never heard anyone say ‘I love a textbook’ before. One thing that I think is missing from all academia is storytelling. So we said, if we’re going to write this book, we’re going to lean heavily on not just our stories, but the stories of people who’ve succeeded and failed at putting these evidence-based innovation leadership and entrepreneurship tactics in the place. And so it’s great to hear that shine through from the reviewer because that’s exactly what we were trying to do: create a type of textbook that students would enjoy, and they can actually be engaging with the content and be able to put that into practice.”
DN: How does the Innovation Studio connect with your book’s study of nursing leadership, innovation, and entrepreneurship?
TR: “I actually teach in our masters of healthcare innovation program and is fully founded on innovation leadership, which adopts what we like to refer to as the entrepreneurial mindset. So if you are in charge of leading people, and that may be in a small capacity to large capacity formally or informally, but you’re always doing a few things.
One new favorite term that I have is building a culture of ambition. And I mean ambition in a way that you’re striving for excellence. So what we teach our team—and what’s in the book—is teaching people to find out what stories resonate most effectively with their co-workers and teammates in the population they engage in, and have that be the driving force that your team unifies around to make significant and substantial change. So by building this culture of ambition, you’re taking on ownership for your actions, you’re taking on ownership for the things that surround you, and the system that you work in.
And that doesn’t mean that you are saying that your system is perfect. But it’s saying that we are in the system, and we’re going to do the best that we can with it. That’s what we’re trying to get people to recognize. And when you come into that with an entrepreneurial mindset, you think about what resources are available to you, what are your key performance indicators, and how you can maximize those, and you let the things that are noise filter out.
So you focus on what’s important, you develop a ‘yes, and’ culture, you empower people to bring their ideas forward, incentivize them, provide them the permission to be innovative, and validate them when they engage in those behaviors. And you build a structure of innovation that lasts beyond your tenure within the organization.
Those are all things that are built into the textbook. And those are all things that we try to get the people engaged in the innovation studio to buy into because we know that if that happens, eventually we’ll find the success that we’re looking for.”
DN: 2020 was a big year for nurse leaders. They’ve been finding innovative ways to cope with shortages, fight burnout, and manage other pain points, and have made a huge impact.
TR: “And you know what, I’m very hopeful. I’m not one of those leaders right now, but I am very hopeful that through the exercises that you just mentioned, people are taking notes and debriefing and finding out what works well.
Because I do think that the exceptional leadership that’s occurring throughout health systems now needs to be the norm. Those things about celebrating our wins, focusing on what’s important today. ‘What’s important now’ — you know, that’s an acronym for ‘win’. How do we win today? What are we going to focus on?
A big component of leadership is making sure that your team is all aligned on the same goals. And, you know, creating the value that you commit to create so that that’s where innovation and leadership all come together.”
Founded in 2017, The Ohio State University Innovation Studio is run by the OSU College of Nursing and Center for Healthcare Innovation and Wellness. In normal times, the Innovation Studio travels the country, encouraging students to create healthcare solutions, and helping them to use technology to develop their ideas into marketable new products.
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How has the pandemic affected the innovation program? DailyNurse spoke to Tim Raderstorf, MSN, RN, the co-founder of the Innovation Studio and Chief Innovation Officer (as well as Clinical Instructor of Practice) at the OSU School of Nursing. Dr. Raderstorf has conducted neurosurgical research on Tethered Spinal Cord Syndrome, but his passion is healthcare innovation.
Before the pandemic, when he wasn’t teaching, Raderstorf traveled the country with OSU’s mobile Innovation Studio. He is also an expert on the role of innovation in nurse leadership and is now an award-winning textbook author. Evidence-Based Leadership, Innovation, and Entrepreneurship in Nursing and Healthcare, the textbook Raderstorf co-wrote with OSU School of Nursing Dean Bernadette Melnyk was an American Journal of Nursing (AJN) Book of the Year, winning first place honors in its category. (In Part Two, he discusses the book and explains why he found the judge’s comments particularly gratifying).
DailyNurse: How have things changed for the Studio during the pandemic?
Tim Raderstorf: “We used to do to makerspaces that would travel. And, you know, it acted as this hub of interaction and engagement and excitement. But when COVID hit, people didn’t want those things [the makerspaces] in their lobbies… and we didn’t want 15 people hanging out in the same location. So, we shut down the traveling innovation studio, which was our original one, and [now we] just run our permanent location, which is right in central campus.”
DN: What did you do when the pandemic hit?
TR: “For the first six months of COVID, because we didn’t open our doors until the students came on campus in September, we ran a virtual makerspace. So Josh Wooten, our shop manager, particularly at the beginning, used our laser cutter and CNC router to make PPE, with our College of Engineering and a variety of public-private partnerships, to get our clinicians the safety equipment they needed to be able to save our communities. We wanted to keep Josh as safe as we possibly could, so we set up a makerspace in his house. He had five 3D printers in his home, and he was printing PPE around the clock with mostly faceshield frames, so that we could hook transparencies or plastic to them. It’d be running day and night, doing work for us while we slept.”
DN: Were the students able to participate at all last year?
TR: “Well, in May [2020], we launched a COVID [Campus Safety] challenge, encouraging everyone to submit their ideas to us virtually. And when students came back to campus, we ran a second virtual challenge asking for ideas that would impact their safety on campus. Things like how to improve mask adherence, social distancing, and the mental health of our student population. We also had pitch days in October and December.
In fact, at that December pitch day, one of the nurses on the unit [came by on her] 15-minute break to pitch her idea to us. And she was wearing PPE, and—unknown to her—it was PPE that we had printed for her.”
DN: Has the pandemic been inspiring nurses to innovate?
TR: “I feel that during the pandemic, some of the acclaim and attention and interest has prompted more nurses to raise their voices in terms of public health and policy, but also to innovate and come up with solutions for the various pain points that you’ve encountered during the pandemic. And I think that’s going to build. I’m very bullish on that. I’m big on systems of innovation and building a structure of innovation, to have a proper culture of innovation that thrives.
Dr. Tim Raderstorf demonstrates an innovation exercise at the Academy of Nurse Leaders.
I’d argue there probably still isn’t much structure for nurses, physicians, pharmacists, whoever is at the frontlines to bring their ideas for [innovations] to most organizations. I do think clinicians have never been more willing and engaged in changing the system. The question is, can systems become engaged and willing and set their clinicians up for success so that they can appropriately drive the changes that need to occur? Particularly as we become cash strapped and healthcare is going through a massive transformation.
I think it there’s going to be a very challenging component to the future of healthcare once the pandemic is over. We have to decide what we refuse to go back to and what we will continue to make changes on.”
DN: Who comes to the pitch days? Students? Faculty?
TR: “We’ve had over 1000 people pitch to us over the last three years. It’s about 55 to 60% students and about 40 to 45% faculty and staff, which is a nice healthy mix, and it’s trending much more towards the students. We are seeing an increase in faculty and staff, but the students are increasing at a much faster rate.”
DN: Are nurses pitching ideas?
TR: “You know, one of my least favorite terms is ‘nursing innovation’. Because there’s no such thing as physician innovation, there’s no such thing as dentist innovation, there’s no such thing as pharmacist innovation. So why do we label ourselves other than just being innovators and really showcasing that we are indeed equals with our peers?
We knew that in order to raise the awareness of the amazing things that nurses do, and create and innovate and invent, that we need to do this alongside our peers, and, you know, almost be humble bragging, as we go along, and said, ‘hey, look, what we’ve created, why don’t you come over here and create something great with us too’.”
DN: When you describe the Studio as “interprofessional,” can you elaborate a bit?
TR: “We encourage people to engage with other individuals who have different backgrounds and professional expertise; [in fact] we require it. If you don’t have an interprofessional team, that is one of the things that disqualify you from being eligible for funding. So if two physicians come up with a great idea, we say, ‘awesome, who are you going to use this on’? And they usually say, ‘well, it’d be an operating room or height’. ‘So who preps your trays? Well, that person needs to be on your team, or you need to be getting insights from the people who are going to be interacting with this tool as well.’”
DN: Are the people who pitch to you mainly aspiring entrepreneurs looking to develop a product that they can sell?
TR: “It’s probably about half and half. A lot of people are interested in developing a new business, a new tool, something along those lines. But [we] also see a lot of people interested in policy change and awareness campaigns. Our most successful commercial effort was a method for preventing addicts from injecting drugs into their system through their IVs at the hospital. We really want to be able to help these people while they’re under our care and give them the resources they need to continue to be successful. So this nurse in the team wanted to find a way to stop people from being able to access the lines without us knowing about it and created a tape that would go over IV ports.
And, you know, it’s now on the market. Her idea has gone from something she drew on a napkin to a tool that is now being used worldwide to help patients.
[The entrepreneurial aspect helps spur change because] there’s nothing that’s free in our health system. That makes it really challenging to scale your ideas without going the commercialization route. If you can’t sell it, it’s really hard to have that mass impact. But really, the key goal of innovation studio is to build a culture of innovation at Ohio State. We really believe that the true impact is in getting our students, faculty, and staff together and creating an atmosphere where great things can happen.
That’s a long game, you have to you have to be patient, and you have to be willing to continue to water the seeds until they’re able to until they’re able to sprout.”
The image of nursing has changed since the days of its founder, Florence Nightingale; however, the devotion is the same. Nursing as a profession, coupled with the men and women who make up its numbers, function as the first line of defense for their patients. Therefore, stewardship, governance, and advocacy for the profession must be employed by nursing leaders for its protection and progression.
Importance of Stewardship
The nursing profession is a vital component in functioning society, and nurses fill the roles of an educator, facilitator of care, administrator, counselor, and advocate. Nursing leaders have a pivotal role in the process of progress and change for the profession. They are the representatives and the face of their departments. They must exercise stewardship at the point of service while working to advocate for respectful interactions with patients and promote a just culture (Murphy, 2009). Stewardship is a concept that includes the philosophy of practical analysis and practice of serving others in such a way as to provide leadership while observing the shared values of the staff for which they are in charge. The staff is the intrinsic force in a department; therefore, its steward’s goal is to serve, protect, and perpetuate its growth and function (Murphy, 2009).
The steward at the point of service must be aware of challenges and differences while cultivating these aspects into objective and impartial practices. Nurse leaders and staff members can promote their practice while creating change by the effective communication of ideas and observations made on patient care. Further, the transformation of current practice into a more efficient delivery of care can be facilitated by open collaboration with nursing leaders and physicians. A realization that we are all in this together would serve to impact nursing in such a positive way.
Improving Nursing Through Shared Governance
Shared governance is a term that was introduced over twenty years ago and was used to provide actionable strategies to provide nurses with power over their practice. Shared governance is a collaborative strategy used by organizations to encourage nursing staff to manage their practice with a high level of commitment to practice (Green & Jordan, 2004). Further, the process of shared governance works to stimulate workplace advocacy, which operates at the local, state, and national levels of government. Without nurse leaders, staff participation, and the use of collective knowledge of patient care implications related to poor staffing ratios, policies will not change. Simply put, shared governance provides nursing with a vehicle to promote their collective voice.
The Leader and Advocacy
Nurses and nursing leaders are already aware that health care reform is needed. They are the first to see a breakdown in the efficiency and efficacy of patient care; therefore, it is the nursing profession’s collective responsibility to promote change (Abood, 2007). Further, to be an effective advocate for change, one must possess the desire, will, time, and energy required to engage in reform at the legislative level. There are a growing number of uninsured patients, a rise in the costs associated with providing quality care, and a continual decrease in the healthcare workforce. These problems impose a great strain on the nurses currently in practice. The strain further imposes the numbers of those who choose to be involved in reform. The current workforce is under excessive stress, which directly corresponds to a lack of interest in representing themselves or sharing their collective voice. Work stress aside, Abood asserts that nurses find it difficult to leave the comfort of their practice to engage in the battle to be heard by their legislators (Abood, 2007). However, without representation from the nursing leadership in practice, policies cannot be changed. It is the combined knowledge and field experience held by the nursing profession that is needed to influence those who make policies for change to occur.
Nursing leadership will encounter greater challenges in the near future. The management of human capital, digital technology advancement, and cost control are three of the major challenges and opportunities that nursing leaders will face in the 21st Century (Lee, Daugherty, and Hamelin, 2017). Nursing leaders will play a critical role in transforming healthcare through active participation on the nursing units and in executive boardrooms. Critical issues, such as an aging population and the nursing shortage, continue to be prevalent in the United States and globally. Therefore, nursing leaders will need to address issues that affect retention and create new ways to promote the profession.
Nursing leaders need to expand upon the foundation created by nursing pioneers such as Florence Nightingale. The integration of shared governance into the workplace begins with the nursing leader. There also needs to be a collective effort to revise and reform policies at all levels of administration within an institution and our state and national governing bodies. There is a legacy to uphold. By joining state nursing associations and showing solidarity, the profession can serve the public in a much larger capacity. The nurse leader has many challenges ahead. In taking pride at the bedside, the nurse has the power to impact not just those that he or she serves, but to the families, administrators, and peers alike. Our presence can be our voice, as well.
Murphy N. S. (2009). Nurse leaders as stewards: the beginning of change. The open nursing journal, 3, 39–44. https://doi.org/10.2174/1874434600903010039. Retrieved September 14, 2020 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737121/
