By Sean Reed PhD, APN, ACNS-BC, ACHPN
Clinical nurse specialists share experiences on how the pandemic and social distancing are highlighting the CNS role.
The “new normal” resulting from the COVID-19 pandemic has altered the way America’s 89,000 clinical nurse specialists (CNSs) do their jobs. For example, how do CNSs perform all the tasks they have been trained to do while maintaining six feet of social distance? What information should be communicated to staff?
Four CNSs and National Association of Clinical Nurse Specialists (NACNS) members recently shared their experiences learned over the past months about how to maintain social distance while taking on new responsibilities and still be effective. Their insights go beyond wearing masks, keeping social distance, and washing hands.
1. Worry only about what you can control.
It’s an ever-changing environment, with new COVID-19 information arriving daily, frequently resulting in new healthcare policies. Early in the pandemic, the Centers for Disease Control and Prevention (CDC) changed recommendations regularly, and CNSs were responsible for disseminated them across many organizations.
“It could get exhausting with the constant changes in policy and protocol. We had no control over CDC announcements, so we just rolled with it and worked to keep everyone current,” said Julie DeVaney, CNS at UC San Diego Health. “We had daily announcements, over-communicated information, and held what we called a ‘Daily Engagement.’ The Daily Engagement was a formal, daily conversation with our leadership and the clinical CNSs so we could disseminate any new information.”
Take the time to critically look at news and other information being released. Because COVID-19 is constantly evolving and new study results are being reported regularly, there is a real need to be vigilant about the types of information being shared. Learning to overcommunicate accurate information takes time and is essential.
“Initially, we dedicated a lot of time for conversations and supporting staff, trying to be sure they had accurate information; keeping them updated,” said Pat Rosier MS, RN, ACNS-BC, a surgical CNS at Berkshire Medical Center in Pittsfield, Massachusetts. “We answered questions like, ‘What was our guidance?’ and ‘What was the personal protective equipment [PPE] to use?’ So, you’re always trying to be sure the [nurses] have the accurate information. And then internally, what were our plans for which units would care for which types of patients? So, we spent, and continue to spend, time keeping staff up-to-date, calming them down, and sometimes we just listen. Listening is a form of communication.”
3. Know where and how the staff is getting their information.
Understand where and how nurses obtained new information. According to Maureen Seckel, MSN, APRN, ACNS-BC, CCNS, CCRN, FCCM, FCNS, who is CNS, acute medicine service line quality and safety and sepsis leader/coordinator at ChristianaCare in Newark, Delaware, it’s important to first locate the news sources used by staff and then check to see if the sources are credible. If the sources aren’t accurate, speak up and inform the staff, and provide sources that are credible. This will enable CNSs to prevent the spread of misinformation before it starts.
4. Persuade with evidence.
As leaders, CNSs need to communicate evidence-based information thoughtfully to staff without simply reacting to whatever new information is presented. They need to use their skill and knowledge to persuade—and back up with evidence—recommended actions. The confidence that evidence brings to new information can reduce the levels of uncertainty nurses often experience working on the frontlines of the pandemic.
“The biggest challenge CNSs had to manage was the staff’s fear,” said Seckel. “Our code words for staff were ‘fluid and flexible’ because what was common practice for COVID-19 today could change next week due to new research. We didn’t want to react before we considered the situation with other experts and leaders, so we put the right information out.”
Messaging becomes exquisitely important in this environment. Rapidly and constantly changing information makes people more fearful. It’s important for the CNS to lead and persuade by taking the time with staff and explaining the evidence.
5. Insist on a seat at the leadership table.
The pandemic led to healthcare operational leaders and clinical leaders working together more closely and communicating more as a team. It’s important to not separate operational and clinical activities from each other and to make sure everyone is working toward the same objectives. This can only happen when CNSs play a leadership role.
“Clinical leadership is imperative in a situation like this. CNSs definitely need to be a voice at the table,” said Matthew Beier MS, RN, CNS-BC, CNOR, director of advanced practice nursing at Children’s Hospital of Wisconsin in Milwaukee. “Decisions should not be made strictly from an operational perspective. Clinical leadership through a CNS, and clinical educator is absolutely 100% needed in a situation like this. We need to make our voices heard and advocate for the clinical needs of the organization, not just the operational needs.”
6. Train, train, train.
All training is welcome but, in particular, pandemic surge training had the unexpected benefit of calming nurses’ nerves and creating an even more collegial environment. DeVaney helped train more than 300 nurses to manage a surge that required moving toward a team-nursing model at UC San Diego Health. DeVaney believes that the pandemic has been enlightening in that it forced her team to learn new ways of getting the job done better.
“The surge training helped calm nerves because it provided a clear idea of what may be expected of nurses,” said DeVaney. “They realized it wasn’t going to be as scary as they thought. Training is helpful in that it sets expectations and helps staff maintain focus.”
7. Maintain social distance but be socially inclusive.
Social distancing between family and patient—restricting access—is the hardest part of the job. It’s wonderful when the patients are awake and alert and want to talk to their family using various media platforms. At the same time, it’s difficult to watch patients with COVID-19 having to FaceTime family members. There is no physical contact with the family. The lack of intimacy can be incredibly sad and heart wrenching.
Nurses can become emotionally drained in this environment. These situations require a lot of discussion with staff in the form of providing care for the caregivers.
8. Master technology and use it.
“Our infection prevention team has been involved from the very beginning dictating a lot of our practices when it comes to entering patient rooms,” said Beier. “We definitely rapidly ramped up our telehealth capabilities doing a lot of work with the nurses using telehealth right on the patient care unit. Specifically, with patients who were positive early on in the crisis, we allowed nurses to stay out of the patient room, only entering for critical needs or necessary assessments and interventions. Other conversing and interactions are done by iPad and other similar devices.”
Necessity as the mother of invention has been visible in many adaptive behaviors, especially when it comes to using technology and bundling care to facilitate patient visits. During the pandemic, CNSs are helping lead efforts to improvise communications channels. All the CNSs interviewed highlighted the importance of technology to help family members communicate with their loved ones in the hospital. From acting as an intermediary between the patient and family on a mobile phone to using Facetime and iPads, CNSs have helped institute a number of communications solutions for their patients. This was especially true in instances where family members were unfamiliar with technology.
Resurgence of the CNS
Maintaining social distance while performing the role of a CNS during a pandemic—aptly categorized as a “roller coaster ride”—is challenging, yet CNSs everywhere have stepped up to lead practice changes needed. CNSs around the country are successfully modifying and strengthening their communications, taking on more leadership roles, and adapting existing systems and procedures for this new normal. Processes like the lessons learned and shared in this article have helped save lives, comforted patients, supported nurses and sparked a growing resurgence of the CNS role in organizations across the country.
Sean Reed is president of the National Association of Clinical Nurse Specialists.