Staff Are Experts at Adaptation after 2 Years of COVID

Megan Courtney began her career at Cincinnati Children’s as a Concierge Services associate for Family Relations on March 16, 2020. Five days later, she was sent home for 3 months.

“I knew next to nothing about the job I was hired to do,” said Courtney. “Then, when I returned, I had to learn a completely different job that was new for everyone.”

Dawn Nebrig, MSW, LISW, director, Family Relations, says the change in job functions among her staff was a crucial piece to ensuring employees reported to work healthy at the beginning of COVID and helping families feel safe when entering the hospital.

“Working a screening station requires a lot of patience, adaptability, and problem-solving. Initially we relied on employee volunteers, but we knew that wouldn’t be sustainable as more employees returned to work. We needed a team to take ownership of the screening stations, and we had the right people to take the lead,” said Nebrig.

Family Relations managers filled day shifts with staff and employee volunteers. Designated floaters managed screening station supplies, relieved screeners for breaks, and helped orient and train other employees for duty.

Screening station staff leaned on their experiences working with families to provide visitors and employees with a sense of ease when they entered the hospital. Allowing people to hear a smile in their voices or arranging screening station stickers into cheerful designs helped the hospital maintain a welcoming quality. Still, the work proved to be a stark contrast in comparison to their previous job functions.

“For four months, most of the people working the screening stations were from Family Relations and Food Services,” said Courtney. “Taking temperatures and asking about COVID symptoms for several hundred people per day wasn’t in anyone’s skill set.”

However, operating a screening station in the Emergency Department (ED) was well within the skill set of the ED staff. The adaptations they made were in response to COVID’s unpredictability.

“Our census numbers dropped by half at the beginning of COVID,” said Robin Noel, RN, clinical manager in the Burnet ED. “Consequently, a lot of people were worried about getting enough hours to provide for their families. At the same time, we had colleagues in other areas of the hospital that needed help. It was crucial that we collaborate with other departments to figure out ways our staff could get the work they need, while also helping to manage clinical needs throughout the hospital.”

ED staff agreed to fill in for other departments when necessary. The ED, along with several other clinical teams, created a shared spread sheet to ensure staff were reallocated where needed. Teams focused on planning and preparation to manage COVID case number fluctuations. Noel says communication efforts were also ramped up to help keep staff updated and engaged.

“We frequently held town hall sessions where employees could ask questions and voice concerns,” she said.

The team also held small, yet meaningful celebrations to help keep morale high.

"We wanted to make sure staff continued to feel connected to their home in the ED,” said Noel.

During the omicron surge, the ED experienced a huge rise in visits. The large spike in volume caused long wait times for patients and families and an elevated level of stress for the staff. The team received help from the Concierge Services team to manage the lobby and keep families updated in the Emergency Room. Thanks to all the planning, other teams were able to reallocate any available clinical staff quickly and efficiently to the ED.

Sharing staff resources is something the department will continue to practice at the Burnet and Liberty locations when one of the locations has a high census.

“Our growing ability to plan, adapt, and collaborate with other teams really helped us through this most recent surge, until we could receive the at-home COVID test kits from the Health Department,” said Noel. “We’ve become more flexible, and that ability will continue to serve us well in the future.”

Nebrig agrees. “Our shared experiences over the past two years have shown us additional ways our Family Relations team can help families and employees, such as rounding to inpatient rooms to get families signed up for MyChart bedside or delivering cafeteria GrubHub food to clinical areas.”

Courtney, now a Concierge Services team lead, said, “I think overcoming the obstacles and consistently adapting to brand new things really helped prepare me for this leadership role. Although a bit scary and intimidating in the beginning, I wouldn’t change the journey I’ve been on for the last 2 years, and I'm looking forward to what my future here holds.”

Josh Schaffzin, MD, PhD, and his colleagues in Infection Control have felt the pressure of allaying fears about COVID at work and at home.

Screening station staff did whatever they could to lighten the mood, even making elaborate designs with stickers.

Collaboration Between Departments Provides New Supports

COVID and the many questions it raised were a persistent presence in employees’ lives, whether they took on unfamiliar roles or worked from home. Melanie Dubose, infection preventionist III, Infection Prevention and Control, remembers how constant COVID felt in the beginning.

“Everything was about COVID with our team. Then we’d go home, and our families would bombard us with questions because they viewed us as experts,” she said. “Employees leaned on one another because we were able to empathize with each other.”

“When you’re being barraged every day with very good, but also very similar questions, it can be overwhelming,” said Josh Schaffzin, MD, PhD, director, Infection Prevention and Control. “I gathered with my family for Passover Seder, and during the meal, my family started asking me questions about COVID. I felt the weight of the world on my shoulders.”

After a few months had passed, it became clear how much stress everyone was under. People came in for one-on-ones to share their thoughts and feelings about their self-care.

Schaffzin said, “It was difficult for me and Felicia [Scaggs Huang], our associate director, to hear because we felt people’s pain that we hadn’t been aware of before. But it was also a wonderful way for us to share and grow. It was a wake-up call for us to discuss self-care more, learn to delegate authority, and work on getting through this together. The organization was great and got behind us, and we were able to partner with some really great teams.”

Collaboration with different teams became an essential process of managing COVID transmission effectively among employees. Two of those teams, Employee Health and 803-SAFE, were experiencing challenges similar to the Infection Prevention and Control team. Increased workload and the overwhelming presence of COVID in their work and personal lives encouraged an atmosphere of support, collaboration, and adaptation.

Two years ago, Anna Sheets, DNP, RN, worked in ambulatory areas that shut down at the beginning of COVID. Like Noel’s experience in the ED, she focused on supporting and mobilizing her team during a time full of unknowns.

“Many of them were worried about getting enough work hours,” she said. “We decided to help with employee testing.”

Sheets enjoyed the work so much that she joined the Employee Health team permanently and now serves as senior director.

Communication between them, Infection Control, and 803-SAFE was essential to keeping employees safe and healthy.

"We experienced a lot of quick changes in the early stages of COVID,” said Brianne Finch, RN, 803-SAFE manager, who transitioned to her role during COVID. “There was a huge surge of activity, and we had to quickly on-board new employees, including staff who were coming to help from other departments, like the NICU. We had to figure all those things out while transitioning an entire team from a call center to working from home.”

Prior to COVID, Employee Health, Infection Prevention and Control, and 803-SAFE would work together when opportunities arose, but COVID presented more urgency and a need to make sure everyone worked in concert. Collaborating on decision-making among the three departments meant communication needed to be quick, seamless, and consistent.

“The rapid rise in volume forced us to prepare differently than we had before and rethink how sustainable our previous plans were,” said Jon Colvin, director for 803-SAFE. “When we went remote, we learned a lot about communication. It wasn’t as important to be in the same room. It was more important that we were all working the same way. If some staff are onsite and some are offsite, it affects the way people pass along information. We decided on the same platform and designed strategies that would allow staff on each team to be notified in real time about any changes.”

Information Services had a huge lift in making sure that departments could communicate freely. Their work was crucial in making sure every employee working from home had the tools, resources, and connectivity needed to efficiently perform their job from home. And their work allowed Employee Health, Infection Control, and 803-SAFE to automate important messages to every employee to limit gaps in communication.

“The structure that we do things on has become shared so that we’re all working from the same source,” said Colvin. “It reduces system inefficiency and has allowed for a closer collaborative effort. Between IS, Infection Prevention and Control, Employee Health and 803-SAFE, we feel like one team now.”

The teams also had to work together to adapt and modify staffing guidelines over the past two years. “We don’t want employees coming in sick, but we also needed to make sure we have enough staff for our patients,” said Colvin. “We did a lot of work with Employee Health and Infection Prevention and Control in determining those guidelines. Overall, working with other teams has been a positive experience that has helped us better understand the units we support. It’s given us an opportunity to show more people at Cincinnati Children’s what we do.”

The shared communication and decision-making have opened better avenues of collaboration. “Collaboration happens so much faster than it used to,” said Finch. “By the time omicron hit, we had developed relationships with Employee Health and the lab, so we were better positioned for omicron than we were at the beginning when we had access to more staff from other departments volunteering to help us.”

“We no longer work in silos,” said Colvin. “We share knowledge and resources, and I think we’ve all learned more about how to help our employees with self-care during stressful times.”

“All three groups have had different stress points at different times,” said Sheets. “For example, this past January during the omicron surge, we added some resources to help answer phones and do telehealth testing. And they’ve helped us with all the work around the vaccine requirement for employment. Across the board, people have shown the willingness and ability to flex their job functions to step up for whatever the organization needs. It amazes me how many people it takes working together to deliver on all the things Cincinnati Children’s provides.”

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