What it takes to be a clinical leader during the pandemic: key insights from CNO Lisa Oldham

Lisa Oldham, CNO and Vice President of Patient Care Services at Orange Regional Medical Center in Middletown, N.Y., has tenure in nurse leadership and witnessed how the Covid-19 pandemic brought her teams of nurses together during a time of critical need.

"We went into the nursing field knowing we would be exposed to various illnesses and diseases," said Ms. Oldham. "On the front lines, we protect each other and embrace the situation so we can best avoid exposing ourselves to the virus. It has been an extremely moving and powerful journey to watch nursing teams support each other."

Here, Ms. Oldham discusses the most important qualities in nurse leaders and the lasting impact of COVID-19 on the healthcare system.

Question: What are the most essential qualities of a clinical leader amid COVID-19 and how will that change post-pandemic?

Lisa Oldham: In real time we’ve seen how one department may need to completely change into a different (an essential?) department. True leadership is able to take that as an opportunity and channel it with staff to create a center of excellence. Someone at a management level needs to provide the coaching and direction to make that change, but strong leaders are successful and are able to make the shift with their teams because they are confident in their abilities.

One great example of strong leadership is our critical care team. Within hours, they created brand new ICUs.. They had a unit with just beds and were able to identify additional staff and train them so they could get these new ICUs up and running within a shift. Other leaders who were only asked to add monitoring telemetry to their process with patients or give different medications, became anxious about the change or didn't know how to manage it. Those leaders needed an administrator to be there to guide them.

We are now trying to do hot washes and debriefs to discuss what we changed quickly and what we want to continue post-pandemic. Some of these skills still need to be fostered and developed. We took a medical unit and made it into a cardiac/telemetry unit. We gave staff the education they needed to work in those units, but now should we have them go back to what they had been doing or give them more skills and competencies? A good leader is already anticipating and teaching it before I even have to tell them.

First and foremost, as we start to adjust to a new normal and sanitize units, we need to look at what we can do better within our departments. We had certain physician groups become more collaborative and work seamlessly as a team. We don't want to lose that, so we're thinking through how to maintain and sustain it .

We are also exploring what metrics we can start monitoring to demonstrate how successful we are with those changes. We are looking at quality initiatives and making sure we can demonstrate that we can operate at a high level of clinical emergency.

Q: What technologies are the most critical for high functioning healthcare teams today?

LO: I think everyone has talked a lot about telehealth; we've used it in a couple of different ways. Medical groups are using telehealth to see outpatients and we have started using it in the inpatient units as well for consultations. Instead of having to wait 24 hours for a neuro consult in person, we can call them up on an iPad and have the patient see them immediately.

We are also facilitating video calls for families that are making end-of-life decisions. We had to do that during trying times, but this will be helpful in palliative care so we don't have to wait for family members to come to the hospital for those meetings. Instead, we can quickly bring people together for those decisions.

Q: What are the biggest opportunities for the healthcare system to better serve patients in the future?

LO: I'm hopeful that the system, including ourselves, will learn from the pandemic and develop a way to be more proactive, specifically regarding the supply chain. If hospitals start looking for solutions proactively to the supply chain issues, we can drive the economy of supply chain management so we are never again lacking PPE or other equipment we need to care for patients. We've learned that we've got more strength as collaborative groups than all being individual entities. There is a huge opportunity at the state and national level as well to look at the supplies provided in healthcare and distribute them appropriately. It shouldn't come down to a hospital’s financial status to determine who gets the supplies.


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