Behind every RN is a nurse manager: 4 tips for these leaders during the pandemic

The nurse manager role is challenging on a normal day, let alone during a pandemic when leading a newly created unit with a team of employees reassigned from other parts of a hospital that is flooded with gravely ill COVID-19 patients.

"When this crisis hit, it just knocked people off their feet. None of us were prepared for what came," Eloise Cathcart, MSN, RN, said of the COVID-19 surges that many New York City hospitals saw in late March and early April.

Ms. Cathcart, who directs the nursing administration program at NYU Rory Meyers College of Nursing, said many nurse managers were tasked with turning units into COVID-19 care areas to keep up with the unrelenting stream of patients from emergency rooms.

These clinical leaders were responsible for designing the unit and securing all necessary medical equipment. They had to teach attending physicians volunteering on the front line how to perform care activities some hadn't done since medical school. They had to provide emotional support for nurses seeing three to four patients die an hour. They had to make sure their team had enough personal protective equipment, that they were taking bathroom breaks and drinking enough water. The list goes on.

"You can imagine trying to manage a unit with this kind of clinical, physical and emotional turmoil," Ms. Cathcart said. "Nurse managers were just thrown into a situation that no one had ever seen before."

In a recent Nursing Management article, Ms. Cathcart outlined several leadership tips nurse managers can take away from their peers' experience in New York City. 

1. Embrace your leadership role, even in times of uncertainty. Nurse managers at New York hospitals had no playbook or protocols to follow when faced with an unprecedented set of challenges this spring.

"You need to embrace your role and take your place as the leader, even though you might be scared to death," Ms. Cathcart said.

As part of this effort, nurse managers should remain visible on the unit and help out with patient care whenever possible. This helps them see firsthand what is really necessary to take care of COVID-19 patients and also helps lift the burden of care off nurses, according to Ms. Cathcart. 

"You need to say, 'I'm here, let me help'" she said. "You need to make nurses feel supported and that someone is there walking with them."

2. How you speak and carry yourself is always your most important management tool. Nurse managers must be calm and focused to help comfort team members, but also always honest and transparent.

"You can't sugarcoat anything, because then people will think you're out of touch with reality," Ms. Cathcart said. "You need to deliver the truth and yet give people hope that they can get through this. That is always a very fine line to balance."

In New York City hospitals, nurse managers had to quickly figure out how to connect with redeployed staff members facing what would likely be the hardest work of their careers, according to Ms. Cathcart. 

"Nurse managers must make their presence felt, and they have to do it fast because they don't have the normal time to build a relationship," she said, noting that drawing back professional boundaries can help foster this connection. 

"This is a time when nurses are experiencing so much grief, loss and fear, so it's OK to relax those boundaries a little bit," Ms. Cathcart said.

3. Have a vision for the day and acknowledge short-term wins. Nurse managers should outline goals one day at a time during the pandemic and acknowledge small wins along the way. Small wins may include discharging a COVID-19 patient or taking them off a ventilator.

Many clinicians may also find comfort in knowing they found a way to honor a patient's life. Ms. Cathcart recounted a story from Lenox Hill Hospital in which a Navy veteran with COVID-19 died while surrounded by his family and fellow veterans working at the hospital.

"It's hard to comprehend the incredible volume of death that people were dealing with during these surges," she said.

But clinicians can take solace in the fact that they've managed to leave some families with a more comforting memory of their loved one.

4. Make sure nurses' voices are heard. When faced with a question or challenge during the pandemic, nurse managers should turn to the people interacting with COVID-19 patients the most — nurses. Leaders must also ensure nurses have a way to share their experiences, whether in person or through writing. This can help validate the difficult work they are doing and reduce the emotional burden many carry.

"Giving nurses the opportunity to recognize the value and worth in their work is, in my experience, the thing that sustains them," Ms. Cathcart said. 

"We're hearing wonderful stories about nurses' heroism, compassion and skill during this time. They deserve every ounce of attention they've been getting," she said. "I just want people to remember that standing with that nurse is a nurse manager. We have to recognize that role, support it and know how essential it is."

More articles on nursing:
Steward Health Care nurses slam gown donations while they're reusing PPE
6 hospitals hiring CNOs
27 nurses share their best tips for self-care during the COVID-19 pandemic 

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