 Hi, everybody. This is Donna Prosser, Chief Clinical Officer here at the Patient Safety Movement Foundation. We are so excited today to be joined by Robin Begley. She is the Chief Executive Officer at the American Organization for Nursing Leadership and also the Chief Nursing Officer at the American Hospital Association. And the AONL has recently commissioned a report on the findings of nursing leadership and the experiences that they've had during this COVID-19 pandemic and some of the lessons learned. So welcome, Robin. Thanks so much for joining us today. My pleasure, Donna. I'm really happy to be here with you. I wonder if you could tell us a little bit about your background. Sure. I've been the nurse executive for the American Hospital Association and CEO of AONL for two years. Prior to that, I was a Chief Nursing Officer at a small healthcare system in Southeastern New Jersey. I had been in the C&O role for 20 years and spent about 35 years of my career in Southeastern New Jersey at that organization in a variety of nursing leadership roles. My clinical background really is the maternal child's health space where I started and had probably about a dozen years in clinical practice. Excellent. Well, welcome and thank you so much for joining us today. We are really excited to hear about your findings from your survey and so I will just go ahead and pass it off to you and you can walk us through this great presentation. Thank you, Donna. So I'd like to start maybe by telling you why we commissioned this study, the survey. We at AONL really wanted to support the nursing leaders and the nurses in the field and we wanted to do it in a meaningful way. We know there was lots of information that was being sent every day whether it was via emails or we all watched the news, we watched to learn about COVID and we strategically decided we didn't want to inundate our members with lots of information but really wanted to provide them with what they needed. So we had been sending out a select group of mailings around e-mailings primarily around what we thought would be most important to them but we really wanted to find out what were the needs. So this was a survey that actually our partners Jocelyn helped us and I have to give them a little bit of a plug. They approached us and said that they would like to do this pro bono for free to help us and they really wanted to give back to the nursing community so they really did a wonderful job for us. So we planned what questions we wanted to ask, ask some demographics which you'll see on the slide but really to find out what we needed to know to support our nursing leaders. So if you want to scroll through a little bit Donna the way the study, the next slide please, the survey was conducted it was there were a few actually there was a there were before the survey went out to all of our members there was also some conversations with some of our members of a small group to make sure that we were asking the appropriate questions and then we sent out a survey in July it was the window of time was actually very small it was only 10 days and at back if we you know I know in COVID time it's you know sometimes hard to think back but when we were you know we're thinking about July we had some organizations that were really in the thick of things from a surge perspective we also had others that were basically had stopped their normal operations at the at the direct direction of for example their governor and were waiting because they did not have COVID you know in their in their settings so it was a real mix across the country and within actually within the first several hours of the survey being sent we received several hundred responses we just could not believe the response rate so we we received almost a little over 1800 responses with you'll see as you see on the screen really high level of confidence you know and the margin of error was 2.82 percent so you know really reliable information next slide please as to be expected of our of our membership you know over 80 percent were the nurse executive and nurse chief nursing officers the vps the director manager said this is pretty consistent with our membership demographics as well here you see a map of you know kind of the where the concentrations of respondents came from so obviously the red you know or the where we received more more responses from but it gives you an idea that we really did have responses from across the country so what did our nursing leaders tell us where their most you know their most pressing challenges early on and and we you know we asked them for different stages so where were they and what did they perceive as challenges as they move through because again this is not hitting everybody at the same time across the country so the primary challenge early on really was there was no playbook even for those that responded that they did have of course their emergency planning process and and policies and procedures nothing specific to this pandemic or even close to this pandemic existed in their organization and also of course you know the shortage of ppe in particular and testing you know also concern about staffing those in the surge part of the of the pandemic express concerns that they you know they were frustrated that they didn't have the answers either they didn't have the answers to give but they also weren't getting answers and that they perceived that there was a lack of trust due to conflicting information and if we think back you know it's a novel virus it's a new you know a new organism though what we told our staff on almost a daily basis in the very beginning changed it was really hard to you know keep changing the message to get it out there to everyone our staff and also to have them believe and trust in us and you know I think the secondary challenge listed there you know as we had travel nurses travel the country as we had particularly in the surge areas and a big nursing shortage you know this was really a change to the culture you know I heard from so many nurse executives outside of the survey that you know that really sort of validated this information that they had never experienced for example not knowing where the gloves or where and 95s were going to come from was so such a different culture perspective that they were always used to some of these these items that were now in short supply were so ubiquitous I mean they were just all over and they never imagined that they would have to do things like conserve you know and in the sustaining phase and as we look at this I think this is really being experienced by many parts of the country at this point in time you know we saw that there was a financial impact to staff that we had to lay off that we had to bring back and as we close other services that are not related to COVID I mean this is one of those really significant concerns first from a financial perspective personally but also from an organizational perspective because we know that hospitals and healthcare organizations were really hit so hard so you know really just you know a different different perspective and these were the concerns and just you know we heard wonderful stories about innovation but just the pace of change I think really did you know have an impact and was challenging to the staff as well so you know as we said nurse leaders really recognize that building trust is difficult when there's constant change so some of the challenges you know and I know you can all see the slides and I'm not going to read every sentence verbatim but this was again from the perspective of the nursing leaders 75 percent of nursing staff on average received training to learn new competencies related to COVID and you know and and care of the patients and their perception was that 62 percent of the nursing staff were needed to treat COVID-19 patients so when you think about that that includes you know transferring and just-in-time training for nurses from areas that for example the elective surgical areas that didn't have elective surgery pretty much were asked to come and work in areas that that were you know were designated COVID units and how they were then given training to be able to adequately and confidently take care of those patients or assist those you know a part of what we also saw was great team models so I thought this was pretty pretty pretty important almost half of the organizations that our nurses came from increased their ICU beds and used them for longer than they anticipated and particularly back in the beginning of the pandemic and you know July is probably you know obviously a few months into it you know we were seeing that length of stay for those patients really was much longer than the average length of stay so this makes sense not only do we have more patients in ICU but they stayed for a longer time so significantly amount more amount of ICU beds and when we asked what were their organization's top three challenges you know we kind of got if you look at it pretty much four responses so access to PPE communicating and implementing changing policies we talked about that a little bit interestingly and I think very importantly the emotional health and well-being of staff we heard that you know and in the qualitative component we heard stories of that you know very frequently and then 54% responded you know search staffing training and and reallocation so all those issues that nurse leaders normally are concerned with was only heightened during you know during the pandemic and the nurses felt if you read you know if you look through this slide that on the Likert scale of one to five and five being very well the nurse leaders felt that they addressed those challenges very well you know average were the high score of four or close to four you know and the lowest score you know a little over 2.5 I think too when you when you you can crosswalk almost the previous slide those those asterisks challenges were the ones that were identified as the hospital's biggest challenge okay what did our nursing leadership expect moving forward and I'm just I just have to add this comment that I wonder if we redo the survey today if we would we would get the same responses and it was only a few months ago but we know how how much the science has changed and how much we've already learned but this is where our you know nursing leaders what they were thinking in July so which of the following temporary advancements will be the most important to maintain beyond the crisis and they were asked to select two so we sort of again about four sort of rose to rose to you know the the larger you know the most quantifiable responses that I'm going to put on my glasses here because I can't see these all on the screen but increased utilization of telehealth and we see this and we hear this not only in the you know in the survey but from everyone that we talked to and all the webinars that we've conducted organizations have expressed that they tried to use telehealth prior to COVID-19 and you know both from a regulatory perspective but also from an adoption perspective either the patients really weren't too crazy about it nor were their staff that completely changed and actually there has been really widespread adoption of of telehealth adaptation and adoption of new staffing models what we did find was when asking specifically about best practices here it was really the intro professional team so in critical care new beds having nurses without critical care skills you know the experienced critical care nurse along with perhaps the respiratory therapist you know their physician colleague as well as I'm just going you know some models had one or two surgical nurses or med search nurses who participated on the team along with nursing assistants they created a team to take care of a team of patients and this is a little different than our modified primary nursing model that we you know that we customarily see we also saw things in the field where teams of folks got together to do testing in one response and one one story that a nurse leader told us how they partnered with you know to become a care team to take over some of the extended care facilities in their in their geographic area so a really great opportunity to see some creativity and also you know models that we may want to you know to continue beyond increased interdisciplinary collaboration as I mentioned and wider recognition of nurses contributions and when you think about this you know I think the whole care team got a lot more recognition on nurses in particular I mean just the hero aspect of what nurses did every day you know we always had the caring and trusting label but I think you know this gave the public more perspective of nurses as you know clinical leaders and brave I'm going to use the word warriors that you know that kind of left you know left their families were selfless in their in their you know it was very rewarding to see nurses being portrayed like that I think the and they recognized that getting recognition really did help support the morale of the team you know and I would generalize this this is not just about nurses of course we know it's really about all the care team but you know very interesting to see how nursing is being perceived and we're going to be seeing if this leads to an increase in people and we hope you know all genders very diverse folk think about nursing as a career so hopefully that will be one of the silver linings to this to this horrible pandemic the next slide let's talk a little bit about how would you rate the support you have received from the following entities during the pandemic and I think you know very briefly I'll say that most of the people the nurses that we surveyed felt that locally their their organization their care team the local folks even so even to a greater extent their local communities were very supportive the federal response fell short in the estimation of the nurse leaders so whether it was lack of consistent information or lack of a consistent process about how the COVID pandemic was being handled and some of the some of that came out in the qualitative information we received but interesting that that was their perspective that perspective okay the vast majority felt prepared for our future future surge you know sad to say right now probably many of the nurses that we surveyed are in another surge we're seeing this all over the country so you know high 80s or you know mid to high 80s 86 percent felt that they are prepared great you know I mentioned a little earlier too the survey consisted of obviously some quantitative you know questions but we also had a few fields where we asked some questions and I don't know about you Donna but when I've taken surveys you know sometimes you see those blocks and you want to fill out the survey and then you see the qualitative area and you write a few words you know just so if anything yeah and just so you can get if it's a required field you put a few words and so you can get to the next section but we saw hundreds of stories literally that were paragraphs and paragraphs long on the screen you see some some examples you know the need to share their story and to connect with others really was so so powerful and you know the folks our staff that read the comments actually thus the our you know our partners who conducted the survey they said they just sat there and cried I mean reading some of the stories so what we're trying to do now with with probably close to 500 separate stories or responses is we're trying to figure out a way that we can publicize more of these with permission of course but we thought that there's just such rich information here and there's just you know just how much heart and soul everybody poured into taking care of each other of their patients I mean it was just it was really extraordinary so hope we have an opportunity to share that with everyone and and we're actually working on that right now right so that's pretty much our key findings we found that you know and I guess to sum it up again I would say that we got really great information about how our organization can support our nursing leadership members but I would say that if I had one takeaway it was that we have to support them emotionally you know they told us we were doing a fairly good job at communicating you know clinical information we had sponsored webinars where the east coast folks that were in the middle of the pandemic could share their stories with people who hadn't seen it yet and were sort of wondering what to do but really they most mostly they said that they wanted to have an opportunity to share and express their emotions and they really wanted to connect with their colleagues across the country so that community of nursing leaders you know and and sharing this experience was really most important to that and that's what I feel that we are able to provide for them and even though right now we can't do things in person you know because of the restriction we found that when we had our annual virtual conference which was the first time we've ever tried that and we had that in September we had we were we were shooting for 500 attendees virtually and we had just shy of 3000 that participated and the chat room the chat box on the side and the opportunity for people to just connect virtually was astonishing and we got really positive feedback so that told us that people do need to connect even if they can't do it you know in person. Wow well and you know you know Robin here at the Patient Safety Movement Foundation we're an international organization but I imagine that every other country can you know looking at their nursing leadership would probably have exactly the same findings you know that I would agree yeah this is hard hard work and so anything that we can do here at the Patient Safety Movement Foundation to assist you in your efforts of providing that emotional support we are happy to do so and and so we really appreciate you coming here today to share these findings from this survey it's very important information you know even though many of us may be tired of the pandemic our frontline team our nurse leaders are still dealing with this every single day and they're I know they're exhausted and they're tired and I am very very grateful for everything that they're doing and and everything that you're doing to support them. Well thank you Donna we we like you said we're just trying to provide the support you know and I know that so many organizations have reached out and really are trying to partner because we all want what's best for our you know for our communities we want what's best for our staff and I the the unprecedented nature of this pandemic I think we can all agree has really also promoted unprecedented partnership so I think that that's you know I try to look for the silver lining and I found a few actually in in in the pandemic experience and I think that that's one of those things that maybe you know we will learn lessons from and be able to make sure we don't forget post pandemic and was my pleasure here today. Thank you so much everybody have a wonderful rest of your day this of course this presentation will be available on our YouTube page and we will also share a copy of the slides in in the description of the video so that you can have access to that. Thank you again Robin and we hope to have you back again to talk about about findings that perhaps if you if you hear learn more information in the future we'd love to hear about it. It would be my pleasure thank you Donna.