Managing a Crisis

By Taylor Utzig

Leading a hospital on a normal day is stressful. During a pandemic, it can seem overwhelming – from staffing, to securing personal protective equipment (PPE), to instituting new safety protocols and procedures.

To better understand how health care leaders are responding to the pandemic, I met (virtually) with Ottawa Hospital’s Chief Nursing Executive (CNE), Vice President of Clinical Programs, and Loyola Nursing alumna Debra Bournes (PhD ‘00). Dr. Bournes has held leadership roles in health care research, education, and administration for more than 20 years. Prior to her current role, she was Ontario’s Provincial Chief Nursing Officer at the Ministry of Health and Long-Term Care.

What was your main concern in the beginning when news about the threat of COVID-19 first surfaced?

DB: In the beginning, our focus was on critical care. What happens if we get overwhelmed? How are we going to make sure we have the maximum critical care capacity? We didn’t have enough nurses to run four times as many critical care beds. So, we formulated a plan for the possibility of a catastrophe, while hoping for the best-case scenario. Like other health care providers, we went into disaster mode and started thinking out each scenario.

What changes did your team make to prepare for the possibility of a flood of COVID-19 cases?

Right about the time the pandemic hit, we had almost 200 Bachelor of Science in Nursing (BScN) nursing students who were finishing their final consolidation placements. They only had a couple weeks to go before they would be eligible to graduate, but we had to stop their placements. So, I hired 125 of them within two weeks into a new role we created called clinical care assistants. We brought them on to support patient care in the acute and rehabilitation care units because we expected to have to redeploy experienced nurses to help the critical care teams. We used a formal delegation process to allow the clinical care assistants to carry out specific controlled acts and take on patient assignments under the supervision of RNs. We also wanted a back-up plan if many of our regular staff got exposed to COVID-19 and had to be on sick leave. In addition, we hired about 70 third-year BScN students to work as orderlies, helping with basic procedures and transporting patients. We mapped out how all our nurses and health professionals could work together in different areas to jointly provide care to large patient assignments if we needed them. They all became part of our army. We were ready for the worst.

As the virus spread, it turned out that our ICUs did not get overwhelmed. Instead, the pandemic hit our long-term care sector the hardest, and we had to pivot to support staffing outside of our own organization at those centers. Once we were able to stabilize a few of the long-term care centers, we sent some students to work with more experienced nursing and health professional staff in long-term care, while others stayed behind to help at the hospital. Our students were instrumental in helping us move and respond to COVID-19. It’s been very powerful. We were very lucky with the timing because our students were able to step in and help. Most of the fourth-year students we hired as clinical care assistants have now completed their BScN program and transitioned into RN roles at our organization.

"Loyola’s program was phenomenal. The faculty and people were very supportive, smart, and passionate about what they did. I wouldn’t have had the opportunities I have had without my experiences at Loyola."

How has your leadership style influenced your decision making and response to the pandemic?

I have spent a lot of time studying with Rosemarie Rizzo Parse, PhD, RN, FAAN. When I was at Loyola University Chicago, she was a professor and the Niehoff Chair at its School of Nursing. In fact, she’s the main reason I chose to pursue my PhD at Loyola. Dr. Parse's humanbecoming paradigm is very much focused on person-centered care and understanding health care from the person's perspective. She continues to be my mentor and her work on leadership has greatly influenced who I am as a leader and how I work with people. She has written a lot about three essentials of leadership: commitment to a vision, willingness to risk, and reverence for others.

During our response to the COVID-19 crisis, we have had to take some risks. I remember getting an email in March about the spread of the virus in Italy and thinking, “Oh my god.” That's when our teams really started working on our response plan. When the pandemic was declared here, I called my team and said, “I’m going to get approval and we’re going to hire these students.” The organization’s investment was eight 12-hour shifts of orientation with a preceptor plus a four-hour team seminar. This was a risk, but it was a calculated risk, which leads me to another component of effective leadership: flexibility.

We had to build. We didn’t just hire these students and put them out there; we created the role, built safety nets, and gave nurses and managers tools for how to work with them. We also looked across our entire organization and mapped out how to transfer nurses, if necessary, to work in other areas. We just started doing things, imagining the worst, but hoping for the best. You can’t get stuck thinking, “This is how we do it.” I had team members say, “Oh no, that’s not our model of care. We can’t do that.” But, guess what? If we don’t have nurses, then a team model is a good model. We won’t do this forever, but here’s how it’s going to work. Here's how nurses are going to lead and direct their teams.

How did you first connect with Professor Parse?

I was working at Sunnybrook Health Sciences Centre in Toronto in 1995. My CNO was Gail Mitchell, PhD, RN, who worked very closely with Dr. Parse. She invited her to a few conferences. I wasn’t a doctoral student then, but I was working on my master’s degree and I enrolled in a one-credit doctoral course on humanbecoming, which sparked my interest in doctoral studies.

That same year, I started applying to doctoral programs not really thinking I would enroll. Turns out, I got multiple offers from programs. I chose to go to Chicago because I wanted to work with Dr. Parse, which turned out to be a very positive experience. I had two degrees from Toronto, so it was nice to see something different, and Loyola’s program was phenomenal. The faculty and people were very supportive, smart, and passionate about what they did. I wouldn’t have had the opportunities I have had without my experiences at Loyola.

As a successful nursing leader, what is your advice to nurses just starting their careers?

People always ask me how I got to where I am, and I don’t think I ever had a grand plan. You need to take opportunities to do different things and create connections. Sometimes you need to go out of your way to do projects, go places, and make connections that may not be part of your day-to-day job, but they build opportunities. You need to take chances. I had never lived away from home, so when I went to Chicago, that was a big deal. In retrospect, it was probably the best thing I did. I learned it’s okay to move. Since then, I’ve moved from Chicago back to Toronto; I’m in Ottawa now. You never know. You have to follow and seize opportunities.

What has been the most rewarding aspect of leading health care teams during this global health crisis?

Watching people step up and do what needs to be done. People get tired, of course, but they also say, “Okay, what do you need?” It’s incredible.