During the COVID-19 pandemic, organizations had to prioritize protecting healthcare personnel (HCP) through effective communication and providing necessary personal protective equipment (PPE). Studies demonstrate that effective communication decreases stress, burnout, and fatigue among nurses.1-8 Also, inadequate and inconsistent supply of PPE is a major cause of anxiety and concern for HCPs.1-8 Mendelson et al5 suggest that organizations have a legal precedence in providing the necessary PPE to protect team members. This necessitates action from organizations in developing robust roles and processes around the use, conservation, and supply of PPE. A quaternary pediatric hospital in the Western United States responded by developing a system of processes to protect their staff numbering more than 2000 nurses. This column describes the creation of specific COVID-19 roles to support the communication and the resourcing of PPE to protect HCPs.
PPE Guardian
The first role created was the PPE Guardian (Supplemental Digital Content 1, http://links.lww.com/JONA/A905). The PPE Guardian was a resource to ensure that HCPs were following proper PPE guidelines during patient care. These staff monitored donning and doffing techniques and provided real-time educational support. Clinical team members serving in this role received education on donning/doffing, reviewed the policies in-depth, and primarily resourced high-risk departments (emergency department, critical care, acute care). Formalized computer-based training was developed and utilized as this evolved into a more consistent and structured role. The PPE Guardian became the conduit for unit-based clinical teams to communicate policy changes and PPE updates. They were considered the subject matter experts and acted as liaisons to escalate any critical concerns to hospital senior leadership, thus supporting 2-way communication.
PPE Protector
The 2nd role created was the PPE Protector Role (Supplemental Digital Content 2, http://links.lww.com/JONA/A906). This role worked in conjunction with the PPE Guardian, but the primary responsibility of this role was oversight of the department's centralized PPE supplies. The PPE Protector monitored and sustained the PPE supply chain within their units, ensuring that the team members had the necessary PPE readily available. In the early stages of the pandemic, the PPE Guardian and Protector roles were staffed by underutilized HCP from other departments; this later transitioned to unit-level ownership, as the organization identified significant value and prioritized having this resource role readily available. As the education and the supply chain stabilized, the PPE Protector was absorbed into the PPE Guardian role. As staffing resources became more limited, the PPE Guardian role served in other clinical capacities to support the department.
Change in Practice
The PPE Guardians and Protectors were trained to support frontline HCPs. The roles became an intricate resource for HCPs in providing feedback, sharing barriers, and obtaining clarification. These resource individuals provided an avenue of nurse-to-nurse communication through the presence of a unit-based subject matter expert who provided education and emotional support.9 In July 2020, the organization circulated a survey to all HCPs assessing the organization's performance in prioritizing employee safety and in communicating essential information. These questions were on a 5-point Likert scale from 1 (not at all favorable) to 5 (highly favorable). In prioritizing team member safety, 79.7% responded favorably, whereas 83.4% responded favorably to communicating essential information regarding COVID-19.
Conclusion
Having an adequate supply of PPE and transparency with inventory was essential in providing guidance to changes in nursing practice during a crisis. Nurses were in a key position in the PPE Guardian and Protector roles to lead peers by providing education and guidance on the proper donning and doffing of PPE. The PPE roles ensured adequate PPE was readily available on the units. The success of these roles implies there is a need for this to continue in some form of capacity in nursing practice. Keeping HCPs safe and having adequate PPE decreased staff stress and sustained morale during the height of the pandemic. Sustaining best practices learned with communication continues to reduce confusion and promote alignment as the pandemic evolves.
Acknowledgments
The authors thank Lalit Bajaj, Laura Barg-Walkow, Donna Border, David Brumbaugh, Kevin Carney, Elizabeth English, Victor Grazette, Daniel Hyman, Kathleen Martinez, Margaret Mote, Daniel Rice, Kyle Starr, Tim Taft, and Kelly West.
References