On an early March weekend in 2020, Montgomery County’s first COVID-19 patient walked through the doors of Einstein Medical Center Montgomery complaining of upper respiratory symptoms. His nurse contacted AnnMarie Papa with this question: “My patient is COVID positive. What do I do?”
More than a year later, healthcare executives are still struggling. Although vaccines provide a ray of hope, Papa and her colleagues worry that people will relax mask wearing and other safety precautions, leading to a second wave. “Or are we on the third wave or fifth? I can’t keep track,” says Papa, EMCM’s vice president and its chief nursing officer.
The pandemic has buried nurses under an an avalanche of short- and long-term psychological symptoms. “Nothing in my career compares to this,” says Angela Coladonato, senior vice president and chief nursing officer at Chester County Hospital. “I’ve seen more burnout and moral distress among nurses than ever before.”
Angela Coladonato, DNP, RN, NEA-BC Senior Vice President and Chief Nursing Officer, Chester County Hospital
Assistant Dean for Clinical Practice, University of Pennsylvania School of Nursing, Philadelphia
Papa sees “a thick brew of despair, frustration, tremendous sorrow, fear and anger—and, yes, exhaustion.”
Numbers testify to the pandemic’s devastation in Chester, Montgomery and Delaware counties. At press time, Chester County Hospital had treated 1,066 COVID patients, a number that peaked with 52 cases in a day.
Main Line Health’s Lankenau Medical Center and Bryn Mawr, Paoli and Riddle hospitals treated more than 12,000 patients. At the peak of the pandemic, 280 patients were treated in one day— and it happened twice.
“I’ve seen more burnout and moral distress among nurses than ever before.”
— Angela Coladonato
Lankenau and Riddle had the highest numbers of COVID cases and the most deaths. “At Riddle, many patients came from congregant living, like nursing homes,” says Barbara Wadsworth, Main Line Health’s chief nursing officer, chief operating officer and executive vice president. “Lankenau has the sickest and most acute patients.”
It’s much the same at EMCM, where more than 4,000 COVID patients were treated. Underlying health conditions in Norristown’s medically underserved community made residents prime targets for COVID. During the height of the crisis, EMCM had 13 COVID patients on ventilators at the same time. “I’ve been a nurse for over 40 years, and I’ve never seen anything like this,” says Papa. “Some people came in with a sniffle, then died.”
During the peak of the pandemic, one nurse told Wadsworth a story she’ll never forget: “She said, ‘I didn’t have any patients to give to the next nurse on duty. All of my COVID patients died.’”
AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, FAAN
Vice President and Chief Nursing Officer, Einstein Medical Center Montgomery, East Norriton
But it’s not just the number of deaths— it’s the way in which COVID patients die. Due to mitigation restrictions, patients are alone in hospitals, usually connected to ventilators and unresponsive. In their last days of cognition, they may have virtual visits with family members. “It’s better than nothing,” Coladonato says. “But not having family and friends by your side when you’re sick and scared is very difficult for the patient and the loved ones.”
Papa puts it plainly: “A COVID death is a terrible death.”
“Before everything else, I’m a nurse. I want my nurses to know that I’m in it with them.”
Even non-terminal cases put a tremendous burden on nurses, who act as de facto family members and medical liaisons to other hospital staff. “In the beginning, no one wanted to go into rooms with COVID patients,” Papa says. “It was, ‘Let the nurses do it.’”
Barbara Wadsworth, DNP, RN, FAAN Chief Operating Officer, Executive Vice President and Chief Nursing Officer
Main Line Health, Radnor
The psychological strain on nurses was apparent almost immediately, so much so that Villanova University launched CHAMPS, a national study to evaluate the real-time health and well-being of COVID first responders. “We were concerned about the emotional welfare of healthcare givers, from physicians to people who clean hospital rooms,” says Donna Havens, a professor and the Connelly Endowed dean of the M. Louise Fitzpatrick College of Nursing at Villanova University.
Launched in April 2020, the study garnered responses from more than 2,500 healthcare workers. Nurses caring for COVID patients reported traumatic stress, depression, anxiety and sleep disorders. “The nurses are wounded by this experience— they use the word ‘haunted’—after the horrific conditions under which they have worked,” Havens wrote in comments that accompanied the report.
Those conditions were exacerbated by life in quarantine away from family and friends, leaving them as isolated as their patients. Neumann University offered its vacant student dorms as housing for nurses working in local healthcare facilities. “We’ve tried to recognize and support nurses in our community,” says Kathleen Hoover, dean of Neumann University’s division of nursing and health sciences. “The lack of information we had in the beginning of the pandemic does not compare to any other infectious disease I’ve seen in my lifetime.”
“Every decision we made, every change we made in those decisions, we explained why we did it and how it made [our staff] safer.”
Chief nursing officers took swift action to support their staffs and other hospital workers. To provide up-to-date information backed by science, Main Line Health created a system-wide command center, helmed by Wadsworth, CEO and president Jack Lynch, and other executives. “Every decision we made, every change we made in those decisions, we explained why we did it and how it made them safer,” Wadsworth says.
Kathleen Hoover, Ph.D., MSN, BSN
Dean, Division of Nursing and Health Sciences, Neumann University, Aston
Wadsworth and Lynch launched weekly virtual town halls that draw as many as 1,700 Main Line Health doctors, nurses and other staff members to each session. And an end-of-life support team of nurses and other healthcare workers was created to support patients and loved ones through the tragedy of a COVID death. “They all volunteered,” says Wadsworth. “They all stepped forward and offered to help patients, loved ones and one another.”
“The lack of information we had in the beginning of the pandemic doesn’t compare to any other infectious disease I’ve seen in my lifetime.”
— Kathleen Hoover
To enhance its psychological first-aid initiative, the Main Line Health team has caring carts do multiple daily rounds through all of the hospitals. A Main Line Health Proud campaign provides nurses and other in-patient workers with lotion and lip balm for skin chapped by PPE, aromatherapy for relaxation, resilience quotes that pop up on computers, and self-care tips.
Chester County Hospital and EMCM have similar programs, and all the chief nursing officers go on hospital rounds, donning PPE and working the COVID units alongside their nurses. “Before everything else, I’m a nurse,” says Papa. “I want my nurses to know that I’m in it with them.”
On her rounds, Coladonato does a lot of listening. “I try to model empathy, dial into the needs of the staff, and adjust accordingly,” she says. “One of the most important leadership skills you can have is to be calm, patient and attentive to your staff’s needs. I try not to let the emotional side of my brain hijack the rest of it.”
Donna Havens, Ph.D., RN, FAAN
Connelly Endowed Dean and Professor, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova
That CNOs are able to do this work during the pandemic is a testament to one of the biggest changes in nursing. “The voice of nursing has been elevated,” Coladonato says. “When I started as a nurse, administrators and physicians made the patient-care decisions. Now, nurses are at the table when decisions are being made.”
It took decades for nursing leaders to earn those positions, slowly but surely making their way through layers of hospital hierarchy well-guarded by men. By necessity, they’ve become better at bringing clinical and financial data and other facts to the leadership. “If I’m going to get a yes, I have to show up with the answers,” Wadsworth says.
“The nurses are wounded by this experience after the horrific conditions under which they’ve worked. They use the word ‘haunted.'”
That dovetails with another significant change. “There’s a big emphasis on higher education for nurses,” says Havens. “Data shows that the more educated the nurses, the better the outcomes of the patients.”
Hoover points to the rise of nurse practitioners, who can practice and prescribe without being covered by a physician. “We’re able to do more to serve our patients,” Hoover says. “We’ve gained independence and autonomy. We’ve earned it.”
Indeed, the pandemic has engendered a new level of respect for nurses. “I’m in awe of my nurses,” Papa says. “They’re the epitome of courage and compassion.”
All of which leads to one of the lasting effects that may change nursing forever. Since the pandemic, Villanova’s nursing program has seen a dramatic uptick in people wanting to enter the healthcare field, particularly nursing. “My colleagues and I across the nation are seeing it,” says Haven. “I believe that, for the first time, people see how truly noble it is to be a nurse. Inquiries about enrollment are booming.”
And nursing is a way to make a difference. “Nurses are active and engaged,” says Hoover. “We have students who can’t wait to serve and treat others with medicine—and compassion.”