Last year, as the COVID-19 pandemic began its spread around the world and through the Shenandoah Valley, Augusta Health had to quickly adapt everything—facility, staff and resources—to suddenly care for patients and treat an illness that had no precedent or protocols.
Enter Nurse MacGyver.
The term ‘to MacGyver’ was coined in reference to a television show where the hero was a master of innovative improvisation. To MacGyver is to adapt and improvise a simple, yet elegant, solution to an impossible problem using existing resources. And while nurses are always creative at improving processes with limited resources, the COVID-19 pandemic elevated those responses to MacGyver level—at Augusta Health, Assistant Chief Nursing Officer Vickie Taylor, RN, DNP, NE-BC led those efforts.
“Initially, when we began our response in March, there were so many unknowns about COVID,” says Taylor. “How contagious is it? How deadly is it? How many patients would need hospitalization and treatment? While there were many unknowns, we absolutely did know that we would have to modify our facility to safely accommodate a growing census and community need, and we did not want to intermix patients on the floor. At the same time, surgical services were suspended across the state, so our Joint Center was empty and available for conversion. It became our first COVID/Respiratory Care Unit (RCU).”
The first requirement for the RCU was to create a negative pressure zone to care for all COVID patients in the re-designed Joint Center. “This meant we had all levels of care—ICU, progressive/step down and medical—in one area,” adds Taylor, “and each of these is a different environment with different equipment, staffing and observation. As the patients arrived, we would reallocate equipment and staff to care for everyone at the level of care required. I give so much credit to our remarkable staff—everyone was pushed to the limit, but everyone modified and adapted to care for our patients and each other. Every day I would round in the unit and ask, ‘What barriers or challenges do we have today? What else can we do to make things better?’”
Quick modifications were made as suggested. For example, the doors in the Joint Center were solid, while ICU staff needed open sight lines to observe their patients. Facilities adapted each door by cutting out the center and replacing it with Plexiglas—which not only provided a sight line, but also provided a message board for writing notes to each other. The process took two hours per door, but all doors in the area were converted within two days.
Another MacGyver adaptation was innovated to reduce foot traffic into the patient rooms. The virtual monitors used for fall precautions were used in the RCU to communicate with patients without entering the room.
“For all of us, helping our patients and families communicate with each other and with the nurses, doctors and other staff—while having to remain physically separate—was a challenge that we worked on every day,” says Taylor. “It was heartbreaking to know that families were facing a difficult time, and they just couldn’t be together to support each other. We created ‘Virtual Visitation Hours’ to help the families interact through iPads, Facetime and Skype. Physicians and nurses also consulted with the families in the same manner.”
“We also created ‘Window Visits’ for the patients on the ground floor. We posted room numbers on the room windows facing the lawn, and would provide families with an assigned visitation time,” adds Taylor. “Then we’d connect the patients and their families through cell phone calls so they could see and talk to each other at the same time. One of our critically ill patients had a very large family, and they all came at once and filled the entry courtyard, and sang and spoke to each other over the phone so they could all say good-bye. There was probably not a dry eye on the floor.”
It was also important to allow the staff to grieve for patients who were lost. They organized virtual Remembrance Services to support each other emotionally. “This was a very difficult time for everyone involved because the patients were so very ill and everything about COVID was unknown. It made no differentiation, and you couldn’t rationalize who recovered and who passed away. Being able to honor the patients and the caregivers’ efforts was a way to keep going during the tough times,” she says.
Those patients who did go home required follow-up care during their quarantine period. So once again, the Augusta Health nursing team innovated and worked with the Palliative/Transitional Care department and developed telehealth visits. Patients were set up with oxygen and provided with medical equipment. Nurses would check in with them daily—and physicians every other day—to see how they were doing and ask information about oxygen levels, pulse, and overall wellbeing, until the patient was able to be seen by their primary care provider. “We filled the gap with follow up telehealth visits, so no patient was left alone and isolated without a resource,” says Taylor.
“Because there was a bit of a delay before COVID arrived in force to our area, we benefitted with some additional time to expand and stay ahead of the surge,” adds Taylor. “Then, as services returned in the summer, we could safely adapt to caring for both the COVID patients and the non-COVID patient population. Our biggest challenge was in December and January, when we had our largest surge of COVID patients admitted for care. At that time, our experience in setting up the RCU and in caring for COVID patients helped us expand quickly and safely to other areas. Again, staff worked creatively and tirelessly to provide exceptional care to our patients and each other.”
“Looking back, one of the notable qualities of the COVID pandemic has been how very quickly it unfolded,” says Taylor. “In January, we were learning about a new virus in Asia and by March, our services were suspended and we were adapting to care for the patients. For everyone, it was ‘on the job’ training to adapt our care, our physical environment and even our emotions every day. It was definitely an exceptional time.”
“But I believe we met the challenge in an exceptional way,” she summarizes. “We kept a positive mentality of ‘We can do this’ and we stayed focused on what was best for the patients and best for our staff. We did not let the stress of the situation overcome us; instead we overcame the barriers and kept everyone safe while providing quality care. We are an even better hospital than we were before.”