May 17, 2021
By Gillian Strudwick

Here’s what I’ve learned after beginning a chief nursing executive role during COVID-19

istockphoto.com/asiseeitA significant contribution of the CNE in Ontario is participating as a member of the hospital board as required by the Public Hospitals Act. The CNE is also typically a member of the hospital’s most senior leadership table.

In fall 2020 I received a call from our hospital CEO asking if I would consider stepping into the chief nursing executive (CNE) role on an interim basis because our current CNE was retiring. It all happened so quickly; I agreed to perform the role, and then jumped in head first. After all, nurses have been essential health-care providers throughout the pandemic, and as Barb Shellian points out in her March commentary in Canadian Nurse, “Nurses are everywhere.”

Courtesy of Gillian Strudwick“I stepped into my role at a difficult time for nurses,” says Gillian Strudwick.

It seems as if the CNE role has never been more critical than it is now, and has been throughout the COVID-19 pandemic. I was most happy to step in and do what I could to support nurses and patients during this time.

It’s now spring 2021, and I feel I can reflect thoughtfully on the last several months. I don’t know if it’s the warmer weather, the energy I feel on hearing that more Canadians are receiving their vaccine each day, or perhaps the extra sunshine that has put me in a reflective mood.

In any case, I am writing to share a few of my thoughts and lessons learned in an effort to further the dialogue about what COVID-19 has meant for nursing and health care.

Establish presence by building relationships

A significant contribution of the CNE in Ontario is participating as a member of the hospital board as required by the Public Hospitals Act. The CNE is also typically a member of the hospital’s most senior leadership table.

Working effectively as a board member and a senior team member requires collaborating with others at these important tables, and to do so, establishing solid collegial relationships is essential.

Now, working in a primarily virtual environment for such meetings means that casual conversations I once might have had while waiting for an elevator or grabbing a coffee don’t happen in the way they used to. Purposeful scheduling of these conversations means losing some of the spontaneous talk that was often the precursor to more substantive conversations.

Fatigue and burnout from weathering the pandemic for so many months had set in.

Given these constraints, I believe something that worked well was setting up 15- to 30-minute “meet and greets” with others at these tables. With our full calendars, scheduling these meetings was sometimes difficult, but they proved to be invaluable. Now, when I raise important issues, others have a better sense of where I am coming from and can better contextualize my remarks.

Addressing nursing fatigue and burnout isn’t easy

I stepped into my role at a difficult time for nurses. Nurses had been present caring for sick individuals, sometimes those with COVID-19, for at least eight months from the onset of the pandemic as declared by the World Health Organization. The daily applause for health-care workers, the complimentary meals, the thank-you cards and posters, and all the other recognition had essentially stopped. Fatigue and burnout from weathering the pandemic for so many months had set in.

While thanking individuals for their contributions and sacrifices can be done in numerous (and creative) ways, and mental health and wellness supports can be mobilized, addressing burnout isn’t easy.

The best way of addressing pandemic fatigue would be not having to don personal protective equipment before seeing each patient, not having to give up face-to-face conversations with patients and colleagues, and not needing to worry about bringing the virus home to our families. And the list goes on.

A key reflection for me has been acknowledging the true causes of fatigue and burnout among nurses, and coming to terms with what I can and cannot control. I then focus my energies on areas over which I do have control, including stepping up recruitment efforts to help ensure adequate staffing, connecting nurses with the wellness resources our organization offers, and supporting nurses in being able to receive their COVID-19 vaccine.

Nursing leadership is essential

One of the first decisions I was faced with upon assuming the CNE role was where I should work. In the region where my hospital is located, the beginning of my new role coincided with a lockdown and orders for all non-essential personnel to work from home.

But what leadership duties of a CNE can be fulfilled from home? And which are in fact essential, and best done at the hospital?

After reflecting on my experience in this role, I have come to believe the CNE should be even more present during times of crisis. I need to spend more time working side by side with direct-care nurses in resolving challenges of the day, while of course being mindful of current public health and infection control guidelines.

These initial reflections are just a fraction of some of the thoughts I have swirling in my brain these days. Like many nurses, I imagine it will take months post-pandemic to consolidate and apply our experience and lessons learned from this critical time.

Gillian Strudwick, RN, PhD, FAMIA, is the interim chief nursing executive and scientist at the Centre for Addiction and Mental Health in Toronto and an assistant professor (status) at the Institute of Health Policy, Management and Evaluation at the University of Toronto. She is also president of the Ontario Nursing Informatics Group and a member of the editorial advisory board for Canadian Nurse.

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