Working without a Playbook - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

During this week, I have had the opportunity to talk with many nurse leaders. The theme that I hear over and over is how they are working without a playbook on this crisis. Health systems have rehearsed for natural disasters, for mass shootings and airline crashes but very few have run a simulation in advance for a pandemic.

Nurse leaders have had to move into uncharted waters in a volatile environment characterized by rapid, sudden and constant change. There has been uncertainty in the accuracy of the information and the projected outcomes of the pandemic. Decision making is fraught with complexity as there is a multiplicity of variables and many unknowns. There is ambiguity moving forward stemming from a lack of clarity about how this event will transform healthcare and the global economy. It has produced a phenomenal level of disruption and a recognition that the future will be much more unpredictable than the past. Healthcare will never be the same.

Few nurse leaders could have imagined even a few weeks ago that they might be doing any of the following to stay on top of crisis:

Plan for 150% hospital occupancy
Turn an OR into an ICU
Recommend multiple usages of PPE
Use a ventilator for 2 patients
Set up an ER in a tent outside their facility
Stop all elective and non-essential surgeries and procedures
Restrict family members from visiting dying patients
Ask laboring mothers to come in alone to deliver their babies
Set up just in time telehealth for nurses to monitor COVID-19 patients at home
Postpone cancer treatments
Send a testing strike force out to nursing homes to test staff
Comfort terrified staff who are worried about transmitting the virus to their families
Bring back their retired staff to supplement staffing
Shed tears of joy for patients who are able to be successfully extubated
Watch an incredible nursing staff come back to work each day when they are fatigued and scared

The above are just some of the just in time strategies that nurse leaders are reporting as they navigate what will probably be one of the biggest crises the world experiences in our lifetime. They are working without a playbook on this one sharing real-time lessons learned but recognizing every geographic area is likely to experience the crisis a little differently. In just a month, we will be celebrating Florence Nightingale’s 200th birthday. I believe she would be proud of the nursing ingenuity that is taking place.

Read Rose Sherman’s new book – The Nurse Leader Coach: Become the Boss No One Wants to Leave