Leading up to 2020, professional nursing organizations around the globe looked forward to a landmark year. The World Health Organization had declared it the Year of the Nurse and Midwife. The WHO would release the State of the World’s Nursing Report—its first ever global assessment of the nursing field—which would figure prominently at the 73rd World Health Assembly in May.
As it turned out, the report was released just weeks after the WHO declared a global pandemic. COVID-19 dominated the agenda at not one but two WHO assemblies in 2020, both held online. And the Year of the Nurse was extended into 2021, as the pandemic dramatically underscored the centrality of nurses to the present and future of world health.
Nurses make up the largest segment of health care providers in the United States and globally. No other type of medical professional spends a greater proportion of time delivering care to patients. For those reasons, nurses often bear the brunt of the responsibility, as well as the risks, of caring for patients with COVID-19.
That has been the case among the approximate 5,000 nurses employed in the seven hospitals and numerous outpatient facilities of UR Medicine, a system that extends across the region.
Karen Keady, the vice president and chief nursing executive for the system, says nurses have taken risks that have also demanded “ultraflexibility.”
When outpatient procedures were suspended in many facilities, “we took all those nurses and brought them in the hospital, where they worked at the bedside day and night, with complete stranger teams that they’d never met before,” says Keady, who is a registered nurse with a PhD in nursing from Johns Hopkins University.
Nurses who had left patient care for leadership positions took on bedside roles. A few nurses came out of retirement. To help nurses make these and other transitions, Keady and faculty at the School of Nursing joined together to create a reentry course virtually overnight. Keady, who credits the School of Nursing, says, “they put it together in, like, a weekend. It was incredible.”
The stories in these pages are just a sampling from UR Medicine nurses who have found their lives upended during the pandemic. With partners and children at home, with frail loved ones nearby whose health is constantly on their minds, they have headed into the eye of the storm. Under unprecedented strain, and witness to great suffering, they’ve also found renewed inspiration and abilities they didn’t know they had.
Says Keady: “The teamwork and commitment, it’s just an amazing thing. I’ve never been prouder to be a nurse than during this timeframe. That’s for sure.”
With No Data to Go On, a Quality Control Nurse Adapts
Registered nurse and nursing quality, safety, and patient outcomes coordinator, Strong Hospital
As the leader at Strong Hospital in charge of quality control in nursing, LaToya Baldwin spends a lot of her time and attention focused on things that have gone wrong. Or on anticipating things that might go wrong without preventive action.
When the pandemic hit—and the things that could and did go wrong exploded in number and scope—Baldwin, an RN with a master’s in public administration who is also a doctor of nursing practice student in the School of Nursing, was nonetheless compelled to step out of her quiet office and don her scrubs.
Ironically, when she returned to clinical work to set up and manage an entirely new unit, it followed months she’d spent convincing fellow nurses to make similarly dramatic changes. In the summer of 2020, she was part of the reassignment team that kept critical units staffed, often with nurses accustomed to outpatient settings, or in specialties far afield from what Baldwin was now asking them to do.
“It was scary for a lot of individuals,” she says of the nurses she approached, one at a time, during that summer. They included nurses who had not worked in an inpatient care area for years, who were now being asked to step up, and to work in an area that could potentially expose them to the virus.
“Those conversations had to be handled with much sensitivity,” Baldwin says. “Because we didn’t want people to feel like they were being forced to do this.”
It was in December that Baldwin was approached herself. The hospital faced an overflow of patients, and Karen Keady, the vice president and chief nursing executive for UR Medicine, asked Baldwin for her thoughts in addressing the problem.
“I said, ‘Maybe we could start a new unit.’ I was joking, right?” Baldwin recalls. But shortly after the conversation, she learned that an obstetrics unit would be devoting the space. She got to work, asking Keady when she needed this done. “She said, ‘yesterday,’ ” Baldwin remembers. “We were both wearing masks, but I saw her eyes. And she wasn’t kidding.”
Keady put Baldwin in touch with the people who could arrange for the equipment, help with the staffing, and handle the accompanying logistics. “We met on Tuesday and we opened on Friday,” Baldwin says.
Eventually some 70 nurses joined the unit under Baldwin’s supervision. As someone who spent 13 years as a nurse manager, Baldwin says it was difficult to lead with so much uncertainty.
“As nurses, we tend to want to have control over our environment, and to have all the information needed to carry out a care plan. We did not have that, and to be vulnerable in that way was very difficult,” she says. Moreover, “staff look to their leaders to have the answer. No one had the answer. We were thirsty for information, which was flowing daily, and sometimes changing throughout the day,” she explains.
For Baldwin, there was also the challenge of moving from the office back to clinical work. She describes office work and bedside work as “two different sides of my brain.” When the temporary unit closed in March, she took a week off before restarting office responsibilities to “reset.”
“But I now have the understanding and exposure to relate to people that are at the bedside, because I was there myself,” she says. “I have the credibility as well, because people saw me in my scrubs, taking patients.”
For now, back in her role as nursing quality, safety, and patient outcomes coordinator, Baldwin, like many nursing leaders, is evaluating what she’s learned. Most of the problems she encounters can be attributed to lack of proper training, she explains. But in the past year, she saw many nurses adapt quickly to new roles.
“I’ve learned a lot about the impact of real-time education and training,” she says.
Successful adaptation depends, of course, on the nurse and the type of roles that are involved. But she’s found that there are nurses “willing and able to flex.” Nurses who have told her, “Call me. I’m willing to do this again.” The question for Baldwin is: how can the hospital respond, for the mutual benefit of patient care and the professional satisfaction of these nurses? What kind of education and training might be involved in creating, for example, a central flex team?
And how can she and her colleagues achieve the delicate balance of encouraging willing nurses, while being sensitive to the lingering trauma of a very difficult year?
“How can we capitalize on this,” Baldwin asks herself, “without bringing up old wounds?”
From a Hard Year, New Self-Knowledge and Perspectives about Care
Meghan Reddy ’20N (MS)
Registered nurse and nurse manager, Evarts Joint Center and the Collins Unit, Highland Hospital
Meghan Reddy has been a nurse at Highland Hospital for 18 years. As a nurse manager in a surgery unit, her job has been fairly predictable.
“Surgery, you come in, there’s a planned procedure, and you do that procedure,” she says.
There are distinct steps before, during, and after the patient’s appointment, as well as clear parameters to define successful outcomes. Reddy describes the work as a good fit for her. “I’ve always thought of myself as a type A person,” she says. “It’s like, I’ve got to color between the lines.”
Now, more than a year following the outbreak of the COVID-19 pandemic, she says, “I’ve learned I’m more adaptable than I thought I was.”
As cases rose in the fall of 2020, the joint center halted scheduled procedures, and Reddy and her team, like so many health care providers and professionals across the area, were scattered across units. Reddy became part of Highland Hospital’s Surge Plan Team. Like counterparts at Strong Hospital, Highland was contending with a looming overflow resulting from rules designed to protect residents in long-term care facilities. Patients who were medically ready to be transferred to rehab or to nursing homes had to remain at the hospital, in acute care beds, because COVID-19 protocols in those other settings prevented them from accepting the patients.
“We took our biggest conference room here at Highland, the Collins Auditorium, and we turned it into a nursing unit,” she says.
Reddy was charged with staffing and managing what became known as “the Collins unit,” which also included an adjoining conference room, and putting in place new procedures for patient flow and care. She led in the development of entirely new protocols: criteria for transfer to the unit; goals for the patients staying there; criteria for transfer to acute or inpatient units if a patient’s condition changed.
The work challenged some of the ways Reddy was used to thinking about patient care. In short, her new role took her from one to the other of what many practitioners have long seen as two fundamentally different realms: she went from surgery to medicine.
Working in medicine, Reddy had to adjust to a messier world, with more uncertainty and variation among patients. “People come in with all these comorbidities, and you’re trying to piece them back together and give them what their best is,” she says. “Sometimes their best is not what I would have considered the best—but it is for them.”
At the Evarts Joint Center, Reddy was also used to a high patient turnover. But now she was developing a different kind of relationship with patients, as well as their families, as she helped patients stay connected with loved ones through FaceTime or Zoom. “We celebrated a 90th birthday. We had T-shirts for everybody. It filled my cup,” she says.
In the months since the temporary unit closed last March, Reddy has found that she values teamwork more than ever. The nurses who worked in the unit came from all over the hospital. Together, they learned, adapted, and helped shape entirely new roles for themselves over a period of what turned out to be mere months.
Back at the Evarts Joint Center, she is both tired and renewed. She is more adaptable than she thought she was. “And,” she adds, “I can help lead the change and get other people to make changes, too.”
A Taste—and a Talent—for Work in the Trenches
Daniel (Danny) Pasquarella
Registered nurse, advanced trauma care Strong Hospital Department of Emergency Medicine
Danny Pasquarella loves the teamwork, the “hustle and bustle,” and the strong bonds he’s formed with his fellow providers in the past several years in the trenches of the emergency department at Strong Hospital.
And he identifies strongly with the people he helps care for.
The “hardest thing,” he says of his experience of nursing during the COVID-19 pandemic, was the no-visitors policy and its effect on patients. “I would think about my grandmother, or my parents, going in there alone. And maybe not coming out.”
An empath with an ability to thrive in the hustle-and-bustle—those are just the qualities any patient or family member would want in someone like Pasquarella. As a triage nurse, he is among the first people a patient may see after arriving at Strong Hospital with a medical emergency. He’s among those who do the first evaluation, leading to the first consequential decision: does the patient go to an acute care bed, what department staff call “on the track”?
Or is the patient’s condition life threatening, in which case they get sent immediately to critical care?
In normal times, there are relatively set protocols that guide nurses like Pasquarella in making that initial call. But during the COVID-19 pandemic, there was a lot more guesswork, as leaders absorbed new knowledge and developed new protocols—“daily, if not hourly,” in the early months.
“If a patient came in with possible COVID, or if they had a positive test result, and they were having respiratory problems, we would just decipher where they needed to go,” he says. There were multiple breathing treatments to decide among. Patients needed constant monitoring, as their condition could change rapidly. Deteriorating patients would be intubated by critical care staff.
“They did everything they could to prioritize our patients,” he says, including transporting equipment to the emergency department, rather than having patients moved to the critical care unit to begin treatment.
Pasquarella has spent a decade in the department, a Level 1 Regional Trauma Center, the highest designation of the New York State Department of Health. The first several of those years he was part of the clerical staff. He joined the nursing staff four years ago, after completing an RN program at nearby Nazareth College. That makes him relatively new, he says, in a department where some nurses have served much longer.
“There’s a bond you form in the trenches,” he says. The nurses look out for one another, along with the rest of their colleagues in the department. For example, one of the nurses took an unused office space and turned it into a “Zen den.”
“It’s really popular in our department right now,” he says of the space that’s designed for one person at a time and equipped with a lounge chair, a beanbag chair, a water cooler, snacks, and a computer. It allows department staff to take their breaks free of interruptions and in peace—“to really get away, and then come back to work.”
Now a master’s degree student at the School of Nursing, Pasquarella has an interest in, and an appreciation for, good leadership. As chair of the emergency department’s Unit Council—a body that offers a voice for nursing staff in decision making—he says, “we have a very strong leadership team. Amazing.” From his perspective as a staff RN, good nursing leaders are people “who are present. Present on the floor and in the trenches with you. That makes all the difference.”
By Barbara (Babs) Greles
What was it like caring for the sickest patients? At Strong Hospital, an intensive care nurse recorded her thoughts in the early days of the pandemic.
Barbara (Babs) GreleS, an RN in adult critical care, had been working in a specialized surgical intensive care unit at Strong Hospital for years before COVID-19 came to the Rochester region in March 2020. When the hospital opened a COVID-19 intensive care unit to handle an anticipated spread of the virus, she volunteered to join it.
That’s when “the ground beneath me began to shift and crack,” she wrote in a brief introduction to her essay, “COVID Chronicles,” published earlier this year in the anthology Her(oics): Women’s Lived Experiences during the Coronavirus Pandemic (Regal House).
While hot spots like New York City were overwhelmed with COVID-19 patients in the early spring of 2020, the pandemic arrived slowly in Rochester-area hospitals. But as Greles shows, the volume of patients wasn’t the only metric by which to measure the emotional toll on health care workers in those early weeks and months.
Her essay is based on a journal she had been keeping, originally on social media, to share with family and friends a sense of what was happening from her perspective on the hospital’s front lines.
April 11, 2020
At the start of my shift, I make sure to fill out the online health survey daily to see if it’s safe for me to report to work. Green check mark. I’m good to go.
My fellow nurses and I huddle at the start of the shift. I stand there in my scrubs, wrinkled as an elephant’s knees. I’m hoping my shield has a little life left in it. I’m imagining the scene from Shakespeare’s Richard III where he gives that great rousing pre-battle speech.
A thousand hearts are great within my bosom:
Advance our standards, set upon our foes
Our ancient word of courage, fair Saint George,
Inspire us with the spleen of fiery dragons!
Upon them! victory sits on our helms.
I’m teamed with a pediatric intensive care nurse who looks like she’s afraid to breathe. I give her a quick tour of the massive unit, explain the negative pressure doors, show her the drips running on the in-poles outside the rooms of our patients. I set her up with a walkie-talkie, and then we gown up for four straight hours in a room with a fresh Mercy-flighted patient.
I stay connected with her through the talkie. “You okay? Go up on that propofol if you need to, twenty mcgs.”
The motor on my head makes it impossible to hear the radiologist. I finally give up and just assist him by trying to anticipate his next move.
My throat is getting scratchy, my varicose veins branching out and making friends with my plantar fasciitis as I stand there holding my patient in position with one hand, stroking her sweaty hair from her face and telling her to hang on. She is very close to my own age. I imagine her being born, riding her first bicycle, telling her first joke. . . .
I am getting dizzy, probably rebreathing my own CO2.
When I was around seven or eight I contracted chicken pox during the summer.
I was quarantined with a high fever, and my mom cooled me with calamine lotion and cherry Jello. My older sisters brought me gifts, books, and Colorforms. I experienced a new pain, like someone trying to cut off my arm with a spoon—hearing my friends playing in the oval swimming pool that sat between two garages in a tiny city yard. I loved that pool. I was sure I would never see it or them ever again. I lay there, surely dying, burning, itching, feeling sorry for my pathetic self.
I think of them as I stand there telling the person in the bed to hang on.
April 14, 2020
You are off the ventilator, breathing on your own, asking me for apple juice. I ask you where you got that unusual, stately name. “My father,” you are proud to say. You are gentle and polite, and you give me hope in an ocean of despair. I tease you that I want to give you a bath so I can read all of your tattoos. Your sister calls twice every shift. I am happy to tell her that you are watching ESPN and looking good. She cries with joy and I knock on the window to get your attention. “Your sister!” I yell, pointing to the phone. You smile and wave and I tell you that she loves you. You give me a thumbs-up and I tell her, “He knows.” She laughs and thanks me. I can hear the lightness of relief in her voice.
My friend calls me the next morning to tell me that you had died. That the nurse held up an iPad so your mom and sister could see you and say goodbye. My friend doesn’t want me to find out when I return to work. He wants to give me the time and the space to grieve you.
I grieve you.
I will never forget you.
I’m so exhausted.
It’s snowing. I watch a surreal sunset from the eighth floor through a blizzard. In April.
The nurses are all over the hospital, moved to wherever they’re needed. They are unsettled, afraid, angry, sad.
I hold the hand of a woman as she lays dying. I communicate with her nurse via walkie-talkie when she needs more pain medicine because the pump is outside the glass door. I wait with her until her breathing becomes easy and gentle. I notice that someone has painted her fingernails bright pink. They were chipped, probably done weeks ago. I imagined her then, maybe laughing and joking and blowing on the polish impatiently to make it dry more quickly.
She cannot get the sacrament of Last Rites because the diocese was swamped with a backlog of sacrament orders.
April 26, 2020
It’s getting curiouser and curiouser. Mark drops me off at the official drop site—the lobby of the Golisano Children’s Hospital. It looks like The Jetsons’ living room. I stand there for a minute, centering myself for the night ahead.
I want to just curl up on that lime green sectional that’s shaped like a boomerang and sleep for a week.
Old friends have come back to the hospital to work in our ICUs. We struggle not to hug.
I’m working with young nurses whose names I can’t always remember but they treat me like a respected elder or an old goofball.
We’re starting to see glimmers of hope; she waves back through the glass, he squeezes my hand for the first time in weeks.
Human touch. Human voice. Human compassion. Sedation. Time. These people are terrified. The virus gives them red eyes that look like a million fiery tears have run through them.
A new nurse, brave as any child soldier, calls me over. “He’s gagging on the tube! What should I do?” She’s trying not to panic, because anxiety is the most contagious germ. I gown up and mask up.
I focus on the patient. I take his hand and meet his eyes. He squeezes so hard my fingers go numb.
“We will get you through this. Okay? You just hang on. You are safe here with us. We won’t leave you alone.” He nods and squeezes harder.
I show the new nurse all the things to do. She is open, grateful to learn.
She is a wonderful nurse.
His wife is on the phone with his other nurse. We talk through the glass. Charades, yelling, writing backwards on the window. I tell his wife that he is my new boyfriend. He is smiling now and gives me a thumbs-up.
His fight to live is only beginning.
I take a cool washcloth and hold it to his reddened forehead. He sleeps the strange sleep of the body under massive attack. Only my respirator mask can be heard in the slowly dimming room.
Outside the window the sun is melting down the side of an indifferent sky.
“We are right here with you.” I tell him. “We’ve got you.”
The essay is adapted from “COVID Chronicles,” by Barbara (Babs) Greles, which was published in Her(oics): Women’s Lived Experiences during the Coronavirus Pandemic (Regal House Publishing, 2021). © Used with permission. All rights reserved.
Dizzying Change—and Heartening Improvements—in Mental Health Care
Laura Inclema ’15N, ’19N (MS)
Assistant director, Ambulatory Psychiatry Nursing Team Department of Psychiatry, University of Rochester Medical Center
In October 2019, Laura Inclema dove into a new role as assistant director of UR Medicine’s ambulatory psychiatry nursing service.
“We were expanding services to meet the community demand,” she says of the program that operates a series of outpatient mental health clinics in the region. “It was great, because we were growing, and there was new opportunity.” Inclema was not the only one stepping into a new role; she was training a team of six newly promoted nursing leaders. When COVID-19 arrived, everything was new again.
She says that working under conditions of constant, unrelenting change during the pandemic took a toll on her and many of her colleagues. It’s been “exhausting.”
“I don’t think that we’ve even started to see the impact that this pandemic is going to have on our workforce,” she says.
But Inclema is optimistic, too, and proud of what she and her colleagues in the ambulatory psychiatry program have accomplished. She helped sow the seeds of some important improvements in the delivery of care—changes she anticipates will endure well beyond the pandemic.
When COVID-19 forced a reliance on telehealth, providers adapted overnight to a change that serves many patients well. The pandemic confronted patients (as well as providers) with challenges in such areas as childcare, and sometimes, transportation. “When we removed those barriers, we had people more engaged in their care,” Inclema says.
Another important change was the expansion of a crisis hotline. In April 2020, Inclema oversaw the transformation of the hotline from a Monday through Friday service to a 24/7 crisis call line. It required a lot of new staffing.
And it came at an auspicious time.
In early September, it became public that Daniel Prude, a Chicago man visiting his brother in Rochester, had died after an encounter with Rochester police six months before, and that the Monroe County medical examiner had declared the death a homicide. Prude, who was Black, had a history of mental illness and was having a psychotic episode at the time of his arrest. A video of the event led to protests and heightened attention to a long-festering problem: law enforcement officers called to respond to mental health crises, while lacking the training necessary to respond effectively.
The call line was already experiencing high volume when people began sharing the number with friends on social media. “I would say that speaks volumes to where our community was, and how much support they actually needed,” says Inclema.
The call line is staffed by licensed clinicians who can help callers immediately—“in the moment, versus having someone call them back,” Inclema adds. “They refer people to different services, including a mobile crisis team.”
It’s a project she undertook with just one of her nurse mangers, Kristy Lamb.
“It’s an amazing service. And we’re really proud of that, and of being able to support the community in this way.”