For this last installment of our series on the two-year anniversary of the COVID-19 pandemic, we spoke with Renee Rassilyer-Bomers, DNP, CMSRN, RN-BC chief nursing officer for Swedish Cherry Hill, about Swedish's COVID response, mass vaccinations and how the pandemic is reshaping healthcare.
Today Renee Rassilyer-Bomers, DNP, CMSRN, RN-BC, is the chief nursing officer for Swedish Cherry Hill. But in early 2020, as the first cases of COVID-19 were discovered in Washington state, she was the regional director of clinical education and practice, responsible for ensuring that our nurses were prepared to meet whatever challenges came their way.
In other words, she had her work cut out for her in March 2020, as the pandemic forced us to rethink how we delivered care during a global pandemic. “Those were the longest 18-hour days. We were meeting every few hours to plan and strategize,” Renee says. “We were working in the moment but trying to anticipate the next two or three days ahead.”
As part of our series recognizing the second anniversary of the COVID-19 pandemic, we talked with Renee about training caregivers to respond to a threat they’d never seen before and how the experience changed health care for the better.
Chief Nursing Officer for Swedish Cherry Hill Renee Rassilyer-Bomers, DNP, CMSRN, RN-BC
Take us back to March 2020. What were you and your team doing to help us respond to COVID?
If you remember, the World Health Organization and the CDC—everyone, really—had different ideas for what the protocols should be. So, my work was trying to fundamentally decide how to rapidly train and educate our teams to care for these patients.
In particular, with larger patient volumes coming in and ending up intubated in the ICU, how do we skill non-ICU nurses to support in the ICU? ICU nurses take care of two patients at any time. Well, all of a sudden we had too many patients and not enough staff, leaving each nurse with three or four patients. You can't do that safely.
So we ended up designing what we called the RN Partner Program. You can't necessarily make a nurse an ICU nurse overnight. It takes six months of training, and we didn’t have six months. In some cases we had just hours to deploy a nurse to the ICU. But we were also working with highly competent individuals. So the RN Partner was an individual who would work with an ED nurse or ICU nurse as a team. Between those two nurses, they would take care of those three to four ICU patients by splitting up the work. The person who wasn’t trained for the ICU would do things like med administration and foleys, while the ICU nurse did assessments, vent settings and the specialty skills. So they each go to the top of their scope and work together to get all the care activities done.
And this is something we developed on the fly?
Nursing is very cyclical, so we did a lot of team nursing back in the day, where we had nurse assistants who partnered with us to take on larger number of patients. But this was applying that concept using two nurses versus a nurse assistant. So it was a new model based on previous models.
Once we built the model, we ended up sharing it with Providence. And Providence built one very similar, using ours as a template. We also shared it regionally, with the local community. And eventually I shared it with New York. We were getting inundated with emails from hospitals on the East Coast, particularly New York. So I was doing presentations on the RN Partner Program and giving them all the materials so that they could just take it, tweak it and run with it.
What made Swedish nurses uniquely prepared to rise to the occasion?
I think people were nimble. Nurses and nursing leaders were able to think quickly and innovatively about how we could do the work differently—and together.
Nurses are innovative. I find that among many nurses—Swedish nurses, especially—when things are broken, when things aren’t working, they figure it out. So they really capitalized on that skillset to figure out solutions. For example, they came up with ideas proning really sick patients. That requires four or five people, so they came up with what they called turn teams that would start on one side of the ICU and turn patients, one at a time. You get to the end, you take a quick break, and you start all over again. So they came up with ideas and strategies like that so that we can ensure safety when our staffing was really stretched.
As an education leader that must have felt good to see that all the training and education that we've given our nurses set them up to succeed.
I was very proud of the education team of Masters-prepared nurses who were able to take training materials that in normal times would have taken us a day or two to train somebody on and do it within a few hours.
They also created pathways that allowed us to rapidly deploy resources and in ways that we never thought. The RN Partners began putting QR codes pieces of equipment, so if you needed to use it but didn’t know how, you could just scan the code and it gave you all the materials you would need to know to run the equipment, like a really quick YouTube video that we would create overnight.
What's your impression of how this experience has changed the public’s view of nursing?
Nursing has always been voted one of the most trusted professions, but what the pandemic showed is that we’re also the connective tissue that gets a lot of the work done, that’s the advocate for patient safety.
But it has also shown the fragility of the profession. Folks are leaving the profession because it's been so hard.
Aside from just training more nurses or encouraging more young people to go to school to become nurses, what can we do to stem the tide?
I’ve got so many ideas. It’s a balance between accessibility—so training—and building structures that help nurses professionally grow and develop and receive recognition. There’s still a hierarchy kind of built in. And what the pandemic has done is demonstrated that the value of nurses goes beyond how we've traditionally scoped health care.
We also need a louder voice for nurses in the legislature. We need politicians who were once nurses serving in health care advisory committees and making decisions for both population health and for reimbursement.
We need education, training and support for new nurses, but we also need to give alternative venues for experienced nurses who don't have the back anymore to lift patients but don't want to leave the profession. How do we train them to transition to educational and mentor roles that will then encourage continuity of the professional line?
I’ve got four kids, and none of them wants to be a nurse, because they’re like, “You work so hard!” So how do we—because of all of the burnout—get this next generation to say, “This is an important profession that brings a lot of meaning”? Most folks who stay in nursing don't do it because you get a great big paycheck and there’s all kinds of accolades. You do it because want to improve the well-being of human beings. You have to have passion to do this work and to stick with it.
Thank you, @SecBecerra, for visiting Lumen Field today to discuss more accessible health care with Swedish Chief Health Equity Officer Dr. Nwando Anyaoku, CEO @GuyHudsonMD and @providence's Dr. Rhonda Medows. pic.twitter.com/wxyG5i9xUR
— Swedish (@Swedish) April 28, 2021
You were instrumental in standing up our mass vaccination clinics. How did that come together?
It started with the vaccine clinics for caregivers, because if you’ll remember, they were the first to get vaccinated. They came to me because I was in charge of the Swedish labor pool. We didn't have nurses available to do it, because they were busy taking care of COVID patients. And on top of that there needed to be new policies and procedures. We didn't have a playbook for doing immunizations with COVID. TB, flu shots, hepatitis B, those types of vaccines don't need to be in deep freezer and don’t have to thaw six hours. The consent was different because it was not FDA approved at the time. It was on an emergency use authorization.
So when you look at that level of complexity, nurses and nurse educators and nurse practice individuals had all the skill sets to figure out—just like with RN partner—what the goal was and how we could achieve it. We needed a process. We needed a policy. We needed to vaccinate a lot of people, but we had to keep them safe and do it quickly and efficiently. So we used everything that we’d learned over the previous year to deploy it.
And because we’d built a playbook that we could scale, that's what led to them asking us set up and manage the clinics for the public at Seattle University and Lumen Field.
We relied heavily on volunteers—close to 900 at Seattle University and 4,500 at Lumen Field. But we figured out how to quickly train these retired nurses, physicians and other volunteers, get them onboarded and do all the regulatory stuff that we needed to do so they could be a part of this.
What have we learned the last two years that changed or improved the way that we provide care?
It's changed everything. We’re in the middle of a nursing staffing crisis, so we're using RN Partners on a daily basis.
It’s changed how we use our volunteers. It's taught us how we can use technology to resource and execute just-in-time events, such as a vaccine clinic or a health intervention.
The materials that we built and used to figure out bed placement, we're still using today. So everything that we've built the last two years, we will continue to use into the near future. We expect the staffing crisis to peak in 2025. It’s not something that's going to go away really quickly, and it's going to take a lot of intentional reinvestment in the profession. We're going to have to provide care differently.
Despite all of the challenges, what gives you hope for the future of nursing?
What gives me hope is seeing the folks who are still with us. They made it through a long, traumatizing experience because they were able to flex and think differently.
It's also grown the voice of nurses at the state level and legislature. Like I said, we need to invest to make sure that we've got nurses in leadership roles nationally. And the pandemic has forced that conversation.
And I think people are recognizing the profession again, not as just heroes, but as folks who are central to health equality for our whole population. The pandemic put a spotlight on inequity and diversity. It highlighted vulnerable populations that don’t have the same access to health care. What gives me hope is that it brought to the surface things that have been an undercurrent in health care for a long time so we can begin to address them.
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