Excellence in Human Understanding Award nominee—Resilient Nurse Manager leads ICU workers as they juggle multiple roles to create compassionate environments for sick and dying COVID-19 patients

During the COVID-19 crisis, the nightly news often covered stories of the extraordinary impact made by essential workers, reminding us of the trust we place in the medical community.

At Bryan Health in Lincoln, Nebraska, the ICU routinely cared for the chronically critically ill, supporting families during some of the worst times of their lives. But nothing prepared the unit for the pressure COVID-19 would put on them as they worked to understand the unique emotional and medical needs of each patient.

NRC Health recognizes this level of care with its Excellence in Human Understanding Award. This article is one of a series celebrating the many nominees for this award and the achievements of healthcare workers who have had a transformative impact on patient care.

One of this year’s nominees is Candy Locke, manager of the medical surgical ICU and the frontline team at Bryan Health.

The nursing team at Bryan Health put together 32 compassionate care visits in November, providing Human Understanding for patients in the COVID-19 intensive care unit. Between the beginning of October and December 2020, Bryan Health had seen about 100 COVID-19 deaths—after having only 25 deaths in the first six months of the pandemic, according to the Lincoln Journal Star.

Leah Harrington, an assistant nurse manager at Bryan Health, reported that patients on ventilators were extremely sick, and recounted stories of nurses losing multiple patients in a day or not going more than a week without a day when a patient didn’t die.

“When the nurses are having nightmares and telling you about it, it’s rough,” she says.

Locke, a nurse for 30 years, admitted she had never seen anything like COVID-19, adding that her ICU nurses were exhausted, “but they were also incredibly resilient.”

With the support of Bryan Health, the nurses got iPads for communication with patients and families.  For the “sickest of the sick,” this gave the patients the chance to see their families and communicate with them to the best of their ability. Wendy Muir, Director of Critical Care Services at Bryan Health, said the whole medical surgical ICU team, while caring for patients who were in isolation, continuously looked for new ways to support and connect them to their loved ones.

Multiple hats

During a shift, frontline workers in the ICU often played the role of nurse, housekeeper, lab tech, and support person in alternation, and were frequently the only source of human interaction or touch a patient might have in a day. They might serve as a shoulder to cry on if a co-worker had a hard day, the person listening to a distraught family member on the other side of the phone, or a kind stranger holding the hand of a dying patient and telling them how much their family loved them. In the course of this unprecedented work, the nurses, techs, and respiratory therapists became more than a team—they were a family.

When a patient became entrapped in the dark feelings that the isolation unit brought out, the team would do anything to bring them a smile. It was not uncommon for hospital rooms to be blanketed with family pictures or homemade posters with words of encouragement.

“Our team even decorated the room of a dying patient with beautiful handmade hanging paper stars before his family arrived to say their goodbyes, in an attempt to remove some of the coldness of the room to give them a different memory than the fact that their loved one was succumbing to this awful virus,” Harrington says.

Muir recalls that a nurse and respiratory therapist once lifted a ventilated patient to a chair and helped him hold an iPad so he could watch his son graduate from high school. Another day, the team brought a long-term ventilator patient outside to feel the sunshine on his skin for the first time in many weeks. They picked up extra shifts, helped train CRNAs and nurses not trained in ICU care in new skillsets to support the ICU, and managed continually shifting knowledge and protocol practices.

“Their flexibility was phenomenal,” Muir says. “The ICU team worked relentlessly to keep patients’ loved ones informed, organizing their busy daily schedule to facilitate family meetings via telehealth, phone calls, or Zoom.”

Critical care for end-of-life matters

The ICU team made promises to families to keep their loved ones comfortable, and to stay with them by their bedside during their last moments of life. During these times they would hold patients’ hands, play a special song, or say a prayer as they passed away.

“Our team dealt with death on an almost daily basis, but continued to provide the best care they could despite their emotions and the grim outcomes they had experienced,” Muir says. “Their selflessness, compassion, and flexibility throughout the pandemic should not go unnoticed.”

They also moved patients as they were ready to go to new rooms, at all hours of the day. In one case, Harrington remembers contacting a patient’s family to let them know they were transferring him, then putting him on a ventilator—and one minute he was talking to her, and the next he was coding. Knowing the family was granted a compassionate visit, she contacted them and held the phone up while they were on their way. It was clear he wasn’t going to make it until they got there, and as Harrington was holding the phone up to his ear, his family was saying goodbye. “It’s so heart-wrenching,” she remembers.

Another time, Harrington recalls, they had a patient who had suffered a massive stroke on Father’s Day. “We knew that he had little time left to live, and his daughter was supposed to be married two weeks later,” she says. “And the nurses knew that they needed to help somehow. Our unit organized an impromptu outdoor wedding, literally in three hours, for her to share her vows with both of her parents alongside her. It was just absolutely touching, beautiful yet heart-wrenching, all at the same time.

“Sometimes we’d finish and think, that was a crummy shift,” she continues. “‘What did we learn from it? How can we grow from this?’ I know we reached out to our wellness team to say, ‘Hey, our nurses are struggling here. They need some support. What can you do to offer them support?’ We turned our break room or our waiting room into a full-staff break room. Our dietary department was amazing—they brought up food for us every day, so we didn’t even have to leave the unit because, by the time we got all of our gear off, we were tired and sweaty and dehydrated. It was nice just to sit down and decompress there.”

Leading with compassion

Muir said she witnessed leaders like Harrington and Locke telling their coworkers, “You take a break. I’m going to take care of the patients for the next 30 minutes. Go on.” Identifying people who needed to work away from the unit for a couple of weeks, they’d get somebody to come in and replace them. As Muir says, they did a phenomenal job.

“I asked this team to be in that position for the last 15 months, essentially,” she says.
“That’s a long time to ask a team to do that. And they took it on, and they changed things completely on the dime half the time, because all of a sudden, they’d realize the science was changing.

“Our team’s truly been resilient during the pandemic, like I said, and we are so proud of the things they’ve done,” she adds. “In our careers, we never considered experiencing a pandemic and witnessing some of the things we did. To be recognized and shown appreciation just makes us truly grateful.”