Mt Kemble Dream Team
at Morristown Medical Center
Mary Ann Morabito, RN, MSN, OCN;
Kelsey Day, RN, BSN-BC;
Jacqueline Tierney, RN, MSN, CHPN
True collaboration and teamwork are the hallmarks of authentic leadership are key to a productive, engaged, and healthy working environment. Not surprisingly, when asked to care for palliative care patients in an offsite unit, MMC nurses from throughout the hospital answered the call to form the Mt Kemble Dream Team. Although they were all entering unknown territory, their commitment would optimize the use and flow of critical and acute care beds in the main hospital and unclog bottlenecks for those patients in need of palliative care expertise.
Senior leadership requested a needs assessment from the palliative care clinicians while they simultaneously worked together to review existing resources. This collaboration resulted in an innovative use of an existing space to be utilized to care for palliative care patients who were dying of COVID-19 throughout the organization. This dream team consisted of multiple departments including engineering, human resources, education and training, environmental services, pharmacy, security, nursing, transport, supplies, and more. Each team member was an integral part of the success of this unit.
Prior to opening the unit, leadership and nursing staff from Simon 3 worked closely with human resources and managers throughout the hospital to secure staff that had been displaced due to the virus. Many of these nurses came from outpatient units and needed education to prepare them for this new and challenging role. Due to tight time frame, we worked closely with Nursing Education to develop an innovative way to train staff on donning and doffing PPE, charting in EPIC, IV pump management, administering comfort medications, and practicing the skill of communicating with patients and families through an onsite orientation utilizing resources throughout the hospital. Onsite certified palliative care nurses were a valuable clinical resource throughout the entire process and provided education and emotional support for the nurses redeployed to this new setting.
Once we started to receive these very special patients, we needed to create daily onsite workflows to support the nursing and other direct patient care staff members. Providing hospice and palliative care can be stressful for nurses in the best of times; doing it offsite, on a COVID-19 unit, with multiple deaths per day, proved to be very distressing for many of the nurses. We conducted daily huddles at the start of each shift to communicate the myriad of changes and policies that would take place each day, to provide clinical and emotional support, and most importantly to highlight their acts of compassion as newly ordained palliative care nurses. There were so many wonderful and touching moments that were shared throughout our time there. Nurses initiated group readings of poems and prayers of support that were reflective and a welcome addition to daily huddles.
One of the most difficult components of providing this special care was not being able to deliver physical touch and comfort to patients and their families during this very burdensome time. We were restricted in the duration that we were able to spend in a patient's room and family was not allowed to visit at all. This provided a great deal of emotional distress for both the nurses and the family as they were unable to participate in their final days and hours and share their goodbyes. As a result, the team developed innovative ways to provide this necessary support in a new approach. It was essential that the nursing staff was able to convey to families that they were there to provide comfort to their loved ones and able to convey their love in their absence. The staff took this responsibility very seriously and provided as much interaction with the family as possible through regular Zoom experiences and calls throughout the day to update them on how their loved ones were doing.
Our team wanted more. They wanted to feel that connection with the patient that was so difficult to achieve when looking through a small window in the patient's door. Through collaboration with the Social Worker, we were able to call family and friends and learn more about each patient. This information was then written up and placed outside of the patient's door. This allowed any staff member who was caring for that patient to learn more about them and use that information in conversation while spending time with them. It meant so much to the staff and the patient to be able to ask them about their children or grandchildren. This simple innovation alleviated a great deal of moral distress for all of the team members and provided a genuine connection.
As you can imagine, this was not an easy experience for any of these team members as we experienced many deaths over a few short weeks. Leadership and nursing staff worked closely together to develop resiliency events and experiences to support the well-being of the entire team. We utilized the services of Integrative Medicine, we cried together, and we celebrated as a team through group discussions, gatherings, and planting a "Garden of Souls" on the grounds of Mt. Kemble in remembrance of all those we lost during our time together. Many of these events had close to 100 percent participation as everyone wanted to be there for one another.
Most importantly, the staff always felt well supported by our management and leadership team. They were consistently onsite to gauge the emotional climate and human response to such a high volume of death. Ongoing leadership communication ensured safe patient care, bolstered staff confidence, mitigated organizational risk, and identified areas for change in future training. The CNO's onsite visit made each nurse feel that their contribution was recognized as an important factor in the overall success of the unit and elicited a spectrum of emotion from pride to release of pent-up sorrow for all the lives lost.
More than simply creating a new working environment we sparked a passion in nursing team members from various departments by tapping into their knowledge and encouraging a culture of shared expertise. It has been almost three months since we closed the doors of Mt. Kemble and many of the staff still keep in touch and several of the nurses have decided to come back to bedside nursing. Although it was not easy, every team member has expressed how proud they are of what was accomplished for these very special patients. We brought together an amazing and dedicated group of nurses to provide the very best care to our patients when their families could not be by their side.