Leadership at Its Best: Supporting Staff Nurses in a Pandemic

In This Episode

The vital role nurse leaders play in maintaining a healthy work environment becomes even more critical – and complex – in times of crisis. In this podcast episode, we welcome New York neurosurgical ICU nurse manager Kishun Moolsankar, who led his team through the COVID surge in one of the nation’s early hot spots. Kishun relates his experiences adapting to new realities, innovating creative solutions and supporting his team mentally and emotionally during the pandemic.

"Sometimes, as a nurse leader, it’s difficult to take constructive criticism, but it’s the only way I think you can grow. Gathering feedback is something I’m going to incorporate into my communication style going forward.”

- Kishun Moolsankar, MSN, RN, CCRN

Highlights

03:12 —

The most surprising aspect of the pandemic for this nurse leader

07:20 —

Innovation spurred by necessity

08:38 —

Why staying connected to and supporting your staff matters

13:00 —

What the COVID-19 crisis taught Kishun about being a leader

17:06 —

How leaders can care for themselves during challenging times

18:44 —

Stepping out of your comfort zone to benefit your team

Transcript

Jamie Davis:

Welcome to the American Association of Critical-Care Nurses COVID-19 Support Podcast. I’m your host, nurse journalist Jamie Davis. Our goal is to discuss important nursing practices during the COVID-19 pandemic and offer tips for nurses on the front lines or behind the scenes. We hear you, we’re with you and we support you.

Thanks for joining us. In this podcast series, we will do our best to provide you with the most current information from our incredible community of nurses. However, you should always check the nursing practice standards for the state in which you’re licensed and working, as well as with the organization or healthcare facility where you work.

Today, we chat with Kishun Moolsankar, a nurse manager at North Shore University Hospital. I ask about how his organization converted the neurosurgical intensive care unit into a COVID-19 unit at the height of the COVID pandemic in New York. We had to speak with him over a phone line due to connectivity issues, so you may notice a slight difference in the audio quality you expect from our show. Let’s listen to Kishun and learn the innovative ways he used his nurse leadership position to provide the support his team needed, so they could provide their best nursing care during the first wave of the crisis.

Kishun, I want to welcome you to the show and give you an opportunity to introduce yourself. Tell us a little bit about your background and your initial experiences with COVID-19 in your facility.

Kishun Moolsankar:

Thank you so much for having me on the podcast. I’m the current nurse manager at the neurosurgical ICU at North Shore Manhasset. Our unit was converted into a COVID unit sometime in mid-March. In response to the increased number of patients who required an intensive care setting, the hospital had to double its capacity of ICU beds. I was involved in the planning, coordination and also the implementation of these ancillary units.

My peers, fellow nurse managers, assistant nurse managers and I were responsible to cross-cover some of these ancillary units. I saw firsthand the toll, both emotionally and physically, that the COVID-19 pandemic had on all of us. Everyone in the organization felt the impact. Our front-line nurses, especially our critical care nurses, struggled with things like ethical dilemmas, compassion fatigue, burnout and a sense of uncertainty and fear when coming to work. I don’t think anyone in our lifetime would have expected a tragedy like this to occur.

Jamie Davis:

I know this has been unprecedented, as you said, and none of us had really expected it. What caught you most by surprise?

Kishun Moolsankar:

What caught me most by surprise was the influx of ICU patients. I never thought, I never imagined, our facility would have to find a way to double the number of ICU beds. I wasn’t prepared for this amount of patients. Our procedure areas and medical surgical units had to be converted into critical care units. With work from all of the departments, it had to be done rapidly. Some of our units did not have bedside monitors, which we were used to in the intensive care setting. We had to be creative and utilize cameras, Amazon Alexa modules, to view patients with ventilators on our monitors.

Although not optimal, I realize that with feedback from the interdisciplinary team, especially our front-line staff, I think we were able to provide an environment that was conducive to the nurses practicing safely and effectively. At the end of our shift, we gathered the staff and asked about feedback, materials, strategic placement of monitors, staff, supplies and what would improve the workflow. It’s difficult to take constructive criticism, but it’s something that’s helped me to grow.

Jamie Davis:

You mentioned gathering the staff together. What else did you do in the beginning to support your staff in the midst of everything that was happening?

Kishun Moolsankar:

One of the things I did, especially in the beginning and throughout the height of the pandemic in New York, was a lot of virtual meetings. I did at least three to five weekly. Utilizing these huddles and our virtual meetings, I was able to first ask the staff what sort of information they needed in these meetings. What did they want to know about what was going on in the facility and also throughout the organization? I kind of tailored my meeting to what they wanted.

I quickly realized it wasn’t all about getting information. It also provided an outlet to speak about their experiences and what questions they had. The meetings were more led by the staff. Those are some of the things I did in the height of the crisis at our facility to help reach out to staff.

Jamie Davis:

As we move forward, of course, things have settled down a good bit in New York, which is great. Do you anticipate keeping any of these changes as an ongoing process for your facility or if needed again if there is another surge in the fall?

Kishun Moolsankar:

There were so many things we learned that, as a nurse leader in our organization, I felt we were going to take forward. Some of what I’ve learned, especially during the time of a crisis such as a pandemic, is that keeping information concise is important to the staff and not have a half-hour to 45-minute meeting. Nurses on the front lines during times of crisis need to adapt rapidly.

Providing support for families in some of the cases was most important, especially when care was futile or the prognosis was very poor. One of the things that came out of COVID-19 is the way we communicate with family, because a lot of our families couldn’t physically make it to the hospital. Utilizing a virtual communication method, we were able to reach a lot of families.

A story I would like to share had such a profound and deep impact on myself and the staff. There was a patient in his 30s who was terminally extubated and, unfortunately, his wife could not make it to the hospital. She asked the patient’s nurse to do FaceTime while we terminally extubated him and she played their wedding song. It was something I have never seen. My whole staff broke down in tears. The way we communicate with families utilizing a virtual platform will be something for us going ahead.

In our unit, from a clinical aspect, COVID-19 not only ravages the pulmonary system, it affects the neurologic system and many other systems in the body. One of the things we struggle with in the neuro ICU and were curious about was when, for example, some of our patients were taken off sedation we weren’t sure if the sedative had an effect, or if they had some sort of neurological insult because of COVID-19.

Our team introduced and trialed a program where we would do rapid MRIs, portable MRIs at the bedside, because there was a lot of hesitancy to transfer a critically ill patient from floor to floor to get an MRI done. We actually trialed this, and we were able to see neurological changes in a lot of our patients. This is going to be adopted throughout our facility. And it was proposed to our critical care performance improvement committee, so it can be utilized in all our ICUs.

Jamie Davis:

That’s fascinating. And what an innovative way to adapt to that particular challenge with this disease, as it does affect so many systems in the body. You mentioned one particular story and how it impacted your staff emotionally. How are you monitoring those types of emotional stressors on your staff and adapting to manage them?

Kishun Moolsankar:

The organization we work for sent a team member support survey to fill out. Basically, it’s a note from the staff, what they needed help with or the resources they needed. Some of the themes that came out of the survey were issues managing stress, issues caring for their overall well-being, care for their physical well-being, and some of our staff were worried about financial well-being. In addition to balancing caretaking responsibilities, some patients have to be separated from their families for fear of transmitting the virus to them.

I’m going to utilize this survey to see what my staff is struggling with most and try to leverage my organization to implement strategies. Some of what we’ve worked on in our institution is adding tranquility spaces. We’ve converted two of our conference rooms, so nurses can have a quiet space and kind of detach themselves from the unit, which has received a lot of feedback. I’m a big fan and a big proponent of informal and formal surveys to judge the effectiveness of these programs. It’s the only way you can create a sustainable environment for our nurses and promote a healthy work environment.

Jamie Davis:

What about an unintended positive outcome? Was there anything that came out of this crisis that you felt was a surprising, positive change among your staff?

Kishun Moolsankar:

We’re currently working on documentation. If you speak to any nurse, documentation is something no one likes. But, what our hospital did – especially during COVID and now that things are winding down here, which included all key stakeholders, including front-line nurses – was to look at the way we document, to try to give our nurses more time at the bedside. That was unintended.

Also, the integration of technology. As I mentioned about MRIs at the bedside, another unintended positive effect was that we created a proning team that consisted of folks from our mobility team, our physical occupational therapist and a respiratory therapist who really helped our nurses to rapidly, manually prone. Before it would take approximately 30 to 45 minutes to prone a patient with all the ventilators, the tubes and everything else. Teams like this were unintended.

Our hospital is divided into different service lines, especially our critical care unit. And it gave the nurses a chance to work with other nurses they would ordinarily never have the chance to work with. The feedback from all our nurses was that they have a greater appreciation for critical care nurses who work in other areas. For example, neuro ICU nurses have a greater appreciation for our CTU ICU nurses and vice versa. I think this has made our organization and our team stronger.

Jamie Davis:

You’ve mentioned so many innovative ideas that changed the way you manage patients, such as bedside MRIs and the proning team. Were there any other standout innovations as a result of caring for these patients and adapting the way you provide care?

Kishun Moolsankar:

These ancillary ICUs, procedural areas and especially the med-surg floor didn’t have the capability of bedside monitors like you’re used to in the intensive care setting. We had to get creative using Amazon Echo cameras and install cameras at the bedside, so our nurses can monitor our patients.

One of the things that came out of this for our patients who are fall risks and restless was installing cameras in their rooms, so we could watch them remotely. Especially, it helped decrease the spread of infection within the unit by keeping the doors closed, and we were able to view these patients. And, going forward, the organization is thinking about utilizing this. It’s drastically changed the way we manage certain patients.

Jamie Davis:

What has the COVID-19 crisis done to change the way you approach being a nurse manager?

Kishun Moolsankar:

Before I would make a decision, I would utilize the multidisciplinary team, especially when it comes to decisions that affect the workplace. At the height of the pandemic, emotions were running high. First, as a nurse leader, I think we must acknowledge that these feelings are genuine and be compassionate and empathetic to our nurses. One of the things I learned, especially when making a decision and not being afraid to fail, you must be decisive. Your decisions must be based on facts, especially if it’s an unpopular decision.

Another is to find an effective way to measure the effectiveness of your decisions, whether it’s through informal or formal feedback, utilizing all the key stakeholders, helping to identify what went wrong, the challenges and what changes we can make. At times, we had to discard the whole plan, which helped me make decisions. And at times, as I said, it might be an unpopular decision.

Jamie Davis:

What have you learned about your personal leadership style during this crisis?

Kishun Moolsankar:

I need to rely more on my team members. As nurse leaders, we always think we can be there 24/7, but I quickly realized I needed a lot of trust in our charge nurses, our assistant managers and our staff in general. I think we lose sight of, especially during this COVID pandemic, that we are more worried about dealing with the clinical aspects and pushing out education. One of the things I kind of left to the wayside in the beginning of this pandemic was staff development. I learned after a few weeks into this that it might be a good opportunity for some of our novice nurses to experience leadership roles. For example, making them charge nurses. I’ve had a few nurses also speak to me and say they would like to take on a bigger role.

This was something I marveled at, because some of these nurses hadn’t taken on the charge nurse role as frequently as some of my other nurses. I was relying on my more senior nurses. And, I’m so happy that some of the nurses did come to me and helped me see that even though we are dealing with clinical issues as nurse leaders, we still have to build and develop our staff.

Jamie Davis:

Communication is so key to leadership and especially for nurses, because so much happens in the exchange of information from one nurse to another. How has your communication style changed? I know you’ve mentioned more virtual meetings. What about getting in touch and keeping in touch with your nurses?

Kishun Moolsankar:

I have a 24/7 open door policy. All my nurses have my cell phone number; all my staff have my cell phone number, no different from pre-COVID. I had a lot of nurses call me after shift, especially the nurse who had the experience with the patient we had to permanently extubate. At the end of the conversation, she just wanted someone to talk to.

The way my communication style will change (and I didn’t do this very well pre-COVID) is that I learned very quickly about gathering feedback from staff on ways to improve my communication style. For example, if I’m going to have a meeting, I try to find out from my audience, my staff members, some of what they want covered in the meeting. I invited my critical care nursing director to a lot of our virtual meetings and daily huddles, and I gathered feedback from her. This was useful in helping me plan my next meeting or huddle.

Sometimes, as a nurse leader, it’s difficult to take constructive criticism, but it’s the only way I think you can grow. Gathering feedback is something I’m going to incorporate into my communication style going forward.

Jamie Davis:

You’ve talked a lot about how you’ve supported your staff throughout the process of the COVID-19 crisis in your facility. What have you done to manage your self-care during this process? Because, obviously, there’s a lot of stress for you in the midst of this, as well as dealing with the stress in your staff.

Kishun Moolsankar:

Three things I could think of. First is, I had to do a lot of self-reflection, especially driving home after a shift, thinking to myself what I could I have done better and what I needed to change. This helped me mentally process some of what happened. It helped me think about some of the positive things and some of what didn’t go right. And, I think it’s a powerful tool using self-reflection and looking at yourself and saying, ‘What can I do better?’ or ‘What went well?’

Also, I’m grateful to work for an organization that promotes good work-life balance for its nurse leaders and staff. I’m a big proponent of empowering staff to make decisions, detaching myself and having a good work-life balance.

The third thing is developing an atmosphere of positivity, which I think has really helped me during this COVID crisis. For example, simple shout-outs during my huddles, calling on a team member to highlight their exemplary teamwork and giving messages of hope. These are some of the things I utilize, and I think they have galvanized and reinvigorated me.

Jamie Davis:

The COVID crisis is moving at different speeds in different parts of the country. There are nurse managers in the beginning of the ramp-up phase and others coming down the other side. What would be a final piece of advice you might offer to other nurse managers, as we close this episode?

Kishun Moolsankar:

Moral distress, compassion fatigue and burnout are all complex issues that intertwine with each other. These are difficult topics to broach, to address and to understand, especially as a nurse manager. This was something I was not comfortable with. I’m still learning about these topics and how to incorporate them more into my practice. Bring all the key stakeholders to the table, start opening up the conversation – that would be the first step.

For nurse leaders, listen to staff and provide a safe space for them to express their feelings, ideas and concerns. Be proactive by building support services for the staff, especially when we have some respite from the crisis, and be active in building those support services. Utilize and leverage the resources of the organization. My organization has put together several programs to assist staff in addressing these issues, and one of your functions is to bring them to the staff.

I also found it useful to utilize two pillars of healthy work environments: effective decision-making and true collaboration. It’s a really great way to bring key stakeholders to the table, to strategize, implement and also monitor the effectiveness of the strategies. And this ensures sustainability and helps promote and achieve a healthy work environment for our nurse leaders, since that’s something you can’t tackle alone. I’ve utilized social work, chaplaincy, nurse educators and our patient/family centered care department to help me to tackle this issue.

Speaking of collaboration, I remember a quote from Helen Keller: ‘Alone, we can do so little but together we can do so much.’ During this COVID crisis I was astounded and amazed by the teamwork from all the disciplines. Watching critical care nurses from other units work with each other, it was something to marvel at. Sometimes we work in silos, but this pandemic has made the team stronger.

Jamie Davis:

Kishun, thanks so much for sharing your thoughts and innovative ideas with us. We really appreciate it.

Kishun Moolsankar:

Thank you so much. I really appreciate it.

Jamie Davis:

That will conclude today’s episode of the American Association of Critical-Care Nurses COVID-19 Support Podcast. Stay up-to-date with us on our website, www.aacn.org, and for more great updates connect with AACN on Instagram at @exceptionalnurses.

Join us for our next episode when we’ll talk to nurse Emily Shands. She stepped up and offered to work in her hospital’s COVID-19 unit only months after graduating from nursing school. We’ll explore how she had the confidence to work in a COVID-19 unit so early in her career and how her time there changed some of her views on nursing. She’ll also share a few nuggets of advice for other new nurses.

I’m nurse journalist Jamie Davis, thanking you for taking the time to join us during your busy day. We hear you, we’re with you and we support you.

Host and Featured Guest

Jamie Davis, BA, RN, NRP (ret.)

Host Jamie Davis is a nurse, healthcare journalist and novelist. He began his healthcare career in emergency medicine, ultimately advancing to chief of EMS. Jamie continued his love of patient care by transitioning to nursing. Since 2005, he’s worked as a journalist covering nursing and emergency care topics, and also serves as adjunct faculty for nursing at Cecil College in Maryland.

Kishun Moolsankar, MSN, RN, CCRN

Featured guest Kishun Moolsankar is nurse manager for the Neurosurgical ICU at North Shore University Hospital in New York. His focus on evidence-based practice for optimal outcomes is reflected in his unit’s gold-level Beacon Award of Excellence designation. Kishun supports nurse-led innovation through AACN’s CSI Academy influencers committee, and has published and presented nationally.