Leadership corner: COVID courage awardees

Ms. Pietrolungo is a cardiac intensive care nurse at Philadelphia's Temple University Hospital. At the end of March 2020, after learning the COVID unit was more than a dozen nurses short of being fully staffed, she immediately volunteered to help. She stepped in at a most uncertain time, when risks of exposure were not fully known, and colleagues were nervous or fearful about exposures. She also transformed the care environment to accommodate COVID-19 patients. “We had to come up with ways to convert the units to hold the maximum number of patients. We transitioned the rooms from holding one patient per room to holding two to three patients per room with makeshift curtains. We also turned the operating rooms into suites that would hold up to four patients on ventilators.” Ms. Pietrolungo influenced other nurses to join and/or remain on the COVID unit. “Despite the significant risk we faced, we all formed a close bond that helped us continue to work the extra shifts needed to cover the shortage of nurses.” Her impact is felt by the patients and families she directly touched and is very likely to be visible in improved hospital nurse retention and reduced state COVID-19 deaths.

What was her motivation? She wanted to do everything she could do to overcome the virus and support her coworkers and community. She was also pulled by a sense of duty. “Treating patients with COVID is hard work and uncomfortable at times, but I go back to our responsibility to the patients, which motivated me to step forward. The patients are very sick and can take a turn for the worse in an instant. You are wearing protective gear for 12 hours a day, and the masks hurt your face. Each time you enter the room, you are coming into direct contact with the disease, and you have to be okay with that risk to perform your job. If all I focused on was contracting the virus, I would not have been able to be the best nurse for my patients ... I took care of my COVID patients like I would have taken care of anyone else.”

Dr. Oruche is an Associate Professor and Director of the Global Program at the Indiana University School of Nursing. Between the end of March and June of 2020, she leveraged her extensive social networks and applied her nursing expertise to create opportunities to publicly address the mental effects of COVID-19 through social media, print, and radio. She created six innovative, educational products for parents, frontline nurses, and underserved communities with state and national impact. Her video product, housed on the Indiana Family and Social Services Administration Be Well Indiana website, was viewed 5,000 times in the first three days after its release. Her op-ed discussing ways nurses could address long-standing healthcare inequities and resultant disproportionate deaths in underserved and marginalized communities was read over 80,000 times. Like Ms. Pietrolungo, Dr. Oruche also encouraged others to action. “As Chair of the AAN Psychiatric Mental Health Substance Use Expert Panel, I shepherded completion of several products by fellows including making treatment accessible and equitable for substance use during the pandemic and recommendations for Congress on how to deal with next pandemic.”

What was her motivation? She told me she was increasingly worried about the potential effects of COVID-19 on mental health, particularly among children and adolescents. “As a longstanding researcher of low-income and minority families and their children with serious mental health disorders, I knew very well the health, social, and economic disparities experienced by our underserved communities. I sought and brainstormed with peers and mentors about advocacy possibilities that might impact the largest number of people. I knew no community or population would be spared COVID-19 effects.” In short, compassion and courage prompted her to action.

Dr. Grinspun is Chief Executive Officer of the Registered Nurses’ Association of Ontario (RNAO), the professional association for Canada's most populous jurisdiction. Grinspun has been at the forefront of the COVID pandemic as it relates to nursing, health, and health care policy. She has done more than 800 media interviews between March and November, 2020. She told me that because RNAO was so engaged in the community, they identified significant issues very early on, including the ways that social restrictions were negatively affecting nursing home residents and their loved ones. She described how residents were not only dying of COVID, they were dying because “there were not enough staff to help with a sip of water, or help them eat, or because they lost the desire to live as their families could not visit.” Dr. Grinspun led the RNAO staff to work with families and she directly engaged with Ontario's Premier and media, until the goal of reuniting residents with their loves ones was achieved. She also pushed forward RNAO's Mind the Safety Gap report and the Nursing Home Basic Care Guarantee: “It's a basic care guarantee for long-term care developed with my colleagues in policy and the long-term care coordinators that outlines how many minutes of care per provider type (e.g., RN, LPN and personal support worker) each resident will receive every 24 hours.” The association used concepts of social movement and actively engaged families and other stakeholders to advance this cause culminating with a government report. “We are still not done,” says Dr. Grinspun, indicating that RNAO expects legislative assurances and faster timelines to deliver on the government commitment.

What was her motivation? She described her appetite and drive for making collective change to improve the world. “What has moved us as family, more than just me, is to leave behind us for our families, children, and grandchildren; and with my RNAO family to leave a better world for nursing and the persons (patients) we serve. You do not achieve that in a day or a minute … As we attain positions of power, we need to use it for really making change that is for the betterment of nursing and society. I never seem to be satiated like when you eat and you say, I cannot eat anymore … I never seem to run out of things that are possible … I do not shy away from the power that I have, and the more power the bigger the dreams for achieving collective good.”

Jason Farley PhD, MPH, ANP-BC, FAAN, FAANP, AACRN is a Professor of nursing, an infectious disease nurse, nurse practitioner, and scientist in the Division of Infectious Diseases at the Johns Hopkins Schools of Nursing and Medicine. With a “how can I help” attitude, Dr. Farley leapt forward when he saw the immediate need to address shortages of personal protective equipment. Those efforts grew into a role representing Johns Hopkins University on the Baltimore City testing initiatives. Upon finding many low-income clinics could not test because of PPE shortages, he met with a group of engineers to improve the design of testing booths that he saw in photos from other countries. Using a rapid continuous quality improvement process, in the span of under four months, his team progressed from the idea stage to schematics, a prototype, field testing, build, and deployment of testing booths at federally qualified health centers, and work with a local manufacturing company for larger scale up. The highest level of attention was paid to every detail such as healthcare providers’ comfort while standing for long periods, the variety of ages and heights of people being tested, the type of gloves used, microbiological testing for safety, the quality of microphones used for 2-way communication, and surveys of users’ experiences. In parallel, and in partnership with academic colleagues, Dr. Farley submitted and received funding to determine COVID population penetrance in the Baltimore area. He also received funding from the National Institutes of Health as co-recipient of a Rapid Acceleration of Diagnostics for COVID-19 (RADxUp) grant and leader of the JHU Coronavirus Prevention Network. These projects are addressing racial disparities in access to rapid COVID testing, resulting behavior change, symptoms, and outcomes. The elegant work he is doing is addressing health disparities locally and will inform efforts nationally and internationally.

What was his motivation? A professional sense of responsibility moved Dr. Farley to act. He saw the pandemic as a challenge his career had been built to address. He was primed and ready to respond and stepped in without hesitation. Unlike the AIDS epidemic which occurred before he finished nursing school, the COVID pandemic struck at a time when he was able to respond, and because of that timing, he felt it was a necessity to respond.