Providing Leadership in a Pandemic
When asked what his initial reaction was when he first heard that Catholic Health would be transferring all its COVID-positive patients to its St. Joseph’s campus, where he is a nurse manager in telemetry, ICU and dialysis, John LaForge’s response was slightly unexpected.
“I was proud that they picked us,” he said. “This was an undertaking that I don’t think anyone thought would be easy. But we became a really solidified team that had a very acute focus on helping these patients and, at the same time, keeping our staff safe.”
Based on what was happening at hospitals downstate, and following algorithms and suggestions from the New York State Department of Health, Catholic Health had determined that making St. Joseph’s the system’s COVID-19 treatment facility would enable them to treat those patients while keeping them isolated from others, and preserve PPE to protect their staff.
Once the decision was made, LaForge, a 2018 graduate of Niagara University’s RN to BSN cohort program with Catholic Health, and his colleagues began making the necessary preparations. The first steps, LaForge explained, were to close the emergency department and create three separate zones within the hospital: a red zone, where patients would receive direct care; a yellow zone, through which patients would be transferred to other areas of the hospital; and a green “protected” zone, where staff could take a break or have lunch without wearing PPE.
The team also built the infrastructure to prepare almost 90 beds and ensure they had necessary equipment, including ventilators. They developed policies to guide them in providing care for a disease that people weren’t familiar with and to help them care for an unusually large patient assignment, and established procedures to facilitate access to technology for the nurses from other Catholic Health sites who volunteered to work at St. Joseph’s to treat the increasing number of patients. Training was offered to the med-surg nurses who were entering the critical care arena for the first time, and weekly tip sheets were distributed to share what the nursing staff was learning as they cared for their patients each day.
To ensure the safety of the medical staff, the hospital’s perioperative team, already skilled in sterile technique, was trained in the process of donning and doffing PPE. They did “an amazing job keeping our direct care staff safe,” LaForge said. “I’m very proud to say that none of our nurses ended up with coronavirus from working with this population. And I don’t know of many places in New York state that can say that they have such a pristine record.”
Other teams were established to tackle specific tasks, including a proning team comprised of imaging department staff who assisted the bedside nurses in turning patients in acute respiratory distress onto their stomachs to help improve oxygenation.
“We accomplished these tasks by working as a team with no egos,” LaForge said. “Everyone was out to try to do the best that we could to protect our staff and to take care of patients that were very, very sick. It was incredible to see people come from all different angles to work on this project, and how smoothly it went together.”
Throughout the months since he began treating COVID patients, LaForge has seen both “amazingly joyful things” and “tremendously heartbreaking things.” He’s celebrated with families whose loved ones recovered, and saw other families whose last moments with their loved ones were via a FaceTime chat. To reassure the direct care staff that its work was making a difference and to ease patient anxiety, the hospital began to play songs over the PA system each time a patient was discharged. LaForge said that the satisfaction of hearing those songs and knowing that the work they did helped somebody get back to their families is something that he will always remember.
This experience also reaffirmed his belief in what nursing is, the quality of people who choose nursing as a career, and the impact they make in people’s lives, he said.
“When you see a nurse stay after their shift to hold someone’s hand until they passed, that’s real nursing,” he said. “Someone who would put themselves at risk to care for someone that they don’t even know and they probably won’t know when this is all over, that’s real nursing.”