COVID 19; A Call to Leadership

By Thomas Davis, DNAP, MAE, CRNA

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The Corona virus (COVID 19) has upended the mundane daily routines that seemed “a bore” just a few short weeks ago.   Fear and panic now drive decision-making and trigger bizarre behavior like visiting Walmart at 3:00 am. for bathroom tissue and an overnight reduction in the sale of Corona beer.  With retirement plans decimated, restaurants empty, national parks and beaches closed, everyday life is on hold and the practice of medicine has changed, probably forever.  In a crisis, effective leadership is necessary at all levels in order to defuse the chaos and develop a reasonable approach to combating the deadly enemy.

From my daily personal conversations with friends across the nation, and a regular review of the CRNA social media, here is a snapshot of the frustration that is being reported by the anesthesia community.

• My academic friend, a program director in Florida, reports that one hospital converted all CRNAs to 1099 employees, sent them home without pay, and told them they would be called when needed.   His education program converted all coursework to an online format and the University pulled students from the clinical area due to lack of protective equipment (PPE).
• Likewise, the program director at my alma mater in Arizona reports that all classes are now online, and students have been pulled from the clinical area.
• Despite the downturn in the surgical case load, the VA hospital in the Baltimore area has kept the CRNAs on the payroll by making them available to assist throughout the hospital as needed and to complete education modules.
• From several CRNA user groups on Facebook, come these reports; a CRNA posts, “For the first time, I have applied for unemployment compensation.”   Another CRNA posts that her facility has shut down for 4 weeks without pay.  From the GI CRNA user group come numerous reports of GI clinic closures around the country; and the few centers that are open report that, like a growing majority of CRNAs who work in hospitals, they do not have adequate protective gear.   Most anesthetists who work in outpatient surgery centers state that they are out of work, with or without pay. 

Leadership is essential

In times of crisis, someone must be at the helm.  Down the road you may not remember the details of the event, but you will remember how the leader handled the problem and how you were treated.  In today’s turbulence some leaders will flounder while others will flourish, earning both trust and respect from their team.  Here are some ways to ensure that you and your team survive the current COVID challenge and walk away even stronger and more cohesive than ever before.

Stay informed.   Every healthcare organization has developed and dispersed policies/procedures to be followed during the COVID epidemic intending to ensure the safety of workers and clients.   Know the rules and follow rules.

The bombardment of COVID information has filled email inboxes with more information/solicitations/finger pointing than most of us can read.  Select a few reliable sources and check them daily for updates.  Recommended sources for information include the CDC COVID web page, the APSF COVID resource center, and the APSF COVID perioperative recommendations.

Over-communicate.  “I can’t get a straight answer out of anybody and I feel as if I’m being deceived.”   People want to know what is happening and if they don’t hear it from you, they will grasp onto every rumor that is circulated.  Show your respect for the team by being consistently forthright and sharing the good news along with the bad.  Crises, i.e. COVID, are usually fluid and your statements may need to be revised as additional information is gathered.  During a time of crisis, start each day with a short face to face briefing (email doesn’t cut it unless everyone has been sent home) providing updates and listening to concerns.  Avoid overreacting to rumors, hose the hype and quickly address any safety issues that are raised by the team. 

Be resilient.  “I just want to hide in a cave until this whole mess is over and things are back to normal.”  We are in uncertain times and resilient leaders embraces the uncertainty while adapting to change.   After finalizing a plan based on what is known, anticipate a government proclamation or local regulation to issue forth and put the total kibosh on it.  That’s the time to keep your cool and adjust your approach based on the new rules, openly communicating to your team both the new plan and the reason for the change.  Don’t fight uncertainty; take pride in your ability to manage whatever comes your way.

Build trust.  “I don’t believe anything that my boss or the company tells me anymore. They don’t have my back and they think only of their bottom line.”  Teams follow leaders they trust and quickly abandon those they don’t.  Make the personal welfare of each team member a priority and listen carefully to issues that affect either their professional or personal lives. Join your team on the frontline, put on your PPE, and show them that you are all in it together.  If work loss or financial hardship is inevitable, take your share along with the team.  Take all safety concerns forward and your team will see that you are not just working for them; you’re working with them.

Focus on safety.  “How can I effectively care for the patient when I don’t have the equipment that I need to protect myself?  What happens when I get the virus?”  In addition to treating patients with life-threatening conditions, team members must know that their personal safety is your priority.   Make sure that every person has received proper training and that PPE is available.  Take a hard stand and do not allow your organization to withhold safety equipment or force your team into hazardous exposure to the virus. 

Delegate and empower.  “There is so much to do and I’m only one person…I need help.” Professional development is an important component of a great job and the COVID crisis is an opportunity to draw on the talent of your team members.  Whether the need be obtaining supplies, keeping records, providing safety training, or creating a reasonable work schedule, you have people on your team who are eager to help.  Establish the criteria and a timeline and then let team members share the administrative burden.   Keep a finger on the pulse and resist the urge to micromanage.

Be sensitive to individual needs.  “School is closed, and my kids are home until I can’t find day care.  The neighbor is looking in but I’m worried…I can’t keep my mind on my work.”  Working their assigned shift is but one component your team member’s busy life.  Everyone has personal needs that affect the way he/she functions on the job.   For many, childcare during school or day care closures is an issue.  For others, obtaining the family’s basic food and supplies is the bigger difficulty.  Be proactive and adjust/stagger work hours to create the time needed to take care of personal needs.

Keep workers whole.    “I was told to stay home and use PTO if I want to get paid.  What happens when the PTO runs out?  What happens to summer vacation?”  In addition to the virus threatening the physical health of individuals, the economic well-being of the country is also suffering.  Shelter in place regulations have closed businesses and put people out of work.  Healthcare is no different as elective surgery has been banned and caseloads have dropped.  As reported previously, many groups simply furlough the CRNAs without pay.  Take up the mantle and fight for your team, making a strong case for your employer to provide at least partial pay while ORs are closed.  Use every resource including PTO, sick time, or unemployment compensation to maintain cash flow to workers.  There may not be cases now, but once the ban on elective surgery is lifted, employers will want CRNAs to be on the job and eager to go.  Don’t make the mistake of throwing them under the bus now and expecting them to be happy to return when called.  Those who sense that they are not being treated fairly may be using furlough time to find other employment.  Do your level best to preserve pay and benefits for your team during mandated down time.

Look at the big picture.    “Our group is so totally focused on the virus that patients with other problems are slipping through the cracks.”  Healthcare workers, our patients, and our families; we are all in this together and will have a common experience to share once the crisis has abated.  Despite the chaos and disruption to business as usual, review the Mission, Vision and Values of your organization and remain true to them.  Most likely, your MVV describes the role that your organization plays in ensuring the health of your community.  Your purpose for existing will remain long after the virus is gone, serving as a beacon to guide you through difficult times.

Prepare for the future.   “We were not prepared, and many workers have been placed at risk.  Let’s make sure we are ready next time, and this never happens again.”  Preparation requires record-keeping. Make your team a part of the solution by keeping a record of glitches as they occur, challenge your team to find creative solutions, and take notes accordingly.  Push for after-action review with other leaders in your organization and develop a comprehensive plan, including an abundant supply of necessary equipment, that positions you to face the next crisis hidden behind enemy lines.

COVID is a crisis without international boundaries.  But it does not need to be a crisis in leadership.  When the dust settles, teams with a strong leader will feel empowered by the experience, minimizing the burn-out and PTSD while shoring up supplies, improving skills and building relationships.  Your “Call to Leadership” in a crisis demands the will to survive and the determination to thrive.

Tom is a skilled anesthetist, published author and frequently requested speaker.