One of the key lessons from the research was the degree to which nurses helped move care out of the hospital and into the community. This reflects a larger movement across the healthcare system to meet patients where they are—which involves a reimagination of how, when and where care takes place. There’s much more in our first AN,TH chapter on Care Delivery, and we encourage you to explore it. In the meantime, here are four ways nurses led the move to bring healthcare into communities who have needed it most during COVID-19.
1. Ramping up a virtual hospital system to increase patient capacity
Maureen Swick, MSN, PhD, RN, NEA-BC is Senior Vice President and System Nurse Executive of Atrium Health, a large health system with facilities across the Carolinas and Georgia. She and her colleagues led a quick expansion of Atrium Health’s existing virtual hospital during the pandemic to increase number of patients it could serve. Sick patients who didn’t require intensive care could receive observation and acute care services in their homes. Through the virtual hospital, patients are outfitted with home monitoring kits that include blood pressure and oxygen monitoring systems, among others, and have daily check-in calls with providers.
“No one ever thought it would be ramped up so quickly and dramatically,” said Dr Swick. “The last I heard it was over 40,000 patients that we had taken care of through our virtual hospital program.”
She pointed out that nurses led and co-led expansion of the virtual hospital—one of the chief nursing executives handled, among other things, CMS and regulatory compliance. Dr. Swick was herself recruited early on to help lead several initiatives, including incident command and surge efforts, including ensuring the virtual hospital had the staff and resources it needed. She said she hopes other systems also appoint chief nurses to positions like this. “I would like to think that most places do,” she told us. “You can't underestimate the value that the nurse leader has sitting at that table from beginning to end, helping with the coordination and the execution of the plans, because ultimately we're impacting patients.”
Atrium Health will continue to expand its virtual hospital, to meet its goal of serving patients in the most appropriate setting. “It is in the patient's best interest to be in the right setting, at the right time,” she said. “We're going to be moving forward with patients who have chronic illness, so they're not constantly in a revolving door of acute care, and they can be seen, taken care of, and monitored virtually in their homes.”
2. Matching community members with the wraparound services they need
"Sometimes crisis pushes you to step into a place you wouldn't have gone when you're really comfortable."
During the pandemic, many patients needed not only medical care, but often comprehensive services, including mental health and social services. Lauran Hardin, MS, CNL, FNAP, FAAN, Senior Advisor at National Center for Complex Health and Social Needs, has devoted her career to helping build the systems that meet individuals’ complex needs. She recalled how during the pandemic nurses played critical roles in bringing complex care into communities, to people experiencing homelessness, social isolation, food insecurity, domestic violence, and more.
“Nurses were deeply involved in the wraparound services, connecting people to benefits, behavioral health, substance use treatment, and really holistically starting to solve the homeless problem in a way that communities could not have conceived,” said Ms. Hardin. “Nurses have stepped to the front as leaders of changes and delivery, so telehealth, street nursing, comprehensive care, and outreach to isolated seniors—really that deep understanding of how to change systems of delivery in the community.”
She pointed out that the work often involved spearheading collaborations across organizations, among even former competitors, since no one organization could handle the need by itself. In California, for instance, there was so much food insecurity, it required agencies, restaurants, local government leaders, food brands, and even a celebrity chef to work together to build a food system using the YMCA as a distribution hub. Nurses were often the ones planning on multiple levels, from large-scale orchestration across partners to bringing care directly to patients in their communities and matching them to appropriate services. Another initiative was spurred by HomeKey funding, said Ms. Hardin, which allowed communities to “purchase permanent building structures and invest in new structures to have a more integrated continuum of care for homeless systems. Nurses are leading a lot of that work in design and delivery.”
Given the success of these collaborations in addressing longstanding health inequities, she hopes that these initiatives will continue—and that nurses will continue to head them.
“I've seen nurses around the country step up with new innovation and new leadership,” said Ms. Hardin. “Sometimes crisis pushes you to step into a place you wouldn't have gone when you're really comfortable. It starts with nurses really embracing our role as transformers—whether it’s within the healthcare system or within the community—and really owning that… How powerful that is for change.”
3. Moving care from hospital to community through a patient-centered approach during the first COVID surge
When health systems were overwhelmed with COVID-19 patients during the first surge, some had no choice but to move care from the hospital into the community to make room for the sickest patients in-house. But not all patients could go back where they’d come from: families were sometimes afraid to take back COVID-positive patients or patients had come from group settings—prison facilities or other communal locations—that were underprepared or simply refused to welcome them back.
Geralyn M. Randazzo, RN, MS, CENP, Vice President of Care Coordination at Northwell Health System, along with nurse colleagues and a multidisciplinary team, led the Herculean effort of moving patients through the hospital network, determining which patients could safely be discharged and where they would go, and making sure the person or facility receiving the patient was up-to-speed, so that care wouldn’t be set back.
“We had to set up best practices to move patients through the continuum and then discharge them into environments that were completely and totally unprepared for some of the things that they were facing,” said Ms. Randazzo. “Rules were changing literally before our eyes, minute to minute, and we needed to develop systems and implement processes to meet the regulatory constraints, and then disseminate information to the 23 [Northwell] hospitals that were discharging, as well as get communication to post-acute partners who were desperately looking for guidance.”
The Care Coordination team made sure patients weren’t simply discharged, but that they had an appropriate place to go. Sometimes they had to set up alternative locations like hotels, and then configure other types of care like meal service, since patients were isolating. They also helped set up technology platforms to monitor patients remotely, since they didn’t have the staff to provide home visits to everyone. Much of this orchestration, said Ms. Randazzo, required new ways not only of thinking but of sharing information—and the Care Coordination teams were the ones forging the partnerships and making sure handoffs to the next level of care were informed, sensitive and compliant.
“Nurses were driving much of the transformation because of their skill sets, from clinical expertise to understanding the financial, administrative and regulatory components,” said Ms. Randazzo. “They understood the nuances about what is required for a patient and what's appropriate and what isn't, and what other considerations are needed. That's where I really found nursing expertise helped, in making sure that the processes and infrastructure to support safe transfers and good patient care were brought to the forefront—that might have been neglected if nurses hadn't been leading those dialogues.”
4. Giving people access to online therapy and psychiatry
“The world was shifting online, and we needed to fill this void, and this immense need that was coming up with the pandemic—the need for mental health services.”
While our ANTH research included a remarkable group of nurses bringing care into communities, they are certainly not the only examples. Nurses are spearheading new types of care delivery all the time: Among them are Pritma Dhillon-Chattha, DNP, MHA, RN and Brighid A. Gannon DNP, PMHNP-BC, who, during the pandemic, founded and launched the online therapy and psychiatry system, Lavender, to fill a large unmet need in mental health care.
The duo, who met in their DNP program at Yale University, had both come to the realization that mental health services in the U.S. are lacking in more than one way: There is no standard means through which to access routine mental health care, which means that people are often in crisis by the time they seek it. And the difficulty in finding and paying for care adds to the frustration felt by those trying access it, and to the risk in delaying it. The situation was exacerbated by pandemic, as people dealt with extreme stressors like job loss and in-person care had largely shut down.
“A lightbulb went off, and I said, ‘we need to pivot right now,’” said Dr. Dhillon-Chattha in a recent SEE YOU NOW episode. “The world was shifting online, and we needed to fill this void, and this immense need that was coming up with the pandemic—the need for mental health services.” Within 45 days of coming up with the idea, she and Dr. Gannon launched the online service, in which providers, mainly psychiatric-mental health nurse practitioners (PMHNP), offer both therapy and prescription of certain medications. Lavender accepts several forms of insurance and plans to expand from New York to Washington state this fall. Drs. Dhillon-Chattha and Gannon are also working on creating other options, including an online chat, to make talking to a provider as easy as possible as we continue to move through the pandemic.
“PTSD is going to be a huge issue post-pandemic because we’ve all experienced this collective trauma,” said Dr. Gannon. “And for those of us who have had previous trauma in our lives, COVID has been really triggering… Some are being re-traumatized in the process of seeking care, so we felt there was a real time-sensitive need for an online psychiatry office that was super responsive and kind at every moment of the client journey.”
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These stories are just a small snapshot of the many ways in which nurses are innovating and leading to improve care delivery in communities. Johnson & Johnson is committed to advocating for, elevating and empowering nurses as they transform healthcare and change human health for the better. The
Accelerating Nursing, Transforming Healthcare
research findings provide strong evidence of the impact of the nursing profession and nurses’ capacity to bring personalized, appropriate care directly to patients where they are. Explore these research findings and join us as we work to define a progressive path forward for the nursing profession that will help drive transformative health change for all.
