While COVID-19 justifiably takes up a lot of bandwidth, the next big crisis could hit a nursing home from any direction, points out Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, AAPACN’s vice president of Education and Certification Strategy. “We have hurricanes, forest fires, floods, and other natural disasters, as well as manmade emergencies, such as a building fire, and even internal management- or staff-driven conflicts that can reach the level of a crisis. A very obvious example of that in many facilities right now is the still-ongoing issue of getting staff vaccinated and boosted with a COVID-19 vaccine.”
Directors of nursing services (DNSs) and other nurse leaders need to have the leadership skills in place so that they can drill down past their own fears and concerns to guide their team through any crisis. Keys to successful crisis leadership include the following steps, according to Stewart:
Get on the catwalk (i.e., model behaviors)
“As nurse leaders, you should model the behavior that you expect from others,” recommends Stewart. “Staff are constantly looking to their leaders, and they will pay attention to how you respond to a crisis. Your attitude is contagious, so choose wisely.”
Going back to the example of COVID-19 vaccinations, vaccine uptake is higher in facilities where the leaders have presented it in the best light possible, points out Stewart. “So, even in situations that either upset you or involve something that you as the leader don’t feel is the right move, take a moment to gather your thoughts and think about why this is important—the positive reasons you are doing it—before you present it to staff. If you are upset and let your staff see that you are upset instead of focusing on the benefits (i.e., the needs that will be met by this action), they could be less likely to get on board with whatever you are trying to do. You have to keep your reactions in check.”
It’s also important to model self-care, says Stewart. “In a crisis like COVID-19 and other emergencies, leaders often work, work, work. When staff see that, they often think that they need to work, work, work as well. While that may provide some short-term gains, the problem is that staff will then get burned out and want to leave their job because the crisis has caused them to have so much stress and anxiety. Therefore, you need to model taking breaks, eating healthily, and other self-care behaviors to limit the negative effects of the crisis on both you and your staff.”
Prioritize communication and information-sharing
Communication and information-sharing is always important, but it’s critical in a crisis, says Stewart. “You want to be a leader who gets out in front of a crisis and is the first to share information with staff. You also should be as comprehensive with your information as you can. Taking this approach reduces their anxiety of the unknown. You don’t want staff to fill in the blanks themselves.”
Nurse leaders also should select the most appropriate communication channel for the information being shared, suggests Stewart. “For example, if the news is sensitive or involves changes that staff will have a lot of questions about, you should deliver that information face-to-face vs. in a mass e-mail. Or if you have no choice but to deliver the information in an e-mail, the e-mail should clearly state what mechanism your staff should use to ask questions, as well as how and when you will provide answers.”
The goal is to have that personal interaction with staff and avoid delays in answering their questions, explains Stewart. “When staff have questions and can’t get answers right away, it will, again, cause more anxiety. They will start filling in the blanks themselves if they look to you for information and don’t get the answers they need.”
Be transparent so that gossip doesn’t take hold
“Transparency might seem like it is the same as communication and information-sharing, but it’s more focused on addressing what is happening within your organization and how your organization is responding to whatever the crisis is,” says Stewart. “Sometimes, leaders avoid telling staff things that will be upsetting. However, you don’t want to let gossip be the channel for information exchanges. Being transparent and keeping staff informed—even when the information is not good—shows that you are concerned, knowledgeable, and on top of things.”
Truthfulness is the bedrock of transparency, adds Stewart. “You should frame the news in the best possible way, but you should always be truthful and avoid overpromising to try to make staff feel better about the situation. Only promise what you can realistically follow up with because you don’t want to underdeliver. Taking these steps will help you build trust with your team.”
Be available to staff
During a crisis, staff experience a multitude of emotions, including fear, anxiety, and guilt, points out Stewart. “You need to be sure to make yourself visible to staff. During a crisis, you may spend more time in an office or in meetings, and it’s concerning to staff when they don’t see your presence in the facility. They may think that you don’t care. So, you have to find a balance.”
Part of being visible is being available to listen to and address staff concerns, says Stewart. “Some concerns may not even be valid, and all you need to do is tell them, ‘This isn’t a valid concern,’ and explain why. What’s important is responding to their concerns both timely and calmly.”
Find the time to be compassionate
To handle the complex emotions and uncertainty that go hand in hand with any crisis, nurse leaders should focus on being compassionate and patient toward staff, says Stewart. “It’s easy to think, ‘I don’t have time to deal with all of these staff concerns.’ The problem is that when we don’t address their concerns, staff feel like they don’t matter. Obviously, staff are extremely important and even more so in a crisis when you need all hands on deck. So, taking the time to be there for your staff in a compassionate way helps ensure that they are there for you as well and don’t jump ship during the crisis.”
One important step nurse leaders can take is to practice gratitude as a component of their daily routine, says Stewart. “Well-being rounds to ask, ‘Are you okay?’ can make a big difference. All you need to do is schedule five to 10 minutes, for example, at the beginning or at the end of each day to listen, to talk, and to be compassionate to staff.”
Small acts of kindness can show staff that their sacrifices have been recognized, adds Stewart. “Even a simple ‘Thank you, I have noticed what you are doing’ goes a long way toward helping staff feel important, and if they feel important, they will be empowered and engaged. It is critical that you treat people with respect and kindness and show them that you are thankful they are here with you going through this crisis.”
Be careful about venting the wrong way
Nurse leaders, like staff, experience some tough emotions during a crisis, but venting in the wrong way could create problems, points out Stewart. “It’s common for everyone now to express concerns to peers on social media, such as a Facebook group. However, there’s a difference between seeking constructive assistance and disrespecting your staff. Any venting that you do could be shared with your staff one day, even from a private Facebook group, and it would be hard to take that back. Instead, have a trusted friend or family member who you can speak with frankly, and save social media for the exchange of ideas and information.”
Re-imagine the new normal
When nurse leaders are trying to deal with whatever problems are in front of them, they sometimes forget to foster a sense of belonging and inclusion in staff, says Stewart. “You want to talk about the crisis, acknowledging loss and tragedy, but you also want to talk about what the future will look like. Everything may not be the same as it once was, but that doesn’t mean it will look like this crisis forever. Reimagine the new normal to create a shared vision and help instill hope for a better future in your staff.”
Practice leadership preparedness
Nurse leaders should approach crisis leadership similar to how they handle emergency preparedness—with planning, says Stewart. “Do some planning before the next big crisis hits,” she recommends. “It’s not easy to focus on the leadership that your staff needs from you when you are in the middle of a crisis. So, take a little time and create a brief checklist of the steps you can take as a leader to manage your team successfully.”
Additional Leadership Resources
- The Agency for Healthcare Research and Quality (AHRQ) has developed a series of three five-minute learning modules to help nurse leaders guide front-line staff to deal with anxiety and stress:
- Module 2: Tackling Stress Is a Team Effort; and
- Module 3: Supporting Each Other in the Quest to Reduce Stress.
- Grief Leadership During COVID-19 from the Center for the Study of Traumatic Stress offers practices that nurse leaders can implement to communicate more effectively to reduce staff worry and distress.
- A Guide to Promoting Health Care Workforce Well-Being During and After the COVID-19 Pandemic from the Institute for Healthcare Improvement (IHI) offers nurse leaders tools for combating staff burnout, fatigue, and emotional distress and is aligned with the IHI Framework for Improving Joy in Work. Providers can get on a waiting list to receive help testing and implementing Joy in Work strategies here.
- Leadership Response to a Sentinel Event: Respectful, Effective Crisis Management from the IHI is a compendium of resources to help leaders plan for and respond to a crisis.
- A Guide to Support the Well-being of Healthcare Personnel During a Time of Crisis from the National Center for Disaster Medicine and Public Health (NCDMPH) and the Uniformed Services University of the Health Sciences provides information and resources on how nurse leaders can help themselves, residents, and staff with physical health and mental health issues during a crisis. For example, the guide includes resources on maintaining sleep health, as well as helping staff manage stress when returning to work.
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