Clinical environments that provide mental health and addictions care have been challenged during the COVID-19 pandemic due to health human resource shortages. This paper provides some insights gleaned from nurse and physician leaders working together during the pandemic in the mental health context to tackle some of these challenges. Key takeaways are provided.
In March 2021, Joy Richards and Brian Hodges shared their experiences as University Health Network's chief nurse and chief doctor, respectively, in an article posted to the organization's website (Richards and Hodges 2021). The two leaders described their combined effort in providing significant support to long-term care homes, which were hit particularly hard by the virus from the beginning of the COVID-19 pandemic. At the end of the description of their admirable efforts, Richards and Hodges (2021) shared the following reflection: "The biggest lesson is that we are stronger together." As the Centre for Addiction and Mental Health's (CAMH's) chief nurse and chief doctor, respectively, we could not agree more. Our work together as discipline leaders has demonstrated that collaboration is essential in meeting the challenging demands of supporting mental healthcare delivery during the pandemic. We have written this piece to share some of the insights we gleaned from working together in this uniquely challenging context, including our shared feeling with Richards and Hodges of being much stronger when working together.
Our first example arises from our belief that the physical, "on-the-ground" presence of clinical leaders is not only important but also essential for working through the clinical challenges experienced on a daily basis at the hospital and for establishing trust and empowering clinical teams to problem-solve effectively (Ahern and Loh 2020). This means not only being present in our offices but also being actively present in clinical areas and problem solving with our clinician colleagues while maintaining or, in some cases, building new relationships across the organization (Taylor 2021). For us, this also includes offering our assistance as direct care clinicians at a time of dire need for health human resources at our organization (Gillian Strudwick in the vaccine clinic and Vicky Stergiopoulos in the bridging clinic). This, in turn, allows us to obtain a more sincere understanding of the realities and stress clinical staff face while practising during the pandemic (D'Auria and De Smet 2020). This then allows for a "medicine, nursing and health disciplines" voice at leadership decision-making tables with a shared understanding of the clinical realities. At our organization, as in others, we have very acutely felt the health human resource shortages. Similar to the situation in other general hospitals, our clinical staff are weary and "burnt out" from working in challenging conditions, being redeployed, being short-staffed or having additional responsibilities to maintain round-the-clock care continuity. Being physically present in front-line care delivery allows us to deeply appreciate and share these experiences with understanding and compassion at key decision-making tables.
A second example is thinking and acting creatively with our operational and information technology colleagues to promote the adoption and use of certain kinds of technologies to support activities that were previously done face to face and are essential in providing mental healthcare. These are activities such as conducting and documenting remote assessments, facilitating a connection between in-patients and family and friends via tablets, ensuring that our patients can connect with members of their support network (e.g., advocates and community workers) and attending therapeutic or recreational groups virtually. Our shared work also includes collaborating with other members of our teams to support the evaluation of these technologies and identify their impact in order to ensure that our reliance on technology does not inadvertently disadvantage certain individuals or populations.
A final example includes supporting efforts to ensure that our patients and staff are vaccinated. These efforts also include addressing vaccine hesitancy. This is truly a collaborative effort with colleagues in other leadership roles (e.g., operations, communications and health human resources), internally as well as externally (e.g., Toronto Academic Health Science Network and regional leadership tables). These are a few ways to ensure that our patients and staff are vaccinated: working collaboratively to communicate and share appropriate knowledge about the vaccines available, offering information and educating and identifying champions in each clinical area to encourage and promote vaccine uptake and, finally, supporting the staffing of the vaccine clinic for patients, staff and the public. While vaccine hesitancy persists in some settings, more than 80% of eligible staff in our facility have been vaccinated to date.
As the pandemic continues, we see several key issues that we will need to address to be in "lockstep" in our collaborative approach. This includes managing dire health human resource challenges, ensuring appropriate round-the-clock care continuity and supporting an exhausted and often "burnt out" mental health workforce. While it will be no easy task, appreciating that we are "stronger together" can be a source of support in knowing that we can get through this difficult time, in role-modelling interprofessional collaboration and in inspiring hope and optimism. We share a few key takeaways from our experiences:
- Clinical leaders ought to be physically present, working side by side with their front-line colleagues in challenging times. This allows for a truly informed voice at leadership and decision-making tables.
- Technology should be leveraged in creative ways beyond virtual care to ensure that our patients have the best care experience possible. Patients and clinical staff can be innovators in this space and be provided with the freedom and support to innovate.
- When resolving key issues, we must work together to create solutions that resonate with multiple professional disciplines (e.g., addressing vaccination uptake) and not duplicate efforts.
- We must be aligned in efforts to advocate for our patients and clinical staff at a regional and a provincial level. Our voices are amplified when we do this together.
As nursing and medicine leaders at CAMH, working together to support some of the most vulnerable members of society during the pandemic has been an honour and a privilege. We owe it to our patients and staff to stay in "lockstep" post-pandemic and accelerate efforts to advance clinical practice and improve patient experiences.
About the Author(s)
Gillian Strudwick, RN, PhD, FAMIA, is the chief nursing executive (interim) and a scientist at CAMH. She is also an assistant professor at the Institute of Health Policy, Management and Evaluation, University of Toronto in Toronto, ON. She can be reached at email@example.com
Vicky Stergiopoulos, MD, FRCPC, MHSc, is the physician-in-chief and a clinician scientist at CAMH. She is also a professor at the Department of Psychiatry, University of Toronto in Toronto, ON.
Ahern, S. and E. Loh. 2020. Leadership during the COVID-19 Pandemic: Building and Sustaining Trust in Times of Uncertainty. BMJ Leader. doi:10.1136/leader-2020-000271.
D'Auria, G. and A. De Smet. 2020, March 16. Leadership in a Crisis: Responding to the Coronavirus Outbreak and Future Challenges. McKinsey & Company. Retrieved May 27, 2021. <https://www.mckinsey.com/business-functions/organization/our-insights/leadership-in-a-crisis-responding-to-the-coronavirus-outbreak-and-future-challenges#>.
Richards, J. and B. Hodges. 2021, March 5. The Biggest Lesson Is that We Are Stronger Together. UHN Foundation. Retrieved April 16, 2021. <https://tgwhf.ca/stories/the-biggest-lesson-is-that-we-are-stronger-together/>.
Taylor, B. 2021, February 25. How to Stay Optimistic (When Everything Is Awful). Harvard Business Review. Retrieved May 27, 2021. <https://hbr.org/2021/02/how-to-stay-optimistic-when-everything-is-awful>.
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