“The best way to find yourself is to lose yourself in the service of others.” – Mahatma Gandhi (Biography.com Editors, 2020, pg. 1)

It is critical to reflect on nurses’ extraordinary frontline efforts...Finding themselves in a global health pandemic for the first time in over 100 years, nurses have been lauded for their courage, compassion, flexibility, and responsiveness. It is critical to reflect on nurses’ extraordinary frontline efforts, gain insight into what worked well and lessons learned, and amass guidance to inform future disaster response. Using exemplars from Advanced Practice Registered Nurses (APRNs; see Table) at an urban, academic medical center in the United States (U.S.), the purpose of this article is to describe how the Serving Leadership model can provide rapid, role-pivoting support and an effective nursing practice response during a pandemic. We invite readers to consider these illustrative challenges and successes within the context of their own institutions.

Table. Roles of Advanced Practice Registered Nurses (APRNs)

In the United States, APRNs provide safe, high-quality, low-cost, evidence-based healthcare for patients, families, and communities. APRNs have earned a graduate nursing degree in a specific APRN role and patient population; attain advanced level licensing and certification; and engage in direct clinical practice with patients and families (National Council of State Boards of Nursing [NCSBN], 2021).

Impact of SARS-CoV-2 on Delivery of Hospital Care

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, and the resulting illness COVID-19), first reported in China as a cluster of pneumonia cases on December 31, 2019, spread to the United States with its first recorded case on January 20, 2020 (Holshue et al., 2020). The World Health Organization (2020) declared the outbreak a pandemic on March 11, 2020. The COVID-19 pandemic had profound impact on the demand, resources, and capacity of healthcare systems worldwide. The challenges brought a new level of understanding about pandemics and required a response that was foreign to most healthcare leaders and administrators. The healthcare community faced preparation for difficult disruptions and situations that required innovation, strong leadership, and bold adaptation.

The challenges brought a new level of understanding about pandemics and required a response that was foreign to most healthcare leaders and administrators.Hospital systems nationwide encountered many challenges as the critically ill COVID-19 positive patients required advanced therapies, including mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Creating a safe environment to care for this population was paramount. For example, facilities needed to establish or convert existing spaces into negative pressure isolation units. Hospital leaders also needed to monitor and access their inventory of personal protective equipment (PPE), such as N95 masks, power air-purifying respirators, and isolation gowns. Other considerations included staffing, patient visitation policies, bed expansions, elective procedure schedules, and ventilator purchases and repurposing.

Psychological Phases of a Disaster

These reactions often affect work-related behavior and productivity.Effective leadership during a crisis requires understanding and recognizing the common reactions (e.g., physical, emotional, cognitive, and behavioral) an individual shows in response to a disaster (U.S. Department of Health and Human Services [DHHS], 2016). Among the typical reactions are anxiety, stress, loss of sleep or appetite, irritability, hopelessness, grief, or family conflict (DHHS, 2016). These reactions often affect work-related behavior and productivity. Furthermore, a community experiences six psychological phases of a disaster: pre-disaster, impact, heroic, honeymoon, disillusionment, and reconstruction (DHHS, 2016). Each phase has distinct characteristics that can help a leader to better understand team encounters and identify the best ways to provide support.

Serving Leadership

Serving Leadership emphasizes the role of a leader as a steward of organizational resources Using a leadership framework is an asset and important skillset for any nurse leader. In a critical, dynamic environment, it is even more important to polish and use skills to the fullest extent. One effective leadership framework is Serving Leadership, developed by Ken Jennings. Serving Leadership emphasizes the role of a leader as a steward of organizational resources (Jennings & Stahl-Wert, 2016). This model accentuates sharing leadership with others as the optimal path to achieve set goals and emphasizes collaboration, trust, compassionate presence, and the ethical use of power (Jennings & Stahl-Wert, 2016). As a contrast, transactional leadership is more traditional, based on authority from the leader and loyalty to that leader with a focus on reinforcement and reward (McCleskey, 2014). The five key concepts (nonsequential) of the Serving Leadership framework include: Run to a Great Purpose, Upend the Pyramid, Raise the Bar, Blaze the Trail, and Build on Strengths. Applying these concepts can benefit any leader who is amidst a critical event (Jennings & Stahl-Wert, 2016).

Exemplars

The elements of Serving Leadership are not exclusive to particular phases of disaster...Leaders in a pandemic can combine principles of Serving Leadership with an understanding of the psychological stages of disaster to ensure continuation of high-quality healthcare. Examples of this are using the expertise and strengths of APRNs, maintaining staff safety within the pandemic environment, and providing the resources and support necessary for frontline workers. The elements of Serving Leadership are not exclusive to particular phases of disaster; however, using APRN role-specific exemplars, we illustrate the various stages of the COVID-19 pandemic and effective operationalization of Serving Leadership concepts.

Pre-Disaster and Impact Phases
In March 2020, as the implications and reality of the pandemic set in, healthcare providers were entering the first two psychological phases of a disaster: pre-disaster and impact. The pre-disaster phase is characterized by fear and uncertainty, with feelings of vulnerability, insecurity, unpredictability, and a loss of control of the situation (DHHS, 2016). APRNs, along with the entire healthcare team, exhibited these feelings as they were concerned for their own safety and the safety of their families.

As APRNs were balancing the needs of their patients and care teams, they also served each other...Information and discovery about SARS-CoV-2 and the COVID-19 illness, was dynamic. Safety guidelines were ever-changing, and the disease course was unpredictable and unknown. Normal routines of daily life for the frontline team were disrupted and changing at a fast pace. It was necessary for leaders to absorb the fears of their team and to mitigate these fears by rapidly interpreting scientific recommendations as they developed. In transitioning to the second psychological phase of a disaster, the impact phase, an initial emotional low is experienced as shock, panic, and disbelief, followed by feelings of family protection and self-preservation (DHHS, 2016). As APRNs were balancing the needs of their patients and care teams, they also served each other, bolstering fellow APRNs with a focus on self-care and wellness.

At the foundation of the Serving Leadership framework are leaders who articulate the team’s greater purpose; direct, motivate, and guide the teams; and focus them to put forth their best effort (Jennings & Stahl-Wert, 2016). By establishing a greater goal, the desired outcome is set and the progress toward that purpose can begin. As APRN team leaders began to formulate greater goals and develop plans of actions, healthcare team members made the transition from the pre-disaster phase to the impact phase.

...two greater goals emerged that described and captured the overall purpose of the response...Like responses to previous pandemics or disasters, two greater goals emerged that described and captured the overall purpose of the response; subsequent initiatives then followed. The first greater goal was to continue to provide safe, high-quality care to patients with and without COVID-19 illness by incorporating innovative initiatives that involved direct patient care, nursing practice, and organizational response. The second and equally important greater goal was to maximize staff safety through resource allocation, distribution of supplies and equipment, training, and providing a safe working environment. However, many pitfalls could have led to suboptimal achievement of these greater goals. Using a fishbone or Ishikawa diagram, we visually present the various challenges faced by healthcare teams in Figures 1 and 2.

Figure 1. Fishbone Diagram of Potential Risks to Greater Goal #1: Providing Patient Care. COVID-19, Coronavirus Disease

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Figure 2. Fishbone Diagram of Potential Risks to Greater Goal #2: Maintaining Staff Safety. COVID-19, Coronavirus Disease; PPE, Personal Protective Equipment

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APRNs offered diverse skillsets and clinical expertise to translate best clinical practices into patient care initiatives with finite institutional resources.With these potential threats front-of-mind, leaders from each of the four APRN roles (Table) organized and mobilized their teams, rich and diverse in specialty practice, to contribute to these greater goals in several ways. APRNs offered diverse skillsets and clinical expertise to translate best clinical practices into patient care initiatives with finite institutional resources. They were able to assist in breaking down barriers to provide solutions that ensured maintenance of both patient safety and quality care while supporting interdisciplinary providers who cared for patients in novel care roles and environments.

Heroic Phase
The third psychological phase in a disaster is the heroic phase. During this phase, emotional intensity continues to increase from the impact phase and is accompanied by an elevated level of activity with a low level of productivity (DHHS, 2016). A sense of altruism is exhibited, and the team demonstrates a high-energy rescue behavior. During the heroic phase, APRNs were motivated and mission-focused to accept challenges and meet the dynamic needs of the healthcare system.

Another essential component of Serving Leadership is to blaze the trail (Jennings & Stahl-Wert, 2016). The act of trailblazing is essential in a crisis. Trailblazing entails clearing the path ahead: finding new, promising ways of doing something and removing barriers and obstacles to team success (Jennings& Stahl-Wert, 2016). Although healthcare teams have experienced and responded to past disaster situations, this generation has never encountered a threat as ubiquitous and paralyzing as the COVID-19 pandemic. The SARS-CoV-2 virus kills both compromised individuals as well as young, otherwise healthy people. The method of infectious spread was initially unclear, whether airborne or droplet. New findings and guidance were coming from every source imaginable and at a rapid-fire pace. This new, unknown fear placed extraordinary stress on our communities, our staff, our resources, and ourselves.

Trailblazing entails clearing the path ahead: finding new, promising ways of doing something and removing barriers and obstacles to team successTo mount an effective response, it was necessary to blaze a new trail. The way we had provided care, controlled our care environments, allocated medications and other resources, had to change. Our “business as usual” days were, for the near future, gone. We needed to pull knowledge from all our previous learning and training, but leverage it in innovative ways to meet this unique threat. It was imperative to step forward and take on new roles, to be flexible and dynamic, and to capitalize on our strengths and the trusting relationships we had built over many years to lead our colleagues through this storm.

Blazing a trail to adapt and overcome first required clear identification of barriers that involved equipment and materials, education and training, and communicating at the systems level. For leadership, the incredible volume of information and conflicting and rapidly changing guidance were overwhelming and difficult to communicate to a large healthcare system. Leaders needed to decide who to trust, when to pivot, how much to share with the team, and when. Not only did healthcare providers need to know crucial information, the development of new teaching and resources for patients and families was critically important. As the APRN team was creating a new path with ideas and tasks to support the identified greater goals (providing safe patient care and maintaining staff safety), internal motivation to make a difference was clear, as illustrated in the following exemplars.

Leaders needed to decide who to trust, when to pivot, how much to share with the team, and when. Clinical Nurse Specialists (CNSs), with their unique ability to influence care at patient, nursing practice, and organizational levels, were well-positioned to blaze new trails. Some developed new specialty-specific COVID-19 testing algorithms for patients (e.g., oncology, transplant) as others worked closely with nurse leaders to operationalize new roles such as safety officers to observe and provide real-time feedback on safe PPE donning/doffing procedures. Maintaining up-to-date knowledge about emerging evidence and expeditiously translating this for staff was a CNS priority.

CNSs empowered nurses and other disciplines with rapidly evolving best practices, physical presence, and direct support... Expertise in both technical and adaptive skills (e.g., trust-building and change management) were also distinct CNS assets. Serving in both direct and indirect communication roles, CNSs conveyed needs that impacted patient care and flow, capacity management, and supplies, leading their teams in management of limited resources. CNSs empowered nurses and other disciplines with rapidly evolving best practices, physical presence, and direct support while they cared for unfamiliar patient populations in alternative environments. As leaders, CNSs readily embodied Serving Leadership by maximizing the strengths of their colleagues, coordinating and facilitating their efforts, and amplifying their voices to leadership.

Although SARS-CoV-2 was a novel virus, the CNS drew from previous advanced patient care and nursing practice experience...In the health system-level command center, the operations team quickly noted that a comprehensive and precise method was needed to track PPE across various entities in a way that would allow for equitable equipment prioritization and allocation. A CNS serving as operations chief coordinated and facilitated the efforts of multiple clinical and ancillary teams, including those responsible for staff PPE. Although SARS-CoV-2 was a novel virus, the CNS drew from previous advanced patient care and nursing practice experience to communicate and coordinate PPE needs from command to bedside and back. In true Serving Leadership form, the CNS recognized and deferred to the expertise of others (e.g., health safety managers, supply officers, fit-testing personnel, volunteers with project management skills) as they worked to champion efforts toward the greater goals and resolve barriers to success. The CNS prioritized these efforts while maintaining continuous communication with command. As a result, the team successfully developed a robust PPE tracking and allocation structure that maximized use of this vital and limited resource to maintain staff safety.

CRNPs, as clinical experts, were central to the provision of focused communication and education...Certified Registered Nurse Practitioners (CRNPs) played a central role throughout our institution during the pandemic by developing and engaging in timely, relevant, and focused communication. Communication served as a pivotal tool. Effective messaging allowed staff to form a connection when their roles were rapidly altered and they found themselves transitioning from practice experts and consultants to novel critical care providers without opportunity for timely orientation and training. CRNPs, as clinical experts, were central to the provision of focused communication and education, and development and synchronized communication of best care practices as information emerged.

...CNMs successfully triaged patient needs by embracing telehealth while postponing non-urgent in-person visits...Certified Nurse Midwives (CNMs) experienced a change in their normal practice and blazed a new trail by quickly transitioning office visits to televisits. The CNM team was removed from the hospital to minimize possible viral transmission and exposure of additional healthcare team providers. Adhering to the national telemedicine recommendations, the CNM team completed obstetric visits by televisit along with gynecology visits where discussions of common issues (e.g., vaginitis) were treated without testing or examination. Telemedicine visits ensured continuity of care for contraception issues as other preventive annual exams were postponed. With innovation, CNMs successfully triaged patient needs by embracing telehealth while postponing non-urgent in-person visits, in the interest of patient safety and exposure.

Honeymoon Phase
Teams felt optimistic that this new normal was temporary and that life would be back to normal in a short time.The honeymoon phase, the fourth psychological disaster phase after the sense of heroism, is characterized by a shift in emotion to optimism, community bonding, and hope (DHHS, 2016). At this point in the pandemic, APRNs were deployed throughout the hospital, settling into new roles and environments, establishing relationships with new team members, and working hard to achieve the greater goals. Teams felt optimistic that this new normal was temporary and that life would be back to normal in a short time.

Raising the bar is another component of Serving Leadership (Jennings & Stahl-Wert, 2016). Setting expectations a little higher for a team stretches their potential and challenges their strengths. Raising the bar is accomplished through communication of desired goals, pursuing process improvement, and making gains in productivity or patient outcomes (Jennings & Stahl-Wert, 2016).

During the COVID-19 pandemic, the healthcare system instinctively called for APRNs to raise the bar...During the COVID-19 pandemic, the healthcare system instinctively called for APRNs to raise the bar by demonstrating expertise in clinical judgment and care practices while simultaneously promoting practice progression and development among peers in a challenging, unfamiliar, resource-scarce care environment. To account for patient complexity and time and personnel constraints, the crisis required a streamlined workflow with creative education and communication practices. Both resources and APRNs needed adaptation to serve in a variety of expanded roles that could meet ever-changing expectations of the acute care provider team. Aligned with the first greater goal of providing patient care, APRNs were involved in protocol development, redeployment of assets, and rapid acceleration of integration.

At the recommendation of the American College of Surgeons (ACS), hospital leaders were asked to minimize, postpone, or cancel electively scheduled operations so that the facility infrastructure and resources could support the pending surge of patients with COVID-19 (ACS, 2020). This rescheduling caused a sharp decline in surgical cases and provided an opportunity to use the critical care skillset of Certified Registered Nurse Anesthetists (CRNAs), who were less in demand in the operating room. Leadership determined that the greatest needs of the hospital were additional staffing for respiratory therapists (RTs) and registered nurses for the intensive care unit (ICU). Many CRNAs redeployed and were trained in those functions.

CRNAs were paired with registered nurses who did not have formal critical care training and needed extra support and mentorship...Before matriculating into a nurse anesthesia educational program, applicants are required to work in an ICU for a minimum of 2 years. Therefore, the 2-day orientation for the CRNAs served as a re-acclimation to critical care nursing. The orientation consisted of unit-specific organization, electronic health record requirements, and familiarity with continuous renal replacement therapy, ICU ventilation modes, and ECMO. The redeployed CRNAs were assigned to work in a COVID-19 positive unit that had previously provided intermediate care before the pandemic. CRNAs were paired with registered nurses who did not have formal critical care training and needed extra support and mentorship to care for intubated, critically ill patients.

...another group of CRNAs was deployed to function in the RT role. The surge of patients with COVID-19 who needed mechanical ventilation caused staffing shortages among respiratory therapists. Therefore, another group of CRNAs was deployed to function in the RT role. Because CRNAs have the skillset of advanced airway and ventilatory management, their knowledge and expertise translated easily to this new role. The 3-day orientation with an RT in six different ICUs consisted of learning equipment (e.g., different ventilators, oxygen therapies), electronic health record charting responsibilities, and specific patient care requirements of respiratory therapy (e.g., equipment changes, ventilator checks). CRNAs were staffed alongside RTs in the ICUs, evenly dividing the patient workload.

CRNPs who had critical care practice expertise were deployed to units where they served as practice experts, led teams of non-critical care providers and junior residents, and collaborated centrally with intensivists to ensure that the complexity of these patient populations was integrated and communicated into care delivery. Within this leadership role, they ensured maintenance of critical care best practices, including hemodynamic monitoring and mechanical ventilation for profound hypoxia. CRNPs were challenged to both serve as mentors for interdisciplinary providers unfamiliar with the critical care environment and simultaneously directly care for a novel patient population.

CRNPs with teaching expertise in specialty practice also developed focused, measurable orientation objectives and content. CRNPs with teaching expertise in specialty practice also developed focused, measurable orientation objectives and content. Their goal was to standardize and support consistent training and practice expectations for CRNPs deployed to care for critical and acutely ill patients. These measurable outcomes were developed according to evidenced-based best practices, dynamically evolving as practice care strategies and recommendations surrounding COVID-19 changed.

CRNPs used communication delivery strategies to ensure that all education material distributed to nurses and support staff throughout the pandemic was vetted by credible medical and nursing organizations, and based on evolving best practices. CRNPs developed central virtual portals to organize and compile educational materials. However, management of the portals required vigilance to ensure that information provided to staff was timely, relevant, and easily accessible from multiple sources. Additionally, CRNPs developed condensed, focused educational materials in the form of “fast facts” and education videos that could be completed in no more than 10 minutes. Both methodologies were developed to support consistent care practices and empower providers as they cared for medically complex patients in alternate and unfamiliar environments. The “fast facts” and 10-minute videos were so well-received, including these methodologies in future large-scale response planning is now highly recommended.

CRNPs ensured that vigilance and consistent care delivery standards were upheld and that staff were empowered to deploy despite their uncertainty. Many specialty surgical patients (e.g., those who had undergone transplant and head and neck surgery) were placed in care locations with nursing staff unfamiliar with them and their specific needs. These specialty patient populations require diligent monitoring for procedural complications and extensive discharge education. CRNPs with specialty patient population expertise served as mentors for nursing staff. They provided engaging communication and education on care practices to empower nurses and interdisciplinary colleagues caring for these complex patient populations.

Collectively, the most powerful communication strategy utilized was supportive leadership of CRNPs with expertise in critical care, advanced hemodynamic monitoring, advanced airway management, and population-specific needs who engaged with interdisciplinary staff redeployed to these practice environments. This engagement enabled consistent delivery of evidenced-based practice care and supported interdisciplinary teams. CRNPs ensured that vigilance and consistent care delivery standards were upheld and that staff were empowered to deploy despite their uncertainty. This facet of APRN leadership should be both remembered and continued beyond the boundaries of this COVID-19 pandemic.

Disillusionment Phase
In this phase, optimism turns to discouragement and fatigueAs reality set in and large numbers of patients with COVID-19 continued to be admitted, the fifth disaster phase of disillusionment became apparent. In this phase, optimism turns to discouragement and fatigue (DHHS, 2016). Physical exhaustion, poor coping skills, alcohol and substance abuse, loneliness, anxiety, and depression may begin to surface (DHHS, 2016). The disillusionment phase can last months to years and can be extended by events specific to this pandemic, including new surges in patient disease.

During this phase, upending the pyramid, another component of Serving Leadership (Jennings & Stahl-Wert, 2016), can be put into play. Serving leaders put their team members and needs first, creating empowerment through shared leadership (Jennings & Stahl-Wert, 2016). Serving leaders also contain their egos and focus on building team confidence, hope, and optimism, all while having a compassionate presence (Jennings & Stahl-Wert, 2016). During the COVID-19 pandemic, as teams began feeling fatigue and exhaustion from disillusionment, it was essential for serving leaders to listen and engage with staff, allow them to articulate their needs and concerns, and facilitate the creation of optimism and hope. Once again, it is important to establish and reassess the greater goals to keep the team focused.

APRN leaders were consistently present with staff, often working side by side to offer support and engagement.Serving Leadership communication strategies are not just a matter of an expert relaying information to interdisciplinary providers, but also involve listening to staff. APRN leaders were consistently present with staff, often working side by side to offer support and engagement. These opportunities for information exchange allowed APRNs to develop meaningful communication and provide education that was both timely and effective.

CRNPs faced many challenges maintaining patient- and family-centered care during the pandemic when visitor restrictions were implemented to increase patient and staff safety and reduce transmission risk. To ensure that patient status communication was consistent among all care team members who provided updates to families, they streamlined information from rounds, daily care goals, and interventions into concise information sheets that were available to nursing and care teams and could be emailed to family members. CRNPs also engaged in institutional discussions surrounding visitation and advocated for family presence during discussions about goals of care and end of life. They provided insight into unique circumstances surrounding these critical discussions and the importance of continual engagement to support families and patients during the complexity of critical illness.

...the disillusionment phase is of most concern with regard to the well-being of frontline workers.Arguably the phase of disaster that needs the most attention, the disillusionment phase is of most concern with regard to the well-being of frontline workers. The COVID-19 pandemic has placed APRNs at high risk of stress and burnout (Peck & Sonney, 2021). Despite PPE, the team risks exposure to the virus every day they come to work. There is also evidence that APRNs experienced moral distress in some geographic locations (Meese, Colon-Lopez, Singh, Burkholder, & Rogers, 2021), as the surge of patients with COVID-19 exceeded bed capacity and hospital resources, leaving APRNs to make difficult healthcare decisions. The resiliency of nurses has been challenged and tested, yet not diminished or broken.

Reconstruction Phase
Reconstruction is the sixth and final phase of disaster. It is characterized by a feeling of recovery in which individuals and communities assume responsibility for rebuilding their lives (DHHS, 2016). In this phase, people adjust to a new normal while they continue to grieve losses. Reconstruction typically begins on the anniversary of the disaster and can continue for a substantial period of time (DHHS, 2016). Although the world approached the anniversary of the COVID-19 pandemic in March 2021, it seems unreasonable to think that our society is experiencing this phase of disaster. Many have recovered from the virus, yet we are still experiencing the crisis with renewed hope as the vaccine is being distributed.

Serving leaders focus on the strengths of the team, rather than the weaknesses. The last asset to the Serving Leadership framework is to build on strengths (Jennings & Stahl-Wert, 2016). Serving leaders focus on the strengths of the team, rather than the weaknesses. They concentrate on enhancing team assets by connecting individual strengths to form a team that will be able to work to accomplish the greater goal (Jennings & Stahl-Wert, 2016). The strengths of APRNs have been on display for entire healthcare systems to witness, appreciate, and value. At every opportunity, APRNs accepted the challenge, practiced innovation, and supplied solutions and ideas that created synergy among teams. As powerhouses of perseverance, they have exhibited flexibility with their skillset to lead, deliver high-quality healthcare, and educate. Each of the different APRN roles have collaborated and built on their collective strengths to offer aid in this global pandemic.

Conclusion

The COVID-19 pandemic has highlighted newfound strengths and capabilities of APRNs. It has highlighted resilience, versatility, flexibility, and adaptability and their ability to pivot and respond rapidly. It has also underscored the intense camaraderie of APRNs who contributed to the greater goal and broke down silos as teams were given the opportunity to work together. For example, the advancement of telehealth has been profound in such a short period of time. Going forward, it is important to capitalize on these strengths as we continue our journey through this disaster. The hope is to continue to strengthen and build on the attributes and skillsets of APRNs.

The COVID-19 pandemic has highlighted newfound strengths and capabilities of APRNs.The COVID-19 pandemic has illustrated the vulnerability of this group of healthcare providers as they continue to provide disaster relief over an extended period. The situation provides an opportunity for mental health CRNPs and CNSs to lend their expertise by facilitating support groups and encouraging safe, social connections and wellness conversations about self-care, stress relief, healthy diet, exercise, meditation, and gratitude. As a society and a profession, we must recognize, support, and appreciate the sacrifice of nurses. The preservation of this frontline workforce will require a strong focus on wellness and self-care. A nurse leader equipped with the Serving Leadership principles and an understanding of the psychological phases of disaster can offer successful leadership to healthcare teams through this pandemic and any that arise in the future.

Acknowledgements

The authors would like to acknowledge and thank Mona Shattell, PhD, RN, FAAN, Associate Dean for Faculty Development, Johns Hopkins School of Nursing and Cathy Horvath, DNP, MSN, CRNA, Program Director of the Nurse Anesthesia Program, Johns Hopkins School of Nursing, for their advisement and feedback. We would like to recognize Claire Levine, MS, ELS for her edits and suggestions with this article. We also are so grateful for all the nurses and frontline workers who continue to tirelessly and unselfishly work day after day during this pandemic providing high-quality care to their patients.

Authors

Andrew R. Benson, DNP, MSN, CRNA, FAAN
Email: abenson4@jh.edu

Andrew Benson is the assistant program director of the DNP Nurse Anesthesia Track at the Johns Hopkins School of Nursing and the former chief CRNA at Johns Hopkins Hospital (JHH). Dr. Benson has extensive experience in anesthesiology, clinical practice, and team leadership. As the chief CRNA, he led a team of more than 100 CRNAs at JHH and provided administrative oversight of all CRNAs across the entire Johns Hopkins Health Care System. He successfully led his CRNA team through the COVID-19 pandemic with redeployment of CRNA teams to the intensive care units to assist with ICU and respiratory therapy care. He promoted advocacy and advancement of clinical practice of the Maryland CRNAs through policy, education, and awareness during his involvement with the Maryland Association of Nurse Anesthetists, which included serving as its president. Dr. Benson earned a BA in biology at Carroll College, a BSN at the Johns Hopkins School of Nursing, an MSN at Duke University School of Nursing, and a DNP at Rush University.

Jessica S. Peters, DNP, MS, RN, ACNP-BC
Email: jsikkem1@jh.edu

Jessica Peters is an assistant professor at the Johns Hopkins University School of Nursing. Her clinical expertise is as an acute care nurse practitioner specializing in surgical critical care since with a focus on general surgery, surgical oncology, trauma and transplant. She received a doctor of nursing practice degree and post masters nurse educator certificate in 2015 from Johns Hopkins. She has also mentored several Fuld Fellows during their quality improvement projects in patient safety and interprofessional communication and collaboration within critical care. Dr. Peters also serves as an active member of the Society of Critical Care Medicine and has served on the society board review, advanced practice and patient family care subcommittees. She is a member of the American Academy of Nurse Practitioners within their Acute Care specialty practice group. Dr. Peters’ practice interests include care coordination, patient-family centered care, and unplanned critical care readmissions for patients with medical and surgical complexity.

Colleen Kennedy, DNP, CNM
Email: ckenne12@jhmi.edu

Colleen Kennedy is a nurse midwife at Johns Hopkins Community Physicians. She has a master's in nurse midwifery from Georgetown and has earned a DNP degree from Frontier Nursing University in 2015 with a focus on clinical protocol and admitting privileges for advanced practice nurses within hospital systems. She has worked closely with safety improvement committees at Johns Hopkins Hospital for reducing risks to laboring patients. She currently works full time with patients in the office and on the labor and delivery unit at Johns Hopkins Hospital. Dr. Kennedy was also the president of the Maryland Affiliate of the American College of Nurse Midwives from 2015-2018. She is a contributor to several textbooks related to maternal and child health.

Michelle Patch, PhD, MSN, APRN-CNS, ACNS-BC
Email: mpatch1@jh.edu
ORCID# 0000-0003-3639-6003

Michelle Patch is a board-certified adult health clinical nurse specialist and an Assistant Professor and CNS track coordinator in the Johns Hopkins School of Nursing. Dr. Patch maintains a clinical practice with Johns Hopkins Hospital and Johns Hopkins Medicine's Armstrong Institute for Quality and Patient Safety. She has held progressive clinical, operational, and safety leadership positions across inpatient, outpatient, emergency, and austere settings. She also has extensive practical experience in emergency management and disaster response, including service as a U.S. Navy Nurse Corps officer and Operations Chief for JHM’s COVID-19 Unified Command Center, as well as current efforts as Director of JHSON’s COVID Vaccine Volunteer Program.