By LISA EISENHAUER
As the COVID-19 pandemic was easing its grip on parts of the country in mid-January, many of the hospitals in the Providence St. Joseph Health system were experiencing their worst surge of the virus yet.
Providence St. Joseph Health tapped frontline workers for extra shifts and moved staff between hospitals in response to patient loads. It contracted with outside clinicians to supplement and give some relief to weary staff.
Greg Till, executive vice president and chief people officer for Providence St. Joseph Health, said the demand on the system's staff has been staggering. "At the same time that we're delivering vaccine to more people than we ever have before, we're also caring for the highest percentage of COVID patients that we've seen and we're also doing everything that we can to continue the routine care that we would have delivered to folks that are having back pain, heart issues or other medical challenges," he said.
Dr. Matthew Swartz, a hospitalist at Avera St. Mary's Hospital in Pierre, South Dakota, takes a moment while caring for a patient with COVID-19 in October.
Despite the endurance challenge of the ongoing crisis, Till said a recent survey of caregivers did not find a significant spike in burnout or stress. In addition, turnover is at the lowest level in the seven years he has been with the system.
"We think a lot of that has to do with how our leaders are caring for our caregivers, the benefits that we're offering our caregivers and the availability of employee assistance program support," he said.
Leadership, added benefits
Providence St. Joseph Health leaders are joining staff on rounds to offer support and pitching in to administer vaccines to colleagues at some sites. Early in the pandemic, the system guaranteed pay for staff who were sidelined by the low patient volume when
nonessential care was paused for weeks. It covered the cost of day care for caregivers' children whose day cares or schools had closed. It also gave two weeks of emergency paid time off to staff who needed it.
Till said the system, which has facilities in seven western states, also has supercharged its EAP offerings. For example, it has set up virtual "behavioral health concierges" that workers can use to schedule free tele-visits for financial, emotional and spiritual support. And the system has launched a campaign called No One Cares Alone that teaches caregivers how to spot stress and strain in their colleagues and respond with empathy.
"Just like our caregivers are doing a full-court press to take care of everybody in our communities, we're doing a full-court press to take care of them," Till said.
Dr. Richard Vath is president and chief executive of Baton Rouge, Louisiana-based Franciscan Missionaries of Our Lady Health System. Vath said FMOLHS has taken many steps to ease the burden the pandemic has put on staff.
The system created a multidisciplinary task force at the start of the pandemic to set standard policies, clinical protocols and visitation rules. The consistency that engendered built confidence. "The staff felt comfortable that the people telling them what to do were people that they trusted," Vath said.
Having systemwide policies also has made it easier to shift staff among facilities, because no new training is required, and it has taken some of the burden off of managers to make decisions on things like care practices and use of supplies.
Vath said FMOLHS has taken steps to ease stress by letting staff take paid time off that they hadn't yet earned and then later waiving payback requirements. The system has paid out resilience bonuses to frontline care providers and added in pay differentials for those who have worked during COVID surges and accepted irregular shifts.
The system's pastoral care team staffs a spiritual support hotline that's available 24/7 to all 17,400 FMOLHS employees.
For managers, Vath restarted semi-
regular meetings that had been conducted two or three times a year to provide encouragement and a backstop. The meetings were paused early in the pandemic. The group has reconvened virtually for now. "We don't focus on the issues that they're dealing with as much as we deal with leadership and talking about resilience and how we can support them," Vath said.
As Catholic Health World went to press, FMOLHS planned to survey staff in late January to assess whether the incentives and support go far enough, given the grinding demands of the pandemic and sacrifices they have made. "While everyone is suffering so much, we really want to get a handle on how we might be able to help them," Vath said.
CHRISTUS Health system has hospitals in Texas, Louisiana, New Mexico and Arkansas, all pandemic hotspots at the start of the new year.
Kimberly King Webb, the system's chief human resources officer, said in mid-January that CHRISTUS had brought in outside clinicians to help staff for the patient surge. A state regional advisory council is providing additional nursing staff. The system also has relied on its staff to work extra shifts. "We have some associates who have delayed their scheduled vacations and chosen not to take days off throughout the pandemic," Webb said.
With that in mind, system leaders decided in December to change the policy for paid time off. The revision allows workers to carry time off hours over for up to one year.
Workers at a Providence St. Joseph Health ministry mug for laughs as they show their gratitude to the community for its support during COVID-19.
CHRISTUS ramped up its assistance programs to ease the strain on workers. One new benefit offered through a partnership with a company called Bright Horizons provides backup childcare for when a school or day care suddenly closes as well as discounts for childcare and tutoring services.
Staff can check in online with counselors as well as attend 30-minute virtual classes on mindfulness and how to manage stress. The system created a well-being guide for leaders that lists resources and offers tips for how they can build resilience in their teams.
"We're just really trying to meet associates where they are," Webb said. "Maybe they don't have as much time as they did before, so we're making it really easy for them to have access to emotional support."
Last year, as the demand to care for patients with COVID was pushing Avera McKennan Hospital and University Health Center beyond its normal limits, human resources staffers began wheeling a "sunshine cart" stocked with stress balls, water bottles, insulated cups, granola bars and stickers with messages like "You're awesome!" Workers at the Sioux Falls, South Dakota, hospital who had been putting in weeks of mandatory overtime help themselves to snacks and a conversational break.
Often, hospital leaders tag along. "How are you doing?" and "What else do you need?" the managers inquire.
Lori Popkes, the Avera McKennan chief nursing officer, said staff are grateful for that simple kindness. It comes on top of a comprehensive assistance program for Avera Health care providers that also includes free counseling and well-being resources. Avera McKennan created a buddy system to pair up co-workers to talk through their stress, it stationed a deejay in a lobby to lighten the mood, and it handed out gift cards and thank you notes to frontline workers courtesy of a hospital contractor.
"I think it's been very good in that there has been support from leadership and the organization as a whole, support to one another as team members and then there's been this tremendous community support," Popkes said. "That has built a really solid foundation for resilience."
Popkes said the staff's spirits have been lifted by the rollout of COVID vaccines. "When the first vaccines started, I walked over to the place where they were giving them (to staff) and it was like you could feel the hope in the air," she said.
By mid-January, the hospital was well into its second round of vaccinations for frontline staff and Popkes said the process was going smoothly. She expressed optimism that the worst of the crisis might be over, at least for South Dakota.
Avera's assistance to workers scarred by the ordeal of the pandemic will continue. Popkes said plans are taking shape to set up a "stress hotline" with trained counselors at the ready to offer support to frontline staffers who, like soldiers returning home from battle, have lingering trauma.
CHRISTUS Santa Rosa has chaplains dedicated exclusively to care of associates
In early 2019, Maggie Jones noticed the stress that workers at CHRISTUS Santa Rosa Health System hospitals were under and suggested to senior mission leaders the idea of hiring a chaplain dedicated exclusively to associate care.
Jones, regional director of spiritual care, got approval for a chaplain devoted to addressing workers' spiritual needs for 20 hours a week for one hospital in San Antonio, where the regional system is based. The go-ahead came with the understanding that the initiative would be on a trial basis for 18 months.
When the COVID-19 pandemic began its sweep a year later, the program already was so popular that the president of the hospital agreed that it was a needed ministry. By last summer, the chaplain's shifts had been expanded to 15 hours a week at each of two hospitals. In addition, the system last year added a slot for a second-year graduate student in clinical pastoral education to offer spiritual care to staff at The Children's Hospital of San Antonio and a part-time chaplain for associate care at CHRISTUS Santa Rosa Hospital – New Braunfels, in that Texas city.
"They stay busy during their whole shifts," Jones said of all the chaplains concentrating on the well-being of CHRISTUS associates.
She said the chaplains are trained listeners. "We are not advice givers. We don't try to fix a person's problems. We simply are there to listen and to share the burden."
All of the spiritual care providers for associates spread their hours across day, night and weekend shifts to be available in person to as many staff members as possible. And Jones encourages them to be creative in how they reach out to associates. One of the chaplains has taken that to heart by crafting a lantern that she carries with her as she makes her rounds. The lantern fashioned with LED lights is a homage to Florence Nightingale who carried a lantern while visiting her charges.
Jones gives the chaplaincy program for associates partial credit for reducing nursing turnover to 20% from 30% at one of the hospitals. Having a group of chaplains focused on spiritual care of associates frees other chaplains to concentrate on ministering to patients.
In addition to making regular rounds in the nursing units to meet with workers, the associate-care chaplains leave cards and notes about how to reach them in break rooms and at nurse's stations. Jones said that while the requests for spiritual care are heaviest among the nursing staff, the chaplains are also available for physicians, respiratory therapists, security and housekeeping staff.
"We're here for everyone," she said of the associate-care chaplains. "We're trying to make that known."
— LISA EISENHAUER
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