Reassigning medical staff to serve in new roles such as the ICU setting has been a crucial care strategy during the coronavirus pandemic.
Particularly in hotspots such as New York and New Jersey, medical staff shortages have been a hallmark of the coronavirus pandemic, requiring reassignment of staff to new roles.
To avoid being overwhelmed by coronavirus disease 2019 (COVID-19) patient surges, health systems and hospitals have redeployed medical staff to fill gaps and bolster the ranks of frontline healthcare workers. For example, anesthesiologists have been reassigned from performing elective surgery to providing respiratory care in the ICU setting.
Brian Lima, MD, surgical director of heart transplantation at Northwell Health's North Shore University Hospital in Manhasset, New York, was reassigned to care for seriously ill COVID-19 patients in a converted hospital ICU. He also is an associate professor of cardiothoracic surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York, and author of a recently published book, Heart to Beat.
Lima recently shared his insights into the successful reassignment of healthcare workers with HealthLeaders. The following is a lightly edited transcript of that conversation:
HealthLeaders: For healthcare workers, what is an effective mindset for reassignment?
Lima: In a pandemic, it's all hands on deck. Everybody has to contribute. For me, I ceased being a cardiac surgeon and became a COVID doctor. At the same time, this is what we trained for. We trained to help people and to save lives. This is what the Hippocratic Oath is all about.
You have to take it one day at a time. Do the best that you can and give it your all.
It has to be a growth mindset. You see the growth mindset in a lot of the entrepreneurial literature. When there is an unexpected development or negative outcome, instead on getting down on yourself or slipping into pessimism, you flip it into a positive. If it is a single event, that is not going to define you as a person or a professional.
In this instance, no one saw the pandemic coming and it is a devastating crisis, so you have to try to flip it to a positive lens. This is an opportunity to grow. This is an opportunity to help others. It is not about you—it is about doing good for as many people as possible.
HL: How did you turn responding to the pandemic to a growth mindset?
Lima: I felt that I took care of critically ill patients all the time. As we converted our cardiac ICU into a COVID ICU, I realized these were also critically ill patients with lungs being devastated by the virus. So, it was a matter of pivoting in the way that I take care of critically ill people and going more in depth into one organ system and managing ventilators.
HL: What are the key elements of training and preparing healthcare workers for reassignment?
Lima: What worked well for us is that there were some physicians who were well prepared for reassignment—they spend a lot of their professional time managing complicated patients on a ventilator. We had refresher training with these specialists through Zoom and refresher documents, so we were all on the same page.
We established an approach for critically ill COVID patients and developed a check list for how we were going to progress through our ventilator management. So, it was nice to have concentrated expertise and to disseminate that expertise to physicians who were getting back into the fray in the area of acute respiratory distress syndrome.
It also is important to have backup, so you are not being put on an island all alone. You could always call upon others—we were all in this together. There was a lot of support from physicians who specialized in respiratory failure. It helped reassigned physicians feel comfortable in working with COVID patients.
HL: Based on your experience of reassignment to the respiratory failure ICU setting, what are the keys to success in functioning well in a reassigned role?
Lima: At the individual level, you have to check your ego at the door. Although you may be expert at a specialty, in this environment, where knowledge about the coronavirus is changing daily, you have to be humble. You have to be willing to ask for help, and the help has to be readily available.
It takes courage. Healthcare workers are in a situation where we have an imminent risk to ourselves and to our families at home. You need the courage to face that fear every day and to continue to do the right thing for the patients.
You need to have compassion. Many of these patients don't do well. This is a horrible disease—a very aggressive infection. Despite our best efforts, sometimes the patients don't pull through. Sometimes, all you can do is be compassionate for the patient in their waning moments. There is no family there for the patients because of the strict visiting rules, so being a surrogate loved one for the patients and being merciful and compassionate is huge.
HL: Are there pitfalls to avoid when assigning healthcare workers to new roles?
Lima: You want to give people the opportunity to contribute and help. You should not make reassignment like a demand. Getting buy in is key—you can't come across as being authoritative. Most—if not all—healthcare workers will step forward. For example, in our department, we volunteered to be reassigned.
Having enough personal protective equipment goes a long way because that's one thing you don't have to worry about. Not having enough PPE is a huge pitfall.
HL: How do you foster willingness for reassignment?
Lima: It comes from the top down. You lead by example. If your leadership is volunteering in the trenches, others will follow that example. In my department, our chair, Dr. Alan Hartman, told us he was volunteering to help cover COVID patients, and we all agreed to do the same. We were not told to accept reassignment, we went along with him.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
It is helpful for reassigned healthcare workers to have a growth mindset—viewing a situation with negative elements through a positive lens.
Reassigned healthcare workers should have backup. For example, physicians reassigned to the ICU setting should have support from critical care specialists.
Reassignment of healthcare workers should be built on volunteerism, not authoritative dictates.