By Melinda Young
The COVID-19 crisis response relied on interprofessional teamwork. But for care coordinators and pharmacists, the team experience during the pandemic was far from optimal, according to a recent study.1
Bedside nurses reported more positive experiences on their teams, but all healthcare workers interviewed for the research said they needed timelier and more accurate communication and sustained leadership support.
“We interviewed frontline healthcare workers who had worked really closely with interprofessional teams before the COVID pandemic,” says Katarzyna Mastalerz, MD, study co-author and associate professor at the University of Colorado School of Medicine. “When the COVID pandemic hit, we were interested in frontline healthcare workers’ perspectives on what happened to their teams. There were different things that happened to teams, and we wanted to learn how that impacted their engagement with work and their well-being.”
Mastalerz and colleagues interviewed frontline bedside nurses, care coordinators, and pharmacists. They found when the first COVID-19 surge began, existing teams were fractured. For example, care coordinators and pharmacists were asked to work remotely. Before the pandemic, they had worked closely with nurses, physicians, and patients on interprofessional bedside rounds.
“This is a common experience that I’ve heard from other healthcare settings, as well,” Mastalerz says. “Leadership made decisions to remove certain frontline folks from the bedside.”
Remote Workers Reported Isolation
Remote work was challenging for people who were accustomed to daily, in-person team involvement. “What those participants described was a variety of emotions and a variety of different ways to adjust their workflow,” Mastalerz says. “They felt removed from the team.”
Healthcare workers reported their status on the interprofessional team seemed to diminish. “Because they weren’t there, people didn’t think to reach out to them as much as they did before,” Mastalerz explains. “For example, a pharmacist before the pandemic felt like the teams were bringing up medication interaction in the course of normal conversation.” Once the pharmacist was no longer with the team in person, they believed no one at bedside thought to call them about issues that could affect patient safety.
“Team members felt they weren’t reached out to as much, and when they were, they weren’t given as much weight,” Mastalerz says. “[Before the pandemic], our care coordinators were bedside, rounding with the interprofessional team. One described it was really difficult to [perform] care away from patients because it was almost like having survivor’s guilt.”
They wanted to be there to see and care for patients who were sick with COVID-19. “A care coordinator said, ‘It was really tough because I couldn’t be there with these people, holding their hands, and I had to do the work remotely,’” Mastalerz recalls. “Most hospitals scrambled with capacity issues, and it took those frontline teams a lot of effort to reach out to someone who was not on the front line.”
The nurses who stayed on the front line, along with physicians, believed their teamwork improved during the pandemic. “They felt like things shifted in some real ways that helped them work in teams better,” Mastalerz says.
Removing care coordinators from the bedside also affected patient flow. While this was not addressed specifically in the study, researchers learned care coordinators believed they could not perform their work to their usual standards because they lacked the information and respect they had when they were physically present for rounds.
“The team wasn’t aware that care coordinators were a resource at all times because they were not there in person,” Mastalerz adds. “You’d have to pick up the phone and call someone to get something done — that’s a few extra steps vs. having someone there with you on patient bedside rounds.”
Interprofessional Hierarchy Diminished
Physicians — who were not interviewed for the study — and nurses continued to work at patients’ bedsides, improving their camaraderie. “What nurses described is they were able to build camaraderie with each other and with physicians, which is the reason their teamwork dynamic changed,” Mastalerz explains. “They had a closer, shared mental model about what they were working on with a new pandemic happening, and everyone was scrambling to take care of patients in a safe way.”
This led to nurses and physicians banding together more than they had before the pandemic. “One participant said the professional hierarchy that always exists seemed to just fall down in front of us as we were doing work together,” Mastalerz recalls.
Both nurses and physicians stayed clustered with patients at the beginning of the surge, when few people were permitted to enter patients’ rooms because so little was known about how to handle the infectious disease and how it was transmitted.
“Physicians were stepping in and doing nurses’ work,” Mastalerz says. “As they were going into patients’ room, they’d find a nurse and say, ‘What duties do you need me to do? I can take the blood pressure. I can take their blood sugar.’”
With fewer resources and fewer people on the front line, everyone did whatever they could to help each other with the workload. “Essentially, physicians and nurses had to do the work that everyone was doing before, and we had to divide that work,” Mastalerz says. “It was a time of crisis, and a time when we needed to support each other, and we really wanted to support each other.”
Everyone benefits without a interprofessional hierarchy. “It’s better for patient safety when everyone is on the same level playing field,” Mastalerz notes. “It’s disheartening what interprofessional hierarchy diminishes.”
After the pandemic surges ended and frontline workflow returned to pre-pandemic processes, teamwork challenges remained because of moral injury and burnout among staff.
“What happened individually, over time with the ongoing surges, is people were really burned out by the work and teamwork,” Mastalerz explains. “Working across teams is a really high-level function in healthcare because you have to make an effort to do it — that’s the bottom line.”
People were tired and fatigued, so it was difficult to keep teams working as seamlessly as before the pandemic. This led to another important finding: Leadership’s response was important to frontline workers, including care coordinators.
“One thing we heard from participants was how important leadership involvement was during those times,” Mastalerz says. (For more information, see story in this issue on how leaders affect teams.)
Leaders needed to communicate transparently and quickly when something changed in response to the pandemic. This is how an organization could build trust and improve engagement in their work. “There were several modes of communication that were coming down during these rapidly changing times of the first COVID surge,” Mastalerz says.
When top leadership left a void, teams developed less formal methods of communication. For example, study participants recalled holding special meetings, called COVID Conversations, Mastalerz says. These were daily huddles co-led by a physician and nurse manager from March 2020 to April 2020.
“Everyone was invited, every day, and they could come in person, by phone, or virtually,” Mastalerz explains. “These talked about what was going on about policy and other changes in the hospital, and it provided space for mutual support.”
Study participants noted the COVID Conversations became a good source of information. “Frontline staff saw the gap and wanted to provide this information, which was really crucial for everyone to know,” Mastalerz says. “That was an interprofessional frontline effort to fill in communications gaps.”
Participants also said it was important for leaders to provide consistent and timely information, even when there was not a clear conclusion. For example, one pharmacist recalled how daily emails from their incident command were a source of comfort. They also wanted transparency — updates even when there was bad news or decisions that were only in progress.
Frontline workers wanted to hear these words from leaders: “Here’s the situation. We don’t know the solution yet, but we’re aware of it, and we are thinking about it and working on it,” Mastalerz says.
REFERENCE
- Jordan SR, Connors SC, Mastalerz KA. Frontline healthcare workers’ perspectives on interprofessional teamwork during COVID-19. J Interprof Educ Pract 2022 Dec;29:100550. doi: 10.1016/j.xjep.2022.100550. Epub 2022 Sep 12.
The COVID-19 crisis response relied on interprofessional teamwork. But for care coordinators and pharmacists, the team experience during the pandemic was far from optimal, according to a recent study.
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