Interview with Dr. Sydney Record, Director of Staff Development and Infection Prevention, Seattle, Washington

Dr. Sydney Record is the Director of Staff Development and Infection Prevention at a Seattle-area skilled nursing facility that cares for almost 120 patients daily. Last week, the facility was informed of its first case of COVID-19 in an asymptomatic individual. Dr. Record received her DNP in Population Health Nursing from the University of Washington School of Nursing.

In your role as Infection Control Chief, what is your interface with the current COVID-19 Pandemic?

1. I stay up to date on current COVID-19 information, meaning I attend many webinars specifically for long-term care facilities and COVID-19. I am also in constant contact with Public Health Seattle and King County as well as our state surveyor assigned to us for infection prevention. This makes me the main dissemination point for COVID-19 updated practices, procedures, and guidelines.
   
   
2. I maintain a list of patients and staff who are sick, what their symptoms are, if they were tested, and what the results are. 
   
   
3. I provide the infection prevention education for all staff which includes
   
   
   1. hand hygiene
   2. isolation Precautions and proper use of Personal Protective Equipment (PPE).
   3. providing the most current information on COVID-19 from our company, local public health, state department of health and CDC guidance
   4. auditing hand hygiene and proper use of PPE
      
      
4. I help create systems to ensure infection prevention measures are in place. For example, our first case of COVID-19 was detected on a separate unit from the rest of our building. I worked with our dietary team, administrator, director of nursing, housekeeping and maintenance to create a system that allows our staff to get supplies (food, linens, nursing supplies, etc.)  and provide necessary services (garbage disposal, delivering mail, providing activities to keep residents actively engaged, etc.) while maintaining limited exposure to staff working on that separate unit. 
   
   
5.  The focus of my role has become a more centralized. There has been a huge increase in the amount of questions and concerns I receive from staff. We increased our monthly staff meetings from once a month to once a week and sometimes twice weekly. Once staff realized how easily accessible I am to answer their questions related to COVID-19, their anxiety level decreased quite a bit. When we got our first case of COVID-19, most staff just said okay and continued working, whereas at the outset, people were talking about quitting work and gossip was spreading like wildfire. If they have a question now, they come straight to me for clarification.
   
   
6. I handle auditing, reporting, and finding suppliers of PPE. Acquiring PPE has been an exceptional challenge. The week prior to our first case of COVID-19, we ended up distributing and using homemade cloth masks that family and friends volunteered to make because we ran out of surgical masks. I have applied several times through our local emergency preparedness network. However, supplies were immediately exhausted. Now we have our names and the supplies we need on a similar list through King County, which is working with the state. Fortunately, our building is part of a larger company that can provide a few supplies like reusable gowns. I was on a call with our network recently where they discussed how to determine recipients of PPE. Equity was a focal point for their decision-making. With so many in need of PPE, they discussed the use of randomized PPE distribution as the most equitable distribution method. 

What is your new reality as Infection Control Chief at your facility? 

Working on COVID-19 is a full-time job in itself. Information changes so rapidly that once you begin implementing new guidance from public health, the guidance has changed within a few hours to days of the implementation. I have to be incredibly flexible and ready to implement new guidance at any time. My role no longer has boundaries as far as work hours go. I get phone calls and texts at all hours of the day and night from staff and public health because I need to be available to answer questions. Trying to prioritize many number one priorities is a new normal. My top priority is keeping our staff and patients calm, safe, and informed. 

Of the many challenges you have faced during this crisis, is there one that is the biggest? 

Trying to implement infection control recommendations. As a doctor of nursing, I am able to find up to date and evidence based information quickly. I provide recommendations, but they must go through a chain of people to determine if we should implement them. Some of the interventions I have proposed have taken a few days or sometimes weeks to implement, but after initially being cast off as too difficult, those interventions have now become the new normal at our facility.  An example is the social distancing. We are a smoking facility. This means we have a smoking area 25 feet outside the building. Our smokers like to congregate together and share cigarettes. I wanted to, at the very least, limit the number of smokers outside at a time. My team didn't want to deal with the ramifications from residents, so they said no it's too difficult. A week later we were directed to implement social distancing and we had to limit the number of smokers outside as well as educate on staying 6 feet apart. 

How did your DNP in Population Health Nursing prepare you for this role and your interface with the COVID-19 Pandemic? 

The DNP in population health nursing program has defined every facet of my ability to comprehend, plan, respond, and take effective action during this pandemic. I would say using nursing models for quality improvement has been the most beneficial piece of my DNP training. I am able to recognize needs, potential impacts, and possible preventative actions by using some of the nursing models instilled by the DNP program. I can also make changes quickly based on staff feedback using pieces of nursing models as a quick guide. For example: We had to think about how we would wash cloth masks once we distributed them among staff. Originally, we thought about washing them at the facility with all the patient linen and clothes. However, when I tried to explain this to staff, they had a strong belief against mixing their masks and patient linen even though the chemicals used and the temperature of the water is supposed to kill all microorganisms. Understanding the attitudes and beliefs of staff helped determine that each staff would be responsible for the washing and care of their own mask. Due to the change of practice staff are now wearing the masks to protect patients and each other. 

What are the leadership lessons you learned in your DNP program that have supported your success during the COVID-19 Pandemic? 

Leadership skills I developed in the DNP-PHN program have proven effective in this pandemic.

During clinical and my capstone project, I was able to refine the leadership principles and practice that guides my work today.  I tend to be the one constantly observing and listening in order to capture the entirety of a situation before making decisions. This helps me know what to educate staff on, how to positively interact for the most effective response, and how to model behaviors that foster change. The impact of this became evident early on as I was put in charge of establishing the agenda and presenting the content for our weekly staff meetings. Staff engagement increases when I present because I have gained the trust and confidence of my staff after working at my center for less than six months.

The DNP program also established the notion of relationship building as a foundation of leadership. I actively engage my staff in meetings and on the floor. I make sure to check in with my staff, listen, find out answers and let them know when they are doing well. It is especially important during this time to thank our staff and show how much we appreciate them. I think this is why they feel so comfortable coming to me with their questions and concerns. There has been lots of turnover and change at our center, so being a solid pillar for them to count on is imperative.

What are some pearls of wisdom that you could share with your colleagues during these very turbulent times?

Take care of yourself. I have to let my brain rest. This means when I come home from work I shower, brief my partner on my day, eat the meal he has prepared and then we watch or conversate about things that make us laugh. I have to laugh or the stress will take over. 

At work, my pearls of wisdom are to try to keep calm. Everyone is stressed during this time, so keeping a level head while working through problems has made it much easier to get work done. Keeping a calm demeanor also helps staff stay calm. I also find that well-timed comedic relief with staff keeps everyone sane.