Ellen Smithline, PhD(c), MS, RN, CEN
Alternative Care Tents of Springfield, MA – Nurse Manager
Clinical Instructor, University of Massachusetts Amherst College of Nursing
In less than two weeks, a team of nurses, engineers, other healthcare professionals and researchers at the University of Massachusetts Amherst designed a low-cost protective face shield that can be mass produced to provide protection to frontline health workers. Together with nurse inventor Rachel Walker, PhD, RN, Ellen played a valuable role by providing her nurse insights into the final design. Ellen, who has over 35 years of nursing experience that includes Ebola, SARS and emergency care, recently paused her PhD program to join the frontlines as an isolation tents nurse manager for communities hit with COVID-19.
J&J: Can you tell us more about the development of this face shield?
Ellen: From my experience treating patients during the Ebola and SARS crises, I know that face shields are incredibly important. Nurses can’t practice social distancing. We knew that to address our PPE crisis, we needed to combine our expertise and mass produce something quickly. By using a laser cutter, we created a shield that can be worn over one’s N95 mask and curbs the need for goggles. It is made from a single, flexible sheet of plastic film that folds and fastens around the forehead and doesn’t require any assembly. The simple, light weight design allows for large quantities to be produced in a short amount of time and can be packed flat which makes shipping, storage and distribution easier. So far, we have distributed over 81,000 face shields to the community. Now we’re working to distribute these masks to more areas that may not get the attention they deserve, such as long-term care facilities, healthcare teams helping those experiencing homelessness, migrant workers and other frontline personnel. As a nurse, that is a large part of the drive – delivering PPE so one can deliver care and essential services.
J&J: Why do you believe it is important for nurses to be a part of the development process of a healthcare solution?
Ellen: Innovation is part of who we are. Nurses naturally prioritize what needs to happen and what they can do to make a difference, and I was able to apply these insights to our development process. From my experience using a shield in the past, I knew fogging was likely to be a problem and encouraged the team to explore pre-coating the shield with anti-fog material. Because I know a lot of nurses like to wear their hair in ponytails, my husband Howard, who works as an emergency physician, and I recommended a longer strap similar to a zip tie that could adjust to various head sizes, hair types and safety googles. I also suggested that we add a place for the care provider’s name, because if we are fully dressed in protective masks, shields and gowns the patient may not know who they are talking to. It’s been an incredible experience to be a part of this collaborative effort from the beginning and empowering to have the members of the team value my input as a nurse.
Jordan Bope, MHI, BA, BSN, RN, Nurse Manager, James Medical Intensive Care Unit
Anne Pontillo, MHI, BSN, RN, CCRN, James Critical Care Staff Development Coordinator
Kori Fenner, MHI, BSN, RN, OCN, Assistant Nurse Manager, 5 James Infusion
Justin Kelly, MHI, BSN, RN, CCRN, RHIA, Staff Nurse, James Medical Intensive Care Unit
The Ohio State University Comprehensive Cancer Center James Cancer Hospital
The COVID-19 pandemic has prevented family members from being able to visit their loved ones in many different units of hospitals. Originally thought of as a complementary service for families to virtually participate in a clinician’s rounds, recent graduates of The Ohio State University’s Master of Healthcare Innovation program, Jordan, Anne, Kori and Justin, worked quickly to transform and implement their idea for a virtual rounding tool to meet the immediate needs of this pandemic.
J&J: Why did you want to implement this virtual rounding tool in your hospital?
Team: The four of us had already been thinking through the development of a virtual rounding platform, but when COVID-19 hit and family members could no longer visit their loved ones, our innovative idea became something we wanted to implement immediately. We were given the green light for a pilot for “Real Talk Real Time” in our James Medical Intensive Care Unit (James MICU) in early April and immediately began incorporating feedback and improving this service for our patients and their loved ones. We believe our virtual rounding tool has been able to provide comfort to family members by allowing them to be face-to-face with their loved one’s nurses or doctors. Unlike other video chat offerings, using the Webex platform allowed us to offer something that is secure and able to be accessed on multiple devices by various age groups. We’re also looking to see what physical benefits it could potentially have for patients as well, such as decreasing their anxiety levels and length of stay. And since our pilot has been so successful, we believe it will soon be implemented in units here treating COVID-19 patients themselves and providing comfort to their families.
J&J: Do you have any advice for nurses who are facing roadblocks in their innovation journey?
Team: Overcoming our roadblocks has been very motivating. There are many times in the innovation process where you may have to pivot and reset, times where you may need to be persistent and times when you may need to compromise. In our case, we originally had the green light to use a specific digital platform for our tool but then our IT Security team let us know we couldn’t use that platform. We got a great piece of advice from a member of our faculty, who reminded us to fall in love with the problem and not the solution. It reminded us it’s not about the specific application – it’s about removing barriers to communication. It helped us to take a step back, continue our innovation, and adjust to a new digital platform. And because we persevered, many leaders in our health system expressed that they are eager to implement this in more areas in our hospital.
Lindsey Roddy, BSN, RN
Founder, CEO, RoddyMedical, LLC
PhD student, University of Wisconsin-Milwaukee College of Nursing
In response to the nationwide shortage of PPE, nurse innovator Lindsey, together with her husband John, an ICU doctor, and her team at RoddyMedical, LLC, developed a viable prototype for the patent-pending Together Mask™ – because ‘Together We Have Hope™’. With a coalition of more than 30 nurses, doctors, engineers, businesses and scientists, the group was able to fast-track the normal 6‐12 months of medical device design and production into just 4 weeks.
J&J: What was the development process like from ideation to implementation?
Lindsey: One evening in March, John and I spoke with one of our neighbors, a nurse on the COVID unit, who shared stories of how in some cases clinicians were reusing their N95 masks for days. We immediately felt compelled to help and that night began sewing masks. Soon, we knew something more was needed. The next day I reached out to my business partner, a product design engineer, and together we quickly brought together a team of nurses, doctors, engineers and businesses to create a design for a mask with a medical-grade filter that would fit comfortably and provide the needed protection for frontline health workers. In just 48 hours we had a viable prototype which now has evolved into a product we are proud of. We have conducted a variety of safety tests and design tweaks to make sure the masks were comfortable, easily assembled and can fit a variety of facial structures. Our final design has two models and features skin biocompatible materials for extended wear skin contact. The mask body and filter are angled to allow use with face shields and has adjustable head straps for a snug fit. Because the filter in our design is already approved by the FDA, we’re hopeful this will fast-track scaling up for manufacturing and distribution. We have made over 150 masks that we have already distributed to local hospitals, and we’re excited about the possibility to bring this to more health systems soon.
J&J: Why do you believe it’s important for nurses to lead in healthcare innovation?
Lindsey: Nurses often serve as the critical voices of the patients. They are able to add insights and expertise that can be valuable to innovation. In the case of the Together Mask™, nurses were asked to help us troubleshoot on the design and improve its comfort level. We held fitting sessions and received input on procedures for the process of taking off the mask to help limit the risk of cross-contamination. Because nurses are closest to patients at the bedside, they understand the value of having the mask be clear plastic so patients can see your words and smile. I would tell nurses never to underestimate the contributions that you can have in multiple areas of healthcare.
Jessica Latham, RN
Critical Care Nurse Educator, Ascension St. Vincent’s East
After their first code blue incident on her COVID-19 ICU, Jessica knew that her team’s usual method of communication would not be as efficient with nurses balancing running the code inside the room and everything else happening outside the patient’s room. Leveraging her team’s insights, the glass doors on patient rooms and a lamination machine, Jessica created “Code Cards” to help get important messages to the nurses within the room quickly and effectively.
J&J: What was your experience implementing your idea for the “Code Cards”?
Jessica: Part of my job as an ICU educator is finding areas where we can improve our nurses’ knowledge base and processes. As COVID-19 started to create more stressful conditions in our unit, I realized we needed a way to help keep the code team informed and those outside the room unexposed. Our ICU doors are glass, so I made laminated “Code Cards” with our most commonly coded medications and procedures. We hold up these communication cards to the glass to get important messages to the nurses and keep staff safe during code blues. About an hour after I had the idea for these cards, I had them laminated and ready for use in our ICU areas. I could not have made it happen without the collaborative efforts of our ICU nurses and managers. These cards are now maintained on our ICU code carts and the process for utilizing them has become much smoother and safer for those both inside and outside the room. I can definitely see these remaining useful for future patients and even beyond this pandemic.
J&J: Do you have any encouraging words for nurses on the frontlines?
Jessica: I would tell other nurses and health workers to lean on their teams. We are all in this together, and interdisciplinary collaboration is imperative during these challenging times. They have called 2020 the “Year of the Nurse,” and I say we have definitely proven this true. These are unprecedented times and we, as nurses, can utilize our critical thinking skills and creativity to improve patient outcomes and our working environments with our innovative ideas emerging from this new and demanding disease.
Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders (SONSIEL)
Rebecca Love, RN, MSN, FIEL, President, SONSIEL
Julia Cooney, RN, MBA, Board Member & Former Senior Partner Healthcare Life Science Consulting, Deloitte
Marion Leary, RN, MSN, MPH, Board Member & Director of Innovation, Penn Nursing
Hiyam Nadel, RN, MBA, CCG, Board Member & Director of the Center for Innovations in Care Delivery, Massachusetts General Hospital
Ann Corcoran, RN, BSN, Board Member & President of AMC Healthcare Solutions, Inc.
Faith Ann Lawlor, RN, Operations Team Manager, SONSIEL
To meet the urgent need for personal protective equipment (PPE) inventory across the country, SONSIEL, a global organization of nurse leaders, innovators and entrepreneurs, mobilized to create the Strengthen Healthcare Ability to Respond to Emergencies (SHARE) program to collect, purchase and distribute vital protective equipment to frontline health workers. SONSIEL board members, Rebecca, Julia, Marion, Ann, Faith and Hiyam rallied their communities and local businesses to move over 100,000 pieces of donated PPE – efforts that were recently featured on ABC News Nightline.
J&J: Can you tell us more about the origins of the SHARE program and what is has accomplished so far?
SONSIEL: Many nurses voiced that their health systems were facing a dire shortage of PPE and we know how important it is for our frontline health workers to be protected. As the need only grew, SONSIEL looked to the next stage of purchasing PPE. We established a GoFundMe campaign to raise funds and, thinking outside the box and leveraging our network, partnered with the GLO Good Foundation, a dentistry organization, to secure sourcing of critically needed respirator masks from China. We leveraged our expertise, innovative thinking and network to create a rapid response with our SHARE program, which called on vital industry, corporate and individual partners to donate product and funds so SHARE could deliver PPE to those on the frontlines. In just 30 days after the launch of the program in mid-March, we have moved over 100,000 pieces of donated PPE to hard-hit facilities across the U.S., including 23,300 respirator masks (N95 and KN95), 20,500 surgical masks, 6,400 Level-3 masks, 1,200 coats and gowns, 45,200 pairs of gloves, 19,000 pairs of shoes, tens of thousands of face shields, dozens of Hazmat suits, dozens of goggles and 240 hand-sewn masks.
It’s truly impressive what we have been able to accomplish together in our first thirty days and we know our impact will continue to grow in the coming weeks. Our SHARE program is a success story of innovation and entrepreneurship, in both a business and clinical context – nurses solving a complex business issue, a broken supply chain for PPE procurement, to address a vital clinical matter – frontline health worker protection. In addition to being able to deliver much-needed resources to the frontlines, we’ve also been able to showcase the vital roles nurses can play in overall healthcare innovation, be it at the bedside or in the larger business ecosystem.
Hunter Jefferis, BSN, RN, CCRN, Assistant Nurse Manager (MICU)
Laureen Jones, MSN, RN, PCCN, APRN-CNS, Clinical Nurse Specialist (MICU)
Levi Wynn, BSN, RN, Assistant Nurse Manager (MICU)
John Byerly, MSN, RN, CCRN-K, Assistant Nurse Manager (SICU)
Anthony Adams, BSN, RN, CCRN, Assistant Nurse Manager (NCCU)
Department of Critical Care, The Ohio State University Wexner Medical Center
As health systems across the country navigated delivering patient care amid COVID-19 while their inventories of PPE continued to dwindle, a driven nurse team at The Ohio State University Wexner Medical Center was committed to implementing an innovative way to preserve PPE- utilizing externalized IV pumps. After creating an evidence-based plan and conducting a two-week pilot, through their data collection they estimate they have saved over 4,500 full sets of PPE as well as IV extension tubing.
J&J: Why did you want to bring this to your hospital?
Team: In critical care, the administration of medications may occur multiple times an hour. Not only does this increase the risk of COVID-19 exposure for nurses, but it also requires them to use a large quantity of PPE. We saw other hospitals experimenting with moving IV pumps outside patient rooms as a way to reduce the amount of times nurses were required to enter the room and knew this could be a transformative solution to our potential PPE shortage. We knew that if implemented correctly, it could also improve efficiency for nursing staff and the organization when we would have to adapt to a reduced supply of our primary IV sets due to the pandemic.
J&J: Do you have any advice for nurses who are trying to implement their innovative ideas in their health systems?
Team: At first, some hospital leaders were reluctant to test this for concerns of how it could affect patient care and increase waste of medications. Because our team was able to offer solid data that showcased the value this initiative could have in our units, we were approved for a two-week pilot to begin implementation. We collaborated with multiple different nursing leaders across critical care, as well as pharmacy, epidemiology and supply chain. We wanted to ensure we could maintain safety for the patients first and foremost, so we worked together to think through things like mitigating infection risk and maintaining our barcode medication scanning. In order to show to our hospital leadership that this could be implemented effectively and safely, we performed several tests and had to identify a standard operating procedure and obtain additional technology components to ensure functionality outside of the room. Because of our hard work and perseverance, our pilot has been successful and the organization is now looking to expand this initiative to other units treating COVID-19 patients.
Colleen Snydeman, RN, PhD, NE-BC
Executive Director of the Nursing & Patient Care Services Office of Quality, Safety & Practice
Massachusetts General Hospital
As COVID-19 continued to spread to major cities in the U.S., Colleen knew it would only be a matter of days before her staff had to be prepared for the number of critically ill patients they would care for. By bringing together nurse leaders, clinical nurse specialists, professional development staff, and respiratory, physical and occupational therapists, Colleen and her team were able to rapidly create a designated interdisciplinary proning team and trained over 80 staff in three days on how to prone patients in respiratory distress.
J&J: What was your experience implementing the prone team training in your hospital?
Colleen: We’re seeing many COVID-19 patients who are critically ill and experiencing respiratory distress. Evidence has shown that turning patients on their stomachs in the prone position might be able to help improve their oxygenation. Turning a patient is complicated, but our nurses have gotten very efficient at this due in large part to this training. When the numbers of critically ill COVID-19 patients began to increase, we knew the existing model we had prepared would not be enough to support the needed demand. Our general care units converting to critical care units and creating this dedicated proning team for all our hospital shifts would be an important support. We began coordinating efforts for the prone training on April 4th and were able to quickly begin the training with videos, reading materials and simulations on April 8th. The nurses were on the units applying these skills the very next day, and to date they have completed over 260 turning events without any complications to a patients’ central lines or airways.
J&J: What has the response been to the prone team on the units?
Colleen: The first day the nurses arrived on the units they were greeted with cheers. They continue to be sought after and are incredibly appreciated. A critical care physician recently told me he needed to prone a patient and couldn’t believe how quickly the team assembled, changed PPE and turned the patients in a timely, safe and efficient way. He thinks our prone team is one of the best things we’ve done for our patients and staff. Our nurses and other frontline health workers are excited to learn from each other, and I think there will be a push to expand our training to other units. The nurses, many of whom have volunteered for this team, have an incredible sense of pride and comradery and feel every day that the ICU staff appreciates them. Personally, when I go out to our units and I see the level of professionalism and care that our nurses are providing to patients, I am just so incredibly proud. Our nurses are saving lives every day, and it’s so ironic that in the Year of the Nurse, nurses are helping to save the world.
Breanna Lathrop, DNP, MPH, FNP-BC
Chief Operating Officer and Family Nurse Practitioner, Good Samaritan Health Center
In these unprecedented times there is an incredible need to share accurate and timely information to the public. Together with Joseph Agoada, CEO of Sostento Inc. and fellow participant in the Robert Johnson Foundation Culture of Health Leaders program, Breanna co-founded HelplineSOS in February 2020 as part of their Coronavirus Support Network. By recruiting nurses to volunteer with their phone helpline, they have been able to alleviate some of the stress on hospitals by answering patient questions, referring people for COVID-19 testing and linking patients to in-clinic or telehealth services.
J&J: What challenges were you and your team facing that led you to set up HelplineSOS?
Breanna: HelplineSOS provides charitable clinics with a technology-based solution to triage incoming calls and allows us to more effectively provide our communities with the support they need during this crisis. For many vulnerable populations, including the elderly, the homeless, or those in rural America, access to a doctor is not that easy. We realized clinics were sure to be overburdened and needed tools to meet the new demands of COVID-19. We wanted to position ourselves as a strong community resource for anyone with limited access to care. HelplineSOS has made this possible with our staff team and 20 volunteers working from home, many of whom are nurses. What also makes our solution unique is how it has been designed. HelplineSOS leverages the existing phone number of the clinic so it can help alleviate some of stress on these clinics without disrupting the relationships they have with members of the community.
J&J: How are you continuing to innovate HelplineSOS as the pandemic evolves?
Breanna: A team of designers and technologists on the Sostento team are continuously improving the system and developing it for new uses with clinics. Right now, HelplineSOS is serving non-emergency COVID-19 patients, however we have already started to build additional features for the tool to serve clinics beyond this initial emergency response. We believe HelplineSOS can be part of comprehensive solution for helping clinics stay open and meet increasing demand. We are working hard to make it no-cost for clinics, and since charitable clinics are so busy, we have also made it possible to be implemented in just a few hours. The rising numbers of COVID-19 cases and the stress on the healthcare system has been overwhelming but working on this project has been an incredible collaboration with innovators, creators and healthcare leaders and a source of hope and energy.
Brittany Merkle, MFA, RN
Lead Innovation Strategist, University Hospital (UH) Ventures
From collaborating on a touchless check-in procedure to triaging an ideas hotline for her health system that has garnered over 250 innovative ideas, nurse innovator Brittany and her team at University Hospital Ventures are working fast and smart to develop solutions to support communities in Northeastern Ohio. Brittany has played a vital role by leveraging her clinical background and design expertise to support a DIY fabric mask initiative that has collected more than 104,000 masks in less than a month – exceeding their goal of 100,000.
J&J: Can you tell us more about your DIY mask initiative and your role in bringing it to life?
Brittany: When COVID-19 hit our community, my team and I turned our efforts into finding ways to preserve and create new PPE. There are over 7,000 nurses in our UH health system, and we wanted to make sure we were protecting our caregivers and providing them and our community with a sense of comfort. Over the past few weeks, I’ve supported on the overall strategy for the initiative, provided a human-centered design perspective to the step-by-step mask production guidelines and continued to adapt and evolve our process based on changing policies and clinical input. My team and I talked through several prototypes, testing potential designs and language with nurses. It has been a large collaborative effort. This initiative has really spotlighted the power of community, and it’s been incredibly empowering for our frontline staff.
J&J: Do you have any words of encouragement for nurses on the frontlines?
Brittany: When the World Health Organization proclaimed 2020 the Year of the Nurse and Nurse Midwife, I wouldn’t say this is how we necessarily expected to seize the opportunity, but I believe nurses really have. If there is any silver lining, COVID-19 has proven that nurses exemplify frontline innovation in many different ways. This crisis is amplifying the nursing profession’s voice in innovation and policy change and creating the changes our healthcare system so desperately needs. To nurses, continue to be you through this process. I think it is going to take time to find a new normal. Grieve how you grieve, normalize your feelings of doubt or despair and find at least three minutes per day to meditate. And as always, know there is another nurse just a call, email or LinkedIn message away.
Amanda Stefancyk Oberlies, PhD, MBA, RN, CENP
Chief Executive Officer, Organization of Nurse Leaders (ONL) – MA, RI, NH, CT, VT
Patricia Samra, RN, MS
President, Organization of Nurse Leaders (ONL) – MA, RI, NH, CT, VT
Senior Director, Workforce Planning, Baystate Health
New England Area
The Organization of Nurse Leaders (ONL) is a not-for-profit personal membership organization committed to the advancement of a culture of health, the delivery of high quality patient care, professional nursing and influencing the development of health policy in Massachusetts, Rhode Island, New Hampshire, Connecticut and Vermont. As a way to support their members during the pandemic, Amanda Stefanick Oberlies, ONL CEO, and Patricia Samra, ONL Board President, implemented weekly virtual meetings to offer support to nurse leaders. These meetings have shared clinical best practices, strategies to conserve personal protective equipment (PPE), ideas to support the well-being of nurses and actions to address the rapidly changing local, state and federal recommendations.
J&J: What was the inspiration behind implementing this meeting series?
Amanda: One of the biggest challenges in working and leading through this global pandemic has been the frequency with which new information and recommendations are generated from local, state and national sources. ONL members had no prior experience leading their organizations through a public health crisis of this magnitude, so we knew we had to quickly create a venue for our members to stay connected and share key insights and other critical information during this tumultuous time. In the role of convener, ONL began with calls with regional chief nursing officers, and realizing the success and value of these calls, quickly created a second call for nurse managers and directors. Attendance for each call has ranged from 45-100 leaders. Topics discussed during the calls have evolved as we progress through the pandemic’s pre-surge, surge and post-surge phases. Early topics included PPE availability and conservation strategies, visitor policies and testing practices for patients and staff and have progressed to topics such as reintroducing elective surgeries and outpatient procedures, caring and supporting clinical staff, how to celebrate Nurses Week and more.
J&J: What has the response been from nurse leaders across the country?
Patricia: As soon as we sent out the invite for the first call for March 12th, our members across New England and colleagues across the country started to send us resources ranging from staffing models, trainings plans, descriptions for new roles, ideas for recognition of the amazing work of our frontline staff, as well as amended HR policies and guidelines for clinical operations. An example of this was when one of our nurse leaders shared that they were asked to create an algorithm for ethical decisions at their hospital and within a few moments another leader on the call was able to share a draft they had already prepared – saving the first leader hours of work. The atmosphere has been one of true collaboration, knowing we will get through this together. We recognize that being a nurse executive can sometimes be a very lonely job, and during times like these, exceptional leaders have had to make hard decisions, and our group has been able to help them feel like they aren’t in this alone. Like many small, not-for-profit organizations, ONL has a lot of work ahead of us as we address the ripple effects of this pandemic. It’s been an honor and privilege to have these relationships to draw upon when the going gets tough.
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The content and images featured in this article are shared and credited to Johnson&Johnson.
Please note that the solutions and ideas listed above reflect the experiences and opinions of the nurses themselves and are not necessarily endorsed by Johnson & Johnson.