Management and Leadership for Fundamental Care

There is a separate section of the clinical guideline for nursing managers and leaders, including nurses leading clinical teams in infection prevention and control environments such as those required for COVID-19. However, anyone can read this section and do this activity. There are some useful ideas here – about organisation, education and staff wellbeing – that everyone can benefit from.

Why is management and leadership included in the clinical guideline?

A consistent message from nurses responding to our survey, backed up with data from our literature review, is that good leadership makes a huge difference to nurse’s themselves in pandemic related infection prevention and control environments. Leaders and managers have a significant influence on what nurses do, how they do it and how they feel about themselves and their job. This part of the guideline will describe how leaders and managers can organise care, keep nursing teams up to date with the latest information and implement strategies to improve nurses’ wellbeing.

Why management and leadership can be difficult when nursing patients in a pandemic such as COVID-19

There is no simple answer to this question. COVID-19 challenged so much of what we as nurses do. It has confronted all nurses with significant professional and personal difficulties. Importantly, these challenges have faced managers and leaders with the need to devise solutions and support staff. Here are just some of the problems leaders and managers have had to address as part of their work with the COVID-19 pandemic:

• Personal protective equipment: educating staff in how to don and doff PPE, helping them understand which PPE to wear when and where, helping them feel safe in PPE, ordering and accessing sufficient supplies of PPE
• Time pressures: unfamiliar routines, PPE donning and doffing requirements, staffing levels and increased sickness levels
• Disruption of routines: the need to reorganise care so that nurses ‘bundle’ care activities together, reduce the amount of time in infection prevention and control areas, minimise unnecessary donning and doffing of PPE, organise sufficient and often scare equipment in sufficient quantities to meet the needs of isolating patients
• Reduction in access to multidisciplinary input: reduced presence of allied health care personnel on wards due to infection prevention and control isolation instructions, lack of ‘ad-hoc’ consultations with AHPs
• Lack of knowledge: nurses redeployed from other areas, nurses inexperienced in respiratory or isolation nursing, frequent and rapid changes in policy and procedures Fear: nurses and health care assistants anxious and scared about spending time in isolation areas
• Shielding: removal of nurses from the team who are at increased risk from infection or living with others in a similar situation
• Nursing distress: reduced wellbeing as nurses manage unfamiliar situations and witness scenes they are unprepared for, including significant numbers of patients dying
• Reduced team cohesion: nursing patients in isolation environments splits teams up into smaller units who may have less time to talk and mix together
• Relative and significant other distress: giving information and managing effective communication systems for relatives and significant others no longer able to visit their loved ones in hospital
• ‘Walking the factory floor’: when managers and leaders don PPE themselves and enter infection prevention and control isolation settings to provide clinical support for the nursing team, it is more difficult to have a presence in the general ward area and respond to urgent issues promptly

What can we do about this?

Thankfully, we can do a lot of things to address these challenges to management and leadership. The clinical guideline lists some of the things we need to remember to do. Each technique is labelled with an easy to remember phrase. All these ideas have already been used successfully by nurse managers and leaders when working in COVID-19 clinical environments. You can read more about these ideas and participate in a discussion about them in the ‘Management and Leadership’ section of the COVID-NURSE clinical guideline.