roviding continuing education has always been a challenge in medicine, whether it’s developing protocols that change as new treatments become available, checking in on necessary skills, or just the difficulties of managing staff time to learn everything they need to be successful.
In our units (the emergency department, Acute Internal Medicine-B, and outpatient clinics) at University of Utah Health, educators faced these challenges before COVID-19. When the virus hit, it exacerbated existing challenges and introduced many new ones that come with treating patients for a novel virus.
The challenge of keeping up with daily change
Protocols that had been in place for years were suddenly changing daily. We had to move quickly to disseminate information to try and keep everyone on the same page. But it was really challenging for even the most seasoned nurses to keep on top of everything—they may have received their 5th email update on swabbing, for example. It increased uncertainty and led people to second-guess their clinical knowledge.
In the beginning, nurses were scared. A lot of people who we would have thought would be ready to take on anything said “I don’t think I should be in that patient population.” They had mastered these skills, but the situation made them afraid to do something that would have felt normal before.
The initial uncertainty surrounding COVID-19 heightened these fears. Sometimes, they were afraid to go home to their family. As educators, it has been a new experience to step into a role of reassuring people. To say “Hey, you know what? It's going to be okay. Just make sure you're following all the steps, it's going to be okay."
Fortunately, some of that tension has eased as we become more familiar with the disease and implement proven processes to help people understand and learn in a rapidly changing environment.
Three ways to make learning new things easier
In some ways, the uncertainty has made staff more eager to learn. They are receptive to new information because they realize just how important it is. The more we communicate, the better. Even what I think is over-communicating is not enough. They hunger for information and want to know everything. It's pretty amazing.
As the volume of new information increases, here are three strategies each of us uses to make learning and retaining information easier.
1. Start with the why.
Try to always give people a rationale of why we're doing something a certain way or why this education needs to be done. People always like hearing the why—why we need to do something. They’re much more inclined, as opposed to just saying, "You have to do this." People want to hear the rationale behind it.
2. Demonstrate new concepts or protocols.
Let them see how it’s done first. I (Sarah) have been working all the tents and the COVID-19 bus for testing. For the first few weeks, I trained people by having them observe me. I wouldn’t ask someone to do something they were uncomfortable with. I feel like letting them see it in action with a bit of distance before putting them in all the gear helped a lot.
I (Emma) work a floor shift every month and help cover lunches. I think staff like seeing me on the floor because they think "Oh, she still remembers how to be a nurse. Oh, she knows what it feels like to be in triage, or to be in a mask all day.”
3. Validate emotions and concerns.
I’ve (Paige) been treating all my staff with the care and generosity I give a brand-new nurse. I validate their feelings. I say "Hey, it's okay, I know that everybody's nervous right now. Things have changed and it’s okay to feel that way." I give them a couple of exercises to think about—when you leave the hospital, or you get into your car, or you step on TRAX; your mindset is different. When it's time to go home, you don't have to think about this anymore. When you’re at work, you're in the mindset of: you’re just going to do it and it’s going to be okay.
It’s still hard. On my unit, we care for cystic fibrosis patients, lung transplant patients and patients who are passing away. We still have patients who are dying, but we can't let family in, or we have to limit who can come in. It's been heartbreaking at times to turn those families away. I know that that really does take a toll on my staff.
Three ways to manage your own anxiety
Understandably, everyone’s anxiety and stress are heightened right now. As an educator, we support and validate others’ emotions as they’re learning. It's important that we take care of ourselves, too. Here are some ways we’ve done that.
1. Get outside
I (Sarah) make time to get outside and go for walks when I’m not working. I have dogs and just got a new puppy, so we have to go for walks! The sunshine really does help.
Especially in the beginning when this first started, I (Emma) could not handle the texting between family, and friends, social media, and the news. I started telling my boyfriend “No phones for one hour. We're watching a TV show." Now, I’ve deliberately decided to get my COVID news at work, and keep COVID there, not at home. For better or worse, I can hear about COVID at work.
I (Sarah) make sure to do something to get away from the news and the internet at least every other weekend. I leave my phone at home—that has helped.
3. Laugh together
Sometimes the best thing you can do in a stressful situation is find a way to laugh about it. On AIM-B (Paige’s unit), we’ve created a funny meme wall where people display things that make them laugh to maintain some levity in a stressful situation.