In Service to Others: APRNs as Leaders During the Pandemic

Abstract and Introduction

Abstract

The impact of the SARS-CoV-2 virus on delivery of hospital care during the ongoing COVID-19 pandemic has required effective nursing leadership of large teams of Advanced Practice Registered Nurses (APRNs). At a large academic medical center in the mid-Atlantic United States, nurse leaders combined knowledge of the psychological phases of disaster and principles of the Serving Leadership framework to mobilize and lead APRN teams to deliver high-quality care to all patients and provide a safe working environment for healthcare teams. In this article, we discuss exemplars that demonstrate the flexibility and strengths of APRNs in all roles who addressed rapidly evolving needs such as resource allocation and education. The conclusion highlights the value and relevance of APRN skillsets to clinical practice and the opportunity to further capitalize on these strengths during the continuing journey through this COVID-19 pandemic and beyond.

Introduction

"The best way to find yourself is to lose yourself in the service of others." – Mahatma Gandhi (Biography.com Editors, 2020, pg. 1)

Finding themselves in a global health pandemic for the first time in over 100 years, nurses have been lauded for their courage, compassion, flexibility, and responsiveness. It is critical to reflect on nurses' extraordinary frontline efforts, gain insight into what worked well and lessons learned, and amass guidance to inform future disaster response. Using exemplars from Advanced Practice Registered Nurses (APRNs; see Table) at an urban, academic medical center in the United States (U.S.), the purpose of this article is to describe how the Serving Leadership model can provide rapid, role-pivoting support and an effective nursing practice response during a pandemic. We invite readers to consider these illustrative challenges and successes within the context of their own institutions.

In the United States, APRNs provide safe, high-quality, low-cost, evidence-based healthcare for patients, families, and communities. APRNs have earned a graduate nursing degree in a specific APRN role and patient population; attain advanced level licensing and certification; and engage in direct clinical practice with patients and families (National Council of State Boards of Nursing [NCSBN], 2021).

Authors and Disclosures

Table. Roles of Advanced Practice Registered Nurses (APRNs)
APRN Role	Brief Description
Certified Registered Nurse Anesthetist (CRNA)	Provides anesthesia care during procedures, including obstetrical, surgical, pain management, and trauma stabilization services.
Certified Registered Nurse Practitioner (CRNP)	Provides primary, acute, and specialty healthcare across the lifespan through assessment, diagnosis, and treatment of illnesses and injuries.
Certified Nurse Midwife (CNM)	Provides healthcare services for women from adolescence to beyond menopause, including independent provision of care; gynecologic and family planning services; preconception care; care during pregnancy, childbirth, and the postpartum period; and care of the normal newborn during the first 28 days of life.
Clinical Nurse Specialist (CNS)	Provides and coordinates advanced care across three overlapping but unique spheres of impact: direct patient care, nursing practice, and organizations/systems.

Andrew R. Benson, DNP, MSN, CRNA, FAAN
Andrew Benson is the assistant program director of the DNP Nurse Anesthesia Track at the Johns Hopkins School of Nursing and the former chief CRNA at Johns Hopkins Hospital (JHH). Dr. Benson has extensive experience in anesthesiology, clinical practice, and team leadership. As the chief CRNA, he led a team of more than 100 CRNAs at JHH and provided administrative oversight of all CRNAs across the entire Johns Hopkins Health Care System. He successfully led his CRNA team through the COVID-19 pandemic with redeployment of CRNA teams to the intensive care units to assist with ICU and respiratory therapy care. He promoted advocacy and advancement of clinical practice of the Maryland CRNAs through policy, education, and awareness during his involvement with the Maryland Association of Nurse Anesthetists, which included serving as its president. Dr. Benson earned a BA in biology at Carroll College, a BSN at the Johns Hopkins School of Nursing, an MSN at Duke University School of Nursing, and a DNP at Rush University Email: abenson4@jh.edu.

Jessica S. Peters, DNP, MS, RN, ACNP-BC
Jessica Peters is an assistant professor at the Johns Hopkins University School of Nursing. Her clinical expertise is as an acute care nurse practitioner specializing in surgical critical care since with a focus on general surgery, surgical oncology, trauma and transplant. She received a doctor of nursing practice degree and post masters nurse educator certificate in 2015 from Johns Hopkins. She has also mentored several Fuld Fellows during their quality improvement projects in patient safety and interprofessional communication and collaboration within critical care. Dr. Peters also serves as an active member of the Society of Critical Care Medicine and has served on the society board review, advanced practice and patient family care subcommittees. She is a member of the American Academy of Nurse Practitioners within their Acute Care specialty practice group. Dr. Peters' practice interests include care coordination, patient-family centered care, and unplanned critical care readmissions for patients with medical and surgical complexity Email: jsikkem1@jh.edu.

Colleen Kennedy, DNP, CNM
Colleen Kennedy is a nurse midwife at Johns Hopkins Community Physicians. She has a master's in nurse midwifery from Georgetown and has earned a DNP degree from Frontier Nursing University in 2015 with a focus on clinical protocol and admitting privileges for advanced practice nurses within hospital systems. She has worked closely with safety improvement committees at Johns Hopkins Hospital for reducing risks to laboring patients. She currently works full time with patients in the office and on the labor and delivery unit at Johns Hopkins Hospital. Dr. Kennedy was also the president of the Maryland Affiliate of the American College of Nurse Midwives from 2015–2018. She is a contributor to several textbooks related to maternal and child health Email: ckenne12@jhmi.edu.

Michelle Patch, PhD, MSN, APRN-CNS, ACNS-BC
Michelle Patch is a board-certified adult health clinical nurse specialist and an Assistant Professor and CNS track coordinator in the Johns Hopkins School of Nursing. Dr. Patch maintains a clinical practice with Johns Hopkins Hospital and Johns Hopkins Medicine's Armstrong Institute for Quality and Patient Safety. She has held progressive clinical, operational, and safety leadership positions across inpatient, outpatient, emergency, and austere settings. She also has extensive practical experience in emergency management and disaster response, including service as a U.S. Navy Nurse Corps officer and Operations Chief for JHM's COVID-19 Unified Command Center, as well as current efforts as Director of JHSON's COVID Vaccine Volunteer Program Email: mpatch1@jh.edu ORCID# 0000–0003-3639-6003.