#livewithrollis Podcast

New Episodes Mon / Wed / Fri of each week - #livewithrollis is a series of shows originally aired on LinkedIn LIVE with several guests throughout the business world. Growth Monday: Rollis Fontenot III and guests talk about how to grow your business and career. Thursday Round Table: Round table discussions with multiple guests/cohosts focusing on people in healthcare.

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CNO NURSE STAFFING UPDATE

March 24, 2021 • Rollis Fontenot III • Season 1 • Episode 18

From the recent #thursdayroundtable #livewithrollis

Staffing updates, vaccinations and other encouraging developments from those working directly in the healthcare community

Host: Rollis Fontenot III

Panelists:
Amy Brown MSN RN
Jacqueline Herd DNP RN
Mona Gaw DNP, MPA, RN, NEA-BC, FACHE, CPHQ, LSSBB
Patti Gilliano-McClung, MNA RN

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Rollis Fontenot III:

Okay, so hopefully we are online and live I think we are at looks like all systems are go. I'm going to double check here in just a second. Folks, if you're just now signing in, let us know where you're signing in from, what city or state or country. We've got a great, great panel today great discussion we have in front of us talking about nurse staffing. And we've got some great leaders here to talk about that vaccinations, observations about just nurse staffing and just nurse leadership, talking about several topics I have on my list here today. So I want to just go ahead and welcome them. And I got three of my guests. Now I have one more this adding, we're adding a little bit later on in the discussion. But Welcome to the show. First of all, I'll start with you. At my top left hand corner. I have Amy Brown, welcome.

Thank you. Thank you

In fact, I think I might want to ask you me to get a little bit closer to you is it's kind a little bit hard to hear you. There we go. Perfect. And then we have Dr. Jacqueline herd. Welcome to the show. Hello, thank you so much. Glad to be here.

Awesome. And then we also Dr. mahna mahna. Gah, Welcome.

Welcome. Good afternoon, and greetings from Texas.

Yes, absolutely. And, well, I'd like to do those of you as you're putting in where you're from in the comments what city and state and country. I would like each of you to talk about a little bit about where you're, where you're from, what area you're in, and a little bit about the scope of your organization. So let's start with you at the top left hand corner. Amy.

Okay, can you hear me? Okay

Yes, yes.

Um, I am in Lansing, Michigan, and I am at spiral hospital. It's a 500 plus bed hospital level one trauma center. We have we had quite a few COVID cases in the spring. And then we kind of dipped back down. And then we searched again, like probably many of you in the in the fall. And currently right now we're doing pretty good. With just around 20. We've been at 20 for the past probably two months. So feels like we're finally starting to get back to kind of our regular day job.

Yes, that's a good thing. Awesome.

So hi, I'll go next. Hey, this is Jackie, and I'm from Atlanta, Georgia. So I am the chief nursing officer at Grady health system. Grady health system is probably about a 950 bed, academic safety net hospital located in Atlanta, Georgia. We are a level one trauma center, we are a comprehensive stroke and burn center. While we're in Atlanta, because of the specialty services that we provide, we receive patients from as far as Miss as far as Alabama and also North Carolina. So similar to what Amy stated, you know, we saw our peak probably about March and I think then we got probably as high as 150. What predominantly probably about more of the patients being in our ICU. And similar to everyone else, our numbers went down and we just peaked again in January and we're starting to see those numbers go down. We were as high as 150. In Atlanta and probably in the other states as well. You know, the governor set up different areas in terms of where we could provide care to kind of help offset some of the patients in the hospital. So we were kind of sharing some of our patients either they were on site at Grady are at what we call our World Congress Center, which was a pop up hospital with about 50 bits.

Okay, we're good, and that's gonna go you next.

Yes, so my name is Mona. I'm Associate chief nursing officer here at Chris's mother Francis health system in Tyler, Texas. We are located in northeast Texas. We are about 500 plus bed, regional center, not for profit faith based organization connected with crystals help crystals health is based in Irving, Texas, with locations in Texas, Louisiana, New Mexico and also overseas in South America. Just like what Jackie and Amy mentioned. It's been a year that we have, you know, been part of the pandemic. And we have been running searches, volumes, running our census at 90 to 95% capacity and really learn in a very, very quick mother. You know how we can be creative and adaptive to what was going on making sure that we were serving our mission of, you know, extending the healing ministry of Jesus Christ to our patients. And of course, our associates, we have dealt with a lot of anxiety, a lot of concern, because we did not know how to deal with the disease early on. And you know, just being nimble learners and working with what we had from a resources standpoint and supporting each other. So I'm really excited to be amongst my nursing colleagues here this afternoon, because I'm also going to take downloads and continue to learn and be able to share, you know, your best practices with our organization. So thank you. That's wonderful. And

speaking of that, because we did, we did start to get into a nice little conversation before we went live. And it was interesting. The kind of the result, we actually came up with a result that we did, I didn't think it was even going to happen. If you don't mind. Dr. Hurt, can you can you touch on that because you were asking about it. And then Amy responded about some some information you were looking for. Yes,

you. So you know, the question that the conversation that we're having earlier, you know, as we're talking about COVID. And during the peak, obviously, we had to have restrictions in terms of visitation, especially earlier around earlier on around PPP, and ensuring that we had enough PE for our staff, and so ensuring that we were restricting or having exceptions in terms of the visitation. And as we're seeing with the increase in the vaccinations, and our number starting to go down. It is time for us to really start having the conversation not only around current visitation and removing some of those exceptions, but really starting to have conversation regarding our COVID. patient, as I read.

As I reached out to other CNO colleagues across the nation just trying to look at and just like we're sharing today is always sharing within the nursing leadership say, What are y'all doing? What can we do? Have you guys changed this, to find out if people have begun or organizations have began to open up their visitation. And it's interesting, because what I found is that while they're opening and allowing 24, seven, allowing two visitors to come in, no one is allowing visitation for our COVID patient is unless what I think we all did is like the only exception was in the life. And as we're coming out of this, I think it's important that we really began to look at how do we start opening up the visitation and allowing especially our COVID, patient COVID is very scary. We know we were in a very dark time. And so when you're talking about patients who are in the hospital, obviously in the ICU, there may be very, extremely sick and not alert, but some of our other patients that are not as acutely ill, but are in the hospital, how do we start making sure that they have that family connection and that support because we know we talked about healing is also being able to be there with your family members. And, you know, the thing that I think about regarding COVID is that, you know, I've not had a family member, or anyone that was sick, or in the hospital during COVID. But I can't even begin to imagine if my son, my husband, my kids knew or hospitalized during COVID. And we're not able to have any visitation. And I do believe the long term effects on that. We have no idea what that's going to look like. And so I was very happy to hear Amy state in terms of what they're doing. And I can tell you, I'm definitely going to reach out to her and get some of that information in terms of best practice. Because I do believe it's time that we have to start allowing those exceptions as well.

Appreciate that. So how has it been working out? Amy?

Yes. So, um, you know, back in the spring, when when things were more uncertain, we were allowing a couple people to visit in those end of life circumstances. And then, you know, our supply came. I mean, our supply was very good right now. We've really, in the fall, we actually had our surge was we also had our mortality was not very good. I'll get a lot of different things. But one of the things that kept coming back is that we, we had all these patients, we probably had about 140 to 150 and are in now 30 of them could have been in critical care with 100 like that, you know, provocation charges.

I'm sorry, Amy is Amy, your voice is going out, it's hard for us to hear you out this way you get closer to your microphone, I apologize.

I'm sorry about that. So we're what we're trying, what we've started to do in December was, we have a, we use a pepper. And so scheduled visits. And they have, we have our patient experience, person, she is working with the families and she schedules them visits, I'll use our nursing leadership team to serve as escorts. And so they don't just get to come to just go visit on their own, it was scheduled visit. And so the nursing leadership signs up, like from two to four, they go down to the lobby, they go through the screening process, help them put them in their camper. And, and then we take them up to the room, and, and so on. I was sharing on Christmas Eve out there was a woman who hadn't had any visitors and 20 days. And so it was her granddaughter that got to come visit. And we went in the room and I said to her, I introduced myself and you know, it looks like you're in a spacesuit. And I said that I was a nurse leader here. And I said, I have someone special to visit with you. And she said who couldn't recognize her granddaughter. And finally, when she got really close to her, and she held her hand, I mean, she just started crying, because she was just so excited. One of her family. And so, I mean, we have dozens and dozens of stories like that. And then we would wait on the floor, like I would wait on the floor, and then I would give them about an hour. And then we would you know, casually say, Okay, it's time to go. And then we would go take, you know, make sure that they done, they got all their peepee correctly. And then within that we would take them and escort them down to the lobby. And so we our goal was to get every patient a visitor, and we definitely have done that. And then obviously, some have already, you know, some were able to do repeat visits. And I think, you know, like that is the best medicine ever. So we have still continued to do that, even though our numbers have dropped. And like I said, I'd be happy to talk more about about that with anyone I one of the things that we talked about is do we do it for end of life? Or do we do it before? And I said, if we're gonna do it for end of life, why wouldn't we do it before? And there were a couple times where we were able to get in the like the wife was able to get in and see her husband. And then they had to ask excavate him. So he was able to say I love you. She was able to hear him and they were able to have that exchange before he was intubated. And so that was my argument is if we're going to do this, why would we wait until they're dying? Why would we do it when they're still alive, and they have that fighting camp.

I wanted to share. Thank you so much, Amy, for sharing that. Jackie, we also have a similar process, we call it a COVID navigators. And this role was actually developed because of our desire not only to meet the needs of our end of life patients, but also majority of our COVID patients. So we started with one COVID navigator, or she was a nurse who was able to connect with families and talk to them about when they would want to come to the hospital. And she provided education on donning and doffing of PBE, making sure that she answered questions of the family members. And then we were able to provide additional resources because our executive team saw that this was providing so much positive impact on our patient families who have not seen their family member for, you know, many days and weeks. So we were able to do more COVID navigators and have started that actually in our limoneira unit and critical care units and we're able to bring into other areas where we had COVID patients. And I just like what you said Jackie, this really is part of you know, holistic healing, because we have received so many positive letters and emails from patient families who felt that they were no longer isolated, to be able to come see their loved one and also helping the loved one with the healing process as a result of being able to see in person their family members.

That's wonderful that is

that that I'm telling you rose that that is that is outstanding. That is just I get chills just hearing you ladies talk about that. Because, you know, I had a just a real sad story when we talked about in the life and a gentleman who had taken care of his wife, he was her primary caretaker. And by the time we were able to get him into visit, she was in a coma. And he was just devastated. And because we hadn't allowed him to come in before, he didn't know for the night, she got everything that she needed. And he didn't get a chance to say goodbye. And so those are the things that the impact on mental health, that we have no idea of what that's going to do. I will say in Georgia, and this is what you're going to see happening in Georgia, we already have legislation this coming up this gun getting through the house regarding requiring a mandatory and allowing families to visit even if it's only for our regardless of what's going on. So we just need to be prepared. And so thank you all for sharing.

That's awesome. Thank you very much for sharing that. And so we got Patty is here. Welcome to the show. Patty Guiliano. Awesome. Well, welcome. Thank you for being here. Hey, thank

you. It's exciting to be here again.

So I'd like you to quick sorry. No, we I know we understand, folks, we folks who are watching, we if you're just not coming in, I have four CIOs. Three of them are a CMOS, and one is Associate Chief, associate CNO. And we're all talking about staffing in terms of the nurse, the nurses, we're talking about visitation, we're going to be talking about vaccinations here and just a number of things that are kind of centered around that. And so if you can't give us an idea of your scope, where you are physically and then this a little bit about the the hospital you work at. Patty, sorry.

Oh, sure. Absolutely. I'm actually I'm fairly new in my role. I've been a CFO for a number of years. But recently, I've just come down here to Texas, and I'm working in the Houston market. With ch I am actually down at the st Luke's market in the southern end. And really, the scope of my role is to support all the nursing services in three different hospitals, mentoring and working with other CIOs. With all that we've been going through recently, of course, with COVID, and vaccinations, you know, mapping in the protocols, and then staffing. So I've been responsible for really helping to manage the deployment of some of our, but they call them star nurses down here, but they're nurses that are brought forward from the state, as well as some travel nurses that we've utilized. And now that we're seeing some of our patients of the population and the acuity has dropped just a little bit. We're looking at trying to stabilize some of our staffing. So I'm involved in all of the general nursing operations and some of the things as we, you know, spanned the globe with with the COVID pandemic.

Oh, very good. So thank you. So now we've got a good background for everyone. As far as where you are, let's I want to move into vaccinations, if you don't mind. And let's talk about what you know what that has been like. I know probably most of you start off with your staff first. And then we can also talk about how that's already worked its way into the community. Mona, would you like to start us off with that?

Sure. So thank you. As you mentioned earlier, we did start with our associates, and we had some stragglers, I was calling, you know, early adopters, and you have laggards. And I think majority of our associates were just waiting to see what you know, potential side effects, you know, would come from the vaccination administration. And I'm very happy to report that you know, with almost 2000 Associates, we have a total of 4000 Associates. The last count was we had had very minimal associates who had side effects. And majority of those were mostly for those who have long term allergy shots or comorbidities that would impact their ability to respond to the vaccine, and others is mostly due to anxiety. So we have had a very, very good burn out of associate vaccination. And what we have done is after the vaccination clinics that we had set up, to make sure that we make room for social distancing and physical distancing. We have now moved that to our associate health. So our physicians, our nurses and other clinical staff can Go on their own time to our associates help to make sure that they obtain their vaccines. From a community perspective, one of our local ministries in Longview, Texas, has been selected to provide community vaccinations to about 16,000 community members. So they do that during the weekends and have been reaching out to our clinical nurses, even our retired nurses to help with the vaccination clinics. And every so often, we would get some requests from our local public health department, when we have vaccines that are about to expire. And you will not believe this, but we will be able to stand up vaccine clinics within 24 to 36 hours, again, speaking to you know, the resilience of nurses and our work with our pharmacies, do make sure that we're able to make use of those vaccines that and not allow them to expire. So definitely, we are on the right track in terms of vaccination. And so I'm just very happy and blessed. I feel that, you know, I was one of those that have been able to take the vaccine during the earlier stages.

That's wonderful. And folks in the comments, if you would let us know how things are going on where you are, how are the vaccinations going, in terms of if you're working at a hospital at the hospital level as well as in the community? How about you, Amy? How are things going? Where are you are,

you know, I just got off a call not long ago, and we are we have about 9000 caregivers, and we're at 68 likes about 65% vaccinated. And so I think that you know, and it wasn't mandatory, so we feel pretty good about that. We've also given probably, I think a total of, we were also vaccinating the community, we had a, we turned in an old auto drive through auto oil change place, we turned that into a testing center, Oh, wow.

hurted. And then when that the testing volume was really going down, in, in December, so we turned it into then a vaccine center. And so that's where we do the majority of our vaccines is through the drive thru, instead of getting your oil changed, you get a you get a vaccine. And they do, they can run through people they are very quickly they can sign up and make appointments, the problem has been, and, and like motor share, too, you know, we had, I mean nursing leaders there, the fact that they'll just do whatever you ask them, that's just, I mean, we not only did we go through a pandemic, but then all sudden, now you have to vaccinate the whole world too. So, um, I, the nurse leaders that I work with did a phenomenal job at just really jumping in and just really wanted to vaccinate the community. And so they just do the phenomenal job, I will tell you that we're still really struggling with our minority population from a community aspect. And that's been a concern of ours, of what we can different or better to reach out to the minority and minorities in our community. Well, speaking

of that, Jacqueline, do you have some good advice on that as well as your update?

I wish I did. So, um, Grady. So our demographics of our patients, if you're familiar with Brady, or Atlanta, are 60% of our employees are African American. And probably greater than 70% of our patients are African American. And so as you know, Georgia is in the south. So we actually, before we actually started giving the vaccine we survey, we wanted to survey our employees to see me who was interested in getting the vaccine, who needed more information and who just outright said, No. So between those that were interested in wanting more information, we were probably at about 70%. So we're really trying to focus on those that were still on the fence, and about 30% or just weren't going to get the vaccine. And so we have been obviously providing the vaccine and making it available to our employees. And we're only at we probably have about 6000 employees. And we're probably only at about 47%. And so we are really continuing to work with them. Some of it is just they just don't trust the science behind it. And our timing, they just want to wait and see to make sure that you know what are going to be the side effects of their colleagues. So we have many, many clinics that are associated with our organization. So while we're not providing it for the community, per se We're providing the vaccine for our patients that come to the clinic and the 65. So within that group in terms of the patients that we're responsible for, we're probably at about, probably at about 74%. And, you know, we're really, you're still trying to encourage, but again, when we look at the numbers across Georgia, in terms of number of vaccines that have been given, we probably have given in terms of first doses, about 1.3 million, probably about 800,000. In terms of a second dose, however, the percentage of African Americans is extremely low. And so a couple of weeks ago, we partner with I don't know, if you all had a chance to see that with Tyler Perry, in terms of really just interviewing him and getting him to talk about, you know, he has some very solid questions regarding the vaccine regarding the science, it really trying to get that information out to encourage our patients of color in our community, in terms of getting the vaccine because we know that is a community that is hit the hardest, when we look at the number of deaths and the outcome. So we still have more work to do around just education and talking about the science behind it. Hmm.

Okay, thank you for that really appreciate that insight. Patti, how about from your perspective?

One of the things that we tried is we work with some community, church leaders and the church. And, you know, we're just weeks before the show of the vaccine, we really wanted to do replication, but is that any type of strategy? Well, you guys said, You're not vaccinating the community. I just wondered if that was another strategy or

so yes, so we're using those strategies. And what we're trying to overcome in, especially in the south for among African Americans is just the history. That that and that is so deeply when you talk about the Tuskegee, which is so close to here in Alabama, when you talk about this Tuskegee syphilis research that was done is, you know, that becomes the part it's sometimes it's really hard to get into the roots and change that trust. And so that's why we're utilizing a lot of our churches are African American healthcare providers or African American leaders, just to talk about it. And just to try and move beyond that. But it's very deeply seated in terms of trusting the healthcare professionals.

Yeah, absolutely. And I want to come back to that, but that to ski in just a minute. But Patti, go ahead. Give us your update, if you don't mind.

Yeah, you know, it's interesting coming from a different market, I was up in the northern market up in Idaho. And they were doing remarkably well, with getting the vaccine out and across the community to high risk individuals. Just getting things started rolled out, of course, all the health care providers and all the first responders and several different disciplines, law enforcement, they were doing a really nice job down here. I'm just beginning to start to see it. But not everybody is getting the vaccines that they're asking for as they're being disseminated out. Some of the larger hospitals are, but some of the smaller ones that are in my area, we all have to, you know, go to the larger ones, they are bringing vaccines and many of our staff have gotten vaccinated, we still haven't really hit that threshold yet, because again, they're in a shorter supply, but they are coming. This is not one of the testing sites that they're using pre vaccination. So again, one of our larger Houston hospitals is providing all that. And again, you know, demographically, because we do have a mixed population, you know, with a Hispanic population, African Americans. And you know, it's important to get the vaccines out to everyone, especially those that are considered more in a high risk group. So I've just kind of scratched the surface down here, but I'll be very active and vocal and trying to make sure that we get that out to our community. And we're going to have some visitors tomorrow from the state government, which is kind of nice at our facility. And so we're going to be asking for their help to help us get those vaccines at some of these smaller community hospitals so we can get it out there.

So is your issue Paddy more of a supply issue or more of an acceptance issue, which one's bigger?

As I see it, right now, it's a little bit of supply and demand because we just don't have the widespread you know, what you would call density getting it out there. Healthcare workers are definitely accessible to getting it but as we want to get it out there and start offering into the community like I did on the northern end of the United States. It's it's only at certain key select areas. It's not as easily I think obtainable. At least that's what I'm seeing. There is some some quick back, you know, some people want to watch and wait and see what the effects of the vaccine are. But I haven't seen that as much as I did. North up north, it was kind of well, it's, we want to watch and see what you know what it's gonna do and how my coworker is down here. Everybody seems very willing to get it. So it's a little bit more, you know, they're more willing to get the vaccine, but it's just the accessibility for those outside of health care to get it. But all of our employees are responding very well, to getting

the motor early. I think you were about to say something when we asked about a comment on getting the local church leaders involved. Did you want to share that?

Yes, I just wanted to share that. You know, that 2436 hour, we had vaccines that were about to expire, we were able to make it happen because our church leaders in one of our local Baptist churches, took on the challenge and worked with us. And we were able to meet the needs of their elderly patient population, mostly African American, very, very, very good group that were willing and able to make it. We had heavy rains on Monday, but they braved the rains. And I'm just so excited because they were able to come in, we were able to give, you know, 300 plus vaccines. And when I went home that night, I was really, really tired. But to my mind, I felt that it was a great experience, because we were able to make an impact on the lives of those 300. community, our residents who really needed the vaccine and did not have a way of getting it, it just so happened that we had available vaccines to give. And we had a team of people who were willing to live their emails behind and be able to view vaccines, we also were able to work with black nurses rock, and the greater East Texas black Nurses Association. They came and were well represented. And just like what Jackie was saying, I think it really sends a very powerful message. If you are working with, you know, the same group, and you're able to identify, and there's that trust that is created. So we're just so privileged to have have been able to do that for our community.

That's wonderful. We've got quite a few that have come in and are saying hello, we have. Let's see, we have an emeritus she's coming in from Florida, we have Leah, she's coming in from Texas, Dr. xenium, Alaska. She's a fellow nurse. She's coming in from Indiana. And we had Casey Smith. He's also with the CH our organization. Patty he had come in a little bit earlier. He's a nurse director there. And we have many others. So those who are watching, if you have any questions while we have this great panel on, feel free to put your questions in even if you're watching the replay, put your questions in and we'll we'll try and get all those questions answered. I'm gonna hit the refresh button, just to make sure I don't miss any more comments, because sometimes they don't come in real time. Let me just check that briefly here. Okay, we have Carrie. And she's also coming in she said, loves Jackie. So Carrie, and Jacqueline. She says I love Love, love. Love those photos behind you. Yeah, and so yeah. So Carrie Anne says very similar here in Massachusetts, a few side effects. But something but I think she's suppressing something too bad. Nothing too bad, but nothing too bad. About 60% vaccinated here in brain tree. Okay, very good. And carry and said, Amy Brown. That's a great idea. So she said something to she's not something you said was a great idea. So maybe let us know what that is carry in. So thank you, for all your comments, keep those coming in. I do want to just circle back to the Tuskegee thing. We've actually refer that to that on another show. But we never actually explained it. And I feel like on one of these shows, I want to get somebody actually explaining it because some people don't know about it. Right? There's some of us who do it's I don't want to assume everybody knows. So Jacqueline, can you kind of give us a little bit of a brief history lesson on that.

So in a nutshell, and I'm originally from California, so I wasn't really familiar with the Tuskegee Institute, because, you know, it wasn't raised in the south. And I think the first time that I saw about it was a movie. And so basically what, and I can't remember the year I don't have it pacifically in front of me, but it was it was at a time where they had a cure for syphilis. And there was a study that was done of Tuskegee, which is an Alabama, where they went into the community and they were seeking. They basically were telling these African American men They would be treated, they would get free treatment for syphilis. So they bought them into the study. And basically, what they did is they did not give them the treatment. And so what they were doing is with these be African American men, is that they were just seeing the impact. They were monitoring, they were doing bloods, and they were checking them. But they were seeing the impact that syphilis would have, when it was not treated. And the sad thing about it, at the time this report, this study was occurring. There were already studies that were completed that art before the cure came for syphilis, that they were aware of what what happened to someone that was not treated. So that whole distrust that these men thought that they were getting treatment for the bad blood is what they call that. And, and the sad thing about it that that obviously came out much later that they never received the treatment. And I think it was during a I think it was during Clinton's presidency, where he volley where the United States government, you know, gave an apology in terms of what happened. And as a result of that, then you now if any of you are doing any kind of research, whether it's in school or at your place of employment, it has to go through the federal government in terms of that whole IRB to ensure that those things don't happen again. So that is something that is very, very, very much deep rooted. And you know, again, when you talk about, you know, when you talk about the the Tuskegee, but you can kind of get into all the civil unrest and everything else that has happened. And 2020 in terms of why with your patients, your communities of color, that hold this distrust.

Yeah, absolutely. Okay. So I just want to thank you for doing that. I just wanted to get, you know, have that on on a recording somewhere, because we've, we've talked about a couple times, and no one's actually ever explained it. So thank you for explaining that to me, you actually taught me a couple things about it. So thank you for that. What are you over as you just just your observations on your nurse staff, your your workers, give me kind of a pulse as to what's going on right now. Because, you know, we hear hearing their things in the news, we, you know, obviously, we're going to hear certain ends of the spectrum on the news. Mostly, it's very, very, I'm not gonna say negative, but it's just it's very tough. Some of the things I'm seeing on the news. So I just want to know, from your standpoint, how are your staff going through all of this? So who would like to start on this and you want to start? Amy, you want to start? Sure. Okay.

Interestingly enough, I had a couple of local reporters that wanted to interview some staff about burnout. And the managers talk to six nurses, and none of them wanted to talk about that in itself, just kind of do it, I think they're tired of talking about it. They should talk a lot, I think it's good for them. But I am worried because we did a lot of different things. With regards to trying to help our nurses cope, mostly in the adult inpatient world, that's where they were dealing with COVID. And just the number of deaths they were seeing, I will say, though, is that we even drop a mental health therapist to, to the hospital to so that it was very, very easy. We bought massage chairs, we had snacks. I mean, we I felt like we thought of everything. But I still think that there's some type of the person in itself still has to be willing to, to accept the help. And that's where I think that we found the most barrier is that there, there are people that the nurses still didn't take advantage of resources. So I am worried that it's going to come back and kind of we're going to see some some downstream effects. Where I'm struggling the most is honestly, with my inpatient nursing leadership team. I've had quite a few resignations, they are choosing to stay at home with their kids. There, they're saying that the stress of the 24 seven was too much. And that they're just they want to go back to that shift work. And so that's something that is definitely top of mind for me of, of how do I recruit nurses to go into this leadership role? Because, you know, even even in the spring, when even when the census strapped the inpatient nursing leadership team, like, I'm sure all of you guys, we never, we never reduced our hours, we only increase our hours because we were preparing for all the protocols that we needed to do. So. Nursing leadership really has never had any downtime for over a year and I and I truly think that they're just completely I hate the worst word, the use of this word but burned out.

Yeah. Yeah, absolutely. Paddy, how about from your perspective? What are you saying? You can speak to your last organization or your new when either one?

Amy Brown