Category: Features

The year 2020 was supposed to be special at the George Washington University School of Nursing. The World Health Organization had designated 2020 as the International Year of the Nurse and the Midwife, and the school was to celebrate its 10th anniversary. Dean Pamela Jeffries was planning an April gala at the Army and Navy Club, and programming would, Janus-like, look retrospectively on the past decade and ahead to the next 10 promising years.  

“That was a big deal for us,” said Dr. Jeffries. “We were ecstatic.” 

Then the pandemic hit, postponing the gala first a few months to August, and then subsequently a year to April 2021. With students and families needing support more than ever, GW Nursing brought new urgency to scholarship campaigns already underway, and the school continued to plan a health summit—albeit in digital form—addressing educational gaps in health professions.  

“We have to stay current with timely topics and needs within our health care profession,” Dr. Jeffries said. 

Helming a school amid a pandemic isn’t easy, but adapting and even shining under pressure in uncertain, stressful circumstances is muscle memory for nurses, whose patients’ conditions may fluctuate by the minute. “We deal with uncertainty all the time,” Dr. Jeffries said. “If I’m in patient care, my Tuesday looks different from my Wednesday. The practice environment changes by the day. So does the academic one.” 

As a nurse with a background in critical care, Jeffries was familiar with the need to be ready for change. “I could have a pretty stable patient come in the unit at 10, but by 11, he could be in respiratory arrest or cardiac arrest,” she said. “I always had to be prepared to deal with emergencies, because I never knew what emergency might be in front of me.” 

The past few months have been exceedingly difficult for almost everyone, and these have been particularly trying times for nurses on the front lines of the public health crisis, as well as for their colleagues in the nursing academic setting. As the pandemic rages amid a period of social unrest and protests demanding social justice, it’s more important than ever for nurses and nurse faculty to prioritize self-care and their own mental health in addition to aiding their patients and students. 

Stories of GW Nursing faculty, staff, students and alumni could fill many tomes, but here is a sketch of several important happenings in and around the school’s community.  

A Drastic Change 

When COVID-19 hit, Dr. Jeffries drew upon her nursing experience to think critically and to prioritize what to do first, second and third. “We just take command,” she said of nurses broadly. “We’re operational. We just lock in.” 

On March 13, the school moved to a fully remote workforce, with faculty, staff and student safety being the paramount concern. At the time, people weren’t wearing masks, but Dr. Jeffries instructed everyone to go home and mitigate risk by doing things like washing hands extra carefully. After addressing safety, she said she turned her attention to what her faculty and staff needed “to maintain structural continuity and to make sure that our students can progress.” For those slated to graduate in May, there was concern over how to ensure they met vital competencies.  

Concerned about staff morale, Jeffries set up weekly meetings with managers and directors to ask what they needed and to talk about how best to support a remote workforce. The meetings helped them calibrate. “That’s what we do as nurses,” she said. “We look at human responses. We look at whether they are stressed, anxious or sad.” 

Jeffries also set up weekly town hall meetings with faculty and staff, which continue to draw more than 100 participants. “We’re here together. We’re a community,” she told the group. “Nurses build community, because when you’re caring for a patient, you include the family. Do they have the resources they need? I don’t want to give someone a prescription for a medication they can’t fill.”  

After reassuring the GW Nursing community, Jeffries emphasized the importance of discussion. “As nurses, we communicate well. We are the most trusted profession,” she said. She placed transparency and team building at the forefront of the school’s administrative response. The environment she fostered broadcast to the entire school community that everyone was in this together. 

“That communication link was important. They were hearing from me. I was giving them all the information I had in real time. That was crucial,” she said. “That carried over from my nursing days when establishing a line of communication with your patients was your top priority.” 

Every town hall meeting, Dr. Jeffries ends with an inspirational quote. “In the beginning, I would bring those, but now I have faculty or staff closing the meetings with their own quotes.” She also had to slow herself down at points, knowing she tends to operate at warp speed. 

“Sometimes I had to remind myself, ‘Hey Pam. Pause here. Let them catch up.’ As dean, I might see the big picture ahead of other people, or I might have a vision that others don’t see,” she said. “As a leader, it’s important to tap into your emotional intelligence to know that when you lead, you have to bring your team along. You can’t be so far ahead.” 

Meetings of a critical-decision team Dr. Jeffries assembled, which had been a daily occurrence at the outset of the pandemic, scaled back to thrice weekly, and now are held two times a week. The team had succeeded in keeping the school up and running in the face of so much uncertainty. “Things were changing rapidly,” Dr. Jeffries said of the early days. “As a leader, you’ve got to be flexible and nimble.” 

Among the things the team has tackled are procuring remote proctoring software for exams delivered digitally, unifying communication so there are no mixed messages going out to different parts of the community, and “Fun Fridays,” where faculty and staff gather online for half an hour to discuss things other than work.  

The latter was in its 24th week at the time of the interview in August, and Dr. Jeffries said participants had shared with the group pictures of their children, of a road trip to Niagara Falls, of home remodeling and renovations, and of pets. One brought the trivia game Kahoot! for everyone to play, and another shared about a new mask-making hobby. Dr. Jeffries showed the group rocks she paints and leaves on a path for people to take or move around.  

“It’s nothing but fun,” she said. “It becomes a stress release.” 

Looking forward, Dr. Jeffries has no more access than anyone else to a crystal ball, but she has seen promising signs in the way GW Nursing has rallied together as a community. The faculty and staff have exceeded Dr. Jeffries’ expectations in their kindness and support, and the prior week, a student anonymously gifted $7,000 in support of scholarships. “It’s wonderful to know this particular student felt so supported through this stressful time that she wanted to acknowledge it through philanthropy,” Dr. Jeffries said. “For the student, $7,000 was probably a lot of money.” 

Dr. Jeffries added that pandemic has been compounded by social unrest and protesting following the May 25 death of George Floyd. With the help of Sandra Davis, assistant dean for diversity, equity and inclusion, Dr. Jeffries penned a message to the public stating unequivocally that the school will not tolerate racism, bias and discrimination and the continuing cycle of health inequities across our nation. Every Tuesday at 7 p.m., the school holds virtual forums called “Continuing the Conversation,” to discuss structural racism.  

“We’ve embraced the need to bring more awareness and change to systemic racism and doing so requires us to bring  anti-racism into our classrooms, into our working relationships, and when we are in clinical settings,” Dr. Jeffries said. She is inspired by the vulnerable and highly personal stories shared by many faculty, staff and students, and is proud that the school has fostered an environment where members of the community feel safe doing so. 

One person, a black woman, shared with the group that at least while quarantined at home during the pandemic, she no longer worries about the safety of her children, who are black teenagers. “That was heavy,” Dr. Jeffries said. “People haven’t walked in other people’s shoes. Those stories were so striking.” 

Duty Calls

If life were a movie, a grizzled Richard “Ric” Ricciardi would have been splitting firewood at the end of a long driveway when Department of Defense officials drove up and told him the world needed him to come back to work. It wasn’t that dramatic, but the DOD certainly caught Ricciardi off guard when it asked for his help to lead COVID-19 operations and public health response at General Leonard Wood Army Community Hospital at Fort Leonard Wood in Missouri. 

“Originally, I was shocked to be honest with you. I was retired from military service. I just figured I would never put on a uniform again,” said Dr. Ricciardi, director of strategic partnerships at GW’s Center for Health Policy and Media Engagement and a professor of nursing. He is also president of Sigma Theta Tau, the international nursing honor society. 

The military’s ask wasn’t that unusual, however. As a 66P (family nurse practitioner), Dr. Ricciardi had worked at the Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services, and he was very familiar with public health models. Where most Army colonels had retired or were working in administrative roles, Dr. Ricciardi kept one foot in clinical practice his entire career and was still certified to practice as a nurse practitioner in Maryland. 

“It really wasn’t my Ph.D. that got me called back. It was that I was still practicing as a clinician,” he said. “For me, they kind of got a twofer.”  

When the initial shock wore off, Dr. Ricciardi felt a sense of pride and honor. “I’ve always been very proud of this country, the American dream and what the country stands for,” he said. “To be asked by the Department of Defense to participate in a national emergency—I felt honored to be asked. If your nation calls and really needs you, if there’s something I can do to make the world a little bit better during a national emergency, I definitely should consider it.” 

Before making the big decision, Dr. Ricciardi talked to his wife—who was supportive—and to Dr. Jeffries, who gave him the green light on GW’s end. He said yes to the DOD, received his orders, and then things moved very quickly.   

At the fort, Dr. Ricciardi works out of an old dental clinic overseeing screening of incoming populations and setting the fort’s public health responses to prevent potential spread of the virus among trainees. Part of that means designing training “bubbles” for recruits and arranging sleeping accommodations in safe ways. (Trainees sleep head-to-feet and feet-to-head.) Dr. Ricciardi didn’t want to identify the fort’s population but said he has screened people “in the thousands.” 

“When conducting training in the field in a COVID environment, it’s about really trying to figure out if there are other ways to do something, like scaling a wall, in a different way, or questioning whether that activity is really something that is required in the training to ensure competence. Can that be left out? Can you just have the person do it on their own?” he said. “The critical element is trying to have reasonable assurance that when people are training together that you have done all that you can to minimize the risk of COVID transmission, such as removing the individuals that either have COVID or are at risk for developing COVID.” 

In high-pressure conditions, self-care is important for health care workers too, and Dr. Ricciardi relaxes by going on walks in the nearby Ozark Mountains. (He posts his stunning flora and fauna photos on Flickr and also writes poetry.) “It’s one way for me to unwind,” he said. “I’d never been to this part of the country before, so it’s quite striking how beautiful the countryside is. The good news is you’re out in the countryside by yourself. There’s no risk of COVID.” 

Dr. Ricciardi said photography and writing help him escape temporarily from overwhelming times with the global economic challenges, systemic racism and the pandemic. But looking forward, he is optimistic about some of the promises of telemedicine and virtual health care, which can handle certain health conditions more efficiently, and cheaply, than an in-person office visit.  

“COVID, in some ways, has been an opportunity for health care to advance and improve its efficiencies, effectiveness and customer service via telehealth and other modalities,” he said. “The paradigm of primary care will change to allow for more of this innovation around telehealth to be incorporated routinely in a visit.” 

“I think consumers are going to demand it and say, ‘I didn’t have to get in my car and drive. I could actually see my provider without leaving work. It worked out well. Why can’t I keep doing that?’” he added. “I suspect for certain kinds of medical issues, consumers will demand it.”      

Clinical Simulations 

Pediatric clinical education instructors Betsy Choma, Kristen Stevens and Jennifer Walsh, who work as a team, have also found ways to adapt to social distancing requirements in ways they think will improve teaching even after there is a readily accessible and effective vaccine. 

When the pandemic forced hospitals to turn away nursing students for clinical rotations, the three instructors put their heads together to find a solution. In mid-March, one cohort of students still had a few weeks left, but the summer group needed to do its entire clinical component virtually. 

It was helpful to know ahead of time for the summer that the three would be designing the didactic (lecture) and clinical portions to complement one another, according to Choma. “The three of us were able to sit down and plan out, ‘OK. If we are talking about respiratory in lecture, let’s have respiratory case studies in clinical,” she said. 

When students see patients in hospitals, they never know what patient they will get at any given hour of any given day, but simulation allows for more customization. “It’s actually nice to be able to tailor and bring the student into the virtual classroom,” Choma said.  

The three could essentially put their pedagogic fingers on the digital scale and design vignettes to ensure students got to see, virtually, every relevant kind of patient. That gave both depth and breadth to the learning, and could bring examples virtually—say of child abuse or vaccine hesitation—that students otherwise wouldn’t necessarily experience. 

In an unexpected way, the virtual nature actually brought the patients to life, Choma added. 

“There are pros and cons of both. We obviously would love our students performing patient care. We’re nurses. That’s what we train for. That’s what we all want,” Walsh said. “With the COVID pandemic, we didn’t really have that opportunity, but we still had to provide a quality education to these students to get them out into the workforce.” Providing the course online allowed for “more synchronously connecting the didactic and clinical learning.” 

The program had previously used simulations and in-person teaching, and Stevens said the three of them found the two approaches to dovetail well. “In simulation you have a safer environment, and you can try things without the same degree of consequence, and so the thinking is very different,” she said. “Versus when there’s a child crying in front of you when you have to talk to the parent.” 

In the fall, students will be learning in hospitals and virtually, and the trio expects even when everything returns to normal to continue to tailor simulations to lecture topics. “As our pediatric curriculum features simulated patients and scenarios increasingly, we look forward to maximizing use of our high-quality simulation lab,” Choma said. “I think we are really going to see the value of simulated scenarios, because we can’t predict the outcomes, but we can control the environment.” 

“We learned so much with this transition to virtual,” Walsh said. “I think there’s no doubt that we will continue to evolve and continue to bring what works best for the students in the future.” 

Finding the Silver Lining 

Before the pandemic changed everything, Leah McElhanon, B.S.N. ’18, M.S.N. ’19, had a plan. She was going to work at a clinic and save enough money until she could hang her own shingle. In March, she realized she had to detour. 

McElhanon was furloughed from the Dallas clinic where she worked. Unsure when she could return to work, she decided to volunteer at the Federal Medical Station in Santa Clara, Calif., as part of the medical team for the nonprofit Team Rubicon. There, she cared for COVID-19 patients before her deployment ended. 

Earlier this year, she started a pro bono practice on the side and began a new job recently as medical director for a COVID testing initiative, which she said is trying to find better and safer solutions to medical problems. (She didn’t want to say a whole lot more about the effort, which is in its infancy.) 

McElhanon has heard from former classmates and colleagues, and she said everyone is physically, mentally and emotionally worn. She felt some inertia initially, when there was some hope that there might be a big breakthrough, but she is prepared now for a long haul. 

Nursing school taught McElhanon to keep a poker face for the benefit of her patients, but in the face of COVID, it’s tough to be stoic. “It starts to wear on you,” she said. She currently has a very close family member in the hospital. Despite a resilient nature, she finds it devastating to be unable to care for her relative. Hospital policies bar visitors of any kind, which makes in-person support impossible. McElhanon went into the medical field to protect those close to her, but now she finds herself stuck at arm’s length due to the ongoing pandemic. 

“The nursing profession is needed now more than ever. Nurses are at the patient’s bedside 24/7, when their loved ones cannot be there,” McElhanon said. “The nurse’s presence ensures that the patient is never alone. In addition to their medical expertise, nurses are everything for the patient. They take on the roles of family, friend, advocate and much more.” 

Somehow, McElhanon sees a silver lining amid all the uncertainty. 

“We can’t change anything we did yesterday; we can only be better today,” she said. “Taking a step back and looking at what this experience is going to offer us. One thing is innovation in medicine. Right now, people are pushing in so many avenues for so many different medications and treatments and protocols. Researchers and medical professionals are out there trying everything that they can.” 

Medical professionals are starting to see that they can not only strive to help with the current pandemic, but also pioneer and push new boundaries. 

“Medicine is very foundational. Views and practices remain inside the box,” she said. “This silver lining is teaching us, ‘Let’s never think inside the box. Let’s keep going.’ I think this may benefit us in the long term. We may be able to identify and prevent viruses sooner. We might be able to predict how other viruses, with which we’re already struggling, infect and overtake the body. We might be able to cure some things that we’ve never been able to cure.” 

It’s really hard to try to find sources of optimism and positivity, she admitted. “But honestly, that’s what we need to do right now,” she said. “We will get through this. We can get through this. We just have to stay positive.” 

AUTHOR MENACHEM WECKER