Chief Nursing Officer Recounts Time as Incident Commander During COVID-19 Pandemic

For Cori Loescher, MM, BSN, RN, NEA-BC, Chief Nursing Officer and Vice President of Patient Care Services, serving others has been part of her decades long career in nursing. She has always liked being involved with emergency response systems because it gives the organization a framework within which you prepare for responding to emergencies. In fact, the Hospital Incident Command Structure (HICS) is set up to provide a certain structure that is organized, has rules to follow and spreads responsibilities throughout the organization. In the past, she has served as incident commander for many events, ranging from snowstorms and hurricanes to a staff strike and the Boston Marathon bombings. But nothing could prepare her for the months long duty of serving as incident commander for the COVID-19 pandemic at Brigham and Women’s Faulkner Hospital.

“Our first COVID-19 planning session at BWFH was on January 24 and just three days later Mass General Brigham established their Hospital Incident Command Structure (HICS),” says Loescher. “That was really when we began to think creatively and plan for how we were going to respond in the days, weeks and months ahead.” It was also the beginning of long days that included 10-12 hours of COVID-19 meetings that stretched between Mass General Brigham, Brigham Health and BWFH in order to capture the latest updates and work streams needed to adapt care right here on our campus. And on many occasions, she would be up until midnight reading and responding to email that came in throughout the day in order to be prepared for the next day’s agenda.

Those early actions laid the foundation for our response at BWFH that would culminate in changes to nearly every function in the hospital, from temporarily closing practices, postponing surgical cases, working remotely, managing our labor pool, how patients and employees access the building and, most importantly, how we would treat COVID-19 patients while planning for a potential surge that could outweigh the number of beds at BWFH. “We literally took apart the hospital as we knew it and rebuilt it as a COVID-19 hospital to respond to the pandemic,” states Loescher.

“One of the most trying times serving as incident commander was around the management of personal protective equipment,” states Loescher. “I had a real concern that we wouldn’t be able to secure the amount of PPE needed to care for our patients and as our COVID-19 patient population grew from unit to unit I had to explain to staff that they might not have all the resources they were accustomed to.” Loescher explains that at first she could see some of the fear on people’s faces, even behind their masks, but then a real sense of pride took over and people began to understand the importance of working together to come up with creative solutions to continue providing high quality care. “Even as the guidance changed, sometimes daily or even more frequently, our staff showed amazing resilience in never letting anything stop them from caring for patients,” says Loescher.

“I would try to walk the units a few times a week to check in on employees and see some of what our frontline employees were seeing because I knew staff feared for their own safety and for the safety of their families,” says Loescher. “While I’ve never seen such sick patients in our ICU and I’ve never seen staff struggle so much with properly donning and doffing equipment because of how frequent the supply changed, I’ve also never seen such camaraderie among staff to take care of our patients, and each other.”

And Loescher admits that taking care of each other was an important part of her role, one that she often relied on herself. “The weight of some decisions and the downstream affect it would have on staff and patients was overwhelming at certain points,” explains Loescher. “There were several times that I relied heavily on our own hospital leaders to review decisions and talk through options to ensure we were making the best decisions we could with the information we had at the time. I will forever be thankful for the entire incident command, all of the branch leaders and each deputy below them. The countless hours spent planning and the dedication to prepare the staff and the hospital was amazing and the work of an entire team.”

One of those decisions that weighed heavily on Loescher, and many members of the hospital incident command team, was the establishment of the crisis standards of care, which are principles put in place during a crisis that guide decisions when providing a normal level of care is not possible. “It’s one thing to talk about potentially not having enough supplies or ventilators for our patients but it’s another thing to actually establish the protocols on who would or would not receive them if the situation arose,” she states. “Fortunately, we never had to implement them.”

When BWFH stood down our incident command structure on May 14, Loescher felt a great sense of pride in the job that she, and her colleagues, had done to care for COVID-19 patients. “Our entire team did an extraordinary job in planning for and caring for COVID-19 patients,” she says. “And while we anticipate having COVID-19 patients for some time, there are incredible lessons that we can use as we reimagine what the future of our care looks like.”

Chief among those is the use of virtual work and how that can change the way we care for patients in the future. Loescher states that the use of virtual technology can be deployed at nearly every patient interaction. “From a virtual visit prior to coming to the hospital and the use of other technological advances while here, we can do a better job of connecting patients with providers and with their loved ones going forward.”

Loescher concludes that there is still work to be done and that we must remain vigilant to continue to take care of our patients and ourselves as we move through the reopening phases. “As a community hospital, I’m very proud of the work we did and the role we played in caring for so many COVID-19 patients. As with so much of the work we are able to do, none of this would have been possible without the extraordinary efforts of our entire Faulkner family coming together!”

Posted 6/8/20