This team has contributed countless hours over the past 2 plus years during some of the most challenging situations I have ever experienced in my 15 years as their leader. Together they rose to the occasion of facing the unknown when COVID arrived in Lancaster County. They had fear of the unknown; however, they were committed to ensuring they learned the latest treatments for the COVID population. In the beginning, things changed by the hour and they needed to be flexible as every day it was something different. Everything in their world was now different.

In an environment where families were normally at the bedside, they now found themselves without any visitors. With the lack of visitors, they took on an additional role of ensuring effective communication with families and implemented the "Blue Jeans" technology so that the families could see their loved ones. Many shifts were spent delivering devastating news to families regarding their loved ones. What I witnessed was a TEAM who stuck together and worked countless hours to meet the needs of the community. They never allowed a patient to die alone and I would frequently see the PCA sitting at the bedside holding the patient's hand while they expired while the nurse was proning the patient next door.

We celebrated the successes and took pictures of patients as they transferred out of the unit or walked back in to thank the staff months later. Nursing at LGH has always been amazing and committed to quality outcomes for the patients. Covid didn't change that even though we endured devastating losses the nursing team continued to advocate for their patients. Proning took a toll on the patients' skin and the Team continued to go back to the drawing board to see how we could decrease the injuries of their patients.

Another piece that the staff did for the patients/families was to keep journals for them so that when they woke up weeks later they could put the pieces together of everything that they had missed. Every patient who returns talks about the journal and how much it has helped them to understand what happened to them. This was another task in an already crazy time, but they quickly learned it mattered.

While ECMO wasn't new we were now running up to 8 ECMO patients at a time. This is a highly complex treatment that was not available everywhere in this country and we maxed out all resources to make it work. Each strain of COVID brought new challenges with it and we needed to develop criteria to ensure the appropriate use of our resources which added another layer of distress for the staff; however, the data supported it was the right thing to do.

While it was hard to see the amount of death, it was more morally distressing to have to take equipment away. When I could show the team the data to support how they were feeling it made sense to not offer advanced therapies to patients that would not survive. Proning was the treatment for our COVID population and the team was quickly in‐serviced on proning and then embraced the proning of the patients. They were a well-oiled machine and would all don their PPE and head down the entire side of the unit to prone their patients. They developed a routine and quickly did a task that 3 years ago would have been a huge challenge. I will never forget the day they said we need to prone this ECMO patient. A task we had never done. With good collaboration and communication they were able to successfully prone the patient and now do it as if it is nothing.

What everyone has learned is never to say it isn't possible or this team will show you it is possible. More patients will be saved in critical care due to proning early on and implementing ECMO seamlessly. These volumes are growing in the non-covid population. The team made grab bags for the common procedures so that they just grabbed the bag with all the supplies to be ready to go. This was a huge efficiency to have everything ready and be able to toss into the room instead of donning/doffing. WE had a‐line/central line/intubation & proning bags prepared.

This team took on every new challenge to continue to deliver the care the patients required. As business re‐opened we faced each day with a full census and the need to juggle beds every day to try to accommodate for either another COVID admission, Heart Surgery, or general medical/surgical ICU. WE would evaluate the patients every morning to see who could be transferred and then collaborate with the providers to get those transfers in. WE partnered with the OHS team to ensure that before they started a case in the morning that they were checking to ensure we would have a bed by the time the patient was due to come out of the OR. There were days that the OHS team needed to hold the patient when the case was finished while the housekeeper mopped the floor and we set up for the new patient. It was very infrequent that we needed to cancel a case but we were literally mopping the floor as the patient rolled into the unit. This truly shows the collaboration between all team members in the ICU as well as other departments. I couldn't be more proud of this team