The COVID 19 Navigation team epitomizes teamwork. When the immediate need arose to put together a team with existing resources to provide telephonic support to our PUI and COVID positive patients the call was answered by our Remote Monitoring, House Calls, ACS Case Management, Patient Education, and ACS Nursing teams. More than 30 employees from each of these departments signed up for seven days per week of work, including holidays, to provide the necessary clinical and emotional support to patients coping with the novel coronavirus. Over the last 365 days since the program began we have heard from our patients how much they appreciate someone checking on them regularly and ensuring they receive medical intervention when needed.
One such patient, Ms. D expressed, "It was so nice to have someone checking on me every day. They truly spoiled me. Every time they called they asked how I was feeling, asked me to take my temperature, and reminded me of what to do if new symptoms popped up; which thankfully never happened. I'm thankful my test came back negative, but I must say, I've missed Ms. Simone's calls."

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The COVID 19 Navigation Program was initiated and handed off to Clinical Integration and Transformation in March 2020. Nurses were surged from various departments throughout Harris Health System to staff this program. Nurses were pulled from the House Call Service, Healthy Heart, Healthy You Remote Monitoring Program, Patient Education, Case Management, Strawberry clinic, Casa de Amigos Health Center, including supplemental nurses from the Nursing Operations Department. These nurses included MSN and BSN-prepared RNs and also LVNs.
The COVID Navigation Program was created to achieve better patient and family outcomes for patients experiencing COVID 19 symptoms, exposed to someone with COVID 19, or had a positive COVID 19 result. We provided community resources, clinical and emotional support, education, and we decreased EC visits and admissions by scheduling telehealth appointments for the patients when needed.
We developed a partnership with the Houston Food Bank to provide a 14-day supply of food for a family of four for patients who screened positive for food insecurity. As of February 2021, we have received 37,376 referrals, navigated 14,000 patients, scheduled a total of 978 telehealth visits, and provided 3,777 Houston Food Bank linkages.
We started with five nurses and our highest staffing during the summer of 2020 was 35 nurses. We worked seven days per week including holidays. We began with a laborious manual referral and tracking process, now we have updated our referral process to include a referral work queue in EPIC. We also went from documenting with smart phrases to flowsheets.
What is most impressive to me is the cohesiveness of the team. In my 25 years as a nurse I have never seen a group of nurses with different educational background, skillsets, and experience work so hard and so well together; when the referrals would increase the referral nurses (they were exempt at the time) would either start their day early or leave late just to make sure the referrals would be reviewed within 24 hours. When the navigators would be done with their assignment they would reach out and offer help to those that were struggling.
These nurses went above and beyond the traditional role of nursing to exceed the patient and patient's family needs. They had no choice but to be flexible, due to this being a new program our processes would not only change daily but sometimes more than once a day. They did not choose to work in the COVID 19 Navigation Program, but they showed up each and every day and they gave 100%.
This program could not have been successful throughout the last 12 months if it was not for the commitment and dedication of all the nurses involved, especially the core team of referral nurses. This group of nurses is true role models of collaboration and teamwork that make a difference in the lives of our patients, families, employees, and the community. They exemplify Harris Health System's mission and vision each and every day by improving the health of those most in need in Harris County through quality care delivery, coordination of care, and education. Virtually, this group of nurses kept thousands of people safer from COVID-19.

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The team went above and beyond assisting patients with COVID and COVID-like symptoms and being there for each other in assisting patients properly.
This team started with a handful of nurses, but over the last year, trained over 40 nurses (many of who are agency nurses) while going through the constant changes made by the CDC in assessing, and documenting patient conversations. Reflecting back on what we have accomplished so far could be done only with perseverance and passion in what we do to fulfill the mission and vision of Harris Health System.
COVID 19 Navigation Team provided support to patients exposed to and up to positive but not ill enough for hospitalization from the start of the pandemic. Providing support not only with patient education and telehealth care when needed, but general emotional support to the community when so little was known and understood about COVID 19. Reassurance that someone cared by daily calls, and at times twice daily, just to check-in and ask how they were feeling to ease the anxiety of the unknown. The navigation team provided support to many in the community who thought they would not be able to receive assistance and care for a number of reasons, including insurance coverage status and immigration status concerns.
At a time when too many unfortunately expired at home for the previously mentioned issues, the word quickly got out that Harris Health System truly cared. One gentleman even called the COVID 19 Navigation line and left a lengthy message thanking the team and the navigator he attributed to his wife being alive. He went on to say that had she not been Navigated and received the calls and instructions from the team, he believes she would have surely died. The team initiated EC protocol for his wife who was admitted for Sepsis and double Pneumonia.
The Covid nurses of HHS are a very unique group. I refer to us as the 'hybrid department' because about one year ago and with little notice, we were pulled from our various working environments to form the Covid Navigation Team. Because Covid was novel to everyone at HHS as well as the rest of the world, we had no idea what to expect: We were literally working, learning, and developing a structure for our team, all at the same time. Also, because what we all know about COVID is ever-changing even a year later, our department has had to endure many changes and revisions along the way involving our processes and we are constantly assessing how to best serve our patients with the staff available to do the job.
Sometimes it does feel like we are those forgotten heroes as we work behind the scenes from our homes far away from the notoriety of the front-line workers at the hospitals and clinics. Nevertheless, we work just as hard and strive to live up to the organization's vision and mission statements. Every day we do what is best for the population we serve. Imagine being part of something that was built up from the ground almost overnight for an illness that was never heard of until last year and then being asked to work with people you have never met, much less seen in person. Yet, today we have screened and/or called over 30,000 patients since the pandemic began last year and we are still growing strong! Kudos to the fearless leaders: Krystal Gamarra and Jackie McLean along with the rest of the team.

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We are Nurses from various departments with different roles, pulled to work together as a team as COVID Navigator. We made it through a couple of surges, working after hours and late nights. Reviewing all referrals and ensuring our patients at home are being monitored, triaged, and most of all listened to with their concerns and fears.
It's been a challenging new role for all the Navigators but we have the best Nurses working in the COVID-19 Navigation Program, lifting, supporting, and helping each other. We will continue to survive with this new change and grateful for the guidance of our Manager, Ms. Jackie!

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Team Members honored with this DAISY TEAM Award:
Debra Lopez, LVN
Simone Johnson, LVN
Belinda Garcia, LVN
Maria Ticas, LVN
Lydia Medrano, LVN
Tonya Green-Miles, LVN
Kimberly Williams, LVN
Joyce Thomas, RN
Sinu Mathew, RN
Pierre Wilson, RN
Flora May Alidon, RN
Blanca Alaniz, LVN
Tseday Yehualashet, RN
April Love Cruz, RN
Mary Lou Tobias, RN
Maira Guevara, RN
Sara Estrada, RN
Veronica Clanton, RN
Dora Norman, RN
Natalie Williams, RN
Jocabed Osoria, RN
Marilyn Pedregosa, RN
Ana Ritchey, RN
Elizabeth Fike, RN
Samena Richards, LVN
Chandra Grace, LVN
Karina Palacios, RN
Marivic Nasayao, RN
Mary Ann Balerio, LVN
Diana Rabello, LVN
Jacqueline Mclean, RN
Madel Aguirre , RN
Ashante Montero, LCSW
Annie Titus, RN
Montre Williams-Mayes, RN
Glenda Irving, RN
Dora Sierra, RN
Katina Lewis, LVN
Yvonne Adams-Sales, LVN
Ashley Moore, LVN
Teneka Winton, LVN
Barbara Burton, LVN
Annese Hearns, LVN
Nikkia James, LVN
Glewana Harris, LVN
Shanel Jones-Branch, LVN
Courtney Stephenson, LVN
Karen Powdrell, LVN
Deloise Johnson, LVN
Joslyn Haynes, LVN
Elizabeth Ojeyinka, LVN
Rachel Fischer , RN
Yessica Acosta, NP