I would like to nominate Toni James, Erika Darst, and Chelsea Norlander for the inpatient palliative nursing team during crisis standards of care. Since Laurie Regan left Kootenai Health and we had been unable to fill her position we only had Toni James, RN Palliative Coordinator, to provide palliative consults for patients for the entire hospital. With the high census and higher complexity of covid patients needing palliative consults, the demand was more than Toni could manage. With crisis standards of care, we suspended clinical documentation improvement chart reviews and queries and temporarily reassigned CDI specialists, Erika Darst and Chelsea Norlander to help support palliative consult requests and expand coverage to 7 days/week to meet demand and provide continuity of care with patients/families. Erika and Chelsea are experienced nurses with strong backgrounds in critical care and complex conversations. They participated in a crash course on complex conversations and palliative care with Toni James and support of CAPC modules and North Idaho Palliative Care Coalition covid specific palliative resources. Even though they typically work a M-F schedule, they adjusted their work and family life to accommodate the need for 7-day coverage and weekend hours. From September to October they have provided 98 palliative consults that include goals of care conversation, adv directive/POST development, Circle of life support for patients/families, terminal vent removal, and coordinating transfers to Hospice or community palliative. The palliative conversations often take an hour or more and repeated visits with patients/families as they work through difficult decisions. Several providers and ICU staff have commented how much they have appreciated the additional palliative support (even Dr. Voight took time to send a jabber voicing his appreciation!). Conducting these complex conversations takes a lot of skill, compassion, and resilience, especially when it's not your normal job. Erika and Chelsea have gone above and beyond to serve a need of Kootenai patients and have done it with exceptional grace. Toni also stepped up as a strong palliative leader to provide the training, coordination, and support of this model work in a time of need. I believe all three nurses should be recognized as DAISY Nurses.

***

I have been a nurse for over 20 years and was a point of care nurse when >VID hit initially. I always tease that I have been in the "princess tower" as in the area I worked in we did not care for COVID patients and if they had even a sniffle they were canceled. I did not lose any hours, and I did not have to wear full PPE. The recent surge found me working as a nurse in a non-clinical role so I was not really aware of what it was like to be a nurse during a pandemic. The cry for "all hands on deck" led me to pick up a shift on the 3E CCU which changed my perspective forever. First, the staff had such a great attitude. They did their work with a smile. While I functioned as a glorified CNA, they appeared genuinely thankful for the extra help. I admired their no-nonsense work ethic as a team to accomplish patient care tasks that left the patient feeling valued and seen. I was in awe of their knowledge and willingness to teach regardless of stressful situations. I tried to find out what makes each of these nurses continue and they said it was work that needed to be done but they were tired. They hoped that this was not the new normal. Some were looking for ways to leave bedside nursing. I finished my shift and sat in my truck and cried. I cried at the overwhelming admiration and pride for these nurses and staff that have been here from the beginning and represented the heart of nursing at its core. I cried because I was so grateful for them and their commitment to patient care and our organization. I cried after seeing the reality of what caring for COVID patients involves and how the world really has no idea what they are up against. I cried because the COVID pandemic is going to change the nursing profession forever and I am not sure how to help these ICU nurses except to express my gratitude, love, and appreciation.