The past two years have been extremely difficult for everyone in healthcare, but this team in particular has had many unique challenges to overcome. They went from historically being an expert pediatric GI unit to being asked to take on pediatric neurology in January 2020. As the team was learning the ropes of this new population, new policies, and new doctors the COVID pandemic came upon us all. Just two short months after assuming care of the new neuro population, this same team was asked to become the pediatric covid unit for all of BayCare. While this was an incredibly scary feat to take on, this team did so with incredible grace and compassion. Much like many other units in BayCare, this team had to help develop processes and procedures for how they were going to tackle adding COVID into their wheelhouse. 

While many of the COVID policies and procedures worked for the adult population, they did not always quite fit the needs of our pediatric patients and their families. Something as simple as “no visitors” in the adult house created an extremely stressful and sometimes hostile situation for the parents of children with COVID. There were many times, in the beginning, we had to ask parents to leave their child alone at the bedside, and this team worked hard to fight for an exception to be made so that their patients could have someone with them to comfort them while they were sick and in a scary environment. The concerns of this team were heard and exceptions were allowed to be made to provide support to our patients and families. However, this did not necessarily mean it made things any easier for the staff. Allowing a single parent to stay for the duration of the hospitalization was very tough and challenging for these families with busy lives outside our hospital walls. The team quickly became concierge and waitstaff instead of just healthcare providers. Since parents couldn’t leave the rooms, the team had to get everything for them all the time. This included their personal Uber Eats deliveries and Target Shipt orders, multiple times per day, per patient. Sometimes the team would spend over an hour walking the exterior of the campus trying to figure out where a delivery driver might be. All to give the parents the best experience they could while under not so great circumstances. Many times, the parents were not even very appreciative of these efforts because they were so frustrated about being kept inside the room with a sick child, but the team never stopped going above and beyond for them and always with a smile. 

At times the team had to wear the hats of many ancillary departments because others were not able to gown up and go into a COVID isolation room. This became extremely taxing on the staff to have to be all members of the healthcare team for every one of their patients. As time went on, we were able to make some adjustments to help support the team in different ways but it never truly eased the burden they were feeling. We tried different processes from having COVID designated nurses, to mixing patients, COVID and NON-COVID. Each option came with different challenges within the unit as well as meeting the needs of the patients. Parents could not understand our policies, despite different ways of explaining things and trying to keep everyone safe while following the latest guidelines. They were frustrated that some doctors would only call into a room while others wouldn’t go in at all. They wanted their toddlers to be able to run around and see the sun, they wanted their other children to be able to visit and couldn’t understand why we wouldn’t allow it. There were post-partum moms who were mentally and physically exhausted from being trapped in a room for days on end with a crying infant and only 4 walls with a TV to occupy the time. Moms who truly needed a spouse there with her to help get her through the emotional battle she felt she was fighting alone. The team had to be that person for every one of their patients every day. They did their best, and many of them volunteered to be the COVID caregivers without hesitation. They went through the emotional roller coaster with their patients and families and didn’t have anyone outside the unit to relate to them and understand what it was they were going through. They were the shoulder to cry on for many parents, as well as the ear to scream in when families reached their breaking point. They always did their best to support the patients and families and would not hesitate to ask “what else can we do” to try and make accommodations where possible. 

They became the resource for every department in BayCare that had a pediatric patient in it with even the potential of having or being exposed to COVID. This team held each other, ancillary departments, and physicians accountable to the isolation standards to keep our patients and our teams safe. It wasn’t always easy to do, but they rose to the challenge to ensure the right steps were always being followed. They created a COVID resource book and took ownership of updating it and passing along notes to one another to be sure everyone was always on the same page with the latest guidelines. They figured out tips and tricks along the way and partnered with key people to help come up with new and innovative ways we could meet families' needs. We had many “window” visits scheduled so patients could see their loved ones through the glass and talk to them on the phone since they couldn’t physically come into the building. The team continued to push for changes to be made to pediatric visitation and as time went on with the support of leadership the policies evolved with a little better enhancement each time. 

Fast forward to 2021, when COVID truly peaked for Pediatrics. The team had figured out how to care for these patients and the MIS-C that comes after COVID, but a new challenge presented itself. COVID Baker Acts. Without intentionally asking the team to take on yet another population, COVID left us no choice. The local psychiatric facilities went through multiple COVID outbreaks causing their patients to all be COVID positive or a PUI. This meant that these patients could not stay in their facility and needed to be transferred to a hospital setting for medical monitoring and isolation. Many of these patients were asymptomatic, which seems like a great thing. However, since these patients were on psychiatric holds they required one on one sitters. At times, the unit would have up to 14 Baker Acted patients, all requiring one on one sitters which the hospital staffing didn’t allow for. The team worked with our amazing behavioral health provider and were able to get orders to double up most of these patients. However, it still didn’t truly ease the burden. There was a revolving door of Baker Acted patients coming in and out every day. As soon as someone was cleared from isolation and received bed placement, another two would come. These patients require close attention, different room configurations, and even stricter rules for parents and families which never seemed to go well. Having sitters in every doorway meant challenges with trying to relieve breaks. There were days when leaders would bounce from room to room just giving breakfast and bathroom breaks, only to have to start over again for lunch breaks. There were many times when the team wouldn’t take a full lunch break because they knew the burden it was placed on the person covering them. Not only was staffing tight for these patients, but the care they needed was also complex in a different way. Medically, most were fine. Mentally, they were not. Taking a pediatric psych patient out of their facility where they have group therapy and day rooms to place them in a tiny hospital room with absolutely nothing but a TV to occupy their time only agitated them more. This led to frequent outbursts and manipulation from the patients, many of which lead to code greys being called because aggressive behavior was being escalated. The staff tried everything in their power to calm these patients, but many of them were on the unit for 10-14 days just waiting for their isolation period to be over. It was a huge disservice to these patients truly needing therapy, but it was necessary to keep the spread of COVID at a minimum. The staff truly felt for these kids. They would try to play “games” with the patients, and work with the physicians to allow certain privileges and they tried to get to know them as best they could with the situation at hand. While I know the team felt like babysitters the majority of the time, I can assure you they were much more to these patients. 

With all of the COVID events and shifts that have taken place over the last two years, this team still endured the regular chaos that comes along with any hospital unit. Admissions, discharges, transfers, medically complex patients, emotionally complicated families, families you love requesting your floor and families that love you more than you love them requesting your floor, staff turnover, bad staffing, high census, patient experience standards to exceed, quality metrics to be met, regulatory visits, leadership and organizational expectations and a never-ending list of education to complete. All of this and more, while upholding the BayCare Values and keeping our patients safe. Many days they were operating in pure survival mode but they never lost sight of the importance of the kids in the beds. They were never too busy to play cards, take a walk to the basketball court, or cheer up a long-term patient who would really rather be anywhere else but here. Few families take the time to truly express their gratitude and appreciation, but this team means a lot to so many families whether they fully realize it or not. 

While the impact of COVID hit some of this team harder than others, the majority of the team is still here providing exceptional care to their patients and families on a daily basis. There were many temptations along the way to transfer to other departments or other areas of the hospital that weren’t required to take on COVID pts. Many nurses would float to this unit and talk about how happy they were that COVID wasn’t on their unit, not realizing how that might make the team feel. These strong few come to work every day and give it their all. This team took the challenge presented to them and far exceeded any expectations one could have of them. While most days they leave work feeling defeated, tired, run-down, and questioning why they still do this job, they should be going home with their heads held high and extremely proud of the work that they do. They affectionately call the unit a “dumpster fire” because of all that it encompasses, but what they don’t always realize is how strong those experiences make them. I can only hope that one day they will look back and reflect on their time as a COVID nurse and tell the stories that they were a part of to their friends and families. Every member of this team plays an invaluable role in making the department flow and giving these kids care I would be honored for my own child to receive. 

The Charges, Nurses, Techs, and Secretaries all deserve to be recognized for the impact they have had on those around them both patients and staff alike. There are a few team members not technically housed in this particular unit that also played an extremely important role and they include Pam Caruthers from Infection Prevention, Kacie Webster and Danielle Worden from Child Life, Kristin Ellis the former PCL, Betsy DeVane the Educator, Dr. Silva and The USF Hospitalists just to name a few.  Other departments such as rehab, echo, social work, case management, dietary, other physician groups, and SJCH leadership also played important roles in supporting the team for the work that they do every day. 

I truly hope that this team is able to be considered for this award. They deserve this and so much more. I am so incredibly proud of each and every one of them and they will leave a lasting impression on me and the story that is my own nursing career. I would love for this DAISY Award to be the reminder they need on a tough day of all that they have accomplished and the impact they leave on everyone around them.