By Lt. Lalita Thambi

New Delhi, May 23 (IANSlife): Nurses are like the axel of a wheel to keep it in place. Take away the axel and everything falls apart. Nurses play a crucial role in health promotion, disease prevention, treatment, and care, and are the heroes on the frontline during the ongoing COVID-19 crisis.

For the past 18 years, the public has ranked Nurses as the No.1 profession when it comes to honesty and ethics in Gallup's annual poll, so nurses have held the public's respect for almost two decades. But this year, Nurses have gone above and beyond what the population worldwide imagines they do.

Throughout the past few days and weeks, I have witnessed remarkable levels of nursing care unfold, incredible displays of professional unity, and an amazing sense of commitment and dedication from all those who are fighting the coronavirus/COVID-19 pandemic from the frontline.

Nurses manning the frontline in the war against corona virus are giving their all to take care of COVID-19 patients, despite the physical, mental, and emotional toll. Never have we experienced a global health crisis of this magnitude. During these uncharted and uncertain times, their hard work shines as a beacon of hope. Many nurses across the globe have been working day and night to protect us from the deadly virus even at the cost of their own health.

As a bedside ICU nurse, when you add personal protective equipment (PPE), your whole routine changes. It is hot. It is hard to talk. Your glasses fog up when you have a mask on. You are motioning to others outside the room in a kind of horrible game of charades (to get) what you need. You must cluster your care. You worry about every step you take and everything you touch inside and outside the room, and you wash your hands they are raw. You face insomnia and stress due to extended shifts. You get less time for family or you are completely out of touch for long. Yet, Nurses have consistently cared for frightened and severely ill patients.

Each day they go into work, they go in with the intent of giving patients the best care they can in order for them to recover from the virus (and other illness and diseases). When patients go on discharge, the brightest hidden smile behind the mask but spark in eyes reveals the happiness a nurses enlighten her heart with. Even when patients die despite nurses' best efforts, they must process a tsunami of emotions, including sadness and grief.

While the situation continues to change and evolve every day, I would recommend the following to be taken care by all our nurse leaders and nursing organisations through the COVID 19 pandemic.

Show strength in leadership: Now more than ever Nurse leaders need to be present and collaborate and work together as a team. Teamwork is the key. The decision-making cycle is rapid-from resource preparation and planning to necessary improvements, process changes and more. Executive nurse leaders are present on all system wide executive phone briefings and incident command briefings, completed with action items and deliverables. Building an infection control team along with nursing leaders is said to be an effective system in raising infection control profile and changing practice in clinical areas, especially during such health crisis.

Communicate timely and accurate information to nursing caregivers: Communicating in real time and with transparency is the safest way to manage the situation. With new challenges emerging by the minute, it is especially important that nursing caregivers are made aware of the steps and actions being taken by their leadership team to remedy issues and maintain safety for themselves and their patients. At Fortis Memorial Research Institute all our COVID-19 messaging is appropriately aligned with our four care priorities: care for patients, care for caregivers, care for organisation and care for the community.

Ensure Nursing caregivers safety: In times like these, nurse leaders should be actively partnering with leaders from other departments for multidisciplinary approach towards better outcome, as well as communication and coordination with state and local officials. At Fortis Memorial Research Institute, we are continually updating our PPE guidelines.

Clearly and precisely convey intended caregiver safety behaviors: With a goal to limit exposure to COVID-19 appropriate caregiver safety behaviours should be reviewed daily which includes social distancing, proper sneezing, and coughing etiquette etc.

Another important recommendation to nurse leaders is to actively use predictive modeling to prepare for future challenges so you and your teams can continue to provide patients with the safe, high-quality care they deserve. Now is the time to take action-Do not wait.

Our leadership teams are communicating round the clock and came up as a strong team to fight against COVID-19. It began with meticulous planning to ensure the safety of the nurses and medical teams including covid and non-covid areas. Many nurses opted to work voluntarily in these wings. Skill mix was kept in mind. Preparedness is the key and healthcare needs to transform itself to tackle extreme situations like these by bringing about infrastructural and process changes, like pre-holding areas, specialized isolation units, negative pressure areas, Creating Green corridor as safety measure, availability and efficient utilization of manpower and PPE, frequent hand washing, regularly disinfecting surfaces, push buttons in lifts, door handles and knobs, frequent mock drills, patient flow management drills etc. At FMRI we are also encouraging telemedicine or virtual visits when possible.

Up-to-date and frequent communication to nursing caregivers by nurse leaders brings caregivers together, encourages confidence, helps clarify any confusion, ensures high quality, safe care continues and shows ongoing support and appreciation.

In the inpatient setting, another strategy we have implemented is care bundling, which is intended to limit the number of times nurses, nursing assistants, care managers and other caregivers enter a patient's room. Multiple tasks are being completed with one caregiver visit to the room. Care Managers also give calls to patients from outside patient's rooms, developing more of a telephonic relationship with patients, they review discharge instructions via phone, email regulatory paperwork to the patient and more. With this more streamlined approach to care, FMRI is also seeing added efficiencies to care delivery and discharge processes, as well as reductions in patient length of stay.

Today we are more grateful than ever to all our nurses as they work, round the clock, putting themselves at risk, to fight the ravages of this pandemic. With that in mind this Nurses Week, I am not just going to say "Happy Nurses Week" to my nurses Instead I am joining hands with our FMRI Team to echo that.

• You are Strong

• You are amazing

• You are indispensable

• You are role models

• A Big Thank You!

Look ahead to continue providing safe, high quality patient care with our team of great frontline warriors.

Lt. Lalita Thambi is Chief of Nursing- Fortis Memorial Research Institute, Gurugram