Three healthcare professionals getting in personal protective equipment
HealthNovember 02, 2020

Developing nurse leaders during COVID-19: A case review

By: Sarah Handzel, BSN, RN
Frequently throughout the Covid-19 pandemic, many healthcare facilities have become overwhelmed with the number of patients seeking care. And while hospitals have taken different approaches to triaging and treating patients with this disease, clinical nurse leaders must still find creative ways to ensure safe staffing levels with the most appropriately trained personnel.

An article in Nursing Management examined one hospital’s approach to treating mild-to-moderate Covid-19 illness.1 Nurse managers at Massachusetts General Hospital (Mass General) developed a way to identify prospective nurses who could assume short-term leadership roles in units specifically designed to deal with Covid-19 patients. Doing so has helped Mass General support the needs of the community while creating opportunities to foster aspiring nurse leaders.

Mass General’s response to Covid-19

As the pandemic took hold in the United States, Mass General leaders created respiratory illness clinics (RICs) to handle the growing number of Covid-19 patients. While ambulatory nurse managers typically provided clinical direction during normal operations, many were overwhelmed by the scope of work required for this unique patient population. As a result, several nurse managers were not able to effectively manage RIC operations on a daily basis.

The need for clinical nurse leaders was apparent, but the process for identifying and training these individuals was not certain. Clinical leadership determined that three to five new clinical nurse leaders (CNLs) would be necessary for each RIC to function most effectively.

Recruiting new nurse leaders

The recruitment of aspiring nurse leaders was not based on positional status; instead, candidates were selected based on the previous demonstration of leadership behaviors. Several traits were desired in CNL candidates, including:

  • The capacity to understand a broad scope of operations while being able to communicate those needs concisely and clearly
  • The ability to function from a systems perspective in the face of uncertainty
  • Previous demonstration of problem solving in a calm, rational, decisive, and empathetic manner
  • Willingness to function within a prescribed leadership structure

Each prospective CNL was contacted by a nurse director who used the opportunity to conduct a virtual interview to confirm interest, explain the CNL role, set expectations, and discuss leadership competencies. Some candidates were also already working in a RIC, which gave the nurse director a chance to observe their leadership skills in real time.

The clinical nurse leader’s role

CNLs selected to be part of the initiative would be responsible for overseeing and guiding advanced practice providers, other registered nurses, and medical assistants. Daily duties in the RIC included assigning and orienting staff to the various positions in the unit, ensuring infection controls were followed, and coaching staff members to help assist each patient as efficiently as possible.

Additionally, CNLs performed various duties to help supplement patient care, including:

  • Cleaning negative pressure rooms
  • Gathering vital signs
  • Managing administrative functions
  • Performing ECGs
  • Performing nasopharyngeal Covid-19 testing
  • Triaging distressed patients in the waiting room

Practice implications and future directions

Mass General identified and hired 14 CNLs to oversee operations within the RICs; five had previous leadership experience and four held formal leadership positions in the past. Generally, the new CNLs felt grateful and excited about the experience, although some noted feelings of inadequacy and difficulty delegating to others.

However, these types of leadership roles helped nurses at Mass General decide whether they would be interested in other types of leadership positions in the future. The program also supported and engaged these individuals in a truly meaningful way, while providing the organization with much-needed staff that value their work and position.

This kind of interim leadership experience brought nurses together from different practice settings and helped hone their leadership skills in the face of an uncertain healthcare landscape. While the program at Mass General was unique to the facility, this example of developing leaders may help others identify and develop their own future CNLs.

Lippincott Solutions note: for the latest coverage on Covid-19 by the Lippincott Nursing team, please visit nursingcenter.com/coronavirus.

Sarah Handzel, BSN, RN
Freelance Health and Medical Content Writer, Wolters Kluwer Health
Sarah has over nine years’ experience in various clinical areas, including surgery, endocrinology, family practice, and pharmaceuticals. She began writing professionally in 2016 as a way to use her medical knowledge beyond the bedside to help educate and inform healthcare consumers and providers.
  1. Bernhardt, Jean M. PhD, MHSA, CNP, NEA-BC. “Creating Clinical Nurse Leaders during the Covid-19 Outbreak.” NursingCenter, 2020, nursingcenter.com/journalarticle?Article_ID=5646742.
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