Leadership in Times of Crisis: A Personal Reflection from a Registered Dietitian in Long-term Care

Planning for and during times of crisis is critical – but what happens when a crisis comes sooner and larger than you can possibly plan for?  Stephanie Isaak, is a Registered Dietitian working in a long-term care facility that experienced one of the very first COVID-19 outbreaks in Ontario. Even amid all the chaos, Stephanie felt it was important to share her leadership reflections as a way of helping others working in healthcare during this trying, stressful and uncertain time. The following blog provides early reflections on the COVID-19 crisis from her personal perspective.

Early March: Planning for COVID-19
Over the last few weeks, COVID-19 has been causing fear and worry in our country, workplace and homes. For me, COVID-19 was something that I had prepared for with my long-term care home.

Our planning considered:

  • Food and supplement shortages;
  • Maximizing storage space;
  • A brainstorm of ideas for low labour recipes and premade products; and
  • Initial discussions about the need for a pandemic menu.

Third Week of March: COVID-19 Outbreak
Before we had the opportunity to implement strategies or precautions, a COVID-19 outbreak was declared at our long-term care home. This meant we needed to react to a serious situation that escalated more quickly than we imagined or could manage.

As a Registered Dietitian in long-term care, it is my responsibility to create resident- centred plans of care that optimize nutritional well-being or delay health concerns. On a daily basis, I am responsible for monitoring residents’ nutritional status and assessing swallowing difficulties, skin alterations, dehydration, weight changes and lab abnormalities. Within a very short period of time, I saw my role and impact on residents’ well being stretched much further than my clinical duties alone.

Planning and Leading During the Crisis
When I received notification that one resident tested positive for COVID-19, I immediately started finalizing a low labour menu that could be put in place in the event of significant staff shortages. I knew that we would need simplified recipes and premade items for staff who would be redeployed to the kitchen and who potentially had limited cooking skill and knowledge of kitchen equipment. As staff learned about the COVID-19 positive case, however, they became fearful and panic began to sink in.

By the following morning, the majority of dietary staff had either refused to come to work, quit, taken a leave of absence or been directed to self quarantine for 14 days, as per Public Health recommendation. At the same time, all residents were quarantined to their rooms to minimize the spread of the virus. The Nutrition Manager (NM) was overwhelmed as she was struggling to fill shifts and had no other option but to also work as a dietary aide on the infected floor. Not only were we dealing with staff shortages and burn out, we urgently needed to strategize a plan for food delivery to 167 rooms while ensuring proper infection control protocol. Initially we did not have the resources required to accommodate the meal service change; but, thankfully, we were able to obtain 150 meal trays, food covers, new carts and a stockpile of disposable dishware to use in the short term. After assisting with those tasks, I was directed to stay at home to complete my regular duties remotely. This also included regularly consulting with the NM and solving issues as they arose.

Because we were one of the first homes in the province to experience COVID-19, we were forced to rely on our own judgement and critical decision-making skills to put an effective plan in place. While we were able to adapt to the circumstances, the impact it has had on our mental health is significant.

Personally Adapting and Coping
During all of this disorder, I can honestly admit that I have been really struggling to find my footing. As I completed insignificant skin referrals and weight reviews from home, it was becoming more apparent that my clinical role was becoming less of a priority. I started to realize that there were other tasks that I could be assisting with that would make a greater impact on the residents. As the COVID-19 situation continued to evolve, our roles and responsibilities were also evolving.  Despite not being as comfortable in food service operations, I knew that I had valuable skills to offer to serve in a different capacity moving forward.

Personally, it has been exhausting and stressful and I am emotionally drained. At the end of the day, however, I know that we have a tremendous responsibility to lead the dietary department through this health crisis. And that alone allows me to keep focused and motivated moving forward.

Leadership Amid Chaos: Reflections
Despite the chaos I just experienced (and am still experiencing), I wanted to take a moment to reflect on key leadership lessons I have learned, or reinforced through this process and feel that others would benefit from:

  • Successful leaders create a cohesive team. I knew that staffing would be an issue, but I didn’t fully appreciate the overall impact it would have on the residents and other staff members. If we only had time to build up our dietary department before the crisis, to acknowledge the important position they were in and to value their upcoming service, staff might have been more prepared mentally. Open communication would have allowed us to keep them informed on the facts and offer reassurance and hope when they started to panic. If staff see confidence and competence resonate from management and leadership, it certainly enables them to be more confident at their jobs.
  • Provide clear direction: It is critical that processes are put in place early. Before the crisis, it would have been beneficial to determine critical infection control points within the food service operation: food procurement, food preparation, meal service delivery and cleaning/sanitization. A clear plan would have allowed for earlier intervention of processes, personal protective equipment and staff training. A silver lining is now that we have experienced a pandemic, policies and procedures can be modified accordingly.
  • Listen carefully. Regular and frequent communication is pivotal to making informed decisions. Staff have been able to provide very important feedback about processes that are not functioning. We learned after a few days that staff did not feel safe during meal service, specifically when plating food and washing dishes. As a result, plastic aprons and goggles were provided for additional protection. Again, if there was more time to prepare, ideally there would have been more opportunity to gather feedback from staff. At this point, we know the importance of our staff knowing that they are heard and that we are listening to their concerns.
  • Lead by example: Be adaptable and willing to do what needs to be done. Since this situation is changing by the hour, flexibility and adaptability must be exercised by all. We learned that by doing, making modifications and trying again, we were able to adjust to the circumstances as they evolved. Currently our main challenge and top priority is finding a way to deliver safe food to our residents. Take a step back and think outside the box to consider alternate or more creative options. As the situation changes, let your moral compass guide you as you determine how your skills can best be used to ensure residential well-being.

During unprecedented times like these, it is imperative that we listen to each other, respect each other and, most importantly, be kind to each other. Doing so will allow us to come together to give the best care possible to the residents we support. I thought it was important to share my experiences so that the lessons we have learned can help us all to move forward with confidence. As for my long-term care facility, if there is to be another crisis as devastating as COVID-19, we will be ready.

About the Author:

Stephanie is a Registered Dietitian and a graduate of the University of Guelph. Over the last 10 years, she has provided nutritional care to residents in a number of corporate and independent long-term care facilities, as well as convalescent care programs. She is dedicated to improving food service delivery, promoting desirable dining experiences and ensuring resident safety. She has been a mentor to numerous dietetic interns and FSNM students during her career and has given countless presentations to RN and RPN students.

Recently, she has taken on a new role as a Clinical Support Consultant in Long-Term Care for a large group of Registered Dietitians across the Greater Toronto Area. In this position she acts as a resource to Registered Dietitians by auditing nutritional care, addressing clinical nutrition concerns, improving facility policies and procedures, coordinating special projects/research studies, and providing training to front-line staff.

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