Managing Critical Care in Ever-Changing Times with Adam Gagnon and Patricia Daley
Managing Critical Care in Ever-Changing Times with Adam Gagnon and Patricia Daley
In our latest episode of Nurses’ Voices, hosts Gail Donner and Mary Wheeler chat with Critical Care Nurse Managers Adam Gagnon and Patricia Daley about how they have adapted during the difficult, tense, and ever-changing times of COVID-19.
In this episode you’ll see how Adam and Patricia have maintained a high level of support for nurses throughout the pandemic while ensuring continued compassion for patients. And although it has been a very challenging time, both Adam and Patricia have had rewarding experiences and we are fortunate to have them share with us. Watch and listen to Adam’s and Patricia’s stories now.
Adam Gagnon BNRN, CNCC(C) Nurse Manager Intensive Care Unit
Chaleur Regional Hospital
Bathurst, New Brunswick
After completing my Bachelor of Nursing degree in 2002, I began my nursing career at the Chaleur Regional Hospital on the float team. I have always been fascinated with critical care so in 2004 I made the move to the Intensive Care Unit (ICU). Over the next 3 years I continued growing as a critical care nurse and served as an Organ and Tissue Resource Nurse and trained as a corneal retrieval technician.
In 2007 the opportunity arose for me to become the nurse manager of the ICU, the past 14 years as have allowed me to represent the needs of critical care nursing through my day to day functions as well as on local, regional and provincial committees.
I have continued my professional development in critical care nursing. I completed my national certification in critical care in 2012, as well as the Leadership and Management Program from McMaster University in 2013. I was privileged to participate in the construction of a brand-new state of the art ICU in 2014.
Critical care is my passion, I am a long-time member of the Canadian Association of Critical Care Nurses (CACCN) as well as the American Association of Critical Care Nurses (AACN). A strong advocate and promoter for critical care nursing, I have presented on critical care nursing to nursing student, presented with a colleague at Dynamics of Critical Care and encourage all critical care nurse to challenge themselves to complete their national certification.
Patricia Daley, RN
I live in Dartmouth NS with my husband of almost 34 years and 3 amazing adult children.
Majority of my nursing career has been in Critical Care. I have worked as a staff nurse in both rural and tertiary ICU’s and ER’s within NS as well as remote nursing in Northern Alberta.
In 2010, I accepted the position of Health Services Manager of the Med Surg ICU at the QE11 Health Science Center in Halifax NS. I transitioned into a new position as Manager of the Med Surg Neuro Trauma ICU at the Halifax Infirmary site in 2018. The decision to move to a different ICU as retirement was approaching was a difficult one. Looking back over the last 3 years, I know it was the right decision for my career. I am so grateful I took advantage of this amazing opportunity to be part of such a dynamic team.
As a Staff Nurse, and later in my career as a Manager, I always took pride in not only being a patient and family advocate but also a mentor and resource to all team members. My office door was always opened…
To say the last 16 months have been challenging in health care is an understatement!
June 1, 2021, after 36 years of working in an extremely rewarding profession, with many remarkable colleagues, as well as diverse opportunities, I have retired.
Managing Critical Care Nurses in Ever-Changing Times with Adam Gagnon and Patricia Daley
Announcer: [00:00:00] This is Nurses’ Voices.
Gail Donner: [00:00:05] This episode of Nurses’ Voices. We are going to talk to two critical care nurse managers who are going to talk to us about the challenges and about the awards, not just in managing nursing, but also in managing in these tough times during COVID
Announcer: [00:00:25] Nurses’ Voices is supported by the Canadian Nurses Foundation and by the Canadian Nurses Association.
Gail Donner: [00:00:33] Welcome to Nurses’ Voices. I’m Gail Donner.
Mary Wheeler: [00:00:37] And I’m Mary Wheeler
Gail Donner: [00:00:39] and we’re really looking forward to this episode of Nurses’ Voices. We’re lucky to be able today to talk to two critical care nurse managers who have between them 25 years of experience as managers. Tricia Daley, and Adam Gagnon have much to tell us about critical care and the pandemic.
About managing, supporting, and mentoring staff about and ensuring quality care for patients and what it takes to manage in these times, we know you’re going to enjoy this episode of Nurses’ Voices.
So let’s welcome Tricia and Adam.
Trisha Daley is a registered nurse from Dartmouth, Nova Scotia. The majority of her career has been in critical care. For the last 11 years she’s been the health services manager of the tertiary care. ICU at the Queen Elizabeth, the second, health sciences center in Halifax, Nova Scotia. And after working for 36 years as a registered nurse, Tricia retired June 1st of this year.
Adam Gagnon has 17 years of experience in intensive care and has been manager for the past 14 years at the Chaleur Regional Hospital in Bathurst, New Brunswick. He completed his national certification in critical care nursing in 2012 and is a longstanding member of the Canadian association of critical care nurses and the American association of critical care nurses.
So welcome Tricia and Adam. We’re very pleased to see you again tonight. So Trisha, maybe I can just start with you.
First of all, congratulations on your retirement. Um, you left QEII, and your role just, I guess, as things were settling or starting we’re always afraid to say they’re settling down, but they seem to be settling down across the country in terms of the third wave of COVID-19 is concerned, but maybe you could talk a little bit about what was it like being a manager over this.
Very, what is clearly a stressful period?
Patricia Daley: [00:03:01] It was challenging. It was very challenging to, to be a manager, but just, you know, it was challenging for the whole team. Um, and that’s how we had to look at it. As a, as a team effort, we were very fortunate in Nova Scotia. The first wave. Was really nothing. Although the anxiety of the unknown was beyond for everybody.
I think it wasn’t just from a nursing perspective, I think just in general, people were concerned about their personal safety, but definitely the third wave we were impacted greatly. But the team stepped up and I was supposed to retire in February, and I’m really glad that I extended it to June to be there, to support the team.
And it just didn’t feel right to leave in the middle of a pandemic. So fingers crossed that we’re on the upside. Now things will improve. They’re definitely improving in Nova Scotia with vaccinations. Obviously that’s helping.
Gail Donner: [00:04:07] Maybe, Adam, you’re in a different situation in Bathurst and your hospital is a little bit different.
Talk about what the challenge or what the experience was like for you during the pandemic.
Adam Gagnon: [00:04:19] Well, there was a lot of like what Trisha said. There’s the uncertainty, the stress of the unknown staff being. Worried for their own safety and the safety for the patients. I think ICU nurses as a whole we’re, we’re very push, push push and go, go over the patients.
But with this, you, you have to take a minute for yourself before going into rooms and putting on your PPE to protect yourself. And it’s just not something that people are used to. It’s it’s. Something goes wrong, you, you, you, you go. So that was, that was hard for, for the team.
Gail Donner: [00:04:55] You’re a hub hospital, I think, is that right?
Adam Gagnon: [00:04:58] We have a lot of specialty services. So we have, we have four or five cardiologist, uh, nephrology for the Northeast. We have a few neurologists onsite as well. We’re one of the major centers in the Northeast of the province that we get to see. We serve not only our population, but the surrounding communities as well.
Gail Donner: [00:05:16] So talk about what was different for you as a manager.
Adam Gagnon: [00:05:22] It was a lot of on known and ever-changing practices and guidelines. As a manager, you’re, you’re leading the team to, these are the guidelines that come out. This is what the practice that we need to do now. And. The next day, or in some instances, even the next hour, everything got flipped on a dime and it, and you have to go back and say, look, I know I just told you this, but now it’s changed.
And it’s this, this and this ICU nurses, critical care nurses, all the, well, all everybody as the team, because even within our unit from respiratory therapy to the ward clerks to environmental services, You have to make sure that everybody on the team is on the same page, especially when it came to the epi and the practices around the rooms and your pandemic phase planning to make sure that everybody is doing the same.
Gail Donner: [00:06:19] Trish, did you want to add something?
Patricia Daley: [00:06:22] I think for us, one of the biggest challenges with the first wave is we realized that, you know, we didn’t, even, if you looked at the modeling, we didn’t have enough say IV-pumps to support, to support. What they predicted. So we had to roll in, we had to bring in new technology, new, smart pumps.
So you’re in a pandemic. Staff are stressed now you’re introducing all new technology. It was very overwhelming. And I agree with Adam, everything was constantly changing. So you’re trying to support your staff and be transparent. Give them all the information and the next day. It’s different. And so that, that plays on the staff.
That’s very stressful for them.
Mary Wheeler: [00:07:07] I’d like to pick up on that. It’s interesting. A couple of weeks ago we interviewed two critical care nurses from British Columbia and they talked about their role and the job they had to do. But one of the nurses made the comment. I had a hard job, but I can’t imagine how hard it was for my manager.
As a manager you have individuals that look up to you that you have responsibility for. So I’m wondering if you could just talk to us about that human piece. How were you able to still support your staff?
Patricia Daley: [00:07:44] Well, my personality is it’s always been that, you know, I’m a registered nurse first and a manager second. And I don’t know if that’s the right attitude, but that’s how it’s always been for me.
And with the pandemic. Yes, there was a lot of meetings, but a lot of things were also taken off our plate because this was the priority. And that’s what we had to focus on. My time was on the unit, being with staff trying to figure out, okay, this is what we’re thinking. We’re going to do. What are your thoughts? How is this going to work?
Because they’re the ones that have to enact what we develop for them. And it has to function properly. And everybody has to understand it. And with things constantly changing my days were long. Sometimes it was 10, 12 hours calls in the middle of the night. That’s just, that was that’s my personality.
Anyway. What I’ve always been like as a manager, that was one of the most important things after the first wave, which was minimal. We only had 10 patients in the ICU. That was it. 10.
I lost a lot of staff. And that was a personal decision that they made. And I, from talking to other colleagues around the province, it seems like ICUs, and COVID, uh, units have experienced the same thing.
Staff had decided that they wanted to try something else. With the second wave, I found the staff, they were upbeat. We really tried as best we could to ensure that we had all the supports that they needed, a lot of planning and being there for them. And we did have deployed staff come in and help us. So then trying to make sure that they’re mentored properly because some of them may didn’t work in ICU for up to 10 years.
They’re not just going to come in and be independent. And so it’s just that building that support and trying to provide as much as you can for your team. It was exhausting. Everybody was exhausted, but I felt supported by the team. And I’d like to think that they felt the same from, from our leadership group.
Mary Wheeler: [00:09:38] And what about you, Adam? Like how was, what was the interface with staff?
Adam Gagnon: [00:09:44] Usually try to be out on the floor as much as I can on a routine basis. It’s very much be there for them. Bring out the changes, talk to the staff that were on the unit. This looks like how it’s going to work. Is this how it’s going to work?
What do you guys think? We offered increased training for when it came to intubation and how we’re going to do it into the, in our negative pressure rooms. We made it mandatory for the staff to practice PPE. I didn’t want them having to stress about, did I do this right. And questioning their moves in a critical environment.
So it came to that. It was wants to be muscle memory. And that was one thing that came back afterwards from the staff or that they were glad that we did that exercise in the beginning because it helped take a weight off their shoulders later on, and then just be there and be transparent with them.
These are the changes it’s not necessarily going to be easy, but that’s what it is. And the staff, they got redeployed in the beginning while we were planning to get retrained, kind of like Trisha was saying, because there was someone that had been out of the unit for a few years.
While they’re there in units, now that work eight hour shifts are no longer on 12 hour rotations and they have, a life outside of the hospital and us getting ready. We don’t want to upheave all their personal life. At the same time they had enough stress going on. So it was working around with their pre, their schedules that were already done and getting training done within those, those hours that they were already supposed to work and their orientation within those hours.
With the understanding that if something happened, that we did have a big outbreak in the first wave or the second wave that their shifts would change from the eights to twelves and in rotation on a dime and it was okay. I I’ll, we can do that.
Gail Donner: [00:11:47] So it’s the old line communicate, communicate, communicate. And then I hear both of you were there with the team.
You talk about the team, you talk about the others and your part of it it.
Can I shift you as a tiny little bit to the patient? Because we have heard so much about the stress on families. People are used to, their loved one goes to the hospital. Over the last 20 years, we moved so much to open visiting and come when you need to with et cetera.
And now all of a sudden, guess what? We’re back to the very old days when you can’t come at all, you must have had to stick handle a lot of family calls or, or support to staff in how to talk to families.
Patricia Daley: [00:12:35] So with the first wave, we were very strict with no visiting and obviously huge impact on not only the families, the patients, but also the staff and we did have the technology. So we would encourage, they could use an iPad. We would do conference calls, constantly updating the families, but that the organization was very strict. Initially. They did not allow family members in, but yeah. Time went on, things relaxed after the first wave, they lightened up their visiting policy and you would be allowed to have one family member.
And it’s really hard. At one point we could have two family members, how do you let a wife and one child when there’s another child. So some of it had to be common sense. We had to look at the epidemiology at the time. Each situation was looked at differently. You still have to have common sense along with compassion.
Um, so we, we just worked through all of that. We did have some families that were very upset. They would go up to the executive director or the CEO or the premier it’s safety for everyone staff included. And we did the best that we could. I think it has had a huge impact on some staff members. And after the first wave, we did have cases that did not end well and patients did die alone and you can’t get that back for families and for staff.
So it’s about making sure that you have the right support for EAP, for your staff, and then trying to support the families.
Gail Donner: [00:14:09] And a lot of stress on the manager I would imagine.
Adam Gagnon: [00:14:12] We were the same way in the beginning. It was absolutely no visitors. And as things progressed, it’s more lax. We’re still, if for the COVID positive patients, there’s no visitors allowed, but we ended up getting iPads within the hospital.
So they, technology is a big thing. The nurses wander in there with their N95s on, they’ll arrange time with the families to have that meeting. So at least they get to see each other and it’s a connection. It’s not the best connection. It’s not in-person, but at least it’s something they’re able to speak to their loved ones and tell them, you know, even though we’re not there physically, we’re there with you.
The no visitors was hard on the staff. One reinforcement we did was heart beat in a bottle. It takes the last cardiac rhythm of the patient before they pass away. And we put it in a vial and if the family wants it, then we give it to the family. It was reminding the staff like the family can’t be there, the patient’s on their own, but you can offer them this just the same.
They can. It was our routine practice for a couple of years now, but they’re able to do that. And I’ve had staff that just sit in the rooms with the patients so that they aren’t alone.
Mary Wheeler: [00:15:38] How did you cope?
Adam Gagnon: [00:15:40] It’s not easy, but you do what you can when you can. And that’s the most you can do, like it was coming home.
Yeah. You’re checking your emails at 10, 11 o’clock at night and sitting, and sitting at the kitchen table and doing your pandemic plan and you do what you can, and then try to find time to relax and take some time for you. And that’s all you can do.
Patricia Daley: [00:16:11] So it was, you know, just being able to get out and go for a walk.
The senior leadership team that I worked for were phenomenal. I’ve worked for a lot of different people that this, the co-, the physician co-leads and the head of critical care from medicine and from a nursing perspective, were a great resource. I think I thrive on that stress. I’ve had a lot of things.
Things that have happened as a manager over the years, I’ve had to evacuate ICU three times. You just, you deal with it. And I don’t know. And now, and I guess I hadn’t retirement to look forward to. There was a light at the end of the tunnel for me. And we, we used to joke about that. I was like, they’d be like, you cannot work six days in a row.
You need to take a day off. And I said, I will get my time off, but I can’t be home worrying about work. And, and the environment I I’m better off here. And I, you know, I slept probably eight or nine hours a night. I looked after myself that way. Um, but again, I knew that I was going to be finished in June.
Gail Donner: [00:17:16] I’ve never been a critical care nurse. And I’m happy to say you wouldn’t want me on your team. However, I’m struck that there was something in the DNA of critical care nurses, because it’s not the first time I’ve heard a version of “you do what you have to do”. You work with your team, you do the best you can and you move forward.
And I feel a version of that and that you did manage even in the very difficult times to find a little time. And maybe that’s something also people need to hear that. Maybe that’s what lets you, or helps you to treat it like we just have to do what we have to do. And if I get out for a walk or if I get to play with my, uh, child for a couple of hours,or go and play in the backyard or whatever it is, then that will sustain me.
That’ll keep me going. Um, to me it sounds like a very huge responsibility for people, for patients with the team. Uh, and so getting it right when we don’t even know what right is from one day to the next.
Mary Wheeler: [00:18:34] Nurses’ voices goes across Canada. What do people need to, to understand about the role of manager?
Patricia Daley: [00:18:41] I mean, there’s, there’s a lot of rewards with it.
There’s challenges, I think have to have a certain personality because you deal with the good, the bad and the ugly, and you do it every day and you have to. I’m just, you have to be consistent in your approach and it’s all about ensuring best practice, um, for our patients and, um, supporting a team.
Gail Donner: [00:19:08] You said there was rewards.
What’s the reward for what was the reward for you everyday?
Patricia Daley: [00:19:14] I think my team respected me. I think, I think I was a good role model. I had a manager when I first started nursing, who, um, just, had great qualities and I, you know, as she helped mentor me as a staff nurse, and I thought those are the qualities I want to have.
And, and I feel like I’ve done that over my 36 years. I’ve been. Pretty consistent. I never would have thought management would have been for me. My manager got seconded by the college of registered nurses and they asked me to step in… that was 11 years ago. Um, I just, you know, I did it for 18 months cause I didn’t have to leave the union.
And then they said, well, you should apply. I was like, oh, I don’t know. I don’t know if I want to take that on, but I’m glad I did. I learned a lot and uh, yeah. You know, you get to see, you get to watch nurses develop, and there’s lots that you can share with them from your experience as well. And it’s all again, it’s all about best practice,
Gail Donner: [00:20:19] Adam.
Adam Gagnon: [00:20:20] You see the staff start as novice nurses in the unit, and then as they grow and develop those skills become charge nurses. And you, you, you, you can tell like they, they take the critical care nursing. To heart. And that ends up being meaning a lot. Uh, I have a lot of former staff now that have moved on to management, so that that’s, that’s actually kind of nice.
Cause you’re working with your. Your old colleagues, your own team members.
Gail Donner: [00:20:50] Neat. I’d like you to be my manager, that’s, that’s what I keep thinking. I’ll say on, on both of our behalf. Thank you extremely muchly.. And I would go so far as to say it really has been a privilege. Yeah. To get to know you a little bit. And I hope that those who listen and watch you, uh, will also feel the same sense of appreciation for you giving us a glimpse of your lives.
Thank you both very much!!
I enjoyed that. What did you take away?
Mary Wheeler: [00:21:27] I think the one nugget for me was when Tricia said I’m a nurse first and a manager second that I was ready to get onto the floor and to be working with my staff beside my staff and us figuring it out together. And when she said that, I thought that’s what, that’s what staff are looking for for someone to be there.
At their side, figuring out because it was new for everyone. And for both of them too, they, again, similar to previous interviews, we’ve done. The team is key. They thrive on the team,
Gail Donner: [00:22:08] but that’s the beauty to me of nursing. That’s what people love. And I guess when we asked the question, it’s kind of different when you’re a manager, but it’s not different for them.
They’re still part of the team. Uh, there may be a bit further from the patient, but do not further from nursing. The other thing was the, I’ll say the quiet confidence, not arrogance. And that’s what I loved. It was just the quiet, you just do what you have to do. And yes, you’re gonna, you know, change midstream and you’re going to have to tell people things they don’t want to hear.
There was such a quiet, calm sort of. We’re, We’re. We do what we came here to do, and I just found it very reassuring.
Mary Wheeler: [00:23:06] And I think that I was thinking of the words, how to describe them. And I, I like how you’ve done it, because if you think of the interview that we had with the two critical care staff nurses, they… the work they were doing, it just kept them going. It was like their role energized them. Then you have the managers who were very calm. They were still committed, but they were calm saying, we’re going to figure this out together.
Gail Donner: [00:23:38] In a time like this. You need to know your managers on your side. Get’s it.. And I got the sense that they knew that’s what they have to do for those staff.
And I suspect their senior management knew that’s what they had to do for them. I just kept thinking to myself, “They like what they do” then you, you know, that’s been something we always impress on anybody that we talk to about career, you know, it has, it has to be important to you. You have to like it.
You have to feel something for it.
Mary Wheeler: [00:24:20] I have felt that in all the episodes that we are doing, Nurses’ Voices, we’ve heard for people that love what they do. And it has every time I get off the interview, I think we are in a good spot. And that’s why these people need to hear these stories to say, and to listen to nurses, whether you’re a new grad or someone just retiring, you have to love what you do.
And if you don’t, it doesn’t mean you need to leave nursing. You just need to maybe find another place within, within nursing.
Gail Donner: [00:24:55] Well, hopefully the other thing Nurses’ Voices will do over time, is show the great diversity of opportunity that exists.
No, that was great.
Mary Wheeler: [00:25:07] It was good. Looking forward to the next
Gail Donner: [00:25:10] Me too!
Thank you very much for joining us for this episode of Nurses’ Voices. I hope that you enjoyed this as much as Mary and I have. And please remember to go to nursesvoices.ca to give us some feedback. And maybe even to tell us your story, also, you can register for sign up for our podcast. or see us on YouTube.
We hope to see you at the next Nurses’ Voices. Thanks for joining us.
Announcer: [00:25:47] Nurses’ voices is created by donnerwheeler. It is supported by the Canadian Nurses Foundation and the Canadian Nurses Association. Nurses’ Voices is produced by Cecktor Limited.
Facilitating Hospital Discharges on Weekends with Gillian Kozinka This episode profiles nurse innovation in closing the system gap to facilitate discharges of patients on weekends to enable the right patient, right place, right care philosophy. This quality improvement initiative focused on improved multidisciplinary communication, resource utilisation and
The L'nu Nursing Initiative with Dawn Googoo This episode highlights the L'nu Nursing Initiative (L'nu means Indigenous in the Mi'kmaw (Mi'kmaq is plural) language). The L'nu Nursing Initiative was created by the Nova Scotia Canadian Institute of Health Research Chair in Indigenous Health Nursing, Dr. Margot Latimer
New Curriculum Design to Help Graduates Be Practice Ready with Sara Lankshear Welcome to the premiere episode of Nurses' Voices, Season Three: Change is Possible! This episode profiles Central Ontario’s first college standalone nursing degree program and the approaches taken for innovative curriculum design that actively engaged health
Michael Villeneuve Reflects on a 44-Year Nursing Career In our Season Two finale of Nurses' Voices, join hosts Gail Donner and Mary Wheeler for an honest and personal conversation with Michael J. Villeneuve, RN, MSc, FAAN, who retired in May 2022 as the Chief Executive Officer of the
Inspirational Nursing Leadership with Irene Andress In our newest episode of Nurses' Voices, Gail Donner and Mary Wheeler have a thoughtful discussion with Irene Andress, RN, MN, Vice President, Programs and Services and Chief Nursing Executive at the Holland Bloorview Kids Rehabilitation Hospital in Toronto, Ontario. Irene discusses her current
Karen Lake’s Journey to Nurse Entrepreneur Join Gail Donner and Mary Wheeler in an engaging conversation with Karen Lake, RN, BN, Caregiving Consultant and Care Navigator in Fredericton, New Brunswick. After a 25 year career as a Registered Nurse in various roles including her last role as