April 22, 2020

'Rural nursing is an art'

Nursing manager Tyler Smith reflects on his experience managing a small rural hospital in Hardisty, Alberta during the COVID crisis

"The last few weeks have been focused on the changing world as it unfolds — the first on opportunity through constriction, and another on transparency in crisis.

To put it bluntly, there is a lot of fear on the frontline — and a lot of courage.

I field a lot of questions about our site in particular: how will we manage a COVID outbreak? What do we do with the public who don't comply with the restrictions and protocols in place to screen and wear proper PPE [personal protective equipment]? What happens to me if I show symptoms? How do I still work my job and manage child care?

There are more questions than answers and information changes frequently, sometimes hourly and we must adapt.

We are exhausted with the anxiety of preparation, anticipation of action and fear of exposure and we have yet to see a COVID case cross our threshold.

From a leadership prospective, I spend my days sifting through a flood of conflicting and repeating information, filtering it into a presentable package for my staff. Every day, I sit in multiple meetings from any of the various portfolios I oversee, each bringing a different perspective on practices that need to be instituted to ensure safety for all workers while we still provide health care to those that require it. Our site was built in 1984 and has had to adapt to the changes in health-care provision ever since.

Rural nursing is an art. We are asked to do the same job as our urban counterparts with a fraction of the resources. This leads us to be creative in how we execute processes and protocols while still providing quality care to those we serve.

Because of this, it is important that we are more diligent than ever to ensure that our communication is clear, our practices refined and our protocols are followed rigidly.

People come to hospitals when they are sick. We do not know what we will encounter when someone presents at our doors.

While we do our best to set up our screening stations, channel everyone through, we cannot afford to be lax in our responsibilities or we may end up exposing ourselves and others inadvertently. We haven't seen a case yet but I believe it is inevitable.

But wait: I mentioned courage. In the last few weeks, I have seen my senior staff step forward and lead conversations with their co-workers on the importance of proper PPE procedures, challenge the public on their perceptions of the severity of COVID and educate with more...courage than I have ever seen.

Despite the grim tidings from news outlets, union outcriers, and social media sharing, my staff are still eager to show up every day and give it their best. They are quite involved in redesigning processes to stay ahead of what may come, to be ready and look out for one another. I support their changes through a lot of conversation and enable them to take action where I can.

I actually felt left out as I had to quarantine for a cough [in March]. We take no chances and my staff have done a wonderful job of filling the gap I left by having to work from home.

There is a cot and sleeping bag in my car along with an extended overnight bag should the situation demand that I remain in the facility so that care can continue.

In addition, my staff are deeply connected to the senior population they serve. The restrictions put in place have greatly limited their contact to the outside world. They have worked hard to continue to engage them with social and recreational activities while still adhering to the ever-changing mandates.”

Tyler Smith is the nursing manager at the Hardisty Health Centre, a small rural Alberta hospital. He also runs a farm and an organizational development consulting firm. Smith holds a master’s degree in leadership and is an active mentor to two UCalgary undergraduate nursing students in NurseMentor. As of April 13, the Hardisty hospital was still without any COVID-19 cases.

UCalgary resources on COVID-19