Francesca (Chessie) Leo, BSN, RN, RNC-NIC, IBCLC, MSDA Class of 2004, is Clinical Nurse Manager at New York-Presbyterian/Morgan Stanley Children's Hospital. Francesca works in the Neonatal Intensive Care Unit, a 58-bed unit that provides Level IV care to a diverse group of patients from all over the world. For the past four and half years, Francesca has been one of the assistant nurse managers on a team of approximately 200 staff members. “I have loved every minute of this role,” she remarks. A typical day before COVID-19 saw her days filled with many meetings and audits, as well as typical challenges such as staffing, admissions, discharges, family concerns, and scheduling issues. Though working hard every day, Francesca remarked there were frequently moments when it felt like there wasn’t enough time to connect with the staff, patients and their families. Now, with just about all in-person meetings cancelled and the main focus being on COVID-19, Francesca notes, “one positive thing that has come from this pandemic is the ability to spend more time on the unit with the team and patients.” In the days of COVID-19, “a typical work day now has a heavy focus on ensuring the team has appropriate supplies and PPE, and that there are appropriate bed spots available for babies who are considered to be PUIs (persons under investigation). A PUI in the NICU is a baby born to a COVID positive mother, or born to a mother whose status is unknown. When managing the care of PUIs, we must wear protective gear until we learn the negative status of the mother and baby. This can prove to be quite difficult when the influx of patients is unpredictable and constantly changing.”
Another new role Francesca has taken on is coordinating the many food donations the hospital receives. Her team jokes that they each have their new "COVID" job roles and hers is “Food and Beverage Coordinator.” Of the donations, she noted, “It has been quite uplifting to receive so much love from our community members. We are truly grateful for every single donation we receive. Nurses LOVE food and other free things, and I love making them smile by facilitating the deliveries.”
Explaining a bit more about what she and her team are managing in their unit, “There are currently no reports of the virus being transmitted vertically (meaning directly from the mother during delivery), and we have not received any COVID positive babies, therefore, working in a NICU places myself and my team at a relatively low risk of being exposed to COVID-19, compared with our colleagues on other units. We do have COVID positive mothers on the labor & delivery unit and some of my team members attend those deliveries and bring the baby back to the NICU. There is a level of risk we face simply by entering the hospital each day, and a greater risk for my team that attends deliveries. But overall, we are grateful to be on a unit with a low risk.”
But while she is thankful, Francesca notes there are other emotions she and her team are navigating through. “Along with feeling grateful comes the feeling of guilt. Many NICU leaders and bedside nurses are reporting feeling guilty that we are working in a somewhat protected area while our colleagues are deep in the COVID fire. Are we doing enough for them? Am I less of a leader or doing less than other leaders who are managing adult COVID-19 patients? Do we deserve the term “hero” or the community recognition when we deal with less COVID than other units? We appreciate the sacrifice our colleagues on other units are making; is our sacrifice worthy too?”
Francesca raises a very important point – the mental health of healthcare providers – leading us to a deeper reflection. “One of the biggest challenges I face as a leader during COVID-19 is keeping my staff calm in the face of uncertainty, especially when I may be scared, too. My role has shifted from one that is heavily transactional to one that is more transformational and emotionally supportive. As a leader, it is the expectation that I care for my staff. This can feel overwhelming, especially when leaders are also frightened by this pandemic. The beautiful thing about working with my team for so long is that there comes a time when you can allow them to support you, too. It’s okay to lean on each other in these unprecedented times. After all, that’s what family does.” There are other challenges as well. Francesca continued, “Another challenge I face is ensuring I provide all necessary information to my team and the NICU families. Due to the fluidity of this pandemic, information and recommendations are constantly changing, and it can be difficult to keep up with the latest PPE suggestions or visitor restrictions. We do the best we can, and part of that includes being honest and transparent about the situation. I am fortunate to work for an organization that has been phenomenal as far as information and proper PPE is concerned. I recognize this is not the case for my colleagues at other institutions.”
When asked what else she would like people to know, Francesca unsurprisingly turns the spotlight onto her team. “One of the proudest moments I have experienced in my time as a leader is when two of my nurses volunteered to offer their help on a COVID floor caring for pediatric and adult patients. When they learned the other floors needed assistance, there wasn’t any hesitation, as both of these ladies have previous experience caring for adults. We occasionally hear stories of individuals protesting the stay at home orders and of nurses being physically and verbally assaulted on their way home from work simply for walking to their car in scrubs. This is awful and really makes you question humanity, until you hear about people volunteering to leave the sanctity of the NICU and work on a COVID floor. That action is heartening and gives me just enough hope to make it through another day.”
In thinking about her career as a nurse and contemplating the healthcare profession in the era of COVID, Francesca continued, “At this point in my 11-year career as a nurse, nothing comes as a shock to me or to my team. Nurses are excellent at compartmentalizing and being rational about challenging circumstances. But I have to tell you - this virus is changing people and changing the way we are processing our emotions. Most of us can hold it together at work, but as soon we leave, we may become teary and worried. We understand better than anyone how bad this pandemic is and that we can never go back to the old "normal." We have come to terms with the reality that we may bring the virus home to our loved ones. Going to work each day is daunting, but we still get up and go because that is what nurses do. (Especially ICU nurses - running towards the fire is kind of our thing.)” And in conclusion, for Francesca, as for so many other Mount alumnae, her role in healthcare is not just a job, it is a calling. “I am overwhelmed by the love and support my friends and family (including my MSDA family!) have shown during this COVID-19 era. Being a nurse leader is my job, but it is also my passion. I, too, am fearful of the unknown, but I will continue to support my staff and our patients for as long as I can. It's the only option! Stay safe out there.” Francesca – your sacrifices, bravery and compassion, not to mention the care you are providing to other caregivers and healthcare providers, makes you not only worthy, but completely deserving, of the title “hero.” Thank you for your service to the community!