It was March 8, a sunny Sunday afternoon in Miami, when the first COVID-19 patient arrived at UHealth Tower’s emergency room, setting off a series of actions in the health system’s response to the pandemic. Within minutes, leaders gave the directive to implement a plan: create a new COVID-19 unit at the top of UHealth Tower.
Week one—“We had everything up within 36 hours.”
Joe Falise, nurse manager for the cardiovascular and neuroscience intensive care units at UHealth, spearheaded the opening of the COVID-19 unit on the 13th floor of the health system’s 560-bed hospital. Launched within 36 hours, the unit was created—following the Centers for Disease Control and Prevention’s guidelines for facilities without access to negative pressure rooms—on the top floor.
“This was plan B, and it wasn’t ideal. But as we watched this unfold, it became obvious that the two existing ER isolation rooms wouldn’t be enough,” said Falise.
The unit—known as penthouse North and South—forms an L-shape and has two long hallways joining at the point. The nurse’s station—where Failse takes the helm—is located at the middle of the L and is one of the first things you see when you walk onto the floor. It’s a bustling scene, with nurses monitoring their patients from this centralized location using telemetry and video monitors, because they are not free to move about in their patients’ rooms as they would normally.
Past the station, down each hall, is silence.
“It’s very different from anything I’ve seen in my 25 years as a nurse,” said Falise.
The halls are lined with isolated COVID-19 patient rooms. The patients are alone—without family members and without clergy—and the only sounds come from medical equipment and hushed voices of two or three nurses working that shift, dressed in head-to-toe PPE.
“There’s no joking around; no cellphones. If you’re not careful, you can really get caught up in the quiet,” Falise remarked.
The nurse manager credits the quick turnaround to the health system’s leadership team, which gave him the flexibility and the resources to get the job done.
“We bring people on who we know can do the job well, and trust is paramount, particularly in times of crisis. There is no time to delay. Our role as leaders is to trust and remove barriers, so our teams can do what they do best. And, I think that’s what worked really well here,” said Kymberlee Manni, chief executive officer for UHealth Tower.
The next six weeks—Consumed by COVID-19.
During the first 14 days, Falise focused on getting input from the nurses to see what they needed, and he set up new processes and expectations.
“I listened to what made them feel uncomfortable and implemented a lot of their ideas,” said Falise.
At the onset of the crisis, he worked more hours than usual, up to 14 hours a day—including some weekend shifts. At that pace, Falise estimated having worked up to 700 hours, so far, in direct response to COVID-19.
There was a point within the first month, where anxiety reached critical levels, as health care workers in Miami began getting sick. “What stressed me the most was not the work or the hours—it was the thought that one of my people would get sick and have an unfortunate outcome,” Falise shared.
To keep contamination to a minimum, Falise implemented a process he learned during the Ebola outbreak from 2014-16. Nurses are required to use checklists when putting on and taking off PPE. The 20-steps are ticked off step by step by a second nurse—an observer—who helps to ensure that no steps are missed.
“They’re [nurses] doing the hard work,” he said. “My job is to monitor them for exhaustion, their emotional status, and make sure they’re not contaminating themselves.”
Falise’s day starts at 4:30 a.m., when he handles the operational aspects of his job—ensuring they are staffed appropriately, processing pay, and adjusting schedules.
He arrives at the unit around 6:30 a.m. for the daily huddle, which includes reviewing the inventory of supplies needed for the day before they begin the shift. “I try to motivate the team and encourage them to follow the processes,” he explained. “I work really hard to help people understand that, as we start to ramp up, we’re in it together. And, we need to stick to the script—we know how to do this.”
Week seven—“Nurses and staff requested to stay.”
In mid-April, right before the unit saw an increase in cases, Falise was able to establish a consistent team of nurses, instead of rotating the staff as he usually did. “We really needed the consistency in staffing, because I would spend a lot of time re-orienting the teams,” he explained. “I had so many people—nurses, observers, and telemetry technicians—who requested to stay.”
Toward the end of April, the UHealth COVID-19 unit saw a spike with 19 ICU patients. But today, the numbers are looking better with an average of 10 patients in the ICU.
Falise pointed out that the nurses are managing emotional and physical exhaustion, noting that placing patients on ventilators is likely the easiest part. Proning patients—turning them on their stomachs to increase oxygenation—is a monumental task. “These are activities that we did every once in a while, but now we’re doing it with almost every patient,” he remarked.
One of the biggest challenges for the nurses is the contactless care that they must now provide to their patients. The ability to visit a patient in their room freely, to provide a gentle gesture of support by placing a hand on a patient’s back, the access to the nursing staff—all of that is extremely limited.
He recalled a moment of pride while watching the cameras at the desk one morning as his team dealt with an emergency in one of the rooms. “I had chills watching the level of collaboration and teamwork among the nurses, therapists, and physicians working in unison to save the patient’s life,” he said.
Today—“Not letting our guard down.”
According to Falise, some of the nurses are living away from loved ones to be safe. With cities reopening and the number of cases leveling-off, he is hopeful, but not overly so. Although he hopes the virus can be contained, he says he doesn’t expect to close the COVID-19 unit anytime soon.
“The hours have been very long, and I haven’t truly had a day when I have not thought about this hospital in over a month,” he said.
Today, the hours have leveled-off a bit, but even when he’s not physically there, Falise’s mind and heart are. He is constantly talking about it, thinking about it, making phone calls, problem solving, and coaching—it’s now part of his DNA.
“Please do not think that anybody is exempt from [the coronavirus],” he said “There’s nobody that’s immune to it. If you’re lucky enough to go through this and have very mild symptoms, consider that a blessing, because there are a lot of people who are not surviving.”
He believes that we will be dealing with COVID-19 for a while. “We’re prepared for anything,” he added.
Last week, Florida leaders issued a phased plan for reopening the state. This excluded most of South Florida, but it included the reopening of parks, marinas, golf courses, and hospitals to perform elective surgeries again—as long as social distancing measures are taken. A question lingers—will this spark another outbreak?
Falise isn’t certain, but regardless, he said, “we’re not letting our guard down.”
As part of National Hospital Week, ’Canes around the globe are uniting, from a distance, to share our gratitude and pride for the unsung heroes who rise to the occasion every day. Learn how you can celebrate the University’s frontline heroes, including UHealth’s COVID-19 unit.
