North Ridge Health & Rehab

Last week I attended the American Health Care Association meeting at the Gaylord National Hotel in Maryland, outside of DC. As I left in my car, last Saturday from my home in Durham, NC, I was excited to get back to a large conference, to seeing all my friends from the post-acute arena, and anxious to hear what’s next. What I didn’t realize was how raw I would be left feeling after the conference.

On Sunday morning, I attended the Quality Cabinet meeting. This is usually an update of the work of the committees we all volunteer in to support the association. I found my table marked “Regulatory Committee” and sat with my fellow committee members. Our chatter was superficial: discussions around travel and sharing of new systems we have found. We were all looking forward to having a great conference, away from the day to day of the pandemic.

The Quality Cabinet is led by stellar leaders in post-acute care, who chose not to do the normal updates but to allow us to share our stories. While this was on the agenda, I did not think at the time I would participate. As they shared their stories of how the pandemic has (had) affected their lives over the past 19 months, I felt compelled to tell the story of a small nursing home, in rural America, who struggled with handling the virus, culminating with the recommendation, that if you know anyone struggling out there, regardless of whether they are your competitor or not, please, please help them! Associations matter and without this Association and my participation in a group called the Nurse Executive Committee, I don’t think I personally would have had the information I needed to help our communities attack this pesky virus on the front lines.

As we progressed through the conference, more and more of this occurred. More sharing, more feelings that had been suppressed, or put to the side coming to the surface. In the opening ceremony, led by Governor Parkinson, I looked around, as I thought I was the only one crying, no, everyone around me was shedding a tear. But what were we crying about? We’re we remembering our staff working many hours day and night without a break? Remembering putting up plastic barriers to isolate our elderly? Closing the doors and telling folks they had to stay in their rooms? Telling families they could not visit? The constant changes, the turning on a dime, the hope that someone would not die? Perhaps it was all of it?

The culmination of this for me, was watching the movie that AHCA has produced “COVID-19 in Nursing Homes”. I came out “raw”. My feelings which had been set aside and put in a box were out for all to see. I sat sobbing in the viewing room. The closing helped, with all the video thanks from the celebrities, but while this was great, this needs to get to our staff. Mission Health agrees. We did a “Thank You” tour in the spring, which allowed our staff to take their feelings and put them into written word. It was a moving exercise that facilitated examining our experiences over the past year and became a touching project to share with the staff back at the communities in recognition of everyone’s work. Writing has always been cathartic for me, and it is helping me again to take my feelings regarding this ongoing pandemic and put them out there, but also to tuck them away again into my box to the side.

I never realized how “raw” this would make me, but that is also part of the grieving process we all need to do, to move forward. I encourage readers, especially those in the healthcare profession, to free-write a bit about your experiences throughout COVID-19. You never know how it might help!

Thank you to the producers of the conference, and specifically Governor Parkinson, Deb Meade, Dr. David Gifford, and Janet Snipes for allowing us to express our feelings; this should only help us in the long run as we continue to deal with this pandemic.


Karen McDonald
Chief Clinical Officer, Mission Health Communities

In 2020, the World Health Organization designated 2020 to be the Year of the Nurse. While it was designed to advance nurses’ vital position in transforming healthcare around the world, only God knew what it was really designed to do last year. We nurses became the front line in a fight that will shape us for years to come.
So that leads me to ask, why did we choose to be nurses? Why specifically are you a nurse? Some would probably say, well, “that’s what I thought I was supposed to be,” or for those of us in the Old Girls Group, it was an accepted path in higher education. Other might say, “it’s a good job,” or even, “I want to take care of people.” Recently, I saw a post on social media that spoke directly to me.
“I was born to be a nurse.”
In the 6th grade, in Mr. Innese’s class in Kensal Park Public School, London, Ontario, we were asked to write what we wanted to be when we grew up, and why. I instinctively wrote, “I want to be a nurse.” I didn’t know why, I only knew that I did. Heck what does a 10 year old girl know anyway? Was it because I was the younger child in a family with a child with major health issues? Was it because I sat in the lobby of the children’s hospital waiting for my parents and sister more times than I can count watching the nurses, in their white uniforms and caps, sometimes with their blue capes on, and wondered what it would be like to be them? Or was it just because…just because I always knew I would be a nurse? 
Now as I look back over this near 42 year career, I am thankful that I have spent the majority of it in Long Term Care. I took the position of Director of Nursing at Methodist Retirement Communities in Durham, NC without ever setting foot in a nursing home! But that is what nurses do. We accept the path presented to us, and jump right in with both feet, and then sort it out.
I have seen the best there is to offer in nursing in Post Acute Care over these years. When I come in contact with you, my fellow nurses, I see similar characteristics. I see men and women whom are caring, communicative, empathetic, detail oriented, problem solvers, are committed to being patient’s advocates, are (usually) willing to learn, have great stamina and mostly have a sense of humor. We could NEVER do this job without a sense of humor! God knows we needed a sense of humor to get through the last year!
I encourage all my nursing friends out there in Mission Health Communities and beyond, to reflect on why you became a nurse—use even one of the characteristics I listed above to guide you over the next year. Write it on an index card, put it in your MAR to refer to during med pass, put it on your desk, or inside your scrub pants pocket. Pull it out through the day and think, have I exhibited that today? 
Mission Health too, is about to embark on a year long project to elevate our nurses. A career ladder program is soon to be launched. Mentorship programs are rolling out. I am forever grateful to the Senior Team at Mission, led by our President and CEO, Stuart Lindeman who have said this is not only important, but necessary for us to retain and recruit the best out there.
Every year, National Nurses Week bumps into National Skilled Nursing Care Week. It’s a great mix, because as we celebrate the residents in our communities, we also step back to thank the nearly 800 Licensed Nurses whom come to a Mission Health Community each day to carry out the work of nursing. I not only celebrate National Nurses Week with you all, I tip my white cap with a black stripe to you, and very much respectfully thank you for all you do.
What will be on your index card?
Happy Nurses Week, 
Karen McDonald
Proudly a Registered Nurse of 42 years
Chief Clinical Officer, Mission Health Communities.

Today, I reflect upon March 13, 2020 when CMS issued a regulatory memo that essentially restricted all visitors to nursing homes, stopped all communal dining and activities and we were told to get the residents into their rooms for the foreseeable future. This major paradigm shift rocked many of us to our core. For years we have lived with culture change and all that came with it. Freedom of choice for the residents was to be afforded from where to eat, when to eat, which activity to attend and generally they should be able to come and going as they pleased. We were taught, and we believed that the community was their home, and we were visitors in it.

If one steps back and thinks about it, this also happened to us outside of the nursing home. Within the next couple of weeks, in late March 2020, we were mandated to wear masks and we were relegated to mostly home cooked or takeout food. We could not attend social  or church activities except those that safely could be held out of doors without crowds, and now we had to essentially “stay in OUR rooms”!

For me, who has travelled now for work, for the past 27 years, this was like taking the morning cup of joe away from a coffee lover! As I flew home on a mostly empty plane on March 16th, I do remember thinking, “when will I travel again”? Then, just when I thought what am I going to do without travel,  the virus began its march across the country and into the nursing homes. Calls ensued daily with our staff for a couple months. We never ran out of topics and we used our collective brains to solve problems like no staff, or no PPE, or how to put a plastic barrier up. One call, in April that will always be ingrained in my mind,  was the discussion on just how deadly this COVID-19 could be to our residents and staff.  My travel schedule was set aside not only due to a “stay at home order” but because I needed to stay abreast of everything day and night. Like many of us whom are nurses, a crisis situation causes us to rally quickly, and to turn on a dime. Those unfortunate communities, who broke the COVID-19 ice early, quickly realized how virulent this virus was.  We had no choice but work together to keep our folks alive and “at home.”  Discussion, on how to do that, will little guidance, in the beginning from the CDC and CMS, was by, as my mom would say, “the seat of our pants”.

But what did we truly gain from this? Were there lessons to be learned? Was there a silver lining?  The initial surprise though,  was that our residents accommodated to basically anything we ask them to. Stay in your room, ok. Quarantine alone in your room for 14 days, ok. Take this big old Vit D and Zinc pill, ok. THEIR resilience helped to keep us focused. After all, THEY missed their families, and freedom. We got to go home, this is their home!

My personal growth is probably the # 2 positive outcome for me (the residents’ positive outcomes are # 1). I encourage everyone to take a minute to take stock of any personal silver linings they may have gotten out of this past year. It’s hard, I know, but if the resilience of our residents has taught us anything, it’s that we find ways to keep going forward. I learned to slow down, that I don’t have to run, run, run to be productive. I fell into my new norm. Up at 6 AM (that’s a new one!), coffee and emails until my lady friends arrived at 7 AM for our daily walk. I relearned my neighborhood and neighbors. My community became very small. During that 1 hour walk every am, we all chatted away, sometimes lamenting about a social event we were missing or about the pandemic itself and the restrictions it was imposing on our lives. We debated the mask rule, the restaurant and church closings, and how our families were handling this. Most of all, we missed our freedom to go where we wanted, when we wanted and with whom we wanted. Imagine how our resident’s felt!

Were there bright moments to be found over the course of the year? Of course. Without these woman, I would now be lost. We check in on each person daily, a quick hello to make sure everything is fine. Most of us are back at work now, our families back together and life has returned to some semblance of normal, but this bond brought on by COVID-19 will forever continue.

As I lament of where we were a year ago to where we are today, I ask others about their silver linings, because despite the tragic loss of life to COVID-19, I saw that we, in post-acute care and specifically Mission communities, have the ability to rise to meet seemingly impossible challenges. New obstacles will come our way in 2021, but we now know that nothing is insurmountable. I believe we are all better leaders for it, and that we will continue to use our abilities to care for those who need it most.

Will life ever return to that pre March 13, 2020? Who knows, but can we take with us some of the lessons learned and resulting growth? Absolutely. What are your silver linings?

Karen McDonald, BSN, RN

Chief Clinical Officer, Mission Health