COVID-19: providing nursing leadership in a public health crisis
UCLH’s chief nurse Flo Panel-Coates explains how the trust’s culture helped it through the peak of the coronavirus outbreak
When Flo Panel-Coates met the Queen in February, she thought it would be the defining moment of her career. But – just a month after the Queen’s visit – University College London Hospitals (UCLH) NHS Foundation Trust was in the grip of the COVID-19 pandemic.
As the trust’s chief nurse and executive in joint charge of its response to the pandemic (with chief executive Marcel Levi), Ms Panel-Coates was stretched to her limit. She has held several roles at chief nurse level in troubled trusts, but this was the biggest challenge of her career.
As one of the largest trusts in the country, UCLH was in the eye of the coronavirus storm.
Getting through the peak of the outbreak
‘We started to see the numbers coming in increasing in March, before the lockdown,’ says Ms Panel-Coates. ‘We were anxiously watching what was happening in China and thinking, will it happen to us?’
‘Staff at all levels were able to come forward with ideas of how we could do things better. We drew on the expertise of people in all corners of the trust’
Planning for a no-deal Brexit meant the trust had already examined new ways of working. ‘We looked at what we had learned from Brexit and our flu plan,’ says Ms Panel-Coates, who is also the trust’s emergency preparedness, resilience and response lead.
Recognising that all the answers would not come from just one person, one of her main aims was to create an environment where staff could bring forward ideas and suggestions for improvement. Her leadership style was to draw on the skills and knowledge of as wide a group of staff as possible.
Although the peak of the outbreak was ‘pretty hard’, Ms Panel-Coates says it was an opportunity for everyone to show what they could do.
‘I remember feeling grateful that I could direct a lot of my energy into something that did good,’ she says.
‘I felt responsible for our staff as well as our patients. Every day we were asking ourselves, are we doing enough? Are we taking the right measures? That was quite difficult.’
The importance of communication and sharing information
One of the challenges for Ms Panel-Coates was the amount of information she was receiving – which all had to be ‘waded through’ – and how clear it was. Honesty with staff about the extent and accuracy of knowledge was crucial, she says, along with the chance for everyone to ask questions, even if face-to-face briefings had been replaced with Microsoft Teams software.
The culture of the trust and its flat hierarchy helped, says Ms Panel-Coates.
‘Staff at all levels were able to come forward with ideas of how we could do things better. We drew on the expertise of people in all corners of the trust,’ she says.
‘It was important that they knew we would support them and provide “air cover” for them in making decisions.’
With 15 years’ experience at executive level, Ms Panel-Coates felt confident in her role, but leading a response to COVID-19 has been a learning experience for her and the trust. Processes had to be continually adjusted as the pandemic evolved, so the ability to be agile was important, she says.
Losing members of the ‘work family’
Hardest of all was dealing with the death of colleagues.
‘We lost people we cared about. We have our little work families and losing members of those was tough, including people who died from other conditions.
‘It almost felt like they were not getting the attention they deserved,’ says Ms Panel-Coates, who is still unsure whether she ‘got it right’ over these deaths. The speed of social media made it challenging, with staff hearing of deaths before the trust could inform them.
Another emotional moment for her and her teams was ‘proning’ patients – placing ventilated patients onto their front – an important but unfamiliar part of care.
‘Not having the ability to look at someone’s face or touch someone is hard,’ she says. ‘It is such an important part of the connection with patients. I remember coming out of the critical care unit feeling so much respect for our teams.’
Ms Panel-Coates was brought up in Walthamstow, East London, in a working-class family with a mixed background – her mother is from Ireland, her father from St Lucia.
A photo of her meeting the Queen at the opening of UCLH’s Royal National ENT and Eastman Dental Hospitals hangs proudly in her mum’s home.
‘My mum can’t stop talking about it,’ laughs Miss Panel-Coates. ‘She came to this country from Ireland with very little, and there was her daughter meeting the Queen.’
Path into nursing and career experience
Ms Panel-Coates was drawn to nursing after her father became ill and died when she was just 12.
‘I was allowed to visit him in intensive care, and I remember the staff on the unit being so kind to me and my mum,’ she says. ‘That had a profound effect on me, and I wanted to go into nursing from an early age.’
After training at London’s Whipps Cross Hospital, Ms Panel-Coates started her career at the North Middlesex Hospital, later returning to the trust as director of nursing.
She also held the role of director of nursing and quality at Maidstone and Tunbridge Wells NHS Trust, and was chief nurse at Barking, Havering and Redbridge University NHS Trust before taking up her current post in April 2015.
She recently celebrated her 50th birthday and, although lockdown has meant some celebrations are on hold, she is hoping to marry her partner later in the summer.
‘My partner, a doctor, came back into the NHS during COVID-19 and offered her services as a haematologist,’ says Ms Panel-Coates. ‘It’s been nice to have her reconnect with the NHS.
‘A situation like this reminds you just how important the people around you are,’ she adds. ‘If we can get through this with little loss of the people we love or feel responsible for, then that’s okay. I feel lucky despite the challenges.’
Flo Panel-Coates: advice on leading an organisation through a crisis
- Bring together people with different experiences as soon as possible. This enables you to get a collective understanding of a problem
- Delegate and be explicit about giving others the authority to do things
- Take every opportunity to listen to other people
- Share the burden and do not be afraid to ask for help and support when you need it. ‘It’s like any job – you don’t do it on your own,’ says Ms Panel-Coates
- Think about self-care, especially at times of pressure. ‘I did get poorly – I was probably just exhausted,’ says Ms Panel-Coates, who tested negative for COVID-19 but was off work for a few days and felt guilty
- Pause and ask someone to review what is being done. It’s always best to find out if refinements are needed sooner rather than later
Alison Moore is a health journalist
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