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Ocala nursing team is pure gold
The Gold Standard
Ocala Hospital nursing unit captures top award in the midst of raging pandemic
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BY BRAD ROGERS | PHOTOGRAPHY BY RALPH DEMILIO
As she talks about what her intensive care nursing unit at HCA Florida Ocala Hospital has had to endure over the past couple of years, Andrea Hunter wavers between beaming smiles of pride and tearful pauses of grief.
“When Delta hit last year, I don’t have the words to describe how horrible it was,” said Hunter, a mother of six and the clinical nursing manager of Ocala Hospital’s Trauma Intensive Care Unit. “If you compare it to the first wave (of the COVID-19 pandemic), multiply it 10 times. And it was people you saw at the grocery store. I had hard-core trauma nurses and I was holding them.
“To give you a scale, in an average month, we’ll have 20 to 30 deaths. Most of them are anticipated deaths. They’re very ill, it’s expected. Then in September 2021, we had 132 people die. And these were people in their 30s and 40s and 50s. These are young people and they’re dying.”
Despite the large numbers of deaths brought on by COVID-19 – especially the Delta variant – and the horrors it inflicted on the patients, their families and those who cared for them, Ocala Hospital (formerly Ocala Regional Medical Center), recently won the gold-level Beacon Award for Excellence from the American Association of Critical-Care Nurses (AACN). It is the highest award in the nursing profession and marked the first time a hospital in the 185-hospital HCA chain, the largest hospital company in the United States, has ever captured the gold Beacon Award, which also hands out silver and bronze awards.
The award is based on six “pillars” of nursing care, including leadership structures, adequate staffing and staff engagement, effective learning and development, evidence-based practices and processes, and outcome measurement.
Richard Rivera, assistant nursing officer at Ocala Health, said the gold-level award – one of only 45 given across the nation and one of only two in Florida this year – is particularly impressive given the pressures being felt in the nursing profession during the pandemic. Not only is there a national nursing shortage, but COVID presented unique challenges because it was new and ever-changing.
“The nursing shortage – it’s here,” Rivera said. “The shortage is not a surprise. But the pandemic just added a layer to the complexity of the problem.”
And the level of emotional toll it took on health care workers had never been experienced before on such a sweeping scale.
“It was a war zone,” Rivera said. “There’s no better way to describe it.”
“No one likes to deal with death,” he added. “End of life is the most challenging piece of critical care. … But the sheer number and frequency of the deaths made it much more difficult.”
Rivera said he has had “a lot of training for mass casualty events, but there’s no training
for the magnitude it presented or prepare you for the emotional impact.”
“The term ‘unprecedented’ was legitimate,” he added.
Hunter said the grief among nurses –from seeing so many people die, from having to deal with angry anti-vaccine families, from having to be alone at the bedsides of dying COVID victims – took such a toll that Ocala Hospital brought in grief counselors for their nursing teams.
“It was the first time I saw the grief cart brought in for patients and nurses,” said Kaitlyn Butler, the hospital’s spokeswoman.
THE WINNING PRESCRIPTION Winning the Beacon Award, Ocala Hospital officials agree, was not only a proverbial feather in the medical center’s collective hat – and a big one – but it also was something of a salve on the emotional wounds the staff incurred during the worst of the pandemic.
“This award shows that no matter how many deaths we had, we still provided excel-
—DR. DARWIN ANG TRAUMA MEDICAL DIRECTOR AT OCALA HOSPITAL
lent nursing,” Hunter said. “This is why you do it. It did mean something, what you did. It really did. The people who come through those doors got great care.”
Dr. Darwin Ang, trauma medical director at Ocala Hospital, put it more succinctly when asked the significance of the award.
“Compared to the rest of the country, we outperformed most ICUs,” he said. “It’s huge. It’s teamwork. If we don’t have great nursing care, there’s no way we can save people’s lives.”
As head of one of Florida’s busiest trauma units, with more than 4,000 patients last year, Ang said the Beacon Award not only bolsters his fellow physicians’ confidence in Ocala Hospital’s nursing team, but it should also boost the community’s confidence in
them as well.
“We’ve got some of the best nurses I’ve ever worked with,” he said. “And they’re expected to do a lot. So, the Beacon Award represents this whole critical care system. It’s not just what we do but how well we do it.”
Ang said winning the award required tremendous data collection and daily communications between nurses and those charged with helping them cope with a new medical crisis. The hospital Beacon Award entry was a compilation of patient outcome data gathered weekly as well as frequent peer reviews and constant examinations of “what went right and what went wrong.” And, Ang added, it’s not just an award HCA and Ocala Hospital should celebrate, but one the community should be proud of, too – considering the award goes to less than 1 percent of nursing units nationwide.
“It’s great for the community,” Ang said. “Winning the gold award is kind of icing on the cake.”
One of the key metrics in measuring nursing unit effectiveness is the rate of infections a hospital reports, Ang said. And during the pandemic, COVID was deemed an infection, thus making the award even more difficult to win.
Charlotte Davis, the hospital’s clinical practice quality coordinator for critical care services and a member of the American Association of Critical-Care Nurses board of directors, compiled the 50-page Beacon Award entry. She said the achievement is remarkable on its own, but to win it during the COVID pandemic is exceptional.
“It took the commitment of the entire team,” she said. “We not only met those six benchmarks, we exceeded them. As a result, we have thousands of people who are alive who shouldn’t be.” She said winning the award required “a perfect storm” of doctors, nurses, support staff and administration coming together and following the science, often as the science about COVID-19 was just emerging. But in the end, she noted, nurses are the frontline force in patient care.
“Nurses drive the clinical outcomes of patients – period,” Davis said.
She echoed Rivera’s acknowledgement that the challenge of the ongoing nursing shortage makes winning the Beacon Award even more special.
“It is like a pink unicorn,” she said. “You’re not going to find another one. It’s very rare.”
Rivera said the Beacon Award not only exemplifies the skill level of Ocala Hospital’s nurses but their passion for what they do.
“You can teach skills,” he said. “You can’t teach attitude.
“I like to say our nurses now have, what do you call it, swag. There’s a professional pride with achieving the award. There’s a continual passion to provide or achieve excellence in patient care.”
LINGERING EFFECTS Beacon Award gold medals or not, where do nurses and the nursing profession go from here? Clearly, COVID changed the profession, indeed the world.
Rivera pointed out the changes are both psychological and structural. Nurses have become more mobile, hence the growth of so-called “travel nurses.” More people are coming into the profession who care about their community. Veteran nurses are taking early retirements. And, of course, there will be almost daily challenges with changing equipment, technology and medications.
Yet, Rivera believes people will continue to be drawn to the nursing profession.
Hunter is more pragmatic, still caught up in the moment.
“It’s been rough, really rough,” she said, holding back tears. “But to come through
—ANDREA HUNTER
all that and be able to say we’re a Beacon Award-winning unit gives us something to hold onto.”
Hunter described her own feelings about what she and her fellow nurses have been through the past couple of years.
“This is the first time I’ve been able to talk about it without crying,” she said. “We’re suffering from PTSD (post-traumatic stress disorder). I think a lot of nurses are doing a lot of soul-searching right now. They’re going to lower-acuity jobs.
“Every nurse who was here through the whole of it, it’s like an adrenaline dump. A lot of them are like, ‘What do I do now?’ There’s a lot of PTSD.”
Yet, Hunter believes the Beacon Award is strong medicine for her emotionally battered charges.
“It reignites your passion for nursing,” she said. “This award shows that no matter how many deaths we had, we still provided excellent nursing. I think a lot of us, though, are kind of waiting for the next shoe to drop.”
Sabrina Braun, chief nursing officer at Ocala Hospital, said she is confident in the future of nursing. She says it is a profession built on having a passion for people, for the community.
“It’s about finding that passion for people,” she said. “Sometimes your patient needs that smile. … And I can tell you touching stories all day long about nurses and their patients. I want to have a hospital that I would bring my family to.”
But Hunter says while the nurses in Ocala Hospital’s trauma ICU revel in winning one of their profession’s top awards, there is still plenty of healing that needs to happen.
“There are a lot of people who are lost,” she said. “They ask, ‘Do I want to do this anymore? I can’t forget about the last two years that just wrecked my soul.’
“How do you put it into words when you’re in the middle of it? How do you tell how you feel when you don’t know how you feel?”
For now, though, the 155 nurses of the Surgical Trauma ICU at Ocala Hospital can find solace in knowing that they were among the best in their profession during the worst of times.
