Utilizing the Pathway Framework to Thrive During the COVID Crisis

Title of article superimposed over a weary-looking nurse wearing a medical mask

This is an executive summary of a session from the ANCC Virtual Summit 2020, “Thriving in Crisis: Utilizing the Pathway Framework.” This summary focuses on the excerpt delivered by Patience Harris, BSN, RN, Sr. Pathway Specialist at the American Nurses Association.

2020 has been a strenuous year on the healthcare system. Nurses especially have felt much of the professional strain in the year of COVID-19. This year has led to nurse anxiety, for a crisis we are not able to see, understand, or prepare for. Nurses are dealing with issues like PPE and work efficiency problems and are adjusting to modified work schedules and responsibilities.

Given this challenging situation, now may be the best time for nursing leaders to recreate and maintain a positive practice environment that will ensure nurse teams feel supported, engaged, and listened to. The ANCC Pathway to Excellence® Framework can help you create a system that will enable your teams to be better partners and even thrive. Here are the Pathway Standards and examples of how they can be used.

Shared Decision Making

As a leader, engage staff at all levels through strategic planning. Because of the pandemic, shared governance councils may not be able to meet as regularly or formally as before, so be creative in how you will continue to seek input from your frontline nurses. Connecting with nurses regularly is key to show them that they have a voice and that leadership is serious about incorporating shared decision-making. For example, consider using a virtual Zoom call for rounding on the unit to give nurses opportunities to speak with senior leaders. Ask bedside nurses to participate in these rounding sessions with the CNO, but not the direct manager for the best and most honest feedback. The CNO at Metropolitan Methodist Hospital (San Antonio), for example, invites frontline nurses to spend time with her monthly to connect on issues.

Be sure to give feedback up the ladder as well. Share input from nurses directly with your Boards or Councils! Rather than just high-level nursing reports, share individual nursing stories or internal newsletters. Your organization’s Board will probably love this sentiment.


Put strategies in place to protect, support and retain your leaders, in particular your nurse managers. At Memorial Hospital (California) for example, it was decided that meetings would be less about protocol and more about caring for the leader. By doing this, Memorial Hospital found issues and concerns that had never come up before within a larger group setting. What are other ways to support your nurse managers? Leadership could commit to being easily accessible, rounding regularly, and/or resiliency rounding in concert with pastoral care and social services that are available.


Because decisions made by Pathway organizations are shared, safety solutions often come from the frontline nurses. Nurses at Providence Hood River Memorial Hospital (Oregon) helped solved common PPE dilemmas on their unit. Nurses also helped fix ongoing issues, like the continuous ICU overflow of patients who were going to new teams, and the communication issues resulting from that. Also, at this hospital, the nurses who were in charge of supplies and workflow adjustments found that processes needed to evolve swiftly in dealing with the resuscitation of patients with COVID-19. The CNO at Providence Hood River Memorial stated that “this is a dramatic change to our usual clinical practice. We learned that our staff really are the experts when it comes to defining workflows, so they must be involved.” Staff ownership on the unit level is key, as it empowers staff to be agile and responsive as they address safety in the workplace.


In the Pathway framework, nursing participation and quality in evidence-based practice is key. Pathway organizations involve nurses in the development and implementation of quality initiatives. In 2020, many new processes, innovations, and treatments which were nurse-generated have become standards. Nurses were involved in the development of COVID-19 airway management isolation chamber (CAMIC) for example. When it comes to quality, nursing must be involved; nurses are key stakeholders for quality, innovation, and safety initiatives to be successful.


Well-being includes promotion of a culture that is civil, offers day-to-day recognition, and addresses physical and compassion fatigue, plus nurse resilience. This Pathway standard is even more vital during the coronavirus landscape we’re in now. Nurse executives need to be proactive in finding ways to combat nurse stress, burnout and even PTSD.

As nurses are working through this crisis, living the Pathways standard of Well-Being is a guide to mitigate the conditions that lead to stress and burnout. Consider Memorial Health South (Florida) which lets its staff know that they care about well-being by delivering yard signs to nurses’ homes that say “You Rock” and are actually signed by the CNO and other nurse leaders. The organization also started “Hope Huddles” where staff members read inspirational quotes and stories. Another health organization, St. Luke’s Global City Medical Center, a Pathway organization in the Philippines, has a rotating flower pod that goes from unit to unit with large flower arrangements and inspirational stories. St. Luke’s also turned its own auditorium into a free grocery store for its staff who have less time for shopping. It also offers free laundry and shuttle services, as well as hazard pay and housing accommodations for those in the most stretched units.

Professional Development

Nurses know that learning is an ongoing process, and is important even in the midst of a crisis. Pathway organizations recognize the importance of staff orientation, collaboration, and professional development in providing safe and effective patient care. In this time of COVID-19, most organizations have implemented some form of cross-training to accommodate viral testing needs and the influx of patients.

During a crisis, onboarding and orientation as we typically know it may not always be possible but can be accomplished through less traditional ways such as virtual meetings or online learning. One Texas health organization recognized the need for leadership development and implemented a professional practice transition program. What made it was that its frontline staff was encouraged to participate, without needing to commit to a leadership role in advance.

Great Communication is Key

The common factor in all of these standards is communication. Now more than ever, effective communication is critical to providing high-quality patient care and to staying engaged with all team members. In these demanding times, even giving bad news to staff is better than leaving them feeling left in the dark. But keep in mind that communication overload can cause problems too. As innovations and processes change quickly, be aware of how and when you communicate to avoid overwhelming your team.

ANCC’s Magnet Recognition Program® recognizes hospital organizations for excellence in patient care and superior nursing processes. Bristol Hospital, a small community hospital in Connecticut and Catalyst Learning customer, is extremely proud to be among the elite 7% of health care organizations with Magnet designation nationally. To uphold this high standard, Bristol has embraced dedication to one theme: developing great leaders at all levels of nursing, including charge and other first-level supervisory nurses.

“Critical thinking, decision making, effective communication, and conflict resolution all help to advance our nurses’ practice. The participants were most engaged in the communication and conflict style assessments. I believe it gave them a greater understanding of how effective communication and conflict resolution skills impact patient care. As the charge nurse, these skills are essential.”

Kerry Yeager, Clinical Informatics Specialist at Bristol.

Being a frontline nurse leader is a high-pressure role that is often assumed with little or no formal leadership training. Catalyst Learning’s NCharge: Nurses Learning to Lead is a dynamic, flexible series designed to improve the leadership, business management, and interpersonal skills of frontline nursing leaders. Critical leadership skills like communication, delegation, and conflict resolution require ample practice time. That’s one of the key reasons up to 70% of the time in NCharge courses is spent in group discussions and interactive activities. Learn more.

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