COVID Response: Q and A with Karen Fountain, Fastaff Director of Clinical Services

Crisis Management Experts Meet Demand During a Pandemic

Fastaff Applies 30 Years of Experience in Rapid Response® Travel Nurse Staffing to Help Battle the Coronavirus

Situation Overview

Fastaff is the pioneer and industry leader in Rapid Response® travel nurse staffing. From natural disasters to census spikes to contagions and pandemics, Fastaff proves to be the reliable partner for healthcare systems nationwide in urgent and crucial situations. 

As experts in crisis management, Fastaff and U.S. Nursing enacted a series of operational maneuvers to ensure reliable delivery to clients fighting the coronavirus outbreak, amidst an out-of-control contagion, an avalanche of unknown facts, a crashing economy, and a 100% virtual work environment. 

In their own words, Fastaff leaders describe how they mobilized to meet unprecedented demand for skilled healthcare professionals. 

Q and A with Karen Fountain, MSN, MBA, RN

Fastaff Director of Clinical Services

Q.  You manage hundreds of nurses on assignment throughout New York City, and in a variety of public health emergencies, what made this crisis different​?
A. The severity of COVID-19 made the situation different than what we have handled in the past. In New York City and New York state, it was the acuity and the death rate that made it dramatically worse than a typical flu or virus outbreak. There was a need for nurses to be flexible and ready for any situation at any time. The patient demand was more than I have ever encountered, and it was all hands on deck all the time. Pediatric nurses became adult nurses. Labor and Delivery nurses were deployed to serve as support nurses in areas they had never worked in before. 

It was very strenuous and eyeopening, but inspiring at the same time. The nurses showed the ability to jump into any situation and do what was best for the patients. All healthcare workers – from doctors to the maintenance staff – came together to fight this. There was a tremendous amount of teamwork and relying on each other – not just for medical support, but for emotional support. It was a very difficult thing to deal with, but we were there for each other. It’s bringing the healthcare community together in a way we haven’t seen before. 


Q. Fastaff is known for recruiting experienced, adaptable nurses who can hit the ground running.  Did your process change during COVID?
A. The criteria did not change, but the volume increased. In March and April, I conducted interviews for 14 days straight, 16 hours a day and I interviewed nurses for the same high standards we typically look for. The first criteria was to make sure they were qualified for the position. We were also looking for people with several years of experience. If someone was going into the ICU or the ER, they had to be specifically trained for these units because the patients were presenting as very sick. 

When I interview nurses, I like to get some perspective on a candidate’s background, and I do a skills checklist. I want them to tell me where they think they would be a good fit. I wouldn’t send anyone to New York City if I didn’t think they had the skills to handle the acuity of the patients. The patient ratios are fairly high, and I have to make sure they can take that patient load. The resources are limited so I can’t send a nurse who has only been in the ICU for a year to some of these intense assignments because they would be lost. 

It is sometimes necessary for our nurses to float. Our belief is that any nurse can be a support nurse. These COVID patients were on ventilators and were sedated. They had to be turned hourly, which requires many hands on, and our nurses had to help in every way needed. To work in this environment you have to be flexible and a little crazy. After all, who runs into a burning building? I give every one of my colleagues the biggest shout out and love for what we do and what we are continuing to do.


Q. At the beginning of the crisis, demand for nurses was increasing so rapidly, how did you keep pace and physically deploy nurses quickly? 
A. Rapid response staffing is second nature to us. We are experts at filling positions fast with very little notice because hospitals come to us when they face critical staffing shortages. Nurses who seek jobs in urgent and crucial situations come to Fastaff and know they will likely have a start date in less than a week where the need is severe. During the pandemic, we have been deploying nurses within 24 to 48 hours in many cases. We also adapt schedules to meet client needs, which means nurses working 48 or 60-hour work weeks to satisfy patient demand. 

We also match our nurses' skills with what the facility requires and review their credentials with that in mind. Some states relaxed licensing requirements or allowed recently expired certifications which is not normally the case. The circumstances required that everyone become a little flexible in order to provide the coverage needed very fast, but without compromising the quality of care. 


Q. How did you support your nurses once they arrived on assignment?
A. I was able to place a large order of PPE and I distributed it to our nurses and others on the floors. I also had a large supply of surgical masks, gloves and hand sanitizer that I could share with them as well. I handed out thermometers to all of my nurses to test themselves every morning. I delivered meals. If anyone got sick, we would arrange for them to go to their primary care doctor or the occupational health department at their facility. We also monitored them every day to make sure they were doing okay. 

In addition, we tried to provide emotional support. If these nurses are holding the hands of patients and they are telling their families that they can’t come and be with them, they are breaking hearts on a daily basis. So, when you sit through that – when you’re holding the hand of someone dying and you are not accustomed to that – it’s extremely hard emotionally. I met with many nurses and provided counseling and support. We also had 
resources and numbers they could call if they wanted to reach out for support confidentially. 


Q. You were deployed in New York, working on the front lines of this battle. What was your experience like?
A. At one facility I worked as an ER nurse and then at another, as a house supervisor. As an ER nurse, it was just non-stop. We had patients who would walk in with oxygen saturation of 50%. We had rapid intubations. It’s hard to describe how frenetic it was. As a house supervisor, I was in multiple intubations and also had many patients coding (losing vital signs and requiring resuscitation). I communicated with family members who were trying to see loved ones and had to explain to them why they couldn’t. It’s definitely heart breaking but it’s necessary.

In the ER, there was a constant flow of patients and the majority of issues were COVID-related. The normal flow of other issues really dropped off. As a nurse supervisor, some days I would work in the ICU, and in M/S on others, and both were very busy. It was like that in every facility in New York City. My family lives outside Albany, NY and I have an apartment in White Plains, and I didn’t go home for six weeks. When I went home it was only for a day and that was after I made sure I didn’t have any symptoms. I have seen my husband maybe five times since March 4th. I think he misses me.


Q. Were you exposed and did you have to quarantine?
A. Yes, and I self-quarantined for 14 days. I had symptoms but they weren’t testing health care workers at that point. I was tested six weeks later and it was negative, and I didn’t have any antibodies so I went back to all of my positions in New York City. It was hard to stay away knowing what my friends and colleagues were dealing with and how badly they needed the help. It’s my job, it’s my duty, I’m a nurse.


Q. How do you help nurses avoid burnout in such stressful times?
A. It’s very hard to manage but I tried to stay in close contact with them. I was just reaching out constantly, having conversations with nurses and reminding them of the mental health services benefits offered by Fastaff.  I needed them to know they were not in it alone.

The Fastaff nurses are used to going into urgent and crucial situations. This one really required everyone in the healthcare community to come together to support one another  and provide excellent care to our patients. They rely on us and we rely on each other. 


Q. Can you share any remarkable acts of heroism by fellow nurses that really inspired you?
A. Yes, by every one of them, who stayed on assignment and didn’t leave. That is heroism and the best moral compass I will ever see in my career. They went above and beyond.


Q. What should all Americans be doing today to reduce the spread and risk to themselves and others?
A. Everyone should be wearing masks and washing their hands frequently. That’s common sense. It seems like a small sacrifice to make to help stop the spread of this contagion.  We need to work toward this goal together, so we can get back to normal life, or whatever the new normal is going to be.


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