Nurse Commander – Dr. Timothy Layman, Western North Carolina

Dr. Timothy Layman, DNP, MSN, RN, NE-BC, is the Administrator of Clinical Operations at a critical access Medical Center in Western North Carolina and Associate Professor at Yale School of Nursing. Layman oversees all clinical operations for the hospital, including outpatient infusion, rural health division, and women’s and children’s health services. Layman is also responsible for implementing the hospital’s emergency preparedness plan for COVID19. This requires establishing active lines of communication to disseminate information; ensuring that all equipment is accounted for and functional; and that the organization can mount a community response and secure necessary staff into the building when needed. Layman reports that because of center’s rural location, they do not expect to see the same magnitude of COVID19 cases as seen in the more densely populated areas across the country. However, as a critical access hospital, their patient population lacks access to primary care and is often quite sick when entering the healthcare system and may experience worse health outcomes as a result of contracting COVID19. When describing the current climate at the medical center Layman says, “Patients and staff are scared right now. People are staying away from the hospital and only coming in if very sick”. Staff with flu-like symptoms are concerned that they may have been in contact with unidentified cases. Currently, 0/56 people who presented with flu-like symptoms, including staff, have tested positive for COVID 19. However, many staff who were home sick are unable to return to work even when asymptomatic until cleared by Work well. One worker has been out for 11 days but feels fine. AMC is also encouraging staff to take time off and using flex time in anticipation of launching a surge response. Layman feels confident that AMC has put all necessary infection control practices in place to slow the spread of the virus.

                 According to Layman, “Communication is critical to effective functioning yet has been difficult to do during this current COVID 19 crisis. Information is coming in faster than we can disseminate it”. The challenge has been making sure that all staff and care partners, both inside and outside of the institution, are hearing the same message and are updated with current and accurate information. Layman has implemented many chains of direct and frequent contact with staff, including calls across the division three times as day seven days a week and staff huddles three times a day to make sure all staff across all shifts are working with the most current information.

                 Layman reports that his facility is not experiencing the shortage of supplies other institutions are facing and attributes this to daily equipment counts, turning in old equipment before getting new and implementing a new role called the “PPE Czar” who is responsible for monitoring all personal protection equipment (PPE). AMC administration is currently on-site following social distancing protocols for meetings and Town Halls but also uses video conferencing when necessary.

                 Layman references Quantum Leadership and a book by Dr. Tim Porter O Grady and Kathy Malloch “The Quantum Leader” when describing the skills a leader needs to guide their organization effectively through a state of emergency, disaster, pandemic. “Leadership is less about ego and more about focusing on what is important for the organization. It requires one to be available and actionable with contingency plans if A, B, and C fail. You cannot do this from afar; it negatively impacts communication and dissemination. Staff want a connection with leadership”. 

                 When asked how being a senior administrator at the decision-making table influences patient care and nursing, Layman says, “I represent two voices – operations and nursing. You can’t take care of patients without staff. I often need to educate both board members and staff about staffing ratios while always striving to deliver safe and cost-effective patient care using evidence-based data to support my recommendations. Collegial relationships and multidisciplinary representation are essential to effective board governance, advancing the nursing profession and the delivery of high-quality patient-centric care. You also need to be comfortable expressing dissenting opinions when necessary”.