UB SON Alumna and Hospital COO’s Mission During COVID-19

At the time of Dorothy Urschel’s interview, New York State was five weeks on-pause as COVID-19 continued to grip the world.

Dorothy Urschel.

For many years, Dorothy Urschel’s email signature was simply: “For our patients, Dorothy.”

This uncomplicated personal mission remained constant throughout her three-decade career, but perhaps no more poignantly than now—Dorothy Urschel, DNP, MS, MBA, ACNP-BC, FNP-BC, RNFA, CCRN, NEA-BC, became COO of Columbia Memorial Health on Jan. 1 of this year.

Within weeks, the COVID-19 pandemic became a critical issue.

Urschel’s years in education—she earned her Doctorate of Nursing Practice degree from University at Buffalo, where she was previously an adjunct professor—taught her to think in a reality-based way and to expect a pandemic eventually. But nothing, she said, could have fully prepared her for COVID-19.

“Organizationally speaking, this is by far the most difficult situation I’ve had to deal with, personally and professionally,” she said.

When she began her career 30 years ago as a nurse and nurse practitioner in critical and acute care, Urschel cared for HIV and AIDS patients. She sees some parallels in terms of not yet fully understanding the virus, how it spreads, and being extra cautious with personal protective equipment (PPE) and personal cleanliness. But COVID-19 is vastly different.

“For now, we are focused on basic symptomatic treatment and trialing different treatments,” she said, “but we are dealing with something that needs antibody testing.”

In her role as COO, Urschel connects Columbia Memorial Health system with its affiliate offices, clinics and laboratories. Promoting patient service and quality is at the foundation of her core responsibility of contributing to the development of strategic goals and objectives for the hospital system, which is located south of Albany, New York. Now her work guiding all staff in “lockstep” service to the community has taken on new meaning.

A COVID-19 world has citizens and businesses pivoting from traditional routines to meeting new challenges. In a hospital system, with certain surgeries and services on hold by executive order from the Governor and outpatient sites temporarily ceasing or decreasing hours, resources have been diverted.

“We have a great need for critical care nurses and physicians, as well as for highly-trained medical nurses, so we staffed-up and redeployed staff to help in other areas,” said Urschel. Columbia Memorial Health has set up COVID-19 testing centers and ramped up telemedicine to continue to serve all other patient needs as appropriate. “We had to quickly become agile,” she added.

While her day-to-day mission is to ensure effective execution of key systems and processes so the hospital organization works, the pandemic requires a different lens to fulfill that mission.

“When COVID-19 came, our initial focus changed to patient and employee safety,” said Urschel, who recalled two questions driving that focus: Do we have adequate PPE? What are our testing requirements for the community or for incoming patients?

While the influx of COVID-19 patients was surging (versus “smoldering,” as Urschel terms it as of this writing), the norm was executive leader conference calls seven days a week, often hourly, with state agencies, Gov. Andrew Cuomo and other regional hospitals. These included managing guidelines and directives coming from the Centers for Disease Control (CDC), Healthcare Association of New York State (HANYS) or World Health Organization (WHO), and region-based calls to put together plans of action. It has been common for rapidly changing guidelines to require attention mid-call as the entire medical system across New York evaluates what to do next.

“We needed to work together to be efficient and to not confuse patients,” said Urschel as she described regionalizing care standards and supply efforts. Some systems, like Columbia Memorial Health, were savvier in locating the right equipment, so sharing sourcing was important for community-wide response until the State of New York could fulfill supply requests.

It was a daily learning process.

“One lesson learned was that the supply chain was not as robust as we thought,” said Urschel.

Protecting staff has been paramount. Fortunately, Columbia Memorial has been able to do so, initially with the help of a group of bankers and businesspersons who donated masks and gloves.

Columbia Memorial Hospital, normally a 192-bed facility, established two COVID-19 units: one 10-bed ICU unit and one 24-bed general medical unit. Both units are—by state mandate for a surge capacity plan—prepared to double in capacity if necessary. The hospital also moved to increase stocks of PPE and added negative pressure rooms and equipment.

This efficient response positioned the Capital Region to be the first to take patient transfers to relieve the pressure on New York City hospitals, with many patients receiving care at Columbia Memorial Hospital.

Urschel noted all these efforts required everyone.

“A hospital is not run by one person,” said Urschel. “It is a cast of thousands — everyone from housekeepers to doctors, putting their lives at risk and doing their jobs in unison.”

She works every day to support them all, including nurses who are holding patients’ hands and using their personal devices to keep patients connected with families.

“I’m so proud of the people I work with,” she added. “This team brings tears to my eyes.”

Overall, Urschel views the pandemic and the future of Columbia Memorial Health as a marathon, not a sprint. Hospitals still must run, and the new programs that sustain them and support growth depend on patients feeling safe there.

“I really want the community to understand that the hospital is still safe and we're doing our best to provide care,” said Urschel. “We come to work every day because of our patients.”

-Terra Osterling