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Nurturing nurses

The leadership of Chief Nursing Officer Terri Church has shined during COVID

By California State University, Bakersfield

February 2^nd, 2022

This is the third in a series of 2022 Alumni Hall of Fame Profiles.

Just before Thanksgiving, Terri Church spoke to a nurse at Bakersfield Memorial Hospital struggling to cope with the COVID-related death of a woman in her late 20s.

“I see her face when I close my eyes,” she told Church, Memorial’s chief nursing officer, “and I can’t sleep.”

A concerned Church asked the nurse if she’d called the employee assistance program or wanted to speak with a hospital chaplain. Memorial was even offering staff trauma-informed counseling developed for 9-11 first responders.

“No, no, no. I’m OK, I’m alright,” the nurse said, to which Church responded: “You don’t sound alright.”

The exchange reveals the toll two years of treating COVID patients has taken on nurses, and how Church has supported those working for her at Memorial. She oversees more than 1,200 nurses and support staff and the care they deliver at the hospital, where she has worked for 13 of her 43 years as a nurse and nursing administrator in Bakersfield.

On Feb. 6 she will assume an even bigger role at the hospital: chief operating officer.

Church has long been known as a quiet but strong leader who listens and learns before acting, nurtures talent, and despite having joined the executive ranks long ago has never forgotten what it’s like to be a nurse at the bedside.

Never have those skills shined more than during the pandemic, her colleagues say. Bakersfield Memorial President and CEO Ken Keller said she’s more than lived up to the nickname he gave her long ago: “Mom."

“She has been that for her entire tenure to the roughly 1,000 nurses who work here,” said Keller, adding he means “mom” in the best and most comprehensive sense.

“She has been a coach, she has been a nurturer, she has been somebody who listens to the questions, concerns, problems that they have individually and collectively, and solves for those concerns.”

Terri Church poses in the ICU — Terri Church in the ICU at Bakersfield Memorial. She likened the beginning of the COVID-19 pandemic to the beginning of the AIDS crisis early in her career, with young men coming to the hospital with a mysterious illness they weren't sure how to treat.

A scary time

The beginning of the pandemic, and of the two most challenging years of Church’s long career, was a very scary time, she said. Church and her colleagues didn’t know if COVID-19 was spread by air or droplet and took whatever masks they could get, including ones on Amazon that looked like they’d been made by third-graders.

Memorial’s leadership met twice a day to make sure it had the right policies, procedures and equipment to handle the deluge of patients expected. And it contended with changing information from the Centers for Disease Control, which initially told healthcare workers not to worry about masking unless they were very close to an infected patient.

“So I was walking around telling our staff, ‘Don’t be afraid. You don’t need to wear your mask in the hallway right now,’” Church said. “And then the very next day I’m saying, ‘OK, we need to wear it all the time in the unit. It’s going to be airborne.’”

Church had her leadership team make rounds on the units, providing information to and answering questions from nurses, including some who responded to the conflicting messages with, “Do you guys know what you’re talking about?”

A frightening question hung over everybody’s head, Church said: “When do we get COVID?”

“We were rounding during the day, at night and on the weekends,” said Robin McNabb, senior director of nursing operations at Memorial. “We needed to be physically present to support our staff so they could support our patients.”

Bakersfield Memorial Hospital workers pose with sign saying Heroes Work Here. — Healthcare workers, such as those posing in front of Bakersfield Memorial Hospital, are among the heroes of the COVID-19 pandemic.

Church was also in constant communication with public health officials and colleagues in other parts of the country to learn best practices for staffing, treatments and surges within the confines of rules and regulations, Keller said.

“All of those things she was able to decipher and provide in a way her team could understand and execute on, at the same time acknowledging and positioning that this is what we’re doing now and next week may be different,” he said.

By summer, the hospital was overwhelmed, Church said. Patients flooded the emergency department just when cases were expected to drop, so Memorial erected a tent outside to segregate the infected and potentially infected from the other patients. The staff was "almost in survival mode," she said.

Without effective medications and best practices, nurses had to try things that seemed to be helping, like putting patients in a prone position to clear their lungs. But that took six to eight people for patients on ventilators and IV drips, and during surges there wasn’t enough staff.

During the “horrible” winter, Church heard incessant code blue alerts from her office, and the hospital morgue overflowed its capacity. At one point Memorial had 2 ½ units devoted to COVID, including 90 beds in medical-surgical telemetry, a step down from the ICU, and two-eight bed critical care units that were also overflowing.

“We saw more dying than we have ever seen in the hospital,” Church said

Through it all, Church acted compassionately, thought globally and connected people to get things done, McNabb said. For example, she directed nurses to call families with COVID patient updates by 2 p.m. every day and worked with patient experience and IT staff to distribute iPads so patients could Facetime with loved ones.

“That was huge at the end of life when the guidelines were, ‘No visitors for COVID,’” McNabb said.

Nurturing nurses

Nurturing nurses

Nurturing nurses

While Church has been “incredibly proud” of Memorial’s staff for learning, adapting and rolling with the punches, they've needed care, too.

Memorial’s leadership has shared information about supportive services, converted visiting areas into respite rooms with massage chairs and soothing lighting, and pushed around a “happy cart” with snacks and drinks.

“We do full-size, not the little, candy bars,” Church joked.

McNabb said the biggest challenge now is addressing staff shortages caused by the ongoing COVID surge in hospitalizations, which is not expected to peak until March. Church, she said, has been calling around to other CNOs in her network to see what can be done, such as offering incentives for taking extra shifts.

A valley girl

Church is a self-described Central Valley girl. Her father was a Sears store manager, a job that took her family from Modesto to Hanford to Bakersfield. She was painfully shy.

Terri Church and her family at Avenue of the Giants in Humboldt County in the early 1960s. — Terri Church and her family at the Avenue of the Giants in Humboldt County in the early 1960s. Pictured is Terri, a family friend, her mother, Aline Short, sister, Kimberly McElwrath, and brother, Mike Short.

Terri Church and her sister, Kimberly McElwrath, and brother, Mike Short. — Church is the oldest of three siblings. She has a sister, Kimberly McElwrath, and brother, Mike Short.

Church graduated from Bakersfield's Highland High School in three years. This is her senior year portrait in 1974.

Church graduated from Bakersfield’s Highland High School in three years because she knew she wanted to be a nurse and senior year social activities just weren’t her scene. Her sister jokes she was born 65 years old.

Her interest in nursing was piqued by a neighbor who’d sit on her front steps and talk about going to nursing school and working in critical care at Kern Medical Center.

“She would come home and tell me all these stories and talk to me about the crash cart and I thought, ‘You know what? She’s really excited about that. That’s what I want to do.’”

Bakersfield College’s nursing program had a waiting list but admitted Church even though she was barely 17. She worked at Montgomery Wards, bought a bicycle to ride to BC, and took classes with her best friend.

BC is also where Church met Charles (Chuck) Church, her husband and the father of their two children, Meagan, a nurse in Texas, and Michael, who works in the local oil industry. They have four grandchildren.

Nurturing nurses

Nurturing nurses

Nurturing nurses

Church’s first job after graduating from BC in 1978 was as a critical care RN in a 13-bed unit at then-San Joaquin Community Hospital, now Adventist Health Bakersfield. It was a great training ground. There weren’t a lot of RNs back then so they never called in sick and they also oversaw the licensed vocational nurses and techs supporting patient care.

The work suited Church’s personality because she likes detail and reaching goals, requirements in the ICU. She also enjoyed watching the introduction of new technology, like the first implantation of an intra-aortic balloon pump at San Joaquin to help hearts pump more blood.

“In nursing it’s never boring and it’s never the same and it just keeps changing,” she said. “I think that alone makes nursing really unique and really rewarding. And you’re taking care of people at their most vulnerable moments, and maybe their last moments on earth.”

A phenomenal leader

Church’s first entry into leadership was as a charge nurse overseeing nursing shifts in the ICU beginning in 1982. She enjoyed getting to know what the whole hospital had to offer and figuring out where to send patients based on staffing and care needed.

She jokes it wasn’t until then that she realized most patients are not critically ill, they go to the hospital for surgery or treatment and then they go home

“I couldn’t even imagine that because we saw all the appendectomies that went wrong, not that there were many, but we saw all the complications,” she said. “I was scared to death to have surgery because I thought, ‘Oh my gosh, people die, people end up in critical care.’”

Nurturing nurses

Nurturing nurses

Nurturing nurses

Church was a phenomenal leader from the very beginning, said Debbie Hankins, who worked for her as a nurse at San Joaquin and is also a veteran nursing administrator in town.

“First of all, she’s extremely intelligent, well-researched,” said Hankins, now chief operating officer of the Foundation for Medical Care in Bakersfield. “She’s also a very strong but very quiet type of leader. She listens intently to people.”

Healthcare changes all the time, and people are always looking to improve efficiency, Hankins said. Church was frugal, she said, but never sacrificed those giving or receiving care.

And she was generous with her knowledge, Hankins said. Oftentimes, leaders take over when there’s an emergency in the ICU. Church, by contrast, mentored nurses by letting them do the work – under her guidance, of course.

“She’s excellent at recognizing people with talent and allowing them to flourish,” Hankins said.

Church rose from registered nurse to chief nursing officer at San Joaquin Community Hospital before leaving for Comprehensive Blood and Cancer Center and then Bakersfield Memorial Hospital. Here she is during her San Joaquin CNO days.

Church assumed the hardest job she’s ever had in nursing in 1990, director of critical care at San Joaquin. She oversaw more than 220 employees with no secretary, no computer, no cell phone – just a pager. Church got great experience, though, getting to write new policies and procedures for the whole nursing department and learning more about quality-of-care issues.

She learned more about the business side of hospitals as director of utilization at San Joaquin from 1992 to 1996, helping set up managed-care and physician-based case management programs and for a decade after that served as vice president for patient care services.

That’s how she finished out her career at San Joaquin.

“After 10 years of executive leadership, I was tired,” Church said. “Executive leadership is long hours, a lot of responsibility.”

Falling for Memorial

From 2006 to 2008, Church was chief nursing officer for Bakersfield’s Comprehensive Blood and Cancer Center, working to speed up the time it took to see an oncologist, improving staff engagement and leadership, and helping open new surgical and dermatology centers.

Church enjoyed a job where she could build teams and be home by 6 p.m., but then began to see signs that the Lord wanted her to follow up on offers to interview for the chief nursing officer position at Bakersfield Memorial. So she did.

“I said, ‘Lord, if you’re going to put me in here, you have to give me love for the place because I have to love what I’m doing, I have to love the people I’m working with,’ Church recalled. “And I’ll tell you, that’s exactly what’s happened.”

Church is most proud of being the driving force behind Memorial’s Pathway to Excellence designation by the American Nurses Credentialing Center. It recognizes organizations with a culture of excellence and high staff recruitment, retention and job satisfaction rates.

Memorial is one of only two California hospitals with the designation. Going through the process improves care, elevates the voice of nurses in decision-making and helps attract and retain nurses, Keller said.

Church with Joan Van Alstyne doing leader rounding in the 1 East Unit at Bakersfield Memorial Hospital in 2016.

Church, middle front, and colleagues celebrating Bakersfield Memorial's first Pathway to Excellence designation in 2015.

Church, third from left, and colleagues celebrating and promoting Bakersfield Memorial's Pathway to Excellence designation again in 2019.

Church was also part of the leadership team that opened a more than 100-bed patient tower, outpatient infusion center for cancer treatment, and Kern County’s first comprehensive pediatric program. It has expanded its heart care, become a certified primary stroke center and partnered with the Grossman Burn Center to open a burn-service line.

Most near and dear to Church’s heart is the pediatric ICU, saving parents from having to travel to Fresno when their little ones need intensive care. Also very rewarding, she said, has been development of the burn center.

“There’s just a lot of emotions with burn patients because some of them have 70 to 80 percent of their body burned. We’ve had teens, young adults, babies,” Church said. “We’ll see them around the hospital in their wagons or walking around and it just always feels good that we could do that for our community.”

Church is always open to other people’s ideas for improving care, said Dave Lozano, who recently retired as Memorial’s longtime pharmacy director. She listened to and ultimately implemented his recommendation to hire a pharmacist dedicated to serving diabetes patients and to assign to pharmacy teams a new mandate to improve documentation of the medications patients take.

Church also rekindled Lozano’s curiosity at work, he said, by “always seeking knowledge.”

“Not just in nursing,” he said. “She was interested in therapeutics. She was interested in procedures. She was interested in everything we do at the hospital. She wanted to be able to speak about all of it.”

And she’s never forgotten what it’s like to be a nurse in the trenches, nor lost her willingness to roll up her own sleeves and help.

One night when they were doing rounds together, Church noticed a patient in distress., Lozano said. Instead of finding someone else to respond, she went straight to the room, wiped her hands at the door and took care of the patient until a couple of shocked nurses raced in.

“Terri stood there until it was all deescalated,” Lozano said. “Then she stopped and talked with the patient, which was pretty amazing. Those are the kinds of things she does all the time.”

Giving DAISY awards to ICU nurses in 2017.

Celebrating Hello Humankindness Week in 2017.

Celebrating Hospital Nurses Week in 2019.

Lessons learned at CSUB

When Church was a young RN, she knew that to stay in leadership she’d have to advance her education. Church earned her bachelor’s degree in nursing in 1990 and master’s degree in nursing administration from CSUB in 1999.

One of the first things CSUB professors helped her do is improve her writing and presentation skills, bringing her out of her shell a bit. She went on to learn what evidence-based care looked like, where healthcare was headed, and how to manage the many emotions that come up while tending to the sick and dying.

She remembers having to tell the story of caring for a patient and what she learned. Every student's story was recorded and shown to the class.

“Some of us cried, so you couldn’t watch them all in one sitting,” Church remembered. “And there was just an acceptance that it was OK. I think that’s when I really started realizing we tend to bury our emotions.”

Leaders must see and address that emotion “to have a healthy workforce,” she said.

The master’s degree enabled Church to become a chief nursing officer, which she did seven years later at San Joaquin. She has remained connected to the university’s nursing program as a member of the CSUB/BC Advisory Board since 1998. The board keeps the nursing school up to date on what students need to know going into their required clinical hours and after graduation.

During the beginning of the pandemic, the board helped ensure nursing students could get the hospital hours they needed to graduate when hospitals were closed to most of the public.

It’s one in a very long list of community activities with which Church has been involved. She’s had multiple leadership positions with the state and local Association of California Nurse Leaders, mentored students in East Bakersfield High’s Health Careers Academy, and oversaw implementation of the Versant RN New Graduate Nurse Residency Program, which has produced 676 clinically competent nurses.

Church preparing meals for Meals on Wheels.

Church volunteers as a judge at the Kern County Science Fair with a Bakersfield Memorial team.

Church participates in Heart Walk with a Bakersfield Memorial team in 2018.

Lately she’s also done a lot of media to update the community on how COVID-19 is affecting hospitals and encourage the public to help alleviate the suffering by getting vaccinated. It’s heavy lifting in a community with high vaccine hesitancy and an aversion to restrictions.

“I know everyone’s tired of the pandemic,” Church said. “No one is more tired of the pandemic than nurses.”

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Footnotes

Story by Christine Bedell, senior alumni engagement specialist

FootNotes

Story by Christine Bedell, senior alumni engagement specialist

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