Stories: Voices from the frontline

Margo Bykonen, RN

Margo Bykonen, RN

After 41 years at Swedish—her entire career—Chief Nursing Officer Margo Bykonen will start a well-deserved retirement at the end of June. We caught up with her in between vaccine clinic shifts to hear about the challenges of the past year, how it’s brought up memories of the HIV/AIDS epidemic and how she’s helping her fellow nurses cope with support from generous donors like you.

With all the challenges of the past year, what are you most proud of?

Our nurses hung in there. Despite their fear, despite their concerns for their own personal health and their families’ health, we worked together to minimize risks as much as possible and take care of the patients that were very sick and dying from COVID-19.

We were going through brands of personal protective equipment that our nurses haven't seen before because that's what we could get with the national shortages. We restricted visitors to protect our patients and caregivers, but that had huge implications for the nurses trying to keep up communication between worried family members and scared patients.

I'm so proud of how all of our nurses and caregiver teams worked together to face a pandemic like we have never experienced before and take care of our community. We continue to do so. We still have patients in the hospital.

What has been the emotional impact of the pandemic on our nurses?

Nurses, typically, are not great at taking care of themselves. I think sometimes it catches up when they least expect it: “Why am I so exhausted?”

There’s a book by Tim O’Brien called The Things They Carried, about the emotional burdens that soldiers returned from the Vietnam War with. I think there’s an element of that in nursing. You don’t know who to share your experiences with, so it festers. That concept of the things that we carry is what has motivated me to do something to try and expand our relationship with the Harmony Hill retreat center.

Back in the 1980s, before there was a treatment for HIV/AIDS, patients were just dying. I was the manager on the HIV infectious disease unit, and we had young nurses taking care of patients in their 20s and 30s who were dying. There’s a pretty terrible set of infections and cancers that HIV/AIDS manifests as, and I would try to get the nurses to come and talk to a psychosocial clinical specialist. Very few nurses wanted to talk about how they were feeling in that setting.

Recently, I’ve been interviewed for the AIDS Memorial Project on Capitol Hill. In bringing up all those memories even decades later, I can get very tearful talking about that time. I worry about the nurses today and what they're going to be like 10 years from now, five years from now, even right now. With COVID-19 pandemic, we’re experiencing things that we've never experienced before. And we have caregivers who not only lost their own family members to COVID-19, but then had to show up and work in that atmosphere. How do you compartmentalize that—or should you compartmentalize that—and move forward?

How are Harmony Hill programs different from what you offered nurses in the 1980s?

I think the advantage of it is you're with your peers. And there's a facilitator who’s knowledgeable about trauma and burden. I think the value is that you're hearing that other people are feeling the same way, and that it’s ok, you’re not the only one.

And nurses need to actually get away, get in a space where they’re not distracted by what might be going on with their patients or other things that are happening out in the unit, like “I need to hand that antibiotic soon…” I've had nurses email me after participating in previous retreats and say they were ready to leave nursing, but they decided to stay because of the experience.

We’ve been able to send 30 to 45 nurses a year with the support of donors, but we’ve got thousands of nurses at Swedish. That’s why we’re working with Harmony Hill to bring a more compact program to the education center at Swedish Cherry Hill. It won’t be quite the same as the lovely retreat space on Hood Canal, but more nurses need this support than ever before. This will allow us to extend this resource to more nurses. And with the support of generous donors, we hope to continue making Harmony Hill retreats available.

What other philanthropy-supported programs made a difference during this past year?

As things were rapidly changing, our RN Unit Champions—experienced nurses who provide hands-on training and mentorship—helped frontline nurses stay up to date on changing policies and procedures around COVID-19. It’s an essential role during normal times, but it was especially vital during the pandemic. So many nurses learn best with hands-on training, where they can work through new skills with someone right there to answer questions.

And with an ongoing national nursing shortage, many of our new hires are coming straight out of nursing schools. We've expanded our nursing residency program for new graduates, but the RN Unit Champions provide peer support so that they have ongoing development beyond their residency, beyond their fellowship.

It's also a great professional development opportunity for staff nurses who want variety in their work and to share the experience and skills they’ve developed. It’s been a great use of resources, and we hope to grow the program because it is invaluable to our frontline staff.

What are you most looking forward to in retirement?

I love nursing. I love taking care of people; one of the hardest parts about going into administration and leadership was being so removed from the bedside. But I've done things to continue that connection, like be a volunteer cuddler for babies in the NICU. After I retire, I plan on doing more volunteer work where I can get back to working directly with patients and the community.

Nurses have been the glue that holds our hospitals and clinics together during the COVID-19 pandemic. To learn more about nurses at Swedish and how you can support their vital work, contact Madeline Walsh at 206-386-3348 or [email protected].