‘The significance of this work is not lost on anyone’

Nicole Courtois, RN, University of Vermont Medical Center
Photo of nurse, Nicole Courtois. She is standing inside a vaccincation clinic. She is masked and holding up a binder entitled, "UVMMC Essex Fairground, Operations Manual".

“Hanging onto the wings of a plane as it flies.”

That’s how Nicole Courtois, RN, a nurse at University of Vermont Medical Center, describes the early days setting up the vaccination clinic at the Champlain Valley Expo in Essex.

In the first month, the group assigned to setting up the clinic, had to quickly develop workflows and make process improvements to accommodate the ramped-up number of vaccines anticipated at the 17,000-square-foot clinic. Initially, the team was vaccinating about 20 people each day, but they knew the supply of vaccine would soon increase tremendously, so the goal was all about how to speed up the process while having very little information about how many patients would qualify for, and seek, vaccination. 

“In the early days, we had to adapt to CDC guidelines, establish the team, develop workflows – essentially build the team while we were administering vaccines,” says Courtois, who, as the vaccination clinic’s onsite leader, put to use 20 years of expertise in developing clinical systems. “We were writing protocols and sending them for review while vaccinating patients. “We were always looking for a way to improve.”

Courtois found improvements wherever she could to increase the number of doses they could administer daily. Everything from the types of needles used to routinely eking-out extra doses in every bottle of vaccine, Courtois pushed the daily number higher. After reaching about 400 doses a day, the pharmacy team lead by UVM Medical Center’s Wes McMillan came in to help prepare syringes and fill them with vaccine. That one move alone was “a phenomenal process improvement,” says Courtois, saving time and allowing vaccinators to administer more doses instead of spending time preparing them, a time consuming and delicate process. The dual practice would become commonplace at vaccination sites across the state.

The can-do spirit extended to Courtois’s partners on the Champlain Valley Expo facilities staff. Their days started early so they could clean the clinic hours before those with vaccination appointments arrived, painstaking and important work when dealing with a contagious virus. They also dealt with Vermont’s mercurial weather, making the driveway and sidewalks safe and passable during the months of ice and snow. “The Expo facilities staff were the first people we greeted in the morning and the last ones working in the evening,” Courtois says. ”We couldn’t have done it without them.” 

This focus on continuous improvement resulted in what some have called the “Big Book of Learning,” a multi-document manual developed during the first few weeks. As the team built the infrastructure and developed workflows, the manual became the source of truth for the operation, documenting all that had been done and a proud and constant reference for the team. In fact, the manual became such a useful tool that it was passed on to Central Vermont Medical Center to help jumpstart their vaccination clinic.

‘A MASH Unit’

Heather Zuk, who works as an occupational therapist, never imagined that she would someday help people get vaccines during a global pandemic. But the one-two punch of COVID-19 and a cyberattack meant reduced hours at her regular job, giving her the time to work as a greeter at the clinic, meeting people as they came in, answering questions and guiding them to where they needed to go.

Headshot of nurse, Heather Zuk.

Her first impression of the clinic was of controlled chaos behind the scenes. “It reminded me of a MASH unit,” she says. “The energy, the urgency, with people running around in sneakers…”

The ‘we’re all in this together’ vibe was irresistible to Zuk, who checks people in, takes temperatures, enters patient information into the electronic health record and schedules second doses. “It’s fascinating and fulfilling to help people navigate their path back to everyday freedom. It feels like a monumental effort and cause, helping our community get out of this pandemic. I really feel like we are making life better for people in Vermont.”

One afternoon an elderly woman came in with a walker. She nervously explained to Zuk that she’d gotten a flat tire on the way there, but had kept going; she hadn’t been out of her house for nearly a year and nothing was going to stop her from getting her vaccine. 

Zuk related the woman’s situation to coworkers at the clinic, and while the elderly woman was being vaccinated, an Expo security employee changed her flat tire. 

“It was such a great example of the team environment,” Zuk says of her time working at the vaccination clinic. “We’re all pitching in to help. The teams are as happy as the people who are getting the vaccine. It’s really a love-love environment.”

“I’ve heard people use the word ‘magic’ to describe the atmosphere at the Expo,” says Courtois. “That magic comes for all those who worked tirelessly to create a place of hope, laughter and joy. Happy tears are a regular part of our days. The significance of this work is not lost on anyone.”

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