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Despite proven benefits to prone positioning in ARDS, a disconnect exists regarding the impressions of its utility among members of the healthcare team. While the majority of physicians view prone positioning as beneficial in ARDS, recent data suggest that the minority of ICU nurses have the same impression. The COVID pandemic has raised particularly challenges in terms of availability of personnel and supplies at least in some institutions. We discuss various barriers to implementation of prone positioning and suggest a number of strategies to optimize patient care. We use a multidisciplinary team approach to execute prone positioning in COVID ARDS., Competing Interests: Declaration of competing interests Disclosure: All authors report no relevant conflicts. Dr. Malhotra is funded by the NIH. ResMed provided a philanthropic donation to UC San Diego. Dr. Malhotra has received income related to medical education from Merck and Livanova, unrelated to this manuscript., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Communicating is essential. The communication chain within units and facilities must be kept strong. Good communication will help staff take responsibility for one another; knowing your work family is looking out for you can offer strength. Respecting each other encourages speaking up to create a platform for shared decision-making and problem-solving. Such shared responsibility will yield the best solutions because the whole is stronger together than individuals alone. Speaking up also is a way to offer immediate feedback if mistakes are observed so that errors are corrected. And when, not if, mistakes are made, staff need to be able to communicate these without fear of retribution., (Copyright © 2020 Elsevier Inc. All rights reserved.)