From Florence Nightingale and Clara Barton to Mary Eliza Mahoney and Mabel Staupers, nursing practice has never lacked for groundbreakers. Even today, nurses continue to shine as the unsung heroes of the COVID-19 frontlines. But, at what cost?
A recent publication by Johns Hopkins Center for Health Security highlights significant gaps in education, training, and resource allocation that have stretched nurses in ways that their foremothers could have never imagined. The report also underscores several important concerns previously revealed by an American Nursing Association survey his past March, including PPE shortages (>50%), being short staffed (66%), and lack of training in COVID-19 testing (50%). Both sources accentuate a critical vulnerability in the ability to conduct essential medical countermeasures in the near future, such as mass COVID-19 vaccination efforts.
Bridge the gaps locally
A myriad of factors contribute to and drive nursing development and responsiveness to pandemics. On one hand, the responsibility for ensuring adequate resource allocation, ability to implement practices that align with quality metrics, and targeted education initiatives ultimately lie with federal agencies and academia. On the other, there are steps that can be taken on the local level to address some of these challenges before the next COVID-19 wave hits.
Staffing shortages and inability to meet surge capacity rise to the top of the list. The COVID-19 pandemic has required nurses to take on greater responsibilities for patient care without adequate training, organizational support, or surge capacity preparedness. While less-affected locales have furloughed nursing staff, others hard-hit by COVID-19 cases have experienced significant staffing deficits. Additionally, nurses are often considered expendable expenses rather than critical components of the care team. The COVID-19 outbreak has also exposed significant shortcomings in workforce development and training, especially around infection control measures (e.g. doffing and donning personal protective equipment). Accordingly, the lack of consistently adopted (and adapted) crisis standards of care across organizations has affected COVID-19 response efforts. Undoubtedly, many of the solutions lay with hospital and organizational crisis leaders and decision makers, who might wish to consider the following:
- Conduct and include nurses in emergency preparedness drills and exercises outlined by Assistant Secretary for Preparedness and Response (ASPR) and Centers for Medicare and Medicaid Preparedness (CMS).
- Develop an expertise migration strategy that ensures that nurses redeployed to cover other departments are able to provide adequate patient care. Turn to hard-earned expertise versus trying to educate and train new talent; by pivoting nurses with relevant experience in the emergency department to the frontlines, their positions can be back-filled with other staff proximal to their positions. Clinical apprenticeship and/or shadowing can address challenges underlying specialty migration, as well as address significant gaps in ongoing nursing continuing education and career development.
- Provide rapid COVID-19 testing to all healthcare professionals and initiate education around vaccine uptake, side effects, hospital policies, and receipt before an agent becomes available. Not only does this reinforce a commitment to workforce safety, but it also provides an important framework for HCPS to provide education and encourage vaccine uptake in patients and by the community.
- Finally, ensure clear, honest communication between leadership and staff targeted toward workforce safety, including risk, roles, and plans to minimize exposure. Data show that lack of access to timely information and communication can increase anxiety levels consequently affecting presenteeism. Regular, transparent communications also helps to reinforce nursing workforce roles as essential team members and not expendable resources that are conveniently cut when budgetary demands become too great.
Recommendations for Improving National Nurse Preparedness for Pandemic Response: Early Lessons from COVID-19. Johns Hopkins Center for Health Security. Bloomberg School of Public Health.
American Nurses Association. COVID-19 survey: March 20-April 10. American Nurses Association.
National Guidance for Healthcare System Preparedness. January 2012. Assistant Secretary for Preparedness and Response.
Emergency Preparedness: Influenza and Viruses. Centers for Medicare and Medicaid Preparedness.
When and Why Health Care Personnel Respond to a Disaster: The State of the Science. Prehosp Disaster Med.