SHIFTING AND SHAPING OUR FUTURE

Join Dr. Susan Hassmiller as she provides an overview and takeaways of the new National Academy of Medicine’s recently issued report! 

Tuesday, September 21st | The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity | Susan B. Hassmiller, Ph.D., RN, FAAN

The National Academy of Medicine report, “The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity”, challenges nursing leaders and other stakeholders both within and outside of healthcare to prioritize addressing the structural inequities that have fueled persistent health disparities.

The report lays out a series of recommendations to help our nation meet the need for a stronger, more diversified nursing workforce that is prepared to provide care and promote health and well-being among nurses, individuals, and communities.

Dr. Susan B Hassmiller, who served as the senior scholar in residence and adviser to the president at the National Academy of Medicine, will describe the key takeaways from the report and discuss how nurse leaders and their organizations can advance the report recommendations.

Register now…

Tuesday, September 28th | Colorado Organization of Nurse Leaders Presidential & Board Address – CONL President Caleb Dettman, MSN, RN, CWCN, NE-BC & Committee Leaders.

Joshua Ewing, MPA – Vice President, Legislative Affairs will join us from the Colorado Hospital Association and will lead a Discussion on Advocacy

Tuesday, October 5th | Leading the Profession to the Future: The Innovation Imperative | Dan Weberg, Ph.D., RN, MHI, BSN

Register Now!

The post The Most Salient Issue of our Time appeared first on Campaign for Action.

Jamy Gaynor, EdD, RN, NCSN, is among the many school nurses who have been contributing to the pandemic response by working as contact tracers.

Before 2020, Eileen Gavin, MSN, FNP-BC, NCSN, who co-leads a team of school nurses in Middletown Township, N.J., was in touch with her local health department maybe twice a year. Now she talks with her local health officer several times a day. “Honestly,” says Gavin, “it started with the question, ‘What can I do to help?’”

The arrival of COVID-19 in Middletown, about an hour from New York City, was overwhelming the health department, so Gavin volunteered to help investigate local cases—a process known as contact tracing. After completing training with the Medical Reserve Corps of New Jersey, she got to work.

Eileen Gavin, MSN, FNP-BC, NCSN, co-lead for school nurses, Middletown Township, N.J.

Gavin began by asking infected people when their symptoms first appeared and whom they’d seen in the days before and after. She reached out to their contacts, referred them to testing, and suggested they self-isolate or quarantine. These activities define contact tracing, but Gavin’s role quickly evolved. She found herself connecting people to food deliveries, mental health services, and insurance and health care providers as she learned of families’ concerns. “People were very comfortable sharing a lot of intimate details when they heard I was a local school nurse,” she says.

While many contact tracers have failed to gain the public’s cooperation, school nurses have succeeded, perhaps because they are qualified for the job in ways few can match. They understand disease transmission, regularly engage in public health surveillance, and know how to educate people about hygiene. Most important, school nurses know their communities, people know them, and that connection fosters trust.

Denise Schwerzler, MSN, RN, NCSN, school nurse, Weston, Mass.

In at least five states, and perhaps elsewhere in the nation, school nurses stepped in as contact tracers when their buildings closed, while tending to a range of other responsibilities. Denise Schwerzler, MSN, RN, NCSN, a school nurse and contact tracer in Weston, Mass., says contact tracing became a full-time job at first, and she spent additional hours each week just keeping up with changes to Board of Health regulations and COVID-19 updates.

Now that school buildings are opening in some jurisdictions, precisely how school nurses will divide their time is unclear, but their contributions during the pandemic have amplified their voices and garnered new respect. The Massachusetts School Nurse Organization has a representative on the state-level reopening committee, and many school nurses, including Gavin and Schwerzler, are serving on committees in their communities.

Another such nurse, Jamy Gaynor, EdD, RN, NCSN, of Marlborough, Mass., says contact tracing deepened her knowledge of the community and her students’ needs. The process connected her with one particular family with issues school personnel were “just touching the surface of,” she discovered. She was able to connect them with community resources and is pleased that some of those needs are now being met.

Linda Mendonca, DNP, PHNA-BC, NCSN, Rhode Island school nurse consultant and president-elect of the National Association of School Nurses

In nearby Rhode Island, Linda Mendonca, DNP, PHNA-BC, NCSN, president-elect of the National Association of School Nurses, has advocated for a school nurse on every school district planning committee in the state. Earlier this month, Rhode Island released a playbook with protocols for keeping members of school communities healthy and safe. As the state’s school nurse consultant, Mendonca sat in on several reopening meetings, bringing a school health perspective to the governor’s office and the departments of health and education. “Some participants were surprised to learn that there weren’t nurses in every school. That was a wake-up call. There’s an understanding now among those government leaders that it’s essential that schools have a school nurse.”

If Rhode Island and other states are successful in reopening their school buildings, Mendonca says school nurses will have their work cut out for them. In addition to their usual activities, they’ll be expected to assess and isolate symptomatic students and keep up with the latest health and safety guidelines. She’s heard that some may be asked to also administer COVID-19 tests, requiring donning and doffing personal protective equipment—a time- and space-consuming endeavor.

“To expect that the school nurse could do contact tracing on top of that is not realistic, but they can educate families on what that process is and really hit the point home that they need to answer the phone and respond to contact tracing calls,” Mendonca says.

Cathy Grano, MSN, RN, CSN-NJ, co-lead for school nurses, Middletown Township, N.J.

Back in Middletown, Eileen Gavin anticipates playing a dual role as school reopens. Over the course of the summer, she and her co-lead Cathy Grano, MSN, RN, CSN-NJ, became “go-to” people for questions on isolating and quarantining. “We’ve been welcomed on advisory boards, led school reentry plans, and presented at school board meetings,” Gavin says, but come fall, “I’ll also be expected to care for the 1,500 kids and 200 staff members in my school who are very nervous about coming back.”

Their solution? While hiring additional school nurses would be ideal, they are already in short supply. Instead, Grano assembled a school-based contact-tracing team in her building, which held a summer program, so that other personnel could take on responsibilities such as notifying parents and identifying close contacts while she cared for and isolated symptomatic students. “We are hoping to have similar teams up and running in our 16 school buildings by the time they open,” Gavin says.

Meanwhile, she feels confident that the strong partnership formed between her township’s school nurses and the local health department will see them through the pandemic, however it unfolds. Over the summer, Gavin says, they successfully contained a COVID-19 outbreak involving 68 adolescents who attended a non-school gathering. Gavin’s connections with the school athletic department alerted her that students were showing symptoms of the disease, and she was able to inform the health department and get contact tracing underway well before test results would have otherwise triggered the process.

“This coordinated partnership is a great model that could be replicated,” Gavin believes. “We are able to reach our health officer within minutes, and the school district is glad we have our fingers on the pulse of the community.” She says that administrators understand this is going to be a very important mitigation strategy once in-person learning resumes.

The post A Season of Contact Tracing Highlights School Nurses’ Influence Beyond School Walls appeared first on Campaign for Action.

Ellen Kurtzman, PhD, RN, FAAN, (front row, far right) and the other 2018–2019 Robert Wood Johnson Foundation Health Policy Fellows on Capitol Hill. Fellows gain insight into health policy through an immersive experience in the federal government.

As the nursing profession continues its central and frontline role in the COVID-19 pandemic, many nurses are calling for policy changes large and small to improve health care delivery and mitigate the impact of the virus on the well-being of Americans.

How can nurses advocate for federal policy change?

The Robert Wood Johnson Foundation (RWJF) Health Policy Fellowship has been providing an unparalleled view of the advocacy process since the program began in 1973. Recent fellow Ellen Kurtzman, PhD, RN, FAAN, associate professor at the George Washington University School of Nursing, found herself in a front-row seat during the 2018-2019 legislative season. She was placed in the office of the Speaker of the U.S. House of Representatives, the Honorable Nancy Pelosi (D-CA-12). From that vantage point, Kurtzman talked with hundreds of the speaker’s constituents and other stakeholders who visited the office to express their views.

After observing how nurses, physicians, insurers, consumers, and other health care advocates delivered their messages, Kurtzman has advice for nurses and professional nursing organizations that want to “up” their policy game. We talked with her well before the coronavirus took center stage, so we went back to her this week to ask how she would tailor her advice to fit current circumstances.

“This is an unprecedented crisis and there’s no operating manual for how to proceed,” she said. “I’ve been told that most Hill offices are working from home. Because face-to-face meetings won’t be possible for a while, nurse advocates may need to hone their abilities to communicate remotely through emails, phone calls, letter writing, and video-conferences. I personally wouldn’t even think of approaching a congressional office at present unless I had something very specific to discuss about COVID-19 or one of the pieces of legislation that’s moving.”

“Right now, we need to support Hill staff who are working 24/7 to resolve the crisis, and, if we can, provide the expertise they need to get the job done. Eventually, the crisis will abate, new COVID-19 infections will slow down, and folks will recover, so I would encourage advocates not to abandon other pressing concerns. As attention returns to these issues, nursing needs to be prepared.”

Here’s what else Kurtzman had to say.

While working on the Hill, what insights did you gain into how nurses can use their expertise to influence policy?

There’s probably no better example of that than Representative Lauren Underwood, who of course is a freshman congresswoman and nurse from Illinois (D-IL-14). She brings her expertise to lawmaking and to Congress, and this role is probably the pinnacle of how nurses can and should be involved in influencing policy.

Of course, most nurses are not going to run for elected office, but I would encourage all nurses to vote, to know who represents them in Congress, to develop relationships with lawmakers, and to learn how to talk about the most pressing issues that affect nurses, their patients, and the health care system.

Nurses also need to know how to engage with lawmakers and their staffs. It’s definitely a different language than, say, the language nurses use at the bedside. Talking to policymakers takes practice, and it’s useful to observe somebody else do it effectively.

How do you get that practice and learn that language?

Many of the large associations brief nurses ahead of time when they bring them to D.C. to talk to legislators. That’s very helpful, but I suspect that they’re not doing role-playing, where they set up a real-life scenario for these nurses and pretend to talk to a lawmaker. Until you’re doing it, until the words are coming out of your mouth and you’re telling your story casually but with technical accuracy, I’m not sure it can be mastered.

Nurses who visited the speaker’s office while I was there spoke about the challenges they face and the value they contribute. They were also passionate about—and felt very protective of—speaking on behalf of patients. But I found that they were less able to speak about issues that plague our health system, issues that I frankly think nurses should weigh in on. For example, issues around insurance coverage and access, issues around payment and affordability, how the Affordable Care Act is working or not working. I found that nurses tended not to talk about those issues.

Is it that nurses avoid these topics, or is it that they don’t know about these topics?

I suspect it’s a little bit of both. When I heard nurses talking about insurance coverage, for example, they spoke about it in terms of specific patient exchanges. For example, “This patient could not receive ‘x’ diagnostic test, because their insurance is bad.” The root problem is likely something about coverage or exclusions or authorization, right? So they view the issue through the lens of their patient, which is completely understandable—but when you’re talking to lawmakers, the conversation should be about what policy levers they can pull to achieve the desired outcome.

What else do nurses and their organizations need to know about advocacy on Capitol Hill?

I think it’s worth noting that I spent nine months in the speaker’s office, and very few nurses came to visit our office to discuss health care issues. There were plenty of physicians and probably even more dentists than nurses who came to talk about workforce, delivery system reform, and patient care issues. Physician groups and insurers came by pretty regularly. Nurses only came when their association, their union, or their institution brought them to town in some organized fashion. It seems like a missed opportunity. There’s a ton of legislation that’s happening on the Hill. It may not have the word “nurse” in it, but nurses absolutely should have input into it, and the legislation would be better if nurses did.

Kurtzman provided a glimpse at near-term policy possibilities in a previous blog post.

The post Nurses: How to Advocate for Federal Policy Change appeared first on Campaign for Action.

MinuteClinic is rolling out “Age-Friendly” care for its older adult customers. Credit: Courtesy of CVS Health

“What matters to you in terms of your care today?” This simple question is one nurse practitioners (and a few physician assistants) have begun asking older adults receiving care at MinuteClinic, the retail medical clinic of CVS Health.

It’s a question clinicians often fail to ask, focusing instead on the symptoms that prompt patients to seek care. But experts in caring for adults aged 65 and older believe knowing what matters to patients and understanding their health concerns in context will help streamline and improve care.

The Institute for Healthcare Improvement (IHI) calls these contextual factors the 4Ms—medication, mobility, mentation, and what matters—and has codified them in a framework called Age-Friendly Health Systems. The 4Ms Framework has been rolled out in hospitals and primary care clinics, and, in June, MinuteClinic began rolling it out in the convenient care sector.

Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation.

“We have got to connect the dots for older people, including at the pharmacy,” says Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation, which is dedicated to improving the care of older adults. Fulmer asked IHI to partner with the foundation on age-friendly care when she took the reins of that organization in 2015. As a nurse expert in the care of older adults, Fulmer was well acquainted with the unnecessary harm that can result from poor care transitions and had an ambitious vision to fundamentally transform geriatric care. That vision became Age-Friendly Health Systems, in which the 4Ms provide a common language that can “connect the dots” across settings and professional disciplines.

The 4Ms in Practice

Ann Lovegren, FNP-BC, provides age-friendly care at MinuteClinic in Portland, Maine.

Ann Lovegren, FNP-BC, is one of two providers at the MinuteClinic in Portland, Maine, which has the highest percentage of older adults of any U.S. state. As a result, Maine (along with Florida and Ohio) was a logical place for CVS to pilot the initiative. As a family nurse practitioner (NP) with additional geriatric training, Lovegren was eager to test out the 4Ms Framework. She says her approach has always been holistic and that she was alert to the cognition, mobility, and medication-related challenges of her older patients before implementing the framework. Nevertheless, she appreciates the structure the 4Ms provide. “What the system does is formalize what we already do here, and then it adds that piece about what matters to people, so that we are all directing our care in a way that aligns with the patient’s goals,” Lovegren says.

This past winter, Lovegren examined an 86-year-old woman who had first visited her two weeks earlier. At the initial visit, Lovegren had urged the patient to get her elevated blood pressure checked by her primary care provider. That proved to be easier said than done. Unable to get an appointment, the woman came back to the MinuteClinic when she experienced heart palpitations. Lovegren discovered her patient’s blood pressure was extremely elevated and instructed the patient’s son to take his mother to the emergency room. The visit might have ended there, but, with 4Ms care in place, the encounter continued with the woman explaining what mattered to her as she faced the prospect of hospital care. “I just need you to know that I don’t want any surgical intervention,” she told Lovegren.

Adapting the Framework for Retail Settings

To facilitate the use of the 4Ms in convenient care settings, The John A. Hartford Foundation awarded a grant to Case Western Reserve University in 2018. Associate Professor Mary Dolansky, PhD, RN, FAAN, and her colleagues at the Frances Payne Bolton School of Nursing used the award to adapt the 4Ms Framework for use in retail clinics. One major change: Dolansky and her team repurposed the framework’s mentation element. Used in hospital settings to emphasize delirium prevention, mentation prompts retail clinic providers to assess instead a patient’s mood and memory.

Mary Dolansky, PhD, RN, FAAN, adapted the 4Ms Framework to assist retail clinics in providing age-friendly care to older adults.

Dolansky is also director of the Quality and Safety Education for Nurses project. Working in collaboration with MinuteClinic, her team has created five online learning modules that MinuteClinic’s busy NPs and physician assistants can complete in short intervals. Using a gaming platform, the team has also designed a virtual clinic where MinuteClinic providers can practice integrating the 4Ms into a virtual patient visit.

While at work, providers receive ongoing feedback through an online clinic dashboard. The integration of the 4Ms into MinuteClinic’s electronic health record will be key to the framework’s success, in Dolansky’s view. She says, “Most practice changes occur because of technological enhancements,” a conclusion she reached while participating in an IHI collaborative learning community.

A Business and Social Investment

Anne Pohnert, MSN, FNP-BC, director of clinical quality, oversees MinuteClinic’s age-friendly care initiative.

Why is CVS making the commitment to provide age-friendly care? “Our purpose across the CVS enterprise is helping customers on their path to better health,” says Anne Pohnert, MSN, FNP-BC, director of clinical quality at MinuteClinic. CVS has another incentive as well, having recently acquired health insurer Aetna. “We ultimately want to look at longitudinal cost savings by identifying and addressing cognitive, medication, and other issues earlier,” Pohnert says.

Fulmer was eager to partner with MinuteClinic because, in her view, “They are unleashing the power of advanced practice nursing,” a priority shared by the Campaign for Action. Of equal importance, Fulmer believes the collaboration will advance what she calls the Age-Friendly Health System social movement. “When 1,100 MinuteClinics declare themselves age-friendly,” she says, “the country will notice.”

Fulmer hopes the foundation’s investment will eventually influence care throughout the retail clinic sector and beyond. Other entities and individual nurses anywhere in the world who want to incorporate the 4Ms into their practice may do so using the free guidance available on the IHI website.

Building a Bridge to Primary Care

Retail clinics have demonstrated their value in multiple ways. They are widely accessible, provide evidence-based care, and offer transparent and affordable pricing. But they remain at a disadvantage in one key area: continuity of care. MinuteClinic can share information with providers that use the same electronic-health-record vendor, but typically the onus is on patients to convey what happens in convenient care settings to their primary care or other providers. Dolansky hopes the 4Ms Framework will help mitigate this problem.

Her team has created an after-visit summary they call a brochure. It has spaces where providers can note what needs to be conveyed to other providers about each of the 4Ms. “We believe that handing the patient this brochure will help cue them to take action and share it with their primary care provider,” Dolansky says.

Lovegren agrees. She says primary care providers in her community are overburdened and often refer their patients to MinuteClinic for routine care. She believes the 4Ms will “strengthen that bridge to primary care.”

In February, after hearing her patient’s remark about not wanting surgery, Lovegren talked with the woman and her son about end-of-life care. Then she documented the patient’s wishes in the electronic health record for her other health care providers. “When my clinic partner followed up by phone the next day,” Lovegren says, “the patient was really grateful. She basically felt we had saved her life.”

The post Nurse Practitioners Provide Age-Friendly Convenient Care appeared first on Campaign for Action.

The stress of the COVID-19 pandemic is taking a toll on nurses. Without intervention, nurses are at risk of depression, anxiety, insomnia, and burnout.

“We knew, going into the pandemic, that nurses’ stress was off the charts,” says Kate Judge, executive director of the American Nurses Foundation, the philanthropic arm of the American Nurses Association. According to a 2016 study, registered nurses suffer from depression at twice the rate of other professionals; a 2018 survey found that approximately half of U.S. nurses experience suboptimal physical and mental health. Caring for acutely ill infectious patients, like those with COVID-19—without sufficient resources or while juggling childcare, remote learning, or ever-evolving government restrictions—is likely to take an additional toll on nurses’ well-being.

The largest study in the United States to document the psychological impact among nurses and advanced practice providers; defined in this study as nurse practitioners and physician assistants, physicians, residents and fellows working on the front lines at the height of the COVID-19 pandemic in New York City, found that levels of stress, anxiety, and depression were highest among two of the groups; nurses and advance practice providers.

In another study, Chinese and Italian health care workers exhibited increased symptoms of depression, anxiety, and post-traumatic stress disorder after caring for COVID-19 patients in the early weeks of the global pandemic. Frontline nurses reported secondary trauma—the emotional upheaval resulting from exposure to the traumatic impact of coronavirus infection on individuals, families, and communities. Evidence shows that secondary trauma can lead to burnout and early exit from the nursing profession, so concerned employers and nursing associations developed accessible support systems for American nurses.

Here is how three different organizations are helping nurses during the COVID-19 pandemic. We realize there are many other programs and welcome your sharing information about them with us in the comments box below.

UnitedHealth Group: Joy in Practice

Approximately 18 months ago—well before any of us had heard the term “COVID-19”—UnitedHealth Group launched the Joy in Practice initiative. Its intent: to create an environment where clinicians experience professional joy and purpose—steps that help prevent and mitigate burnout.

Mary Jo Jerde, senior vice president, UnitedHealth Group

According to Mary Jo Jerde, MBA, RN, FAAN, senior vice president at UnitedHealth Group and leader of its Center for Clinician Advancement, focusing on joy was a deliberate action. “We believe joy is more than the absence of burnout and the associated stigma around mental health concerns,” Jerde says. “Our clinicians told us, ‘Make it positive.’ Joy is about connections to meaning and purpose.”

Prior to COVID-19, the initiative had already produced an hour-long webinar entitled, Finding Joy in Practice Again, and multiple podcast episodes on topics such as self-renewal and purpose. When the COVID-19 crisis hit the United States, the Center for Clinician Advancement quickly scaled up and adapted current offerings to better meet current needs.

A 90-minute webinar on mental health and COVID-19 was initially attended by nearly 3,000 UnitedHealth employees. The webinar was repackaged as four podcast episodes so busy nurses could consume content at their convenience.

“We’re bringing forward tools that everyone can use to support each other,” Jerde says. “Investing in these programs is a tremendous priority for UnitedHealth Group. We want our highly-skilled professionals to remain and develop at our organization.”

Research supports the wisdom of that investment. One recent study shows that every dollar invested in employee wellness provides a return on investment of $3.00 to $4.48.

Trusted Health: Just-in-Time Support for Frontline Nurses

When Dan Weberg, PhD, RN, Head of Clinical Innovation at staffing agency Trusted Health, saw the impact of COVID-19 on Trusted’s nurses in New York City and Michigan, two COVID-19 hotspots, he reached out to his former mentor Bernadette Melnyk, PhD, APRN-CNP, FAANP. “Our nurses are so stressed,” he told Melnyk, and asked what they could do together to help.

Bernadette Melnyk, chief wellness officer, The Ohio State University

Melnyk is chief wellness officer at The Ohio State University (OSU) and dean of the College of Nursing. Her research has demonstrated that cognitive behavioral skills training can improve nurses’ mental health, healthy lifestyle behaviors, and job satisfaction. Together, Weberg and Melnyk brainstormed an innovative solution: an emotional support line and an optional wellness coaching initiative to teach cognitive behavioral skills to nurses caring for COVID-19 patients.

“Many nurses who call the support line just need validation that the stress, depression, and anxiety they’re experiencing is normal for what they’re going through,” Melnyk says. OSU nurse practitioner faculty and students, who staff the support line, also suggest simple evidence-based strategies such as deep breathing while washing hands, steps nurses can take to feel better amid overwhelming stress.

Trusted Health nurses can also opt into a four- or eight-week wellness program that includes cognitive behavioral skills building, mindfulness, and therapeutic communication. Participants work one-on-one with a wellness support partner. Weekly sessions are tailored to participants’ needs.

“If you have problems with emotional eating because of your stress, we can help you with that,” Melnyk says. “If you’re experiencing anxiety or depressive symptoms, we can teach you cognitive behavioral techniques that not only will help you now, but also help you the rest of your life.”

American Nurses Foundation: National Well-Being Initiative for Nurses

In May 2020, the American Nurses Foundation launched the National Well-Being Initiative for Nurses, a collection of resources intended to help nurses build resilience and heal from the trauma caused by COVID-19.

Created in partnership with the Emergency Nurses Association (ENA), the Association of Critical Care Nurses (AACN), and the American Psychiatric Nurses Association (APNA), the initiative offers a variety of evidence-based interventions, including:

• Nurses Together: Connecting Through Conversations, hour-long peer support calls led by ENA nurses.
• Narrative Expressive Writing, a five-week program that involves responding to COVID-19-related writing prompts and includes feedback from a certified responder.
• Happy and Moodfit, two apps that help nurses monitor their moods, strive for wellness goals, and access emotional support.
• A self-assessment tool to help nurses understand their mental health needs.
• Hotlines and resources to connect nurses to additional support.

Kate Judge, executive director, American Nurses Foundation

“The purpose of the Well-Being Initiative is to provide easy-to-access tools to help nurses process, respond to, and recover from the pandemic,” says Judge, executive director of the American Nurse Foundation. “This isn’t just about becoming the best nurse you can be; it’s about helping nurses become happy and whole.”

ENA president Mike Hastings, MSN, RN, CEN, has led a couple of the peer support calls and is inspired by the camaraderie and community among nurses. “We may work in different care settings, but we all face the same struggles,” Hastings says. “We’re not alone, and together, we will get through this.”

The post Novel Programs Support Nurse Well-Being During Pandemic appeared first on Campaign for Action.

Kristen Brown, DNP, MS, RN, advanced practice simulation coordinator in a sim lab at Johns Hopkins University School of Nursing. The COVID-19 pandemic has spurred nurse educators to reconsider simulation’s role in preparing nursing students for practice. Credit: Nicole Fauteux

When COVID-19 led hospitals and other clinical sites to close their doors to nursing and medical students earlier this year, concerns focused on the coming surge of patients. Would hospitals be overwhelmed? And would graduations be delayed, depriving clinical sites of talent they might desperately need?

The answer to this second question appears to be no, at least as far as entry-level nursing students are concerned. Most of this year’s seniors graduated on time, and, in some cases, early. Many states issued temporary nursing licenses so new graduates could serve on the front lines before sitting for their licensure exams. And with the suspension of most elective procedures, many experienced nurses found themselves furloughed despite the anticipated nursing shortage during the surge.

With these immediate concerns in the rearview mirror, state nursing boards, accreditors, and educational associations are reflecting on the changes schools made to propel their students over the finish line to graduation. Like others teaching throughout the country, nurse educators moved their didactic courses online, but providing clinical experiences during an infectious disease pandemic required additional consideration.

In March, national nursing education associations and the National Council of State Boards of Nursing (NCSBN) proposed the use of practice/academic partnerships to provide opportunities for students to augment staffing at clinical sites during the pandemic. The model generated enthusiasm in many quarters, but few clinical sites were in a position to establish the partnerships while tackling preparations for a surge in COVID-19 patients. Instead, most programs turned to simulation to replace cancelled clinical experiences.

The Pre-Pandemic Status Quo

Simulation was well established in health professions education prior to the current public health crisis. Educators see it as a way to enhance student learning and provide experiences such as assisting at the birth of a child—an event that can’t be timed around student schedules. Although state rules vary, nearly half of states allowed one hour of clinical simulation to substitute for one hour of in-person clinical experience up to 50 percent of the clinical hours in a given course prior to the pandemic.

The 1-to-1 ratio and choice of 50 percent are not arbitrary. In 2015, NCSBN completed a multiyear study of clinical simulation in entry-level nursing programs, which showed this ratio to be effective in producing clinically competent graduates.

Changes During the Pandemic

Since the advent of the COVID-19 pandemic, NCSBN has been monitoring how state nursing boards have changed their requirements to help programs keep their students on track. With the need to find alternatives to working directly with patients, many states that previously limited simulation in nursing courses to less than 50 percent raised their limits; some states already at 50 percent issued temporary rules allowing simulation to substitute for 100 percent of students’ remaining clinical requirements.

“COVID made it a necessity to replace some clinical experiences with simulation, and our programs have done an amazing job,” says Gerianne Babbo, EdD, MN, RN, director of education at Washington State’s board of nursing, the Nursing Care Quality Assurance Commission. In March, the commission provided additional flexibility for nursing programs by allowing simulation to count for 50 percent of total student clinical hours during the crisis. The commission also supported computer-based virtual experiences to count as simulation.

Mary Sue Gorski, PhD, RN

Babbo’s colleague Mary Sue Gorski, PhD, RN, director of advanced practice, research and policy, says few programs were positioned to take full advantage of the 50 percent threshold. “Our annual survey of prelicensure nursing programs showed 5 percent to 10 percent of clinical hours on average were met with simulation, and only one program reached 20 percent prior to the pandemic.” Nevertheless, she expects these changes to provide a springboard for programs that had laid the groundwork for greater simulation use.

In contrast, programs that prepare advanced practice registered nurses (APRNs) have not been given the option of substituting simulation for clinical hours. “The APRN certifying bodies have been very clear that they will not change their required number of supervised direct clinical-care hours,” says Michelle Buck, MSN, APRN, CNS, who serves as APRN senior policy advisor at NCSBN. “Clinical hours may be augmented but not replaced with simulation.”

Michelle Buck, MSN, APRN, CNS

That decision does not appear to have prevented most nurse practitioner (NP) students from graduating on time. “We did an informal survey of what boards were hearing from APRN programs, and a surprising number said there were still supervised direct clinical opportunities for their students.” What’s more, APRN programs typically have additional clinical hours built into their curricula, so most spring graduates had already met or exceeded their requirements before the pandemic arrived.

Research Needed to Inform the Path Forward

Whether nursing programs should increase their use of simulation once the pandemic ends is open for debate. Some studies suggest that greater use of simulation would enhance learning because clinical experiences are often unpredictable, vary widely, and involve significant amounts of downtime. Recently, a small observational study attracted attention with its finding that in-person simulation is far more efficient than traditional clinical education—so much so, the researchers argue, that allowing one hour of simulation to substitute for two hours of direct clinical experience might actually enhance student learning.

Donna Meyer, MSN, RN, FAAN

“The benefits of simulation for prelicensure students have been demonstrated through evidence-based research,” says Donna Meyer, MSN, RN, FAAN, chief executive officer of the Organization for Associate Degree Nursing (OADN). “It is important for state regulatory bodies to review and consider the NCSBN National Simulation Study and other research when they set limits on how much high-quality simulation can substitute for traditional clinical hours.”

No one would argue with that sentiment, but there are gaps in the research record. The NCSBN study looked only at entry-level nursing students, which is why the organizations that oversee NP education and practice decided to stick with the status quo.

“Everyone agrees that simulation is important to augmenting clinical learning, but we lack evidence that simulation can replace direct patient care experiences at the graduate level,” says Mary Beth Bigley, DrPH, APRN, FAAN, chief executive officer of the National Organization of Nurse Practitioner Faculties. “Fifteen national organizations came together and agreed that NP education requires a minimum of 500 direct care clinical hours and that all students must continue to meet competencies prior to graduation.”

Research is also needed into whether direct care experiences can be replaced with virtual simulation—those online clinical experiences that are easiest to implement given the constraints imposed by COVID-19. The question is whether virtual simulations are as effective as in-person simulations. These are typically highly structured and supervised by faculty who brief students before and after to help them prepare and process their learning.

Susan Forneris, PhD, RN, FAAN

According to Susan Forneris, PhD, RN, FAAN, director of the National League for Nursing (NLN) Center for Innovation in Education Excellence, there are efforts underway to find out. “Academic leaders in simulation are really trying to compile the evidence to better inform boards of nursing, who then can promulgate rules and perhaps allow for a different ratio of simulation to clinical hours,” she says.

Deborah Trautman, PhD, RN, FAAN

Information on changes in the use of simulation should also be forthcoming from the American Association of Colleges of Nursing (AACN), which sees simulation as a valuable tool to augment learning and advance nursing competency. “As faculty become more comfortable with this teaching platform, I expect to see the use of simulation expand across all types of nursing programs at a more rapid rate,” says Deborah Trautman, PhD, RN, FAAN, AACN president and chief executive officer. AACN plans to monitor the use of simulation, including faculty perceptions, in future surveys.

Nancy Spector, PhD, RN, FAAN,

At NCSBN, Nancy Spector, PhD, RN, FAAN, director of regulatory innovations, is currently in the process of reviewing the literature to get a better handle on the efficacy of virtual simulation. “The evidence is very strong for quality clinical experiences,” she says, “and there’s no evidence for allowing more than 50 percent simulation to count toward clinical requirements. I’m afraid that the current laxity will continue after the pandemic has passed. Boards that are already at 50 percent are now allowing up to 100 percent simulation, and in states where COVID-19 prevents people from getting together, they are moving to virtual simulation,” she says.

Bryan Hoffman

Whatever policymakers decide, there seems to be consensus about one thing. As OADN Deputy Director Bryan Hoffman put it, “Everybody should be relying on the same research to make decisions about these issues.”

Opportunities Ahead

As schools consider their fall semester options, Susan Forneris says the conversation has shifted to the logistics of potentially bringing students back to campus and into simulation labs. “They have to be able to maintain social distancing, wear face masks, have disinfection and temperature protocols, and then have a system that says students are cleared to be in the environment—everything down to what will happen if they go to lunch or use the restroom and then come back to the lab setting.” These procedures may constitute an additional simulation of their own, mirroring what students may eventually encounter at clinical sites.

Beverly Malone, PhD, RN, FAAN

Importantly, no one is arguing for the elimination of a mainstay of nursing education: encounters with actual patients. “The connection between the nurse and the patient in face-to-face clinical care is incredibly powerful,” says NLN’s chief executive officer Beverly Malone, PhD, RN, FAAN. “You can’t replace that patient who surprises you, who somehow connects with something inside you and makes you want to give more and help in a meaningful way.”

Ensuring that such opportunities remain available, regardless of external events, is part of the thinking behind the proposed practice/academic partnerships. In a recent editorial, Maryann Alexander, PhD, RN, FAAN, chief officer for nursing regulation at NCSBN, suggests the partnerships would allow clinical sites to integrate students and faculty into their workforce instead of shutting their doors to students during an emergency.

“Practice and education could partner and adopt this model as part of a healthcare facility’s and an education program’s emergency preparedness plan,” she wrote. “Concurrently, nursing education programs could be equipped with simulation scenarios to prepare students to work in a crisis.” In fact, schools with existing partnerships in Idaho, Iowa and Oregon have managed to keep students on-site, and clinical sites have benefitted as schools have shared scarce resources such as personal protective equipment.

Mary Beth Bigley, DrPH, APRN, FAAN

“What COVID-19 has done, for better or for worse, is made us move out of our comfort zones,” says Mary Beth Bigley. “We were ready for this transformation, and this has forced us, and I think the outcomes are going to be very positive.”

The post Nurse Educators Consider the Path Forward During COVID-19 appeared first on Campaign for Action.

RINIMC senior Jillian Corbin packs personal protective equipment in her family’s kitchen before heading to work as a certified nursing assistant providing home care during the COVID-19 pandemic.

When Jillian Corbin heard about the Rhode Island Nurses Institute Middle College Charter High School (RINIMC) at the beginning of her freshman year, she promptly filled out the paperwork and transferred. She never dreamed she’d be spending the final semester of her senior year of high school working on the frontlines of a pandemic as a certified nursing assistant (CNA), but that’s where she is today.

RINIMC opened in 2011 with a mission to diversify the nursing work force by making nursing careers more accessible to students from a high-poverty area of Providence, R.I. According to RINIMC Chief Executive Officer Pamela McCue, PhD, RN, the school, where 88 percent of students receive free or reduced-price lunch, also aims to eliminate health care disparities in the community.

One way RINIMC prepares students to study nursing is by offering college-level courses through a partnership with the University of Rhode Island (URI). RINIMC’s model is unique because it also partners with the Community College of Rhode Island (CCRI) to provide certification opportunities for students and community members to become CNAs or emergency medical technicians (EMTs). These certifications qualify students and other young adults for entry-level health care jobs, simultaneously increasing employment and health care knowledge in the local community.

Corbin has taken advantage of these opportunities. She completed her CNA coursework during her junior year of high school and began working 40 hours per week as a home health aide the next summer. When her senior year started, she reduced her work hours to weekends and after school. She is also completing her EMT certification.

Corbin says the job has kept her out of food service and retail and helps pay for essentials like car insurance. She feels a strong connection to her clients, whom she describes as a second family. “I think about them all week,” says Corbin. “Some clients need minimal help, but others are bedridden or have catheters, amputations, or ostomy bags, so I do a lot of personal care and other little things. Just talking to them can light up their room.”

When asked how her job has changed since the spread of COVID-19, Corbin says, “It’s been scary for the clients. I try to ease them when I can.” She notes that some health care workers have been exposed to the virus or have become infected, so her agency needs a lot more help, making Corbin’s 20 to 30 hours per week essential to the community.

The risk of becoming infected herself is not lost on 18-year old Corbin.

“I thought about not doing it for a day,” she says, “but then I decided it’s worth it because I see how much people need the help of a CNA or a nurse.”

RINIMC Chief Executive Officer Pamela McCue, PhD, RN

McCue, who has led RINIMC since its founding, expresses pride in the work of her school and its students. “We set out to diversify nursing and contribute to the Rhode Island health care workforce, and we’re doing it,” says McCue. Corbin is one of many RINIMC students and graduates studying nursing who, thanks to their certifications, are contributing in the current crisis. “They’re out there as CNAs and EMTs. Our graduates are doing the work.”

With funding from a recent grant, RINIMC plans to expand the certification programs in two ways. McCue says, “We’ve added a third certification for patient care technician, which is another high-demand entry-level position.” Although currently on hold due to shutdowns related to COVID-19, McCue explains, the school’s certification programs will also become available to students from other local high schools and to unemployed or underemployed adults in the community. Certification programs previously offered to non-RINIMC students in the summer will be expanded to year-round.

“These certifications are not the end goal,” McCue says, explaining that the end goal is to get participants to see themselves as health care providers. She hopes the field experience will motivate them to stay in health care and acquire more training and earning power. Corbin is a case in point. She has already taken multiple college-level courses through the RINIMC program and plans to attend CCRI in the fall of 2020 before transferring to URI to complete her bachelor’s degree in nursing.

Corbin will attend the Community College of Rhode Island in the fall before transferring to the University of Rhode Island to complete her bachelor’s degree in nursing.

“Attending RINI and working as a CNA changed my perspective on a lot of things,” Corbin says. “I used to be very shy. But working in health care, you need to be open and willing to talk to anybody. It’s taught me about empathy and compassion and about how to meet different challenges.” She adds that her work has raised her aspirations. “I want to be a nurse practitioner,” she says, “so being a CNA is just a start for me.”

RINIMC’s success has garnered much attention, and McCue has been approached about replication. She and other school leaders are currently forming a nonprofit to disseminate the model to other communities: “Next stop,” she says, “Albany, N.Y.” In McCue’s estimation, the RINIMC model “speaks to the social determinants of health” because the school is improving the health-related knowledge of the community while also increasing the earning power of individuals who live there. She says, “If we can go into underserved areas where the quality of education isn’t where it should be, then we can change the trajectory for each student’s family.”

The post High School Student Finds Herself on the Frontlines of Care appeared first on Campaign for Action.

Nurses are facing unprecedented challenges right now—supply shortages, shifting protocols, and uncertainty about their own health status in the absence of readily available tests for COVID-19. With these realities in mind, we’ve gathered some stories that showcase nurses’ responses to the pandemic, their needs at this difficult time, and actions taken by their leaders and government, which directly impact those providing care. In this post, we hear from nurses on the frontline. In a separate post, we look at what government and nurse leaders are doing to ensure the nursing workforce is adequate and protected during the COVID-19 pandemic. 

Preparedness varies

At Seattle’s Swedish Medical Center, which treated some of the first U.S. patients diagnosed with COVID-19, intensive care unit nurse Stephanie Bandyk, RN, painted a reassuring picture last week. She reported that she and her colleagues had adequate personal protective equipment (PPE) to do their jobs safely and that educators were readily available to staff, making sure everyone was using their PPE properly.

In contrast, Missouri-based travel nurse Rainee Sinroll, RN, told STAT News, “This is unlike any other outbreak I’ve been involved with.” Sinroll worked during the H1N1 epidemic and has spoken with other health workers in her region. “There’s absolutely no training and information to the staff that will be involved. And no message to the community that would lower cases, thereby allowing better care in our facilities.”

STAT also quoted other hospital employees frustrated by their inability to get tested for COVID-19 despite having recently been ill. A certified nurse assistant (CNA) in Alabama described the situation as confusing, arbitrary, and chaotic. “No one among the CNA staff is talking about this in any meaningful way,” she said. “If the nurses are, I don’t know about it.”

“Nurses often face what is called moral distress—defined as knowing what should be done for a patient while at the same time being unable to provide the appropriate care, often because of constraints imposed by organizations or practice settings,” wrote University of Pennsylvania nursing and bioethics professor Connie Ulrich, PhD, RN, FAAN, in a March 10 op-ed in The Boston Globe. She cited a national survey, which had 8,200 respondents as of March 16. Most of those nurses reported their employers had inadequate protective equipment on hand and had not sufficiently informed them about how to recognize and respond to cases of COVID-19.

Many of these concerns center on the risk health workers face of contracting the virus given insufficient stocks of PPE, insufficient training in how to use it properly, and shifting guidance. The Centers for Disease Control and Prevention (CDC) revised its interim infection prevention and control recommendations for COVID-19 in light of increased demand for PPE and supply-chain disruptions. “Many of us were taken aback to read the new document,” wrote Betsy Todd, MPH, RN, in the American Journal of Nursing’s Off the Charts blog. She explained the CDC rationale for recommending the use of regular surgical face masks instead of N95s and reminded readers that PPE is not the only line of defense against the virus. “Engineering and administrative controls are considered the most effective infection prevention measures, because they are ‘built into’ physical systems and protocols,” she said.

Self-care

As rewarding as it is, nursing is a challenging profession under the best of circumstances. Under current conditions, nurses need all the support they can get to stay healthy and well. For some, free access to the Headspace meditation and mindfulness app may help. For others, the knowledge they acquire from Nurse.com’s free course on COVID-19 may give them a greater sense of control. For those not engaged in direct care, such as the Berkeley, Calif., nurse-midwife student Britt Urban, RN, who is organizing volunteers in her community, finding a purpose and serving others may provide a path through this crisis.

Last week, one nurse at a major New York hospital shared her fears and the source of her strength—from first hearing about the virus in January until last week, when she volunteered to fill in on a unit that had placed many of her colleagues in quarantine. “I’m staying calm by thinking about how I’ve handled really tough days in the past before—and I got through it,” she said. “I have a really great team of nurses that I’ve worked with and I’m not alone in this. This is going to be something that we will get through.”

The post Nurses on the Frontlines of the COVID-19 Response appeared first on Campaign for Action.

Nurses are facing unprecedented challenges right now—supply shortages, shifting protocols, and uncertainty about their own health status in the absence of readily available tests for COVID-19. With these realities in mind, we’ve gathered some stories that showcase nurses’ responses to the pandemic, their needs at this difficult time, and actions taken by their leaders and government, which directly impact those on the frontlines of care. In this post, we hear what government and nurse leaders are doing to ensure the nursing workforce is adequate and protected during the COVID-19 pandemic. In a separate post, we share the experiences of nurses on the frontlines of the COVID-19 response.

Nurses attend White House briefing

Last week, representatives of 12 national nursing associations advocated for the nursing community and explained nurses’ roles in responding to the outbreak during a White House briefing with President Trump, Vice President Pence, and members of the Coronavirus Task Force. In her prepared remarks, Deborah Trautman, PhD, RN, FAAN, president and chief executive officer of the American Association of Colleges of Nursing (AACN), captured the mood of those assembled when she said, “As we look at the challenge before us, it is imperative that the safety of the public, our nurses, and our nursing students, are top of mind.”

Debbie Hatmaker, PhD, RN, FAAN, chief nursing officer at the American Nurses Association, stressed several concrete steps that could address safety concerns. She called on the government to promote the use of telehealth and incentivize manufacturers to ramp up production of N95 respirators. She also recommended “implementing creative staffing strategies that utilize nurses who are currently not in direct patient care and senior nursing students to help meet patient demand.”

Strains on the workforce are already evident

In some of the hardest hit communities, the need for reinforcements is already a reality. In New York, the state health department has asked recently retired health professionals to register as volunteers who can act as reserve staff. Westchester County Executive George Latimer put out a separate request for retired and non-working nurses with New York State licenses to be on call to meet spiraling health care needs. And in New York City, 1,000 retired health professionals heeded Mayor Bill de Blasio’s call to staff drive-through testing centers.

The routine 14-day quarantine of every health professional who becomes exposed to the virus is also constraining the workforce. Jennifer Nuzzo, DrPH, SM, a senior scholar at the Johns Hopkins Center for Health Security, thinks this practice will soon become unsustainable. Instead, she believes hospitals will need to strike a balance between prudent isolation and maintaining a functioning health system.

To address workforce shortages, moves are underway to ease the ability of nurses and other health professionals to practice where they are most needed. On March 18, the federal government announced the Department of Health and Human Services would take steps to allow nurses and other medical personnel to practice across state lines. Several states had already taken steps to grant temporary licenses to out-of-state nurses in order to increase staffing levels amid the COVID-19 pandemic and several others were working with the Centers for Medicare and Medicaid Services on provider licensing waivers. The libertarian Cato Institute applauded states for leading the way on removing occupational licensing barriers and urged governors to seek legislation making temporary license reciprocity permanent. “If making it easier for doctors and nurses to provide care to their state’s residents is good in time of emergency, it should be good when there is not an emergency,” wrote Senior Fellow Jeffrey Singer.

Currently 34 states are members of the Nurse Licensure Compact, which enables nurses to practice in other Compact states without having to obtain additional licenses. At the start of this month, the Michigan House passed a bill that would make it the 35^th state to join the Compact.

All hands on deck? Not necessarily when it comes to students

While some have called for students to fill workforce gaps, many hospitals have cancelled nursing student rotations to protect both students and patients. Nursing students who rotated through the Kirkland, Wash., nursing home that was hard hit by COVID-19 are now in self-quarantine.

Clinical venues that usually host trainees are also concerned about reserving their stocks of personal protective equipment. The AACN has posted guidance advising programs to limit student contact with known cases of COVID-19 while allowing “clinical students to continue their roles as part of the care team.” AACN is also hosting a series of webinars to help academic programs make informed decisions, provide leadership, and continue to deliver learning opportunities as appropriate. Meanwhile, the delivery of the nurse licensure NCLEX exam to testing centers in the U.S. and Canada has been delayed.

In the United Kingdom, the government has placed emergency nurse registration at the top of its coronavirus agenda. A proposed law would give the Nursing and Midwifery Council new powers to temporarily register “fit, proper and suitably experienced persons.” “We have been clear that students in the last six months of their degree must be free to choose to work,” said Royal College of Nursing Chief Executive And General Secretary Dame Donna Kinnair. “They must also be supported and supervised during their placements, and be properly remunerated.”

The post Pandemic Strains the Nursing Workforce appeared first on Campaign for Action.

A nurse with Boston-based Partners in Health swaddles a child at an Ebola treatment center in Sierra Leone. Health workers treating patients with the new coronavirus must also wear protective clothing and take other precautions to avoid contracting or transmitting the virus. Photo credit: Rebecca E. Rollins, Partners in Health.

In 2016, Charting Nursing’s Future released a policy brief on disaster preparedness and response. Among other topics, the brief looked at how nurses responded to the Ebola virus outbreak and the impact of that outbreak on how nurses did their work. Now that U.S. clinicians have begun encountering patients with the novel coronavirus that originated in Wuhan, China, COVID-19, we are sharing lightly edited excerpts from our earlier article. We hope these observations from nurses who confronted the Ebola outbreak will help inform their peers who are preparing for patients with coronavirus.

The 2014–15 Ebola outbreak proved to be a cautionary tale for our nation’s response to new infectious diseases. Nurses were squarely in the public eye: examined, criticized, and, at times, praised as singular heroes amidst failing institutions. The nation learned that some hospitals and regions are better prepared than others to address infectious disease epidemics; that nurses are on the front lines of care; and that, without adequate training and protection, nurses put their own health and safety in jeopardy to care for the public.

Teamwork and Preparation Save Lives

When the head nurse of the Nebraska Biocontainment Unit (NBU) donned protective equipment to meet her first patient with Ebola, she had practiced the ritual for nine years. She and fellow nurses even picked the equipment and designed the protocol.

After the NBU agreed to accept the first patient, staff repeated drills and refined protocols so that patients would receive optimal care while staff stayed safe.

But preparation was just one factor that helped Nebraska Medicine and Emory University Hospital safely and effectively treat patients with Ebola. NBU’s clinical care was shaped by a deliberate culture of collaboration. Team members shared information at shift-change huddles. Nurses, doctors, and respiratory therapists spoke up if they saw something troubling and avoided traditional hierarchies that hamper open communication.

It’s no coincidence that the NBU was designed and staffed during Nebraska Medicine’s journey to Magnet® designation. To earn Magnet status, hospitals must demonstrate that staff work as a team, and that the institution fosters a culture that lets nurses flourish professionally; grants professional autonomy and decision-making authority at the bedside; and gives nurses a voice in their work environment.

“It’s about the involvement and engagement of staff at the front line,” said Shelly Schwedhelm, MSN, RN, NEA-BC, executive director, emergency preparedness and infection prevention at Nebraska Medicine. “Including them in decisions about policies and protocols as well as in critical thinking to solve problems and confront unique situations—this was a daily requirement during care of patients with Ebola.”

At Emory University Hospital, staff on the isolation unit team that cared for Ebola patients called themselves a “family,” underscoring the collaborative nature of their work. All team members, regardless of role or profession, were empowered to share accountability for following safe practices. Nurses and physicians implemented an active buddy system for donning and doffing protective gear.

“The first thing hospitals have to do is work on the culture,” said Susan Grant, MS, RN, FAAN, who was then chief nursing executive at Emory Healthcare (the comprehensive network that includes the hospital). “Every member of the team has an equal role. It’s about partnership and interprofessional collaboration. In order to be patient- and family-centered, you have to be team-centered.”

Behind the Headlines

At Texas Health Presbyterian Hospital in Dallas, poor communication among a nurse, a physician, and a patient led to the discharge of Thomas Duncan, the first patient diagnosed with Ebola on U.S. soil.

When Duncan was later readmitted and presumed infected with Ebola, nurses followed the CDC’s guidance on protective gear, but the agency’s directives shifted on numerous occasions. This undermined nurses’ confidence, according to an independent panel report released by the facility. Ultimately, two Texas Health nurses were infected with the virus; they recovered, but Duncan died.

The hospital is a two-time Magnet-designated institution, underscoring the challenges faced by any non-biocontainment hospital in treating an emerging infectious disease. Unlike nationally designated treatment centers, Texas Health had no warning that an Ebola patient would walk through its doors.

“There are aspects of what happened at Dallas that could have happened anywhere,” said Nebraska Medicine’s Schwedhelm.

Not everyone agreed. Nina Pham, RN, who contracted Ebola while taking care of Duncan, is suing Texas Health Resources, saying it did not adequately train and protect nurses. Since the incident, the hospital announced that it has improved its workflow and medical record software to clearly highlight travel risk and emerging infectious diseases; put in place new procedures to more quickly identify at-risk patients; developed a triage procedure for at-risk patients that quickly isolates them; and increased its emphasis on communication between nurses and physicians.

Preparing for the Unknown

For decades our nation has felt isolated from infectious diseases that prevail in other parts of the world, but the arrival of Zika on the heels of the Ebola crisis  brought home our vulnerability, and the advent of coronavirus adds to it.

“We’re used to having a vaccine or a cure,” said Pamela A. Thompson, MS, RN, FAAN, chief executive officer of the then-named American Organization of Nurse Executives. “Ebola forced us to ask: How do we create a system that allows us to manage the ambiguity of what we are preparing for, while keeping our patients, and the entire health care team, safe?”

As a first step, she recommended nurses and other health care personnel maintain their skill in standard (once called “universal”) precautions—protocols for handling blood and bodily fluids as if they were infectious.

Effective communication is also critical.  To forestall public alarm, Thompson said messages to staff, patients, and the community must be clear and fact-based.

Organizational best practices may include:

• screening patients at all entry points, including primary care venues;
• communicating travel histories to all team members;
• establishing systems of community-wide coordination;
• forging ties with public health agencies to increase awareness of potential threats.

Even with these practices in place, Thompson concluded, “There’s always going to be this unknown piece—something you didn’t anticipate—and all the systems you designed to that point may not work. That’s where providers’ creativity and ingenuity come in.”

A longer version of this article first appeared in When Disaster Strikes: Nurse Leadership, Nursing Care, and Teamwork Save Lives. You can access the full brief on the Robert Wood Johnson Foundation website.

The post As Nurses Prep for Coronavirus, Lessons from the Ebola Outbreak appeared first on Campaign for Action.