Male nurse wearing PPE gloves and mask with arm to say stop

The nature of nursing puts frontline staff at an increased risk of COVID-19 exposure. While hospitals touted significant shortages of medical supplies and personal protective equipment (PPE), nurses still showed up and did what they do best - save lives. Maintaining a focus on the positive aspects is vital to getting through this together. However, we can also learn from this crisis and improve the landscape of healthcare forever.

What Is the Impact of the Coronavirus on Healthcare?

COVID-19 significantly impacted health care in many ways. There are overtaxed health systems, inadequate PPE, and lack of critical supplies at some hospitals. PPE is woefully limited in some areas of the country, resulting in changes in policies and regulations.

What Are the Real Issues Nurses are Facing?

Nurses are understaffed and facing mandatory overtime in some medical facilities. Forcing current nurses who are already stressed and overextended to work overtime puts them at further risk. The majority of health systems also lack adequate staffing contingency plans for the surge of COVID-19 patients. Politicians and administrators have thrown out ideas like aggressively recruiting travel nurses, encouraging retired nurses to return to the field, or pushing out student nurses quickly, but none of these are realistic or sustainable.

Nurses need equipment to care for their patients properly. The guidelines surrounding PPE have relaxed, and PPE can be reused. While medical supplies are not readily available, healthcare workers need all that they can get during this time. Many nurses struggle with feeling safe when this is a radical change from how they've practiced throughout their entire careers.

Many nurses are concerned about the risk of becoming infected and spreading it unknowingly. In one study in the New England Journal of Medicine, nearly 90% of pregnant COVID-19 patients were asymptomatic on admission to labor and delivery. If COVID-19 is not quickly identified in patients, staff can be exposed to infection and silently transfer it to others. Missing the diagnosis of COVID-19 puts healthcare workers and their patients, fellow nurses, and family members at risk.

Attendance policies often call for points as penalties for absences, instilling fear for nurses to call off. When a healthcare worker calls off sick, they typically receive points or another penalty. Nurses who catch the virus at work still fall under the twelve weeks of Family and Medical Leave Act (FMLA) for a combination of personal and family illness. If the disease lasts longer than that, or they must take time off to care for a sick dependent, it is up to the employer's discretion whether or not to grant temporary unpaid leave. If they do not approve of the temporary leave, nurses may lose their jobs. Nurses have to go to work - few can afford to quit. Many worry about the impact of a period of unemployment during this crisis on a resumé. However, simply showing up puts nurses at risk. The lived experience of merely walking through the front doors after a temperature check and social-distancing line can be draining. Nurses are risking exposure and potentially bringing it home to their families. Since daycares and schools are closed, childcare often falls on the shoulders of possibly elderly family members - a high-risk group that should be protected. During the pandemic, nurses experience real and inescapable fear. Anxiety and depression surrounding the trauma during this time may become rapidly apparent.

RELATED: How to Manage Your Stress as a Nurse

What Must Be Done to Protect Nurses?

After this public health crisis, it is crucial to prioritize keeping nurses safe. The best practices will implement comprehensive public policies to both limit spread and protect healthcare workers. Ideally, there will be task forces at local, state, and federal levels involving both political and healthcare officials. Nurses must be at the front-lines of the decision-making, just as they are at the front-lines of the pandemic.

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It's nearly impossible to predict a pandemic for staffing purposes. However, providing safe staffing levels at baseline sets the stage for less burnout and more nurses. Hospitals should consider having a pool of float nurses, per diem staff, and nurse techs to support one another. Teamwork is essential in this fight.

While trying to play catch-up when medical supplies are dwindling is nearly impossible, it's time to have creative solutions for the regular use of PPE. While the CDC loosened restrictions surrounding the use of PPE, it's time to create guidelines based on evidence. Nurses need to feel heard in the acquisition and implementation of PPE. They must have a place at the table in all healthcare and advocacy task forces.

While there is an increased risk of infection to nurses, often it is difficult for them to be tested. By implementing widespread expedient testing, healthcare workers' lives can be saved. Having enough tests to check for the virus is crucial to curbing the spread and protecting those most at risk. If a nurse is symptomatic or exposed to an infected patient, they should not have to fight for testing.

Attendance issues surrounding sick leave or paid time off have long been a point of contention among nurses. If a nurse tests positive for infectious disease, there needs to be an allowance in the hospital's attendance policy for non-punitive time off without accruing points. While COVID-19 is the impetus, other conditions like influenza should not put a nurse's career in jeopardy. Furthermore, if exposed to an infected patient, nurses should be able to quarantine for the 14 days without being concerned about keeping their job or feeding their families.

Nurses have become burned-out increasingly over the years, and it's time for employers to protect their staff. The strain will only increase following the pandemic. Many nurses are describing significant fear interfering with their ability to do their job or relax during leisure time. Health facilities, medical, and nursing boards need to break the stigma surrounding mental health treatment. COVID-19 exposed weaknesses in how our healthcare system utilizes and cares for nurses. During this time of conflict, companies and citizens across the world began to work together to improve conditions for nurses. We need that type of teamwork in the healthcare field. The nation must work to improve outcomes in the face of a global pandemic. Nurses deserve better. Coming together as a nation and a country is the best way to fix this.

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Caitlin Goodwin, RN, MSN, CNM
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