Surgincal mask with airplane COVID-19

When 2020 started, it was thought to be the "year of the nurse" as it marked the 200th birthday of Florence Nightingale. Nurses and nurse practitioners were in for a big surprise, as their dedication and loyalty to the profession were, and still is at the time of this writing, put to the test as COVID-19 wreaks havoc around the world. Because of this unprecedented pandemic, the healthcare system in the United States has been stretched extremely thin. Some states are having to take drastic measures to help care for the patients affected by COVID-19, on top of an already impacted system.

To help in care delivery, some states are temporarily suspending or revising practice guidelines to allow for more bandwidth among healthcare workers and providers. For example, practice agreements with nurse practitioners have either been suspended or waived in some states. New York, one of the hardest-hit states thus far, has suspended written practice agreements or collaborative relationships between nurse practitioners and physicians, effective until April 22, 2020. Additionally, neighboring Pennsylvania has suspended certain prescribing restrictions as well as restrictions surrounding specialty practice. In other words, a nurse practitioner who is certified in family medicine may work in another specialty during this public health crisis.

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COVID-19 Need for Nurse Practitioners

Nurse practitioners have been critical in healthcare delivery, even before COVID-19 exploded in the United States. The U.S. already has a significant physician and nursing shortage, and with the surge of patients flooding into the healthcare system due to COVID-19, nurse practitioners are even more in demand to help manage the influx. Some may even be asked to work outside their specialty; for example, a clinic NP may reed to be reassigned to acute care. Of course, this is dependent on state regulations/emergency procedures and the nurse practitioner must be trained appropriately.

Registered nurses are also facing changes in their practice. Healthcare systems are taking drastic measures to mitigate the spread of COVID-19. Non-vital in-person appointments are being cancelled, as are elective surgeries and procedures. Non-essential care is being delayed in preparation for a likely large-scale influx of patients. Additionally, care is being transitioned to the virtual platform - something that is not always widely utilized but is now a necessity.

As far as caring for patients directly, there is not much difference in terms of bedside tasks caring for a sick patient in isolation. However, working during a pandemic presents other types of challenges. One major challenge facing nurses is proper personal protective equipment (PPE). There is a nationwide shortage of masks and gowns, to the point where the CDC has loosened guidelines in hopes of preserving supplies. Hospitals have resorted to rationing equipment to ensure there is enough to last until more are obtained. Many nurses are fearful it is not enough protection and are concerned about maintaining the integrity of PPE if they need to re-use it.

COVID-19 Surges While Nursing Need Surges

Additionally, in preparation for surges, state leaders are suspending nurse-to-patient ratio laws. While leaders deem it necessary to ensure the increased number of patients are cared for, nurses are already stretched thin. Imagine a nurse assigned to COVID-19 patients. He or she is assigned several, as cohorts are needed to preserve PPE. A nurse caring for five patients, with a suspended ratio law during a surge, might be expected to care for seven (or more) COVID-19 patients at the same time. This workload terrifies nurses. Not only does it place their patients at risk, but it also places them at risk for illness, burnout, and medical errors.

Another change nurses may face is reassignment to different care areas. At the time of this writing, nurses in New York are being asked to come out of retirement. Nursing students are being allowed to work through executive orders. Nurses in outpatient settings are being cross-trained to inpatient. Nursing is different across the board - outpatient nursing is vastly different than inpatient. Nurses need to learn or re-learn a whole new skillset - skills they may not have used since nursing school. Moving to another care area, especially during a pandemic, can be stressful and cause a great deal of anxiety for some nurses. It's important for nurses to recognize this, and to advocate for proper training in which they feel competent to perform the tasks that are asked of them.

The COVID-19 pandemic is an unprecedented event in the United States - one that healthcare systems in the U.S. have never experienced to this magnitude. However, change is nothing new to nurses. They may need to be even more flexible than they already are. It's essential that nurses remain in touch with their fears, anxieties, and stressors to be able to address them in a healthy way. It's also important for nurses to recognize that it's perfectly okay to be scared. Again, nurses should address those fears and work to manage them. Above all, nurses should always remember their purpose - to care for the sick. As Florence Nightingale said, "How very little can be done under the spirit of fear."

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Amanda Bucceri Androus, RN, BSN
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