Leadership Recovery: The Future of Nursing

October 25, 2020 by David Nitkin | Categories: Leadership Recovery | Tags: clinical iinfomatics, nurses No Comments ↓

A photo of the Nurse Statue in the garden of the Galt Museum & Archives.
Photo by Graham Ruttan

The Issue

The nursing profession underwent many changes during the coronavirus pandemic first wave. The virus brought with it challenges for all health professions, none more so than nurses. In particular, commentators began opining on the Trends, Forecasts and Outlook lessons learned internationally, not just in North America. This blog updates the EthicScan review of changes in nursing literature issued in the period 15 March-30 June – what you are reading here deals with more recent professional literature published in the period 1 July-15 October.

Changes in Nursing

Since the start of the COVID-19 pandemic, nurses have held principal responsibility for the front-line defence against COVID. Nurses:

(a) assess, advise, treat patients;
(b) direct patients to the most appropriate level of care,
(c) conserve access to physicians for those who need them most; and
(d) follow-up and monitor COVID-19 patients for clinical deterioration.

Nurses then are a scarce resource.

In several meaningful ways, their lives and livelihood have changed. As cities and provinces went on lockdown across the country, health care’s immediate focus was to “flatten the curve.” Many nurses pleaded on social media for people to stay home and prevent the spread of the virus, so our hospital systems didn’t become disastrously overwhelmed. “We go to work for you, so stay home for us!” they declared.

At the same time, some nurses who didn’t work in an emergency room or on COVID-19 critical care or telemetry units were having their work hours slashed, being furloughed, or in some cases, lost their jobs altogether. The financial stress has hit these nurses hard, especially as areas of the hospital were closed because they were not deemed “essential.” (This has been a tough time for many nurses, not just the ones directly fighting COVID-19).

ER nurses at the start of the pandemic found themselves scared at work because of fear of contracting COVID-19 from their patients. Conversely, many were being canceled from work frequently because their unit didn’t always have the staffing needs (because people stopped coming to the ER unless they were having complications from COVID-19 or they absolutely had to go there for a serious injury). When staffing was reduced, per diem or agency nurses were the first to be called off.

Conditions imposed by the pandemic are reframing how we view frontline hospital resourcing and management, in particular informatics and nursing. Nurses have vastly increased their profile as frontline lifesavers during COVID-19, as they have had to step up to significantly more clinical responsibility as a result of doctor-resourcing pressure. They have been placed in the middle of a complex and a rapidly evolving digital health-care delivery environment. In many situations, they have stepped into roles that hospital managers might not normally have ever put them in, and they’ve proven that they are an underestimated and under-utilised health-care system resource.

Photo by Georg Arthur Pflueger

Those nursing sector changes can be summarized to include:

greater role recognition and front-health care rank ”essential service” status
greater stress – COVID patient surges amidst PPE shortages and often being the only person present when patients died proved to be physically, mentally, and spiritually exhausting
greater clinical role responsibilities in hospitals, primary care and digital informatics
high levels of death of nurses who cared directly for COVID patients – that is, dozens in Canada and hundreds in the United States
leadership in interoperability, that is getting disparate clinical systems to work together in order to share data and information across different systems and between institutions
high spikes in unemployment and underemployment in developing countries.

Trends Affecting the Future of Nursing for the Better

Photo by Rusty Watson on Unsplash

Experts suggest various ways in which COVID-19 will change the future of nursing for the better.

1. Higher public awareness regarding a lack of nurse safety: It is no secret that nurses were forced to work in some unsafe situations during the COVID-19 pandemic, without the proper personal protective equipment (PPE) to protect themselves. But for years, nurses have worked in unsafe situations with disruptive and potentially violent patients, unsafe staffing ratios, and other occupational hazards. Nurses have been demanding protection for a long time. The lack of PPE and the total unpreparedness of our health-care system to manage patient care safely during the virus is now transparent. For once, hospital administrations around the country and the public are listening to nurses DEMAND to be safe at work. The future of nursing will hopefully be safer for nurses.

2. Nurses are discovering ways to practice nursing away from the bedside: Not all nurses want to work at the bedside forever. One of the reasons many nurses wanted to go back to nursing school in their early 30’s was because they knew that the profession offered flexibility. The arrival of COVID-19 may be the push that inspires many current and future nurses into other non-hospital nursing roles. Examples include aesthetics nursing, medical writing, home health care, legal nurse consultant, insurance case manager RN, or even starting a nurse-run business.

3. More reputation respect for those who choose care at the bedside: The pandemic made some nurses realize that bedside nursing is what they were put on this earth to do. Watching how the virus can devastate lives has inspired them to improve their clinical skills and specialties, including work in an emergency room and ICU unit. A global pandemic makes everyone re-evaluate their own personal and professional lives – and the nursing profession is no exception. In some ways, a pandemic crisis that doesn’t kill nurses can make them stronger – bargaining rights, employment security, flexible work conditions, career role shifts– if they learn from the experience.

4. COVID-19 has inspired some nurses to move into specialty roles within their hospital: These enriched options within hospital departments and clinics can include pediatric care, neuro/trauma telemetry care, informatics, and emergency medicine. COVID-19 has provided hard evidence that nurses can move upstream into more complex treatment and technology roles in clinical care.

5. Resourcefulness, adaptation and resiliency are a nurse’s superpower: Nurses have adapted well despite impossible and stressful circumstances in some cases. This includes coming up with new safety protocols and ideas to prevent spread within hospital units and each other. One example is how nurses started moving IV drips and all other machines towards the doorways of patient rooms, so they didn’t have to always walk in and out of patient areas. This technique, while simple, helped prevent the spread of the virus. Another example is how nurses began taping large photos of themselves smiling to the front of their gowns so that patients felt like they were speaking to a human and not a mask. A simple, but an impactful gesture exemplifying compassionate accessible care. Give nursing thought leaders a problem, and they will find you a solution — even under the most stressful circumstances.

6. More opportunities in telehealth positions: The pandemic changed not only things for the nursing profession, but also how nurses were giving patient care, thanks to social distancing efforts! Telehealth made it possible for clinicians to have patient appointments from afar, and it will be here long after the coronavirus is gone. This is great news for nurses who still want to give one-on-one patient care in some way, but don’t want to spend 12-hour shifts on their feet. Some of the benefits of telehealth nursing include part-time options, shorter shifts, and even working remotely (at home!) in some cases.There has always been a need for telehealth, especially in rural areas where patients have a hard time being seen in a doctor’s office.

7. Nurses are finally publicly getting the credit they have deserved all along: Most nurses say they entered the nursing profession to help humankind and make an impact on the world, not receive attention. Whether through the news, social media, or word of mouth, however, nurses are being recognized for the value they bring to health care and our communities. Their “social capital” and hero frontline care-worker status has grown. Nurses finally hear the words, “thank you for your service,” which for many is what keeps them going. The future of nursing needs gratitude.

Nursing Profession Forecasts:

Looking forward, experts in the field identify a number of transformative forecasts.

1. More advocacy: Nurses have more opportunity to be and be seen to be on the front lines in terms of addressing political advocacy, systemic health inequity, and institutional reform—notably hospitals, nursing homes, and emergency care. Nursing can and should be the trusted profession to help our nation build a culture of health, reduce health disparities, and improve the health and well-being of the country’s population.

2. More input into public policy: Some experts see that nurses can form a “cadre of leadership” taking advantage of a cross-sector alignment of health care, public health, and social service systems in order to promote population health and more efficient use of resources. They call for more input from nurses to assess and meet social needs in health care and conduct case management for vulnerable populations to promote health equity.

3. Better investment of health-care dollars: Nurses have a role to play in speaking out to national solutions such as:

(a) early-childhood education programs;
(b) raising the minimum wage;
(c) building more health into health care to prioritize preventive health and primary care,
(d) diversifying the health-care workforce to reflect the racial and ethnic composition of the population;
(e) accelerating interoperability of patient-care networks; and
(f) raising awareness of inequities so as to build political will and consensus to address them.

4. More opportunity to recruit minorities, people of colour and immigrants to join the ranks of nurses and other medical and health care disciplines.

Photo by Hush Naidoo

5. Better disaster-inoculation training: Nursing curricula and continuing education should include more content and clinical experiences in emergency, critical care, and public-health nursing; disaster preparedness; advice on family health and safety counselling; and basic principles of epidemiology.

6. Advances to palliative care: As the rapid influx of patients threatened to overwhelm health systems during the coronavirus pandemic, palliative nurses played and were seen to play diverse meaningful roles in supporting patients, patient families, and colleagues. Issues surrounding serious illness, dying, and death have become continuous threads of daily mainstream media, politics, and policy making. Some expert observers conclude that investing in a global culture of palliative care scholarship for nurses and health professionals across practice domains is one of the most practical and accessible approaches to ensuring person-centred health care in the face of a future public-health crisis.

Conclusion:

We appear to have learned much during this global pandemic that we can use to help change the nursing profession for the better. Nurses have a lot to teach us and we all will be better for listening more carefully in the near future to the lessons they have learned.

The Issue

Changes in Nursing

Trends Affecting the Future of Nursing for the Better

Nursing Profession Forecasts:

Conclusion:

Further Reading: