COVID-19’s Impact on Nurses Jeopardizes Quality Care
President Joe Biden signs H.R. 1667, the Dr. Lorna Breen Health Care Provider Protection Act, Friday, March 18, 2022, in the Oval Office.
Creating a pathway for policymakers, providers, and the public to understand and recommend a new professional nursing dynamic, the Institute of Medicine’s 2011 Future of Nursing report (https://nap.nationalacademies.org/catalog/12956/the-future-of-nursing-leading-change-advancing-health) investigated the current and future state and challenges of the nursing profession.
The Future of Nursing (https://nam.edu/publications/the-future-of-nursing-2020-2030/): Leading Change, Advancing Health provides a blueprint for improving nurse education, leadership, policy making, and workforce planning data collection. Today’s issues—healthcare reform, new technologies, patient-centered care, respect for the profession and its expertise—merit consideration in national priorities for the next 10 years.
Chaired by then–Health and Human Services (HHS) Secretary Donna Shalala, PhD, the committee identified (https://www.hhs.gov/about/news/2022/02/24/hhs-distributing-560-million-provider-relief-fund-payments-health-care-providers-affected-covid-19-pandemic.html) four areas for reform:
- Reconceptualizing the role of nurses among the entire workforce, the shortage, societal issues, and current and future technology
- Expanding nursing faculty, increasing nursing school capacity, and redesigning nursing education
- Examining innovative solutions for nursing care delivery and education
- Attracting and retaining well-prepared nurses in multiple care settings
In developing the report, the Institute of Medicine defined (https://nap.nationalacademies.org/catalog/12894/a-summary-of-the-february-2010-forum-on-the-future-of-nursing) four points that reflect commitment to the nursing profession:
- Nurses should practice to the full extent of their education and training.
- Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
- Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States.
- Effective workforce planning and policy making require better data collection and an improved information infrastructure.
For nearly 10 years, those reforms were gradually moving forward. Then COVID-19 changed the global health dynamic.
The Pandemic’s Professional Perils
Throughout the pandemic, nurses are dedicated to their work despite being overwhelmed by the extent of patient—and colleague—mortalities. The already precarious healthcare environment is overloaded, and nurses from every specialty bear the brunt of COVID, even accounting for 32% of all known deaths from COVID-19 (https://www.beckershospitalreview.com/public-health/nurses-account-for-most-known-us-healthcare-worker-covid-19-deaths-guardian-khn.html). Stress, trauma, and burnout are taking its toll.
During a March 2, 2022, hearing before the U.S. House of Representatives’ Energy and Commerce Committee, an Emory University Hospital frontline nurse testified (https://energycommerce.house.gov/sites/democrats.energycommerce.house.gov/files/documents/Witness%20Testimony_Austin_OI_2022.03.02.pdf) about the direct impact COVID-19 has had on the profession.
“In addition to the crushing workload, nurses are under additional strain due to the complex care that treating patients with COVID-19 requires. Often this care requires one-on-one support, which is difficult to provide when you are tired and short-staffed,” she told the committee. “In addition to the physical strain, there is the mental stress that is plaguing our workforce. As we deal with patients becoming sicker and dying, we see nurses’ morale suffer.”
The effects reach beyond frontline nurses, too, according to findings in the 2021 Lived Experience of the CNO During COVID-19 report that measured the weight of the disease on health care. Among the chief nursing officers (CNOs) who responded, 81% said that staffing suffered the most, 58% reported (https://www.healthleadersmedia.com/report/exchange-insight/healthleaders-cno-exchange-lived-experiences-chief-nursing-executives-during) increased burnout, and 70% admitted to changing care models because of nurse turnover.
Jarring responses from the health and medical field in another poll stunned elected officials with statistics on how COVID-19 decimated morale and shook providers to the core. “About half of healthcare workers have felt defeated by the demands of their jobs during the pandemic, whereas another 30% struggled (https://morningconsult.com/2022/02/17/health-care-workers-pandemic-burnout-mental-health-polling/) to cope with work stressors over the past six months.”
Public Policy Priorities to Support Nurses
Those firsthand accounts opened lawmakers’ eyes, but it took a tragic 2021 public event to galvanize the U.S. Congress into action. Under the pressure of the unrelenting crisis, a New York emergency room physician committed suicide, devastating the health and medical community. Through her family’s efforts, the Dr. Lorna Breen Health Care Provider Protection Act (https://www.congress.gov/bill/117th-congress/house-bill/1667) passed into law with overwhelming bipartisan support on March 1, 2022. The bill’s elements instructed HHS to study and develop policy recommendations on:
- Improving mental and behavioral health among healthcare providers
- Removing barriers to accessing care and treatment
- Identifying strategies to promote resiliency
Meanwhile, the Health Resources and Services Administration began distributing federal grants to 78,000 providers and healthcare facilities across the United States. HHS Secretary Xavier Becerra announced in late February 2022 that the $11.5 billion in Provider Relief Funds would “ensure (https://www.hhs.gov/about/news/2022/02/24/hhs-distributing-560-million-provider-relief-fund-payments-health-care-providers-affected-covid-19-pandemic.html) our providers have the necessary support and tools to keep our families safer and healthier”—recognizing that a healthy nursing workforce means a stronger patient population.
Because advocacy is often considered a marathon and not a sprint, ONS takes the long view. Even under COVID-19 conditions, nurses are advocating for the future of the nursing profession and encouraging the next generation to choose nursing as a career.
Gretchen Berlin, RN, a senior partner at McKinsey and Company, a global management and consulting firm, said (https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/nurses-and-the-great-attrition), “I am quite optimistic. I think there are a lot of really bright minds trying to solve this. There are a lot of committed health systems, employers, and societies trying to invest and fix it. I think more than anything, there’s a really committed workforce who’s excited to innovate, who has shown tremendous flexibility and resilience already and will continue to do that going forward.”