2020 was designated as the International Year of the Nurse and the Midwife. It definitely has been – although in a way no one could have foreseen. The goal of the campaign was to raise awareness of the vital role of the nursing workforce and the need for greater investment in the profession. The COVID-19 pandemic has undoubtedly achieved these aims in a way that would never have been possible with any organized campaigns.
Collectively, 2020 has probably been one of the most challenging years for the human race since World War II, and it has been particularly tough for the health workforce. However, the COVID-19 cloud also has some silver linings for the nursing profession and society.
Nursing issues and COVID-19
From when the disease first spread through Wuhan in China, nurses on the frontlines made global headlines with the images of exhausted nurses with facial bruising caused by wearing PPE for hours on end.
From there, the focus on the nurse’s significant role in the pandemic picked up across the world and has still not subsided. The news coverage has been mostly negative and depressing, highlighting many of the long-standing issues in nursing.
Inadequate PPE for many frontline workers
As early as April, nursing organizations worldwide called for an urgent resolution of the shortage of the PPE needed to protect nurses against infection. As the year went on, US nursing unions’ actions focused mainly on employers’ failure to provide adequate PPE to protect health care staff and patients. An example is the day of action arranged by National Nurses United and other organizations in August – six months into the epidemic.
Organizations representing various health care professions made recommendations to the government for policy changes that would increase PPE supply and ensure that employers provided the required protection. However, nothing was done, and after nearly a year, frontline workers at many health care facilities still don’t have adequate PPE. While there was a real lack of availability at the start of the epidemic, the problem is still there appears to underscore the focus on profits before people by politicians and health care administrators.
The shortage of nurses
Nursing leaders and organizations have warned about nurses’ shortage for decades in the US and globally. This was highlighted by the State of the World’s Nursing report, which was released by the WHO on International Health Day on April 7. The report clearly demonstrates to policymakers that investment in nursing education, jobs, and leadership are essential.
Globally, there was an estimated need for 6 million more nurses even before the pandemic broke out. COVID-19 is emphasizing this point dramatically with the shortage of nurses reaching critical levels. In some areas, patients are being turned away, not due to a lack of beds and equipment, but because there are just not enough nurses to care for them.
At the start of the pandemic, many states adjusted licensing requirements or issued emergency orders to recruit more nursing staff. Currently, nurses licensed in one state can obtain a license to practice in almost every other state with little delay, whether the state is part of the nursing compact or not.
Most states have also made it easier for nurses who had left the profession to start working again, and in some states, nursing students were even allowed to graduate early or obtain a special license. The National Council for State Boards of Nursing maintains an entirely up to date schedule of each state’s requirements.
During the first wave, there were a few COVID-19 hotspots with high numbers of infected patients and hospitals were able to meet their staffing requirements with traveling nurses moving to areas where the need was the greatest. Agencies report that even then job postings for temporary nurses were around three times higher than usual.
With the current second wave in the US, a great number of cities and states are experiencing high rates of infection simultaneously and, according to hospitals and nursing agencies, the demand for nurses is rapidly outstripping supply. Even the media are carrying headlines such as the one “America Is Running Out of Nurses” which recently appeared in the New Yorker.
Across the US, health care facilities and states are competing for staff with travel nurses being offered up to $10,000 per week. There are even reports of nurses resigning from jobs in low-paying states, or where employers are not providing them with adequate protection, to become travel nurses for the highest bidder and where employers are contractually obliged to supply correct PPE.
Nursing during COVID-19
Nurses were overworked with high burnout rates even before the pandemic, and many left the profession for this reason. During the pandemic, nurses are working even more shifts, which often stretch past twelve hours, because of the need. This even applies to nurses who do not care directly for COVID-19 patients as they try to keep the other health services running with less staff.
It is clear from interviews in published media and stories which nurses have shared on social media that, besides the longer working hours, the actual tasks of caring for COVID-19 patients are emotionally draining. The patients that nurses are looking after are more critically ill than usual, and they are seeing more deaths than they have ever experienced before. As no visitors are allowed, nurses also often have to stand in for their dying patients’ families.
Furthermore, every day nurses are facing the risk of infection with the coronavirus themselves and the fear of infecting their loved ones. Statistics have shown that healthcare professionals are becoming infected with and dying from the coronavirus at a far higher rate than the public in general.
Besides burn-out and emotional distress, nurses are also suffering a moral injury caused by having to deliver substandard care because the health system has exceeded its limits. What effect will this have on the mental health of nurses, now and in the long term? Many nurse leaders have expressed their concern over this and a number of support programs have been introduced by nursing organizations and employers and will probably need to continue even when the pandemic has passed.
Despite all the challenges, as always in the history of nursing, the caring profession has stepped up to the plate and is providing the best possible care.
The upsides of COVID-19
The pandemic’s positive side might be difficult to contemplate while we are still under the second wave’s strain, but it might be just what we need to do at the close of the year to give us hope for the future.
The focus on nurses and nursing
The aims of the 2020 Year of the Nurse and Midwife were to highlight the indispensable role of the nurse, to show what modern nursing looks like, and to call for greater support and investment in the nursing workforce. COVID-19 has certainly achieved these aims worldwide. Never before have nurses and nursing had such wide news coverage in the media and as much support from the public.
Nurses have positively been portrayed as highly skilled professionals. The modern nurse was shown to look after their patients in a highly complex technological environment while still caring for each person with love and compassion.
Despite the emphasis on how tough it’s been for nurses, the nursing profession’s publicity during the pandemic appears to be paying dividends in recruitment already. Both in the US and in other parts of the world, there are reports that applications to nursing schools have increased considerably. This phenomenon was also seen after the Spanish Influenza pandemic of 1918.
Besides the positives of COVID-19 that relate specifically to nursing, there have been many others that will directly or indirectly impact the profession. We discuss just a few examples, but the future will probably reveal many more.
Growth points in science and technology
Never before has the scientific community developed solutions to a new disease so rapidly. One just needs to consider the processes of identifying the virus, developing diagnostic tests, finding treatment options that reduced the death rates considerably within the first couple of months, and now the availability of vaccines after less than a year. Much of this success can be attributed to international collaboration between scientists, enhanced by today’s rapid communication technology, and through the availability of decades of previous, often obscure, research into viruses.
Across the world, stay-at-home orders increased the publics’ use of modern communication technology. Videoconferencing has become widely accepted for work, education, and even health-care consultations. Large numbers of people have now become familiar with this technology and the greater use of videoconferencing is likely to continue after the pandemic.
Telehealth will probably become a nursing growth area because it is a cost-effective way of delivering health care to more people. Educational institutions were forced to develop new ways of using technology to teach at a distance. These new applications could provide a means to admit more students where there is a shortage of faculty and limited classroom space.
Changes in society during COVID-19
The nurse’s task of encouraging people to take responsibility for their own health should be made easier by the valuable lessons which were brought home to the public during the pandemic. They have learned that modern medicine can’t fix everything. The public had to protect themselves and others against COVID-19 through isolation, social distancing, masks, and hygiene measures.
The coronavirus also highlighted the dangers of the so-called lifestyle diseases – those chronic conditions caused mainly by unhealthy choices. After clearly seeing that people suffering from comorbidities such as obesity, diabetes, and hypertension have a significantly increased risk of severe infection and death, more people will hopefully take the steps needed to prevent these conditions.
People seem to have developed a greater sense of community across the world due to the stay-at-home orders and other effects of the pandemic. They got to know their neighbors for the first time, people stepped in and helped the frail and elderly, volunteered, and supported those who had lost loved ones. Donations to assist those who suffered economically increased. There are also reports that, in general, people seem to be kinder, more patient, and accepting.
This might be what is needed in our highly individualistic and competitive modern society, which psychologists believe is the main driver for the rise in mental illnesses, especially anxiety and depression. Research has shown that social interaction and support networks act as a buffer against mental illness.
Will COVID-19 change the future of nursing?
“We will remember the nurses who have died,” said Annette Kennedy, President of the International Council of Nurses in her message for International Nurses Day this year. “And the best way to honor their loss is to ensure that the legacy of 2020 is a stronger nursing workforce, with better access to vital equipment and pay and working conditions that reflect the high esteem that nurses are held in by the general public.”
The pandemic has set the stage for change by showcasing nursing’s nature and the value of a strong nursing workforce, highlighting the pressing issues in the profession, and gaining even more public support than before.
It remains to be seen whether the 2020 spotlight on nursing will translate to action by policymakers. It is up to us to drive this agenda. The pandemic has given nurses an even stronger voice and we must use it to advocate for the change we need.