Tener Veenema, a fellow at the American Academy of Nursing; and Diane Meyer, an analyst at the Johns Hopkins Center for Health Security explain why nurses were not prepared for Covid-19, and how systems can change to better handle future public health emergencies.
As Covid-19 continues to spread across the United States, it has become evident that the country was woefully unprepared to staff, mobilize and protect our nation’s nurses in order to meet the surge of patients presenting with a severe and contagious respiratory disease. This lack of workforce preparedness is particularly shocking in light of warnings that a new pandemic would eventually emerge and the abundance of guidance and lessons learned from other events such as the 2009-2010 H1N1 pandemic and the 2013-2016 Ebola outbreak.
Nurses on the frontlines are working under extraordinary stressful circumstances and without the proper personal protective equipment (PPE) and other resources needed to keep themselves, their patients, and their own families safe. A recent survey of 32,000 nurses revealed that 87% of nurses are afraid to go to work and 36% reported having to care for an infectious patient despite inadequate PPE. Nurses reported an urgent need for education on caring for Covid-19 patients, PPE usage, personal safety and Covid-19 testing.
Nursing represents the largest sector of the global healthcare workforce. Ideally, nurses would play a critical role in preparedness and response initiatives including strategic planning, community engagement, health education and promotion, and rapid implementation of interventions safeguarding public health. So what are some of the factors that have contributed to a lack of preparedness within the national nursing workforce during this pandemic and how do we address them?
Nurses currently lack emergency preparedness education
It is critical for nurses to have the knowledge, skills and willingness to respond to pandemics. Schools of Nursing over the past 20 years have resisted integrating public health emergency preparedness and response (PHEPR) content into nursing curricula. They cite the trend of shorter and accelerated nursing programs has resulted in less time for what is deemed ‘non-essential’ content.
Following 9/11 and the 2001 Anthrax attacks, there was interest from several schools of nursing to add core competencies for nursing PHEPR; however, these efforts were short-lived. While schools of nursing teach students the basics of infection control and prevention, they lack training for disease surveillance, containment, and PPE use.
As a result, new graduates enter the profession lacking critical knowledge necessary to keep themselves and their patients safe. In the workplace, lack of knowledge is compounded as hospitals fail to make comprehensive continuing education programs available to nurses. We can address this issue by making baccalaureate and post-graduate emergency preparedness programs mandatory.
The public health system has not drilled nurses on emergency situations
Experiential exercises enable healthcare professionals to better understand their roles during an emergency. These exercises are critical in identifying gaps that can severely limit a real-time response. The Joint Commission requires that hospitals conduct emergency drills twice a year, but budget cuts have limited the scope, size and number of exercises.
The primary source for funding preparedness is through the Public Health Emergency Preparedness Cooperative Agreement and the Hospital Preparedness Program (HPP). But both programs have experienced significant funding cuts since 2003. Fortunately, the recent passage of the CARES Act includes significant funding for public health preparedness through the CDC and a $250 million appropriation to the HPP. Going forward, the use of these funds should mandate that all hospital-based and public health drills and exercises are inclusive of nurses in their design, delivery and evaluation.
Staffing shortages and a lack of cross-training left nurses ill-prepared to help their patients
Nurses have a long history of being understaffed, which has proved catastrophic for pandemic response. The Bureau of Labor and Statistics estimates that an additional 200,000 nurses will be needed each year through 2026 to fill open positions and replace retiring nurses. Investing in growing this workforce, including through education and incentivizing hospitals to maximize their nursing workforce, would greatly improve our ability to respond to future public health emergencies.
Each public health emergency will likely require a different set of competencies. For example, many Covid-19 patients have required critical care, which includes advanced skills that not all nurses possess. A radiological or nuclear emergency would require different competencies, such as decontamination and the management of thermal burns. By cross-training nurses to have skills in multiple different areas such as these, the healthcare system can better prepare itself for the inevitable fluctuations in patient needs that will occur during emergencies.
Despite stress, anxiety and long hours, nurses aren’t provided with adequate mental health care.
During the pandemic, nurses have had to care for sick colleagues, be isolated from friends and family, experience lack of physical security and more. While some hospitals have increased resources available to support the mental health and wellbeing of healthcare workers, these services remain unavailable to many nurses across the U.S. Clinician ‘burnout’ is already common amongst healthcare providers and Covid-19 will likely hasten the adverse emotional and mental health effects upon nurses. The healthcare system should move aggressively towards implementing support services in order to retain staff and keep quality of care high.
Nurses have the highest degree of contact — both in terms of time and intimacy — with patients. Investing in nursing will have a significant return on investment for disaster preparedness and response. Now is the time to heed the message that the Covid-19 pandemic has sent to drastically ramp up and expand efforts to prepare nurses for this and future pandemics.