Nurse Leaders Aspire for Greater Role in Decision-Making During and Post-Pandemic

A recent survey of nurse leaders identifies top challenges and essential focus areas for the healthcare industry to focus on to support nurses.

A survey of nurse leaders nationwide identified the top challenges they currently face during the COVID-19 pandemic.

Of the more than 200 respondents, which included assistant managers, managers, directors, and chief nursing officers, 61% reported emotional and physical fatigue among themselves and their teams, 53% reported difficulty meeting work and family needs due to inadequate staffing, and 35% reported poor organizational communication, including across departments and from senior leaders down to mid-level leaders and staff.  

"We're living through unprecedented challenges but what we're seeing is amplified versions of what our daily challenges have been for the last 20 or 30 years," says Lori Armstrong, DNP, RN, NEA-BC, CEO and chief clinical officer of Inspire Nurse Leaders, which conducted the survey.

For example, staffing has been a longstanding issue that was only exacerbated by COVID-19, says Armstrong. Early in the pandemic, while the demand for nurses to serve in ICUs and ERs rose, the need for OR nurses plummeted. This resulted in some nurses being furloughed, while other hospitals struggled to meet staffing needs. In fact, hospitals in harder-hit communities were calling in retired nurses to serve.

Nurse leaders throughout the nation were advocating with the U.S. government to loosen the restrictions on nurse licensure requirements from state to state so that nurses from the Midwest who weren't being immediately affected by the pandemic could go to New York and help, for example.

"We had to go and plead for that. My interviews with nurse leaders and the survey revealed we should have the systemic processes in place, so we don't have to formally go and beg. Restrictions should automatically be loosened during a time of an unprecedented pandemic or an emergency, but we have some legacy legislation in place state-to-state that prohibit nurses from practicing not only to the full extent of their license, but practicing where they can and when they can to help patients in need," says Armstrong.

Utilizing Goodwill to Advocate for Change

In the 1850s when Florence Nightingale returned to the United Kingdom, she was hailed as a hero due to her service in the Crimean War when she recognized the link between hygiene and sanitary practices with soldiers' mortality resulting in improved outcomes. She would go on to use her influence, clinical acumen, skills, and data to transform healthcare.

Armstrong says the pandemic and the admiration from the public currently placed on nurses puts them in a similar position to advocate for positive industry changes. The survey found that more than 50% of nurse leaders felt that they weren't involved in decisions about nursing care, which is an issue that must be addressed.

"What this survey is saying to the nurse leaders is that our global attention and our depiction as heroes, [can be used] to become a movement for influence and change. Nurses are the most influential link to quality of care," Armstrong says. "They need to be the first or the final deciding voice for decisions about patient care, nursing care, and staffing. And, sadly, that's not the case."

She recommends to hospitals to examine their governance structures to see whether their chief nurse and nurse leaders throughout the organization are involved in effective decision-making or key decision-making committees. And if they're not involved, change it.

According to Armstrong, nurse leaders have a moral obligation to push the industry forward. With hundreds of thousands of nurse leaders across the country, in very disparate types of organizations, it's hard to have that unified influence, but she says she expects them to unify in the coming years after this pandemic.

"I'm calling COVID-19 the crucible of nursing today. We're being transformed into a more refined and stronger voice with greater influence in healthcare," she says.

Moving Forward

Armstrong says the pandemic has solidified nursing's role as leaders and as the cornerstone of care delivery. So, as healthcare industry stakeholders deal with the financial and emotional well-being toll the pandemic has taken, she recommends the industry take the following actions to ensure a strong nurse leader population that can meet the challenges posed by crises like COVID-19:

• Refrain from limiting or eliminating education and leadership development dollars for nurses and nurse leaders. "We need strong, competent, and expert caregivers and leaders now more than ever," says Armstrong.
• Petition the government to provide funding opportunities to hospital and healthcare organizations to support nurse leader development efforts.
• Have schools reexamine their curriculum to include practical and experiential leadership training for baccalaureate- and master's-level nursing.
• Invest in nurse staffing model innovation aimed at achieving a more flexible design that's built on an affordable supply of nurses, demand intelligence, and the matching of patient needs to nurse competencies.  
• Activate comprehensive short- and long-term well-being support programs for all frontline workers, especially 24/7 caregivers like nurses. "We must take immediate action here. Evidence-based practices are readily available and should be considered a must-do and not a could/should do for every hospital. If we as healthcare stakeholders do not set this as a priority, mental health and wellness of every healthcare provider nurse, physician, etc. will be the next pandemic," says Armstrong.