As frontline nurses continue to care for the growing number of COVID-19 patients, enact strategies to reduce their risk of burning out.
Prior to the COVID-19 pandemic, nurses were already facing a high burnout rate—with nearly four out of 10 nurses reporting they felt burned out—possibly due to long hours, increased workloads, weak work cultures, fragmented communication from leadership, and the emotional toll from caring for significantly ill patients.
"Faced with the overwhelming emotional and physical turmoil of the pandemic, these feelings of burnout are compounded among our frontline nurses and those in nurse leadership roles to the point of trauma," says Cecil.
Staffing issues also intensify nurse burnout, she adds. Before the pandemic, departments were already struggling with staff shortages. In fact, according to an article published in 2018 in the American Journal of Medical Quality, the country is forecasted to have a shortage of more than half a million registered nurses by 2030. Now, as the pandemic stretches on, a growing number of nurses are being exposed to the virus, requiring time away from work to quarantine.
"This can be a huge loss to the department and adds to the burden of working staff. The pandemic has also encouraged many nurses to retire early, shifting to work away from the bedside, or taking more time off to spend at home with their children who are engaging in remote learning. While understandable, this puts more pressure on short-staffed nurses in the hospital," says Cecil.
Cecil shares three strategies to address the growing problem of nurse burnout.
1. Create Coaching and Mentoring Programs to Develop Leaders
To proactively combat nurse burnout, Cecil says health systems should identify good nurse leaders and support them. "Now more than ever, we need leaders capable of offering the emotional support needed to empathize, look after each nurse's personal well-being, and ensure everyone feels valued and heard."
Developing nurse leaders and others with sufficient leadership skills will help inspire their teams, put staff needs first, and position them as trustworthy mentors who can provide guidance for reducing the symptoms of burnout, she says. "Today's pandemic has the power to make or break a department and good leaders have potential to ensure their team comes out of this stronger than ever."
To provide leaders with the proper coaching and mentoring to be effective and meet the needs of their staff, Cecil suggests using independent consultants or designated leaders within your organization to provide coaching and mentoring to new leaders. The coaches and mentors should be experienced in leadership through various disciplines of nursing and should have a certification in their specialty and/or leadership. The coaching and mentoring should include bolstering communication skills, executive presence, leader rounding, delegation skills, and the ability to focus on the strengths of the staff to drive empowerment.
She also suggests that leaders have succession plans in place early on by identifying potential candidates and then providing them with consistent coaching and mentoring. A succession plan would include identifying individuals who have goals to be leaders and the necessary skills and education. Leadership courses would be used to educate them on the essential skills of leaders. As they progress, more duties to grow them as leaders would be added, while the mentors observe and provide feedback.
2. Increase Communications With Staff
Strong leaders take the time to have one-on-one conversations with each staff member, as well as facilitate group conversations, says Cecil. "An exceptional leader has strong communication skills, and connects with staff in a transparent, empathetic manner. Particularly when COVID-19 first hit and there were so many unknown factors and unpredictable patient volumes, direction was always changing. While it is OK to not have all the answers, strong leaders are up-front with nurses about what information is available, what remains unknown, and what they can expect every day to the best of their knowledge, helping to build trust."
She suggests setting up recurring 10–15-minute check-in meetings with individuals or teams at the start or end of their shifts every month or every other month to discuss how they're feeling. Doing this will make a world of difference. To make these check-ins more manageable and to ensure the responsibility doesn't fall to a single person, consider spreading them among the leadership team.
If scheduling does not allow for a team to meet regularly, Cecil suggests ensuring impromptu conversations happen regularly.
"While it is easy for these check-ins to fall to the wayside with the chaotic work environment and schedule common among nurses, leaders cannot afford to not make time for it," she says.
3. Incorporate Frontline Nurses in Decision-Making
Nurses are on the frontlines and know what the barriers are to care and can provide innovative solutions, so their input in real decision-making conversations is important, says Cecil. "Particularly during the pandemic, involving frontline nurses will not only improve an understanding of their lived experience but will also help with engagement and adoption of new processes, as well as give them the sense that they are involved in decision-making and not just being told what to do. This will ultimately keep nurses engaged in their roles and improve retention."
She says leaders should talk with staff and ask pointed questions about what's going well and what can be improved. These discussions can be guided by asking questions like, "How are you doing?" Asking how things outside of work are going, such as family and school, is especially important than ever in light of COVID-19's impact on families and homelife.
Other simple yet specific questions to ask include:
What is going well? What should we keep doing more of?
What is not going so well? What can be improved? Do you have suggestions for a solution?
In a year unlike any other, what were the hottest nursing topics? Here's a roundup of our most popular nursing stories.
As we approach the end of the calendar year, let's look back on the year that was. I have compiled a list of HealthLeaders' most-read nursing stories in 2020.
Unsurprisingly, COVID-19 was the most popular topic, followed by other themes such as nurse advancement to the C-suite, millennial and Gen Z nurses, and racism in the healthcare work environment. The following is a list of the top five HealthLeaders nursing stories, ranked by popularity.
Nurses are no longer limited in the senior leadership positions to which they can aspire. Nurses have the skills and knowledge for success in a variety of C-suite roles to make healthcare better. In this article, three healthcare executives who have advanced from the bedside to the C-suite share how their backgrounds as nurses have helped them find success leading organizations.
Having a nursing background has helped Joyce Markiewicz, RN, BSN, MBA, CHCE, executive vice president and chief business development officer at Catholic Health in Buffalo, New York, understand what makes or breaks a good business development opportunity, she says.
"Because I've been at the bedside, I look at things through a different lens. When I'm looking at a potential business opportunity, I don't always just look at what does it do to the bottom line," she says. "Of course, that's an important component of it, but I also try to look at how it aligns with the mission of Catholic Health and what it's going to do for the patient. Does it improve access to care? Is it going to provide a better service? Is it something that people need? Is it what they want?"
The COVID-19 pandemic has created an environment that calls for new ways of delivering care. This has led to a great deal of innovation from both bedside nurses and nursing leadership. In this article, nurses share how they responded to the never-seen-before crisis to care for patients and make the profession stronger.
For example, at Penn Medicine Princeton Health, in an effort to preserve PPE and provide good patient care, nurses created new care models in record time, says Sheila Kempf, PhD, RN, NEA-BC, the organization's chief nursing officer.
"In the beginning, the nurse performed all patient-related tasks because it was about preserving PPE and providing good care. For every patient on the med-surg floors who needed respiratory treatments, the nurses completed the treatments. They provided all the dietary and environmental services tasks," she says.
But following COVID-19's initial appearance, the nurses at Penn Medicine Princeton Health redesigned the nursing model to include an "inside" nurse within the patient room and an "outside" nurse or "runner" outside the patient room.
Ernest J. Grant, PhD, RN, FAAN, president of the ANA, said in the association's statement. "As a black man and registered nurse, I am appalled by senseless acts of violence, injustice, and systemic racism and discrimination. Even I have not been exempt from negative experiences with racism and discrimination. The Code of Ethics for Nurses obligates nurses to be allies and to advocate and speak up against racism, discrimination and injustice. This is non-negotiable."
In this article, Grant explains that when unchecked racism in the healthcare work environment becomes deep rooted and ingrained, it can affect the care patients of color receive. Racism in the healthcare work environment can also prevent people of color from attaining leadership level positions.
"Racism is a public health crisis, and I think as nurses, the most important thing that we can do is to educate ourselves and use the fact that we do have the trust of the [public] to influence and educate others and to realize the systemic injustice that is going on. And, of course, [nurses can] encourage people to educate themselves and to vote for political candidates who have a proven track record of working against racism and injustice. What's going to help to promote change is to realize the power of the vote that you have and the power of the voting box to help bring about change and reform," says Grant.
As millennial and Gen Z nurses have started to make up a larger portion of the nursing workforce, leaders at Nashville-based HCA Healthcare were curious about what matters to them. They teamed up with The Center for Generational Kinetics to study what drives, engages, and motivates millennial and Gen Z nurses. The results are published in the report, Employment Vitals: Millennial and Gen Z Nurse Expectations.
Millennial and Gen Z nurses cited team dynamics, professional growth opportunities, and flexible scheduling as important factors in the work environment.
Jane Englebright, PhD, RN CENP, FAAN, senior vice president and chief nurse executive at HCA Healthcare, says, "[Nurses] want to grow and develop and learn new things, but they want to do that at a little bit faster pace than what we have seen in the past. [M]ovement [in the organization] and doing something new and different feels like progression to them, whereas traditionally we thought if you weren't getting a promotion or moving into management, it wasn't progression. They see any opportunity to learn and gain new skills and knowledge as progression, which was refreshing to see."
As many Americans sheltered in place due to stay-at-home orders, nurses and other healthcare professionals worked each day to care for patients with and without COVID-19.
In this article, Megan Brunson, RN, MSN, CCRN-CSC, CNL, American Association of Critical-Care Nurses Immediate Past President and night shift supervisor for the cardiovascular ICU at Medical City Dallas shares what nurse leaders can do to support nurses during the pandemic. This includes masking and gowning up with them, acknowledging their ethical and moral conflicts, and keeping them aware of what resources are available to them, such as an Employee Assistance Program and counseling.
"We need to encourage staff to speak up when they're seeing things that are distressing them now, whether it be care situations or ethical concerns, and [to escalate those issues]. When you do that, you're asking nurses to be courageous, to speak up, and sometimes that's not easy. So being available as a leader to really encourage them to have that courage is important. Then finally, acknowledge what they're doing and their contributions," says Brunson.
The board of directors of the American Association of Nurse Practitioners announces Jon Fanning, MS, CAE, CNED, will be its next chief executive officer.
Jon Fanning, MS, CAE, CNED, has been named chief executive officer of the American Association of Nurse Practitioners (AANP). He will succeed David Hebert, JD, who is retiring, on March 1, 2021.
Since 2013, Fanning has held several roles at the American Psychiatric Association, which has 200 employees and members in more than 100 countries. Those roles included chief strategy officer, chief membership officer, and interim chief financial officer.
Global human capital consulting firm Korn Ferry conducted the candidate search in conjunction with the AANP board of directors and CEO search committee.
In a statement, AANP President, Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, said, "[Fanning] brings a wealth of leadership experience to this role and has a strategic, forward-thinking world view and vision… We look forward to working with him to advance the Association’s goals as defined in our mission and strategic plan, while representing the more than 290,000 nurse practitioners nationwide.”
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.
The survey also revealed an underrepresentation of Hispanic and Black nurses in comparison to U.S. Census data.
Although the average annual salary for registered nurses (RN) has increased, the gender pay gap between males and females has also increased to nearly $7,300 annually, according to the 2020 Nurse Salary Research Report, conducted by Nurse.com and Relias.
The report, which was based on survey results more than 7,400 nursing professions nationwide, found that the average annual salary for RNs rose by $1,630 since 2018.
However, not only did male RNs continue to make more than their female counterparts, but the pay gap also grew by nearly $700 since 2018.
Advanced practice registered nurses (APRN), licensed practical nurses (LPN), and licensed vocational nurses (LVN) also participated in the survey but no statistical difference was found between the salaries of males and females.
The report also examined demographic data and found an underrepresentation of Black and Hispanic nurses when compared to the 2010 U.S. Census data.
For example, 11% of APRNs, 11% of LPNs/LVNs, and 9% of RNs are Black, compared to 13% of the U.S. population who are Black.
Meanwhile, although 18% of the U.S. population is Hispanic, only 8% of APRNs, 7% of LPNs/LVNs, and 6% of RNs are Hispanic.
A recent survey of nurses finds that while nurses are taking on more leadership responsibilities during the pandemic, they still fall behind in the respect gap with physicians and patients.
As COVID-19 cases and hospitalizations continue to surge, nurses continue to step up and take on leadership roles. However, recent survey data suggests that there's still progress to be made with nurses being recognized as leaders during the pandemic.
A survey of 300 full-time nurses conducted by The Harris Poll on behalf of University of Phoenix between July 30 and August 11 found that 73% said that they had taken on more leadership responsibility since the beginning of the pandemic. Further, 78% reported feeling like other staff members looked to them as leaders.
For example, nurses at Providence Health Care in Vancouver took on more responsibility for appropriate personal protective equipment use, says Agnes T. Black, RN, MPH, director of health services and clinical research and knowledge translation.
Despite a majority (61%) of respondents who reported that they thought their opinions were valued more by colleagues since the pandemic began, even more (84%) would like nurses to have a stronger leadership role. In fact, 55% of respondents said they thought their voices weren't really being heard during the pandemic. Additionally, 41% said no one has taken their opinions/concerns seriously.
"It is always important to listen to the voices of nurses," says Black. "Nurses are the most numerous of the healthcare professions, and most of them are right at the point of care, so they see and hear and can interpret the feelings and experiences of the patients, other nurses, and other members of the healthcare team. Listening to nurses is like putting your finger on the pulse of healthcare itself."
Part of the issue with being taken seriously may be how others perceive the nurse role. Nearly two-thirds (65%) of respondents believed there was a respect gap in how their employers viewed nurses and physicians. This was despite the fact that most believed their employer treated them fairly (80%) and cared about their employees (77%).
Further, many nurses (63%) felt that physicians did not respect nurses as much as they respected other physicians. Similarly, three-quarters of nurses believe a respect gap exists between how patients viewed nurses and physicians.
To stand out as leaders during the pandemic, Black says nurses need to continue being more vocal, and adds, "[Nurses] are smart and capable and have important information to contribute, but too often they allow their voices to be silent. When nurses speak up, patient safety increases, health equity increases, collegial relationships are stronger, and the healthcare system improves."
Working Conditions
Beyond how they felt they were perceived by others, survey respondents were also asked how COVID-19 had affected their day-to-day work experiences. Since the pandemic began, 22% of nurses said their work-life balance has improved even though 31% said their work hours have increased. Survey respondents reported working 42 hours per week on average.
While the primary reason for the increase in hours was due to the influx in COVID-19 patients (78%), 37% reported working more to make up for other staff members who had their hours cut or were furloughed or reassigned. Likewise, 28% cited other staff members quitting as the reason for their increase in hours. Additionally, 8% said they traveled to other areas hit hard by COVID-19 to help.
Non-COVID-19 patients also contributed to the increase in work hours: 36% of survey respondents cited an overflow of patients coming from other hospitals as reasons for their increase in hours.
Twenty-one percent of survey respondents reported their work hours decreased during the pandemic. More than half of them (54%) expressed concerns with their job security although only 15% reported that their employers were struggling financially.
Of the nurses working reduced hours, the most cited reason for working fewer hours was fewer patients willing to come into the hospital/office (65%). These nurses also cited fewer scheduled elective surgeries/traumas (42%) and their physical location either being closed or seeing few patients (36%) as the reasons for working less.
Beyond the number of hours worked, the surveyed nurses report that other aspects of their jobs have changed. For example, nearly half (49%) of surveyed nurses reported that their job duties and responsibilities have changed since the beginning of the pandemic. Nurses also reported changes in the type of patients seen (39%), work settings (37%), salary/hourly wage (13%), and job title (3%).
Despite these changes, 52% of nurses said they had the same amount of career options as before the pandemic. For the rest of the respondents, 28% felt as though they have fewer options and 20% felt they have more career options. Regardless of career options, 58% of nurses believed they have become better professionals in the industry and better team members to their colleagues.
In general, 55% believed they have become better human beings since the pandemic began. More specifically, 39% thought they had been better spouses/partners/significant others, 39% better friends, and 27% better parents.
Pulse Check
Despite the extraordinary circumstances they find themselves in, most of the surveyed nurses report liking their jobs (90%) and being satisfied (88%). Moreover, most nurses recognized that their jobs are more important than ever (87%) and, if they could go back, they would still choose to be in the profession (86%). This explains why 99% were proud of the work they did, and 96% said nursing is their calling, not just a job.
Despite the demands put on nurses during the pandemic, 52% rate their current physical health as "excellent or very good." And although 45% rate their emotional/mental health as "excellent or very good," they also reported feeling exhausted (65%), fearful (49%), underappreciated (36%), depressed (30%), expendable (24%), and underutilized (8%). This may explain why 58% of nurses said their mental/emotional health has become worse since the start of the pandemic, compared to 31% who reported their mental/emotional health had stayed the same.
Additionally, 78% of respondents said that the pandemic was the most challenging time in their careers, with risk of exposure to COVID-19 being their biggest concern (88%), followed by their organization's ability to keep up with a surge of COVID-19 patients.
Editor's note: This was updated on November 10 with comments from Agnes T. Black, RN, MPH.
The virtual summit brought expert speakers together to discuss topics of interest to nurse leaders to help them navigate the current healthcare landscape and plot a road map for the future.
In the age of COVID-19, nurse leaders must grapple with new challenges—increased patient volumes and limited resources, to name a few—while managing increasingly stressed teams. The pandemic has affected all facets of healthcare but nurses on the frontlines are hit especially hard.
At the HealthLeaders Nursing Now Online Summit, sponsored by Kirby Bates Associates, in October, expert speakers discussed strategies for nurse leaders to navigate this new landscape created by COVID-19 and enrich the working environment for their teams. The following are three lessons to take away from the summit.
In addition to its impact on healthcare costs, SDOH are a huge factor in health outcomes and nurses should be mindful of them and be more engaged when interacting with patients, says Fink-Samnick. "We know that patients who are unemployed or who don't have as much access to healthcare, are really struggling with accessing appropriate care, as well as testing in their communities. COVID-19 has only made all of these factors worse. COVID-19 has totally amplified every single social determinant, which is overwhelming," she says.
Beyond tackling implicit and explicit biases that may exist against certain populations to address SDOH, Fink-Samnick calls for focusing on funding initiatives and community collaborations to establish short- and long-term sustainable programming. She points to existing successful programs as models like Blue Cross Blue Shield Institute, which partners with transportation providers, pharmacies, and grocery stores to address at-risk behaviors.
WellCare's GED test benefit program is also a success to look to as a model, says Fink-Samnick. It was created after WellCare noticed that many of its beneficiaries lacked access to education. By providing GED test prep classes, telephoning coaching, and paying testing fees, WellCare has seen substantial savings. AmeriHealth Caritas has similar programs that focus on early childhood and higher education, language literacy, and job placement.
2. Maintain Open Communication and Engagement to Help Retain Nurses
"One thing that we can do to retain nurses is keep communication open. Make people know that they are important. If I feel like I'm a part of something, if I feel like I have a say in what happens on our unit, that I'm being listened to by my leader, then I want to stay. It's just that simple," says DeBois.
Rather than just letting staff go through their day-to-day duties without checking in on them, dedicate a few minutes for short breaks in which you ask them how they're doing, if they have any suggestions to make their days go smoother, etc. DeBois says this will help keep staff engaged and give them a sense of purpose, which will ultimately help with retention.
This type of honest and open communication is the best way to show continued support for your staff and keep them encouraged, she adds. Even keeping staff in the loop about the latest comings and goings of the hospital or department will go a long way. So, for example, if there has been a shortage of PPE, provide updates on the situation and when more PPE is expected to arrive.
"You don't want to leave moments open for your staff to wonder what's going on and to feel left out of the conversation," she says.
DeBois also suggests picking a small handful of nurses to serve as team leads and says, "Recognize your nurses that are leaders on your unit and cultivate that. Let them shadow you so they understand what's going on. Then they feel a part of the team."
In turn, these team leaders can relay important information back to the rest of the team so everyone is on the same page and understand what's at stake, she adds.
3. Keep Business Communication Professional
Perhaps now more than ever, effective and professional communication among your staff is important and can strengthen team relationships and foster collaboration. Effective business communication practices can reduce instances of fragmented or hostile gossip that can serve as barriers but it's not always clear how to encourage staff to adopt these habits, says Diana Swihart, PhD, DMin, MSN, APN CS, NPD-BC, P-PCA, FAAN, CEO and managing partner of the American Academy for Preceptor Advancement.
Swihart suggests nurse leaders partner with an educator who can introduce the principles of effective communication and talk to the staff about how they can change the way they communicate or express themselves when they're working within the context of a business environment. In that same vein, inviting a representative from your human resources department to give a presentation can also be helpful.
Modeling business communication principles can also be effective, Swihart says. "You'd be surprised how many people are listening to the way that you express yourself as a nurse leader … the way that you use your language, the ways that you actively listen to them, the way that you attend when they are speaking, the way that you redirect their questions so that you can get more information and you help them to be the ones who are guiding the conversation or guiding the communication that is on the table at the time."
More than one-third of healthcare workers hospitalized for COVID-19 were nurses, underscoring the need for continued infection prevention and control practices.
During the early months of the pandemic, nurses and nursing assistants were hit particularly hard, accounting for a large percentage of healthcare workers hospitalized with COVID-19, according to an analysis released by the CDC.
The CDC says it examined 6,760 adult hospitalizations from COVID-19 in 13 states from March to May and found that nearly 6% were healthcare workers.
Of those, 36% were in nursing-related occupations. Nearly 28% of hospitalized healthcare workers were admitted to an intensive care unit, 16% required invasive mechanical ventilation, and 4% died.
Ninety percent of healthcare workers hospitalized had at least underlying condition, according to the analysis.
These conditions included obesity (73%), hypertension (41%), chronic metabolic disease (37%), diabetes (31%), chronic lung disease (27%), and asthma (18%).
The CDC says these findings underline the continued need for infection prevention and control in healthcare settings, such as use of recommended personal protective equipment, hand hygiene, and physical distancing, as well as mitigation efforts in the community to reduce the transmission of COVID-19.
BCEN's 2020 Distinguished CPEN Award winner discusses why certified nurses are suited to lead during a pandemic and how investment from hospital and nurse leadership can foster professional growth.
Certified nurses have long been champions for innovation and improvement at CHOC Children’s Hospital in Orange, California, says Lisa J. Chambers, MSN, MPS, RN, CEN, CPEN, TCRN, emergency services/trauma clinical educator, so when the COVID-19 pandemic struck, they stepped up to transform emergency department processes.
The following has been lightly edited for brevity and clarity.
HealthLeaders: How have you seen certified nurses innovating during this pandemic?
Lisa J. Chambers: Certified emergency nurses are confident in innovating improvements in emergency department flow, depending on the day-to-day needs. Our department has certified nurses making decisions on every level of department function and care provision. Creating a COVID-19 workflow in the emergency department occurred, in part, through collaborative discussions with certified nurses and the emergency physicians that work in our department.
Identifying patients and parents with potential exposures and those who also were arriving solely for a COVID-19 test was helpful early in the pandemic. Then, once the virus became community-acquired, almost every symptom that a patient presented with meant they may be a COVID-19 positive patient. We have a COVID waiting room for patients and families who arrive only wanting a COVID-19 test. They sit in family units socially-distanced and then are tested in a negative pressure area to avoid any cross-contamination.
Sick patients are processed through the department in a socially-distanced manner with increased vigilance over surface disinfection and isolation precautions. The reality is that anyone may be positive and without a negative test, everyone must be considered either positive and symptomatic or positive and asymptomatic until their COVID test is processed and reveals the results.
HealthLeaders: What characteristics do certified nurses embody that makes them suited to lead during the pandemic?
Chambers: Certified nurses have been found to be more confident in their care delivery and have a stronger knowledge base. This is because they have a deeper depth of understanding of the concepts around care.
There is a bit of risk involved with paying for the certification exam and the overarching concern that one might not pass. Finally deciding to test is a leap of faith. Studying and preparing to take the exam does take a bit of commitment … but [certification is] the seal of confidence that nurses recognize that they have indeed attained what they hoped for, and then they are able to perform at an even higher level because they themselves feel the weight of their knowledge and responsibility.
HealthLeaders:The current situation in the world has caused many to rise to the occasion, but do you have any examples of how certified nurses were innovating before the pandemic?
Chambers: All the leaders in our department have at least one certification. Our pediatric base station coordinator Kim Zaky, MSN FNP-c, MICN, CEN, CPEN, TCRN, helped our hospital establish the first pediatric base station on the West Coast.
And there are several [CPENs] on our Clinical Practice Council, which is a shared governance group. The CPENs champion many improvement processes in our department. Some examples are bedside report audits and a metabolic patient care improvement process.
HealthLeaders: What lessons can nurse leadership and/or hospital leadership take away from your experience?
Chambers: At CHOC Children’s Hospital, because we are a Magnet [Recognition Program®] hospital, we take nursing certification seriously. Nursing excellence helps us to promote excellence in care delivery and improve patient safety. Having a reimbursement and reward program in place helps the nurses know that the hospital is committed to the nurses' growth and the quality of care delivery. Up until a year ago, the cap for all reimbursement for education was kept at a one-time reimbursement of $10,000. Then last year it went to $10,000 per year. This is a very generous and helpful benefit to all of our staff.
The hospital also offers classes and many opportunities to grow and expand knowledge, experience, and leadership skills. They have invested in the infrastructure and the support standards that allow for professional and personal growth.
HealthLeaders:Post-pandemic, do you think hospitals will seek out more nurses with certification?
Chambers: That is difficult to say. There is still a nursing shortage and not all hospitals can wait for better qualified candidates to fill positions. A hospital like CHOC that truly demonstrates a commitment to help nurses grow while improving the level of care for the patients is a rare and wonderful treasure. Many hospitals want the nurses to be certified, but do not want to help the nurses afford the honor. Nurses do not tend to invest in themselves, as they are really focused on benefiting others. When nurses feel invested in, it helps to grow a sense of commitment and loyalty.
Surveyed nurse leaders who feel supported by their teams and organizations consider themselves more prepared for a future COVID-19 surge.
Nurse leaders says their biggest challenges during the COVID-19 pandemic are communicating and implementing policy changes, surge staffing and training, the emotional health and well-being of staff, and access to personal protective equipment (PPE), according to a survey conducted by AONL and Joslin Marketing.
The survey of more than 1,800 nurse leaders asked them to score how effectively they felt they were able to address these challenges.
While they reported that they felt they handled communicating and implementing policy changes and surge staffing "well," access to PPE and staff emotional health and well-being were closer to "okay."
Despite these COVID-19-related challenges, 86.23% of survey respondents felt prepared for a future surge.
Those who felt better prepared were those who felt that support from their teams and organizations exceeded or far exceeded expectations.
