Nurses are experiencing and witnessing disruptive behaviors in the workplace and healthcare leaders should address them to improve staff engagement, morale, and retention.
A survey of nearly 2,500 nurses on disruptive behaviors in the workplace found that 25.1% reported sometimes being ignored or given the silent treatment by other nurses, possibly putting patients at risk.
Survey respondents also reported frequently witnessing disruptive behaviors in the workplace, including seeing nurses mocked or insulted behind their backs (25.3%) and seeing others receive uneven workload assignments, seemingly based on favoritism (17.7%).
The report suggests that when disruptive behaviors are addressed, it leads to improved collaboration and communication in the workplace, as well as improving staff engagement, morale, and retention.
Healthcare leaders can begin to address disruptive behavior in the workplace by heightening awareness of them. The report, which can be downloaded here, contains a 15-question assessment tool that can be used to measure the frequency of common disruptive behaviors in the workplace.
BCEN's 2020 Distinguished CEN Award winner Jude Lark discusses how certified nurses have innovated during the pandemic and how hospital and nurse leaders can help them succeed.
The COVID-19 pandemic has challenged healthcare workers these past months like no other time in recent history but certified emergency nurses (CENs) rose to the occasion, according toJude Lark, BSN, RN, CEN, CCRN, emergency services clinical nurse educator at Atlantic Health System’s Overlook Medical Center in Summit, New Jersey.
"I believe our certified nurses came through strong. They utilized their knowledge of best practices and skills to help us facilitate and drive new, innovative ways to care for our COVID patients and each other," says Lark, who was recently named the Board of Certification for Emergency Nursing's (BCEN) 2020 Distinguished CEN Award winner.
Due to their nature, CENs have a higher level of competency and knowledge, Lark says, and they have been providing the emergency department with the expertise and the ability to adapt and drive necessary changes for the patients, staff, and the community to deliver quality and safe care during a challenging time.
CENs as Innovators
A challenge faced by emergency departments during the pandemic is safely triaging a high volume of patients who may be infected. "Right from the get-go, we had heard that we needed to become prepared. And then the patients came in one by one and then one by 100, so we had to learn as we went and teach as we went," Lark says.
In responses, Overlook Medical Center changed its triaging process, with a screener and a nurse stationed outside to screen patients for COVID-19 symptoms then appropriately place them in the department, she says. Next came figuring out how to handle the high volume and acuity of the COVID-19 patients, which necessitated setting up tents.
Staff would also need to be trained on using powered air purifying respirators (PAPRs), which no one in the department had used before, Lark says. "So, we created a video. I used physicians that came in on a Saturday and filmed the process of donning and doffing the PAPRs so that you could properly protect yourself when you're intubating or doing any aerosolization-type of process. You need to protect yourself and the rest of the community by wearing the PAPRs."
How nurses responded to codes also had to be redesigned to avoid possibly contaminating crash carts, Lark says. To avoid bringing the crash cart into a patient's room, grab-and-go bags were made so a staff member could remain outside the room and quickly hand them to someone inside. To communicate with colleagues outside the patient's room, staff members inside the room used dry erase markers to write on the windows to minimize opening and closing the door.
Help CENs Succeed
Even before the pandemic, Lark says CENs were stepping up and taking an active role as leaders due to a strong focus on shared governance at Overlook Medical Center and Atlantic Health System. CENs serve on system governance committees as well as site-specific committees that address quality, practice, professional development, and research.
Leveraging the knowledge and expertise of CENs, the health system, including the emergency department educators, developed its first emergency residency program for nurses over the past year. According to Lark, the first group of 10 emergency department nurses are set to graduate next month. "We're very excited about this type of a program that will lead to improved learning, education, critical thinking, retention, and certification."
Lark credits Overlook Medical Center with creating an environment in which CENs are encouraged to succeed and thrive through promotion of professional development and certification. "Whether you are a hospital leader or a nurse leader, promotion of [professional development] goes a long way," Lark says. For example, Overlook has provided annual certification review courses for the staff. Nurses from other health systems in the tri-state area are invited to join the review courses.
In June, Overlook held a two-day certification course with Jeff Solheim. Since then, five nurses have become certified and seven more are scheduled to sit for the exam before the end of the year, Lark says.
"It takes a leadership group to stay on track, to drive and maintain positive encouragement toward certification. The hospital must say it stands behind you and will reimburse you for everything that you're going through to become certified," she adds.
The Future of CENs
Lark predicts younger nurses and new graduates from residency nursing programs will seek out certification earlier in their careers and, as a result, their clinical abilities at the bedside will improve as the years go by.
While the pandemic has been a trying time for all healthcare workers, Lark says now is the time to regroup and reenergize nurses' passion and drive toward certification.
"I think [certification] does excite the team. It excites the newer nurses and I see more advancement in certified nurses—a higher percentage, certainly—across the country," Lark says. "I see more residency programs across the country because we're finding that this is a better way to educate that new graduate coming out of school. I believe that's part of our future."
Nurse leaders Joanne Disch and Mary Beth Kingston share insights about how to overcome challenges and continue to push nurse leadership forward as a valuable voice in the healthcare industry.
Nurse leaders are no strangers to overcoming challenges. Drawing from their experiences, Joanne Disch, PhD, RN, FAAN, board chair for Advocate Aurora Health; and Mary Beth Kingston, PhD, RN, NEA-BC, executive vice president and chief nursing officer, Advocate Aurora Health Milwaukee, recently shared their experiences as nurse leaders about how they pushed forward during a session at the recent American Organization for Nursing Leadership (AONL) 2020 Virtual Conference.
The following are four ways Disch and Kingston say nurse leadership can be strengthened:
1. Extend Professional Generosity
Disch says a chance encounter with a fellow nurse on a flight 20 years introduced her to the concept of professional generosity, a topic on which she has often written and spoken. Seated side-by-side, Disch and the other nurse spent hours exchanging advice about challenging situations they experienced. At the end of the flight, the other nurse thanked her for her professional generosity.
"[Professional generosity is] the idea that you freely give—whether it be expertise, resources, or your time—to a colleague. And there's no quid pro quo; you just want to help somebody do their very best work," says Disch.
On the other end of the spectrum, Disch also discussed her experiences with professional stinginess. "I worked with a few people who held resources too close to the chest, they didn't share information, they might not include me in workgroups that it would be appropriate that I was part of," Disch says. She adds, professional stinginess can extend further to faculty who may not share grants or publications, or make students wait for days before returning a marked paper.
2. Use Setbacks as Steppingstones
While acknowledging that there have been many wonderful moments in her career, Disch says there have been disappointments, challenges, and setbacks she has faced that have actually helped her along the way. As an example, Disch recounts that when applying for graduate school she was rejected by several schools due to her grades. "In fact, one very prominent school sent me a letter saying, 'Don't even apply for graduate school. You'll never make it,' " says Disch.
But the University of Alabama at Birmingham gave Disch a chance and accepted her, she says. At the university, Disch would go on to be named "outstanding graduate student" and find a mentor in Dr. Marguerite Kinney , who would help usher her into critical care and connect her with the American Association of Critical-Care Nurses (AACN).
"My experience there was fabulous. I was so grateful that I had gone there, and I maybe wouldn't have if anybody else hadn't rejected me," Disch says.
As far as other challenges, Disch points to professional relationships that didn't start or end up the way she would have hoped but provided opportunities for her to learn about herself and about being a leader. For example, while serving as a chief nursing executive, Disch says her first meeting with a chief operating officer (COO) started with an aggressive anti-nurse joke and a dismissive attitude.
"We embarked upon probably a yearslong effort to get to know each other and for me to understand his story," Disch says. "I look back now and I think I was using my nursing assessment, my nursing diagnostic skills, to try to get at what was the story with this person."
Disch says after learning more about the COO's background and treatment by nurses in his past, she came to understand that he was insecure and intimidated by nurses. Once an understanding was achieved, the two developed what Disch says was an incredibly collaborative relationship.
Kingston says it is common to "go into avoidance mode" when encountering someone you feel doesn't care for you or you don't particularly care for. In these situations, Disch says she likes to step back and ask herself, "What is it about them that is really irritating me? What does it say about me? What can I learn? What's their story?"
By persisting with people with whom she felt diametrically opposed, Disch says she learned much about herself and would develop professionally generous relationships.
"Setbacks can become steppingstones," Disch says. "Not everything turns out happy, but I have been so fortunate to have colleagues across my career, who have stepped forward to give me advice, give me some resources and opportunities."
3. Serve on Boards
Disch, who has served as the president of AACN and the American Academy of Nursing and as chair of the National Board of Directors for AARP, says she has faced challenges while serving on nursing and non-nursing boards but the unique attributes nurses contribute are priceless.
"What we bring is a sort of understanding of the human condition. We know on the ground level what healthcare means, what it has to look like, what threats to safety and quality are, and we think about people in the context of their families. We are relationship-based/big picture, and yet can be very focused on the details of this particular patient and their family," Disch says.
Having a nurse serve on a board changes the conversation and the focus, Kingston says. While everyone on the board is concerned about quality, they all may not necessarily understand what that means. Having a nurse present can help the board probe an issue rather than accepting everything at face value.
"A nurse will say, 'Can you dig a little bit deeper into that? And what about X? What about by Y? Going down a layer beneath the report is really valuable," Kingston says.
Disch adds that even when a board has a physician on it, a nurse's perspective is still valuable. "Nurses know what happens at 2 a.m., which, on average, many physicians don't. So, physicians are great, they should be on the boards and also nurses, because of the perspective."
4. Know how to handle crisis
Nurse leaders are currently facing extraordinary circumstances as the country continues to deal with the ongoing COVID-19 pandemic.
"It's very hard being a leader today. At times in my career, I phrased it as taking people on a journey on which nobody wants to go," Disch says. So, during times of crisis, it's important to fall back on your relationships, she advises. When faced with issues and challenges, she suggests bringing together a team to brainstorm and ensure you get enough input to decide the best strategy, but to move expediently.
Disch says it’s also important to think differently and challenge yourself to not rush back to the way you've always done things.
Kingston adds, "We all do come to those situations with our own biases and experiences and it's more comfortable to want to go back to the way it was. I think that right now is going to change the game, for sure."
The president of the American Association of Nurse Practitioners discusses challenges nurse practitioners face during the pandemic and advocates for modernized practice guidelines.
As the U.S. healthcare system continues to grapple with COVID-19, nurse practitioners (NP) who have traditionally practiced in a variety of healthcare settings continue to serve a vital role in the response to the pandemic.
"When COVID-19 first hit back in the spring, we had thousands of nurse practitioners answer calls to serve and volunteer on the frontline, especially in New York, which was very hard hit," says Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP,president of the American Association of Nurse Practitioners (AANP). Since then, NPs have continued to serve across the country, including leaving their own practices to go work surge staffing, staying in their own practices to diagnose and treat COVID-19 in the outpatient setting, and serving as acute care NPs in the hospital setting managing acutely ill patients on ventilators, Thomas says.
Early on, NPs faced many of the same challenges as other healthcare providers: personal protective equipment (PPE) shortages, ever-changing Centers for Disease Control and Prevention care guidelines, and limited access to COVID-19 testing, Thomas says. With improved supplies of PPE and more readily available testing as more private labs have come on board, these barriers are lessened for NPs.
Persisting Challenges
While a recent survey conducted by the AANP finds that a majority of NPs (82%) reported that their practices are better prepared to manage COVID-19 patients than at the beginning of the pandemic, some of the challenges from the early days of the pandemic persist.
"In some areas, testing is still limited to a certain set of eligibility criteria. I think that those are pockets of the country that still don’t have ample supplies, or it might be institutional restrictions that say that patients have to meet a certain set of criteria for testing," Thomas says.
According to the survey, 36% of respondents reported having patients turned away from testing sites for not meeting specific criteria. Even when patients are tested, 78% of NPs reported significant delays receiving the test results.
Perhaps the biggest challenge facing NPs is outdated practice guidelines that exist in many states regarding NPs, Thomas says. In many states, NPs are required to have a collaborative practice agreement with a physician that includes a number of provisions, but she says there's no evidence to support that having such an agreement improves quality of care or access to care.
During the pandemic, some states have issued emergency waivers suspending collaborative practice agreement requirements for NPs to increase capacity and improve access to care. "We'd really like for those governors to make those waivers permanent, and then have other governors get on board with modernizing their outdated licensure requirements so we can really do everything that we can to improve the overall health of this country," Thomas says.
COVID-19's Lasting Effect
While the pandemic has highlighted ongoing issues with the U.S. healthcare system, it has resulted in some beneficial consequences. For example, Thomas points to a whole new appreciation for infection prevention and control among the healthcare community and the general public, adding now more than ever there's an awareness of the importance of hand washing as it relates to the spread of disease.
COVID-19 has also shone a light on the health disparities and access to care issues that still exist in this country, Thomas says, "And we really need all healthcare providers practicing to the top of their license to be able to provide access to patients who so desperately need it. … There are millions of patients that live in health professional shortage areas, and we know that NPs will go and practice in these underserved areas."
Thomas says she also believes telehealth will be the wave of the future for NPs and will play an important part in their role as they look at ways to improve access to care. During the pandemic, federal waivers have gone a long way with popularizing teleheath's use. Before COVID-19, telehealth was restricted to Medicare patients living in rural communities. The temporary waivers remove certain Medicare limitations on telehealth, opening it up to a larger patient population.
Thomas says telehealth is a way to provide access to healthcare for people who may otherwise go without it or who may be inconvenienced when they seek it out. For example, working parents or patients who must work all day may otherwise be unable to get away for a medical appointment. With telehealth, patients can access medical services from their home or office without having to worry about driving to an appointment and waiting to be seen.
"It's definitely something that's here to stay and I'm very pleased about that," Thomas says.
Charleen C. McNeill, PhD, MSN, RN, discusses key findings from a survey of nurses' emergency preparedness competence, the current state of emergency training, and what nurse leaders can do about it.
In addition to the ongoing COVID-19 pandemic, the United States and the world continues to be challenged by disasters, such as droughts, earthquakes, fires, floods, severe weather events, and terrorism. When they occur, nurses are called on to respond during and following a disaster.
"Nurses are widely recognized for the key roles they play in disaster preparedness and response," says Charleen C. McNeill, PhD, MSN, RN, an associate professor in the nursing science department at East Carolina University College of Nursing in Greenville, North Carolina. As the largest body of healthcare providers who often find themselves involved in the acute post-disaster phase of response measures, nurses are critical in preparedness efforts and must educate themselves on the risks and hazards in the areas in which they live in order to plan appropriate response measures, McNeill says.
Unfortunately, nurses may not be receiving the training in emergency preparedness to meet the public's needs in response to a disaster. McNeill recently co-authored a study in The Journal of Nursing Administration that examined nurses' self-reported levels of professional emergency preparedness competence, including their likelihood of reporting to work in response to a disaster.
Nurses' professional emergency preparedness is an indicator of their level of knowledge in preparing for and responding to a myriad of public health emergencies and disaster types, and is critical in facilitating positive health outcomes, McNeill says. "If nurses lack professional emergency preparedness competence, the ability of the healthcare sector to respond adequately during a crisis will be degraded, resulting in increased morbidity and mortality of impacted populations."
In a survey of nearly 200 registered nurses and licensed practical nurses, respondents scored highest when asked about triage and basic first aid competence—43% provided a positive response, meaning they were familiar or very familiar with the topic. "Triage and first aid are skills taught at the baccalaureate level and utilized most frequently in practice, particularly in emergency departments, so it is logical that nurses would score highest in this category," McNeill says.
However, other than triage and first aid, all other categories had low positive response rates, McNeill says, including:
26% for the incident command system
23% for isolation, quarantine, and decontamination
21% for psychological issues
18% for detention and epidemiology
18% for clinical decision-making
13% for accessing critical resources and reporting
"As these topics are not taught at all or not taught in detail as they relate to disasters as a part of formal education in the college or university setting, it is logical that nurses would score lowest in them," McNeill says.
The Current State of Emergency Preparedness Training
As the credentialing body for nursing programs for colleges and universities, the American Nurses Credentialing Center provides the framework for baccalaureate-, masters-, and doctoral-level nursing education.
At the baccalaureate level, there is some guidance about what a nurse with a Bachelor of Science in Nursing should know about disasters as a generalist, McNeill says. However, there are very few questions on the National Council Licensure Examination related to disasters, meaning the content may not be a priority in an overburdened curriculum.
"Additionally, competencies in disaster content at the [Master of Science in Nursing] and [Doctor of Nursing Practice] levels are notably absent, though these competencies are in the process of being updated and it is hopeful such content will be included. As a result, nurses must obtain training above and beyond their degree programs to gain necessary professional emergency competence. While there are sources available to do this, including the content in formal education programs would be critical to improving baseline nursing knowledge of and response to disasters and emergencies," she says.
McNeill says she is hesitant to suggest best practices to ensure nurses are competent in emergency preparedness. "Recommending best practices implies that many methods of ensuring competence in emergency preparedness areas have been utilized and evaluated to provide the basis, or empirical evidence, to make such recommendations. However, though these topics are taught using various methodologies by a number of different organizations, methods of teaching have not been evaluated enough to provide recommendations of best practices."
She adds that in the 15 years since the nursing community began evaluating disaster nursing knowledge formally, knowledge has not improved significantly. This underscores the need to formalize this education in college and university curriculums and evaluate its effectiveness.
"It is my hope that it will improve, but time will tell. Until then, we must begin with a restructuring of formal Disaster Nursing education in the U.S. as recommended by ['Call to Action.']"
Editor's note: This story was updated on September 14, 2020.
Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP, DBH(s), of EFS Supervision Strategies, LLC., discusses key vicarious trauma concepts, how to assess it in the workplace, and strategies and available resources to manage it.
As the COVID-19 pandemic continues to stretch the country's healthcare system to its limits, frontline healthcare professionals are at greater risk of experiencing vicarious trauma. Beyond normal stress, vicarious trauma results from repeated exposure to traumatic events that lead to escalated feelings of powerlessness and guilt similar to post-traumatic stress disorder. In turn, healthcare professionals who experience vicarious trauma are susceptible to increased stress, anxiety, substance abuse, depression, and unfortunately, suicide.
"We are just seeing the start of a mental health crisis from the pandemic. Probably not a day goes by in which we don't see at least 10–15 headlines on various new terminology about mental health as a crisis," says Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP, DBH(s), of EFS Supervision Strategies, LLC. "While this was still going on, we felt that it was essential to just acknowledge and think what we need to do to best prepare our workforce for what is coming and what to expect moving forward."
In a recent HealthLeaders webinar, Fink-Samnick discussed key vicarious trauma concepts, how to assess it in the workplace, and strategies and available resources to manage it.
After her presentation, Fink-Samnick answered questions from the audience. The following transcript of that question-and-answer session from the webinar has been edited for brevity and clarity.
Q:Do you have a self-assessment or inventory worksheet you can recommend?
Fink-Samnick: There are so many! The Coronavirus Anxiety Workbook is a great resource for self-assessment. I've had colleagues use it themselves. I've had colleagues use it with patients with severe mental illness. It really speaks to a whole boatload of symptoms to normalize the realities that we're facing right now because everyone's anxious. Anxiety before COVID-19 was probably the top behavioral health symptom. And we know the challenges with anxiety when it totally interferes with our occupational and our life functioning, which many people are feeling right now. The workbook is awesome.
PsychHub and the Mental Health Playbook have a lot of health assessment sheets. Another site is called Therapist Aid. Anybody that does behavioral health knows that this is one of the prime sites that treatment professionals use. It is full of self-assessments on anxiety, stress, and depression.
One of my favorite tools is called a DASS-21. It is 21 very simple questions that you score and it will give you the level of anxiety, depression, and stress. It is a beautiful worksheet that can really help you level set where you’re at. It is also one of my favorite ones to use with clients. I’m not ashamed to admit that I even use it myself to do a check-in. So, hopefully those are helpful.
Q: I noticed my staff are getting very testy with each other. Do you have suggestions for diffusing this before it gets out of control? They have been a cohesive team and now they are complaining about each other.
Fink-Samnick: This is common in any environment where there's stress. It's a dynamic that is common in workplaces that are facing budget cuts. I often talk about it even in the context of workplace bullying where staff get crispy around the edges; they're scared, they worry, and they can't talk about it. You want to try to pull them together for a "kumbaya" moment, but they don't want to.
The best way that I have found to deal with that with colleagues is to just approach them. Go up to them and say, "Hey, what gives today?" Don't try to explain it or try to rationalize it. Some people have asked if they can go up to a colleague and give them a hug. Well, I suppose yes, if you have that kind of relationship.
You can try to tell folks, "You can feel this way but don't take it out on each other. It's only going to make it rougher. The first thing people do when they get frustrated is take it out on each other. That's the most normal thing in the world but that's not going to cut it. That makes your work workplace and work experience even tougher.
I'm a firm believer—as a New Yorker—in getting out of the corner and saying, "I know you are testy. I know you're crispy. Stop! Let's figure out together how to work through it." That's a thing that folks have done. They get together and they [say], "All right, everybody's feeling it. Let's figure out how to get rid of it right now." And tomorrow they may need something else and that's OK.
Q: How do we best cope with the reality of colleagues and friends who are not following Centers for Disease Control and Prevention (CDC) protocols (e.g., wearing masks, social distancing)?
Fink-Samnick: I want to be respectful because there may be some listening to this webinar that have their own views and maybe cringe when I mention the CDC. I often say you can't be accountable for everybody else. You can only be accountable for your own practice, your own patterns, and what you do. So, what do we do? You try to educate. You try to guide. You be mindful of your distance from those people, try to inform them, and then let it go. You've got to save the energy and use it where you can. But you've got to protect yourself; you absolutely must protect yourself.
Q:Have you heard of Code Lavender? Any successes with that type of program?
Fink-Samnick: Code Lavenders are interesting. I think every organization is trying to do something special for the workforce with positive acknowledgments and really trying to reframe. There are different types of programs, so I'm going to talk broadly. For example, there are things like at a hospital that has a higher percentage of COVID patients, [so] music plays every time there's a discharge.
The interesting thing about Code Lavenders is that they were not designed for the workforce but more for patients, family members, or other visitors to achieve emotional equilibrium. To that end, there is an opportunity for the industry and its organizations to develop unique initiatives to address workforce stress and its behavioral manifestations.
Betty Nelson discusses how the pandemic has changed nursing education, what changes may come, and how nursing educators are looking forward.
The intensity and volume of the COVID-19 pandemic has forced nurse educators to reexamine how to educate nurses and stay on track for completion. As a result, nurse leaders have stepped up to ensure learning educational milestones are met while maintaining patients' health and safety.
"This is a real opportunity. We have to make sure that we continue to demonstrate the intelligent and effective leadership capabilities of nurses as leaders in healthcare and being seen as a credible authority for decisions and actions," says Betty Nelson, PhD, RN, dean of the School of Nursing & Health Sciences at Capella University in Minneapolis. "Nurse leaders in this country are exceptionally talented, prepared, and skillful but are not always brought to the table. This crisis has brought more nursing leaders to the table; staying at the table is essential for continuing effectiveness, not just a response to the pandemic."
In a recent interview with HealthLeaders, Nelson discusses how nurse leaders have adapted education in response to the pandemic, how it may continue to change, and why nurse leaders need to stay proactive.
The following transcript has been edited for brevity and clarity.
HealthLeaders: Set the scene for us: What has nursing education been like during the COVID-19 pandemic?
Betty Nelson: The COVID-19 pandemic has created a number of new challenges for nursing education and exacerbated existing ones. Perhaps the most prominent challenge is our ability to provide learning experiences in clinical settings. Many clinical settings had already been stretched to capacity for students. COVID-19 necessitated a halt in student access to clinical settings. At Capella University, all our programs have clinical placement requirements that align with professional standards that must be met, and skills and competencies that must be tested.
Our programs are designed, however, in ways that allowed us to adjust the clinical experience requirements to leverage remote and virtual experiences. Many of my colleagues who offer pre-licensure programs have maximized the use of high-fidelity simulations and virtual experiences. But that can't replace human patient interaction 100%. The threshold can be raised higher, but hands-on patient care experience is necessary.
In addition to telehealth, which is the application of communication technology to direct patient care, the application of telecommunication skills and techniques are being adopted in healthcare management as well. The pandemic is challenging us to design and deliver creative solutions to decreased availability of clinical settings yet still deliver effective education that meets professional standards and desirable learning outcomes. Using tools and methods that leverage remote technologies is an exciting opportunity.
HL:How do you think nursing education will change going forward?
Nelson: That's a very difficult question. Nursing education is not homogeneous. Different schools structure their programs and experiences differently based on their school-level philosophies. All of us act to meet accreditation requirements, both programmatic and regional accreditation. However, the comfort level with utilizing assisted-education tools and techniques like simulation, virtual, and remote varies greatly among schools.
Some of that is not necessarily just philosophical, it's financial. It's expensive to have a simulation laboratory, and it's expensive to have some of the IT support required to seek these remote or technology-driven opportunities.
This is an exciting and challenging time for our accreditation and regulatory organizations. The strain on clinical site access set against the rising need by nursing schools for clinical site access, requires accreditors and regulators to evaluate standards and requirements relative to a safe balance between in-person patient care experiences and remote and simulated patient care experiences. Maybe some standards will have to change or new ones will be developed.
HL:What are your big concerns for nursing education in the near and long term?
Nelson: My biggest concern is that we need to be more planful and responsive. This isn't new; the pandemic is shining a bright light on it. We should be looking into the future to identify knowledge and skills needed to respond to and anticipate changes in the healthcare system, patient care sciences, patient and community needs, environmental impacts on health, and demographics.
This is not just a nursing problem, it's a healthcare system problem. We are the biggest group of healthcare providers, so we can be in a position of leadership in this area.
