The impact of the COVID-19 pandemic on nurses worldwide and their essential role in infectious disease management were addressed in two recently published white papers: COVID-19 and the International Supply of Nurses (www.icn.ch/system/files/documents/2020-07/COVID19_internationalsupplyofnurses_Report_FINAL.pdf) from the International Council of Nurses (ICN) and the Rapid Expert Consultation on Staffing Considerations for Crisis Standards of Care for the COVID-19 Pandemic (www.nap.edu/read/25890/chapter/1) from the National Academies of Sciences, Engineering, and Medicine. The authors of the National Academies' report note that “the availability of trained staff, more than any other element, will likely continue to be the biggest challenge of COVID-19 hospital care.” The ICN states that nurses “are central to successful progress in suppressing [the pandemic] and will be the mainstay of post COVID-19 health systems.”
An adequate supply of nurses with the right skills is critical to mounting a rapid and effective response to a pandemic such as COVID-19 and other health crises, conclude both reports after reviewing the impact of COVID-19 on health systems. They detail an initial response focused on scaling up intensive care capacity. Hospitals reconfigured units to accommodate critically ill patients while decreasing and, in some cases, eliminating elective procedures and other routine admissions. In many countries, calls went out to nonpracticing nurses to return to the workforce. In the United States, nurses were also recruited from other states to respond to hard-hit areas, notably New York City, which in the early days of the pandemic was the first “epicenter” of virus transmission. The Nursing Licensure Compact (NLC), which allows nurses with a license in one state to practice in 34 participating states, was helpful to this rapid response since obtaining a new state license can take weeks or months. Some non-NLC states also enacted emergency legislation to temporarily allow licensed nurses from other states to practice. And, as the pandemic continues, six states have pending legislation to join the NLC, according to the National Council of State Boards of Nursing.
The ICN report focuses on the pandemic's impact on global nursing, including the degree to which individual countries rely on foreign-trained nurses to supplement their workforces. Internationally, recruitment of nurses from low- and middle-income countries has been hampered by pandemic-related travel bans and country lockdowns that have prevented nurses from moving from one country to another to work. To sustain their own nursing workforce, some low- and middle-income countries have offered nurses incentives to remain in-country, while others restricted nurses from leaving or froze applications for overseas health care jobs.
The ICN report notes three major concerns in the initial response to the pandemic: maintaining safe staffing levels; staff and patient safety when nurses are called on to work in unfamiliar environments, such as providing critical care with little or no training; and inadequate personal protective equipment (PPE). The National Academies report addresses these and other challenges that could impede effective response to COVID-19 and future pandemics. Recommendations include reducing the burden of disease through community-based interventions such as physical distancing and use of masks; transferring patients to diffuse the burden of care; redistributing staff within hospitals, across facilities, and from local and national areas with less need; curtailing elective procedures and routine care; and expanded use of telemedicine. Both the ICN and the National Academies group recommend ensuring support of nurses on the front lines through measures such as increasing staffing; providing hazard pay; facilitating childcare, eldercare and transportation; and, of primary importance, ensuring the availability of appropriate PPE. Both groups underscore the importance of psychological support for nurses through counseling services, stress management, and appropriate time off.
The final impact of COVID-19 on the nursing workforce will be determined in large part by the actions of nursing coalitions and effective national and international nurse workforce policy development and implementation. In this Year of the Nurse and the Midwife, so designated by the World Health Organization in honor of the 200th anniversary of the birth of Florence Nightingale, it has never been more apparent how much every society depends on a robust, skilled, and committed nursing workforce.—Karen Roush, PhD, RN, FNP-BC, news director