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Nursing2020 covers the latest news in nursing and healthcare. See what's making headlines this month!

Wednesday, May 13, 2020

The World Health Organization (WHO) released its anticipated State of the World's Nursing 2020 report last month as the coronavirus pandemic highlighted the daily heroics of nurses around the globe. As we celebrate the 200th birthday of Florence Nightingale this week and continue to recognize National Nurses Month, let's take a look at this first-of-its-kind report and examine its major takeaways.

The WHO, in partnership with the International Council of Nurses and the global Nursing Now campaign, released the report in recognition of 2020 as the Year of the Nurse and Midwife. In the foreword, the organization points out that, while there is a lot to celebrate, there are vast inequities in the global distribution of the nurse workforce that must be addressed. The foreword also included a plea to governments and stakeholders from around the world to make significant investments in nursing education; to create at least 6 million new nursing jobs by 2030, primarily in low- and middle-income countries; and to help strengthen current and future nurse leadership. The organization argues that most countries can reach these goals with their own resources.

Major findings

Here are some of the report's key findings.

• The nursing workforce is expanding, but this expansion is inequitable, insufficient to meet the rising demand, and leaves certain populations behind. Although nursing is confirmed as the largest occupational group in the health sector and grew between 2013 and 2018, a global nursing shortage of 5.9 million still remained as of 2018. To that point, over 80% of the world's nurses are located in countries that account for only half of the world's population. Further, 89% of nursing shortages are concentrated in low- and lower middle-income countries. 

• To address the nursing shortage by 2030, the total number of nurse graduates must increase by 8% per year on average and the capacity to employ and retain these new nurses must improve. Current trends indicate that the world is on track for a needs-based nursing shortage of 5.7 million, primarily in Africa, southeast Asia, and the eastern Mediterranean.

• The evidence suggests that advanced practice nurses can increase access to primary care in rural communities and address disparities in healthcare access for vulnerable urban populations.

• One out of every eight nurses practices in a different country from the one in which they were born, which shows that the international mobility of the nursing workforce is increasing. Failure to manage nurse migration can exacerbate shortages and health access inequities. Many high-income countries are excessively reliant on international nurses due to low numbers of graduate nurses or existing nursing shortages in their countries.

• Although most countries have a body responsible for nursing regulation, nursing education and practice "is not harmonized beyond a few subregional mutual recognition arrangements." Regulatory bodies are challenged to keep education and practice guidelines updated and nursing workforce registries current.

• Approximately 90% of the nursing workforce is made up of women, but few healthcare leadership positions are held by nurses or women. There is also evidence of a gender-based pay gap as well as other forms of gender-based discrimination. Legal protections for nurses to ensure fair working hours, conditions, pay, and other social protections are in place in most countries, but they are not equal across regions. Further, 37% of countries reported having safety measures in place to prevent attacks on healthcare workers.

Major takeaways

The report underscores the need for drastic action in the next decade to solve these issues and inequities. The authors laid out some future directions for countries to pursue moving forward:

• Countries need to increase funding to educate and employ at least 5.9 million additional nurses and address the global shortage. This requires additional investments in nursing education, amounting to an estimated $10 million per capita in low- and middle-income countries.

• Countries must strengthen their capacities for healthcare workforce data collection, analysis, and use.

• Nurse mobility and migration should be monitored effectively and responsibility and ethically managed.

• Additional investment is needed in nursing faculty and to expand clinical placement programs to attract a diverse student body.

• Policymakers, employers, and regulators should coordinate to provide a positive, enabling work environment for nurses. They must also ensure that staffing levels are adequate and that policies are in place and enforced to address and respond to sexual harassment, violence, and discrimination within nursing.

• Gender-sensitive nursing workforce policies must be planned and put into action, including an equitable and gender-neutral system of remuneration among healthcare workers.

• Professional nursing regulation must be modernized, including the development of harmonized nursing education, credentialing standards, and interoperable systems to allow regulators to verify nurses' credentials and disciplinary history easily.

The full report is available for download here, and an easy-to-read summary can be found here.

Monday, April 13, 2020

At this stage of the COVID-19 pandemic, the shortage of personal protective equipment (PPE) has been a growing concern for some time. For healthcare professionals, the situation is becoming dire both at home and abroad. In some cases, nurses have had to bring in their own PPE. In a recent statement, The Joint Commission declared its support for healthcare professionals who bring in their own "standard facemasks and respirators" when their facility is otherwise unable to provide the necessary PPE.

The Joint Commission statement acknowledged that hospitals must conserve PPE to protect those performing high-risk procedures. The organization also recognized the uncertainly surrounding the use of privately owned masks or respirators in clinical settings, but it emphasized that no Joint Commission standards currently prohibit this practice. Additionally, the statement went on to note that homemade masks such as scarves and bandanas are not considered PPE. Although the CDC recently recommended the public wear cloth masks in addition to established social distancing practices, these are "an extreme measure" for healthcare professionals that should be used only as a last resort if proven PPE is unavailable.

As US healthcare professionals persevere through the COVID-19 pandemic, the government has stressed the need for citizens to protect themselves and others. To address shortages and prioritize resources related to COVID-19, President Trump invoked the Defense Protection Act in an executive order on March 18, 2020,  giving (among other provisions) wide powers of allocation to the Secretary of Health and Human Services. Hopefully, these provisions will help protect frontline healthcare professionals such as nurses when they need it most. 


Friday, March 27, 2020

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The COVID-19 pandemic has put much of the US in a standstill in recent weeks as healthcare professionals work to accommodate mounting cases around the country. COVID-19 seems to be everywhere—on social media, in the news, in the community, and in healthcare facilities. According to an online tracker of COVID-19 cases compiled by Johns Hopkins University, there were more than 90,000 confirmed cases and nearly 1,400 deaths in the US as of 2 p.m. on Friday.1

COVID-19 is caused by a specific virus called SARS-CoV-2, which has been colloquially referred to as "the coronavirus" by media outlets.2 Having originated in Wuhan, China, the virus was designated as a pandemic by the World Health Organization on March 11, 2020.3 It has affected many countries around the globe, including the US, where all 50 states are reporting cases.2

As healthcare facilities race to prepare and respond, there have been many headlines regarding public reaction, from retail business closures to supply hoarding.4,5 The practice of "social distancing" has emerged in a nationwide (if not, global) effort to curb the spread of COVID-19, with the White House issuing guidelines for limiting unnecessary exposures.6,7 These include avoiding travel, shopping outings, and social gatherings of more than 10 people, as well as working from home when possible.7

Twenty-three states have issued stay-at-home orders to date, asking residents to leave their homes only to buy food and medicine and for other "essential" reasons that vary by state, such as outdoor exercise while maintaining a safe distance from others.8  Some states had closed "non-essential" businesses but had not issued a statewide stay-at-home order as of noon Friday.8  However, many cities and counties around the country have issued stay-at-home orders, even if their states do not yet have a similar policy.

CDC efforts to reduce the spread of COVID-19 have focused on travel guidelines, resources for identification and tracking, and the development and production of diagnostic tests.2 Meanwhile, healthcare organizations and professionals continue to prepare, adapt, and provide care in uncertain times. Internationally, South Korea made testing notably accessible and efficient by opening "drive-thru" facilities, in which passengers were swabbed in their cars.9 Similar facilities have popped up in some municipalities and healthcare centers around the country as testing has ramped up in recent weeks after initial delays.10 Several clinical trials are underway to find a potential COVID-19 vaccine, and the WHO announced a major study last week that will compare treatment strategies in a streamlined clinical trial design in which doctors around the world can participate.11

The US is also among scores of countries facing a widespread shortage of personal protective equipment (PPE) for healthcare workers amid the pandemic. The WHO said in a media briefing on Friday that the PPE shortage is "now one of the most urgent threats to our collective ability to save lives."12

The Food and Drug Administration (FDA) released a guidance this week that outlines temporary policies to help curb the PPE shortage while a federal public health emergency declaration related to the COVID-19 outbreak remains in effect.13 The guidance is designed to increase the availability of general use face masks for the public and particulate filtering facepiece respirators (such as N95 respirators) for healthcare professionals. The new guidance can be found here.

The introduction of COVID-19 and subsequent efforts to contain the virus have resulted in societal changes both at home and abroad. The last few months have been chaotic and stressful around the world, especially for nurses and everyone in the healthcare workforce. Sharing knowledge and insights will be vital as the world fights this virus.

On behalf of Nursing2020, we would like to wish all our readers and their teams good health, personal safety, and the best of luck in the coming weeks. As such, we have provided the following additional resources:

• www.coronavirus.gov

• www.cdc.gov/coronavirus/2019-ncov/hcp/index.html

• www.who.int/emergencies/diseases/novel-coronavirus-2019

www.jamanetwork.com/journals/jama/fullarticle/2762692

https://tools.ovid.com/coronavirus/

https://www.nursingcenter.com/coronavirus

Stay safe!


This is a developing story. Check back with our blog for updates in which we'll share guidelines and other helpful information for nurses.

 

References

1. Coronavirus COVID-19 global cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. Coronavirus resource center. Johns Hopkins University & Medicine. 2020. www.coronavirus.jhu.edu/map.html.

2. Centers for Disease Control and Prevention. Coronavirus (COVID-19): situation summary. 2020. www.cdc.gov/coronavirus/2019-ncov/cases-updates/summary.html.

3. World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. 2020. www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.

4. Duffy C. Nike, Urban Outfitters and other retailers shuttering stores temporarily because of coronavirus. CNN. 2020. https://www.cnn.com/2020/03/15/business/retailers-nike-store-closures-coronavirus/index.html.

5. Frankel TC. The toilet paper shortage is real. But it should be brief. The Washington Post. 2020. www.washingtonpost.com/business/2020/03/13/toilet-paper-shortage.

6. Stevens H. Why outbreaks like the coronavirus spread exponentially, and how to "flatten the curve." The Washington Post. 2020. www.washingtonpost.com/graphics/2020/world/corona-simulator.

7. The president's coronavirus guidelines for America: 15 days to slow the spread. 2020. www.whitehouse.gov/wp-content/uploads/2020/03/03.16.20_coronavirus-guidance_8.5x11_315PM.pdf.

8. Secon H. Almost half of all Americans have been ordered to stay at home. This map shows which cities and states are under lockdown. Business Insider. 2020. www.businessinsider.com/us-map-stay-at-home-orders-lockdowns-2020-3.

9. Bicker L. Coronavirus in South Korea: how 'trace, test and treat' may be saving lives. BBC. 2020. www.bbc.com/news/world-asia-51836898.

10. Affo M. The US decided to make its own coronavirus test, but the process was plagued by errors and delays. Here's a timeline of what went wrong. Business Insider. 2020. www.businessinsider.com/us-coronavirus-testing-problems-timeline-2020-3.

11. Kupferschmidt K, Cohen J. Race to find COVID-19 treatments accelerates. www.science.sciencemag.org/content/367/6485/1412.

12. World Health Organization. "Media briefing on #COVID19 with @DrTedros. #coronavirus" March 27. 12:14 p.m. Tweet.

13. Food and Drug Administration. Enforcement policy for face masks and respirators during the Coronavirus Disease (COVID-19) Public Health Emergency: Guidance for Industry and Food and Drug Administration Staff. 2020. www.fda.gov/media/136449/download.


Friday, March 20, 2020

Nurses, physicians, advanced practice providers, and other caregivers are now facing overwhelming odds and experiencing not only their own fears, but also guilt. They must face not only patients whom they cannot serve adequately because of a lack of resources, but then must return home with the worry that they are potentially infecting family, friends, and neighbors they encounter. The danger in these experiences is to psychologically develop traumatic countertransference, which occurs when caregivers are faced with insurmountable odds and actually try to meet people's unrealistic expectations. The result is feelings of guilt and even anger over the inability to meet them. As caring persons, they do their best to meet the impossible demands of those who came for help.

In traumatic transference, people project their sense of helplessness and hopelessness and communicate it in many ways, including sadness and anger. The negative feelings aren't really about any one person; they are a reaction to the situation. No one else can truly understand the unique situation and all the stresses they experience. Two important things that can help in these times of crisis are friendship and prayer (or in secular terms, a sense of "mindfulness"). Something else that is essential to remain faithful as a caregiver in overwhelming situations is the ability to let go. 

As a nurse, you can only do what you can with those you serve. You can only protect yourself physically as much as possible before returning home to those you love. If you step back from your role because of guilt, over-responsibility, or the anger and pain of your patients, this is understandable. Don't pick on yourself; you have given so much you don't deserve such bad treatment—especially from yourself!   

On the other hand, if you can remain in the fray through keeping in mind and addressing the psychological dangers to you, you will be pure gift to those who need you—not simply for the physical care you offer but, of equal importance, in being able to remain with others when all you can provide is a sense of presence at a time when it is dark for patients, family, and even yourself. One of the greatest gifts you can share with others during those times is a sense of your own peace and a healthy perspective, but you can't share what you don't have. And so, be clear, but also very gentle in how you view and treat yourself. Guilt is understandable at times but, in the end, it is a waste of energy and becomes problematic not simply for you, but for those you serve and live with because the self is limited and when the resiliency reservoir is emptied, no one wins. 

***

Dr. Robert J. Wicks is the author of Perspective: The Calm within the Storm, Overcoming Secondary Stress in Medical and Nursing Practice, and co-author (with Mary Beth Werdel) of A Primer on Traumatic Growth.


Thursday, November 14, 2019

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Nursing2019 seeks qualified nurses and other health professionals willing to review and critically evaluate manuscripts to evaluate their suitability for publication, relevance to readers, and consistency with evidence-based practice. We are seeking reviewers in all fields and research. 

Peer reviewers are asked to review three or four manuscripts per year. Invitations to review a manuscript are sent via e-mail, and reviews are submitted via the manuscript management portal, Editorial Manager. The invitation to review e-mail provides an abstract, a direct link to access the manuscript, and additional instructions. Reviewers have the option of declining to review a manuscript if they feel the topic is unsuitable or circumstances at the time make completing the review impossible. If a reviewer does not acknowledge interest or decline a review (using the weblink provided within the invitation to review) within 7 days, the reviewer is automatically uninvited. Peer reviewers are not paid but can receive CE credit and are able to list their service on their CV. 

Each peer review is evaluated for quality and thoroughness by an editor and is then scored. High quality reviews earn qualified peer reviewers continuing education credits. Our publisher is accredited to provide continuing education credits to NPs, nurses, and physicians. During the peer review, reviewers are asked several questions, including if they would like to receive continuing education credits. After a high-quality review is completed, a certificate of continuing education is mailed to the address provided by the peer reviewer within Editorial Manager. 

If you would like to join our peer reviewer panel, or you have questions before deciding, please e-mail Andrei Greska at Andrei.Greska@wolterskluwer.com. Volunteer reviewers should list their areas of expertise, so we know which types of manuscripts to send, and should also attach a current CV to the e-mail.