The COVID-19 pandemic has presented health systems with the ultimate balancing act: Care for an influx of patients and ensure nurses and front-line staff are adequately supported, all amid staffing and personal protective equipment shortages.
Here, six nursing leaders discuss the measures health systems have implemented to protect their nurses and where more work could be done as the U.S. battles its worst virus surge yet.
Editor’s note: Responses are presented alphabetically and were lightly edited for length and clarity.
Question: Have hospitals and health systems adequately taken care of their nurses during the pandemic? What can they improve upon in 2021 to make sure nurses feel safe, happy and supported?
Debra Albert, DNP, RN, Chief Nursing Officer and Senior Vice President of Patient Care Services at NYU Langone Health (New York City): We sought to emotionally support our nursing staff by providing them with an outlet to share their stories and gather their experiences. We invited RNs to share their stories on a specially designed website, and they came flooding in.
As COVID-19 rampaged through our health system, we implemented this because we knew RNs were ripped from their normal practices and thrust into new, unfathomable roles. They were pushed to the brink of their clinical nursing skills and their emotional limits. Despite the unprecedented circumstances, we felt this was an opportune time to collect as many of the nursing stories as possible.
We wanted a record of the feelings, perceptions and experiences of all our nurses. We needed to hear of their challenges and triumphs — what went well and what went wrong. They expressed their fears and sadness, their sense of solidarity with other RNs pooling together their strengths and resources, and their pride in providing the best care possible in the worst scenarios. Most of all, the stories enabled RNs to inspire and support each other — to keep pushing forward in the face of the unknown.
Dale Beatty, DNP, RN. CNO and Vice President of Patient Care Services at Stanford Health Care (Palo Alto, Calif.): Our focus has been to enhance our structure and processes to ensure our nurses have access to various resources to help them perform their jobs safely and to take the very best care of themselves.
In addition to rigorous infection prevention measures, we established new roles and processes to ensure that safety and well-being are part of our system. A new role, interim director of COVID-19 clinical practice response, allows focused attention to nursing practice in the pandemic. Training and staffing plans developed by our Office of Research and Patient Care Services helped support staff and patient safety throughout numerous clinical trials related to caring for COVID-19 patients.
As CNO, the hospital team and I heightened our focus on nursing resilience. Our nursing psychiatry liaison held numerous debriefing sessions with front-line staff. Our shared leadership council developed a subgroup to focus on access to numerous resilience tools across Stanford Medicine.
Additionally, we've introduced programs to provide comfort and wellness for our nursing staff. These include on-demand chair massages, free counseling sessions for staff and their families, pet therapy, music in our atrium, mindfulness resilience training, anxiety-management guides and "tea for the soul" with our hospital chaplain.
Vicki Brownewell, RN. CNO and Vice President at Houston Methodist West Hospital: I am very proud of the way our entire hospital system rallied around our front-line staff, including our nurses. Almost every employee was actively doing something outside of their normal duties to support our caregivers.
For example, researchers created devices that provided extra protection for staff, and athletic trainers joined proning teams. At one point, corporate employees spent 10 percent of their time in the hospitals helping in many ways, such as being screeners or runners. While the physical help was appreciated, the sentiment of "we are all in this together" was just as important for our nurses.
Across the country, health systems could have done better by ensuring staff were financially whole when business was slow. For example, Houston Methodist managed this by placing nurses in procedural and outpatient areas. Additionally, some hospitals could have better maintained ample access to PPE. Our system had a large stockpile and never ran out. However, when we started to run low, we strategized by sterilizing and reusing PPE.
Moving forward, it will be important to look for ways technology can help provide safer, more effective care. This includes areas such as virtual communications, decision support and streamlined documentation. Hospital systems should continue to find ways for creative staffing and maintaining competencies outside of silos, which will allow us to be more flexible when sudden needs occur.
Pat Diaz, RN, a nurse at University Hospital & Medical Center (Tamarac, Fla.) and delegate for 1199SEIU United Healthcare Workers East: The COVID-19 pandemic has been a colossal failure in the way health systems and the government treated nurses and other caregivers on the front lines of public health. We were called heroes and essential, but we were treated as expendable.
Everyone knows about the critical shortages of PPE, but the lack of transparency and oversight, improper and inconsistent safety protocols, and other misguided policies put us at risk while we cared for our patients. On top of that, hospitals even cut staffing and benefits to workers in the middle of this unprecedented public health emergency, all while accepting billions of dollars in government pandemic funding.
Hospital systems, along with new government leadership, should put patients and people over profits or politics. In 2021, we expect and look forward to a better, smarter approach in and outside of our workplaces.
Ernest Grant, PhD, RN. President of the American Nurses Association: Based on input from our members and from nurses working in hospitals and healthcare facilities across the country, experiences vary. All of us recognize many employers are doing their best under unprecedented circumstances. As we see surges in cases and hospitalizations across the country, nurses' safety and well-being remain a top concern. A recent ANA survey indicates that PPE shortages persist and reuse practices for single-use PPE are on the rise, despite a lack of standard practices and evidence of safety. ANA continues to urge employers to ensure that nurses have access to the highest level of PPE, along with regular updates about the status of supplies.
Additionally, it's essential for providers to facilitate ongoing transparent communication about what is happening in the facility, in the community and nationally to protect themselves and the public. Employers of nurses must provide concrete systemwide plans to effectively manage both a surge of COVID-19 patients and to sustain operations throughout the pandemic.
The ANA continues to call for solutions to address the trauma, grief, moral distress and post- traumatic stress disorder our nursing workforce is experiencing — and will struggle with long after the COVID-19 crisis is over. The day-to-day stresses that nurses face with a recent surge in patient numbers, a rise in multiple deaths per shift, issues around access to PPE, anxieties about family and personal health, and ethical and moral conflicts have greatly impacted nurses' mental health and well-being. These insights were gleaned through a comprehensive survey conducted by the American Nurses Foundation. Employers must allow additional downtime and psychological support, and refrain from retaliating against nurses who report unsafe working conditions or voice concern over insufficient PPE. ANA condemns employers that retaliate against nurses for speaking up.
Nurses' voices must be heard and valued at all levels of a healthcare organization — not punished. We have to safeguard nurses' well-being and take heed of their invaluable insights so that we can recover faster and stronger. Recognizing and supporting the mental well-being and resilience of nurses is nonnegotiable. The daily reports of infections and deaths among nurses makes it absolutely imperative that employers continue to do everything within their powers to protect staff.
Annette Sy, DNP, RN. CNO at Keck Medical Center of USC (Los Angeles): Keck Medicine of USC took several actions to take care of our nurses during the pandemic. First, we created a Care for the Caregiver program to provide housing to nurses and other front-line staff wishing to self-quarantine away from home to safeguard family members. The program also provides access to meals, toiletries and comfort items, music therapy, financial and legal guidance, and childcare/tutoring services.
Second, we made PPE a top priority from the start. We originally experienced a shortage of N95 masks, but were able to safely stretch our supply. Today, we are in much better shape than we were back in February and March. We have grown smarter and learned we cannot rely on just one or two vendors for supplies. We are also keeping extra stock on hand to prepare for the next wave of COVID-19.
Third, we made our nurses comfortable by creating dedicated COVID-19 units. Nurses working in these units were provided additional scrubs and dedicated changing areas. We created a COVID-19 transport team so nurses would not have unnecessary exposure to the disease and dedicated elevators for COVID-19 patients to also minimize exposure.
Additionally, we have always encouraged open communication. Throughout the pandemic, our leadership team made sure to meet with our nurses, hear their concerns and work with them to address those concerns. In addition, I am holding the first of what will be several virtual town hall meetings with nurses in the upcoming weeks.