Nurses have won the hearts and minds of the American public for their acts of true heroism, unbounded compassion, and expert skill during the COVID-19 pandemic. For the 18th year in a row, nurses were voted the most trusted, ethical, and honest profession in a Gallup poll. But it’s still often a struggle for clinical nurses to have their voices heard in venues where policy decisions are made that directly affect how we care for our patients. While nursing remains the largest workforce in the hospital, nurses still have to fight for a seat at the table.
What we have seen with the COVID-19 crisis is that while other departments are thinned and made to work remotely, hospital leaders are working tirelessly to ramp up the number of clinical nurses to care for patients with COVID-19 and meet the demands of the additional responsibilities they are now expected to take on. It has become abundantly clear how crucial the clinical nurse is to keeping the hospital going.
Before the pandemic hit our hospital with a vengeance and our services were still in full swing, hospital leaders began making plans for nurses to screen visitors in the lobby for signs and symptoms of the virus. Fearing that this added responsibility would remove clinical nurses from the bedside, we questioned the need for nurses to ask the standard screening questions. We were met with a resounding, “It HAS to be a nurse!” Clinical nurses were called upon to manage the screening table because their clinical knowledge, assessment skills, and judgment were seen as indispensable in determining who could enter the building or not. Overnight, nursing staff essentially became the hospital gatekeepers in a highly dangerous time.
We had to quickly convert our orthopedic unit into a COVID-19 medicine unit and onboard over 30 redeployed staff from the operating rooms, postanesthesia care units, pediatric units, and pre-admission testing as our hospital was reconfigured to create maximum capacity for COVID-19 patients. During the first week that we began receiving patients with COVID-19, it seemed that other ancillary staff were scarcer than ever before. For example, to minimize exposure and decrease use of personal protective equipment, dietary personnel were no longer entering patient rooms to take meal orders or deliver meal trays. The meal trays were left on a cart in the middle of the unit and had to be distributed to each of our 30 patients within 30 minutes to meet food safety guidelines. Nursing staff quickly solved that problem, as nurses do—they came up with a process to streamline the passing of meal trays and placing menu orders for their patients. In addition, environmental services workers were no longer entering rooms to empty trashcans. It would be a responsibility of the nurse to move the trashcans to the doorway for emptying, again in effort to conserve personal protective equipment for the essential clinical nurse. The clinical nurses, already overburdened with orienting redeployed staff, had to take on this additional role too.
As the weeks have passed and waves of COVID-19 patients have flooded in and out of our doors, it has become abundantly clear that the clinical nurses have truly made our successes happen. Over the past few weeks, savvy and caring clinical nurses persuaded the kitchen to puree lentil soup so an 88-year-old woman with advanced dementia, one of our first COVID-19 patients who came to us from a nursing home, could finally eat something she liked. They also arranged a surprise Facetime birthday party with a 40-year-old COVID-19 patient and his mom that brought tears to everyone’s eyes. Nurses have succeeded in restoring humanity to keep families together in a time when they are unnaturally forced to be apart.
Clinical nurses have their finger on the pulse of each person under their care, literally and figuratively. As the layers of other disciplines have been peeled away, what is left is the single most important relationship at the core of patient care—the relationship between the nurse and patient. The pandemic has shown beyond a doubt that nurses are the backbone of healthcare organizations.
Just as the pandemic has reconnected many nurses to the values, ethics, and passion that brought them into the profession in the first place, this time, rightfully named the Year of the Nurse and the Midwife, may be an opportunity for us to own our practice in new ways. It’s time for us to take our seat at the table.
Marisa DeFilippis is a nurse manager at NYU Langone Orthopedic Hospital in New York.