Nurses, NPs, and other APRNs on the front lines of COVID-19: How do we protect the nursing workforce?

Author(s): Donna Hallas PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN

COVID-19

Today, we cannot escape the turmoil of living every moment of every day immersed within the chaos of the novel COVID-19 pandemic. Registered nurses (RNs), nurse practitioners (NPs), and other advanced practice registered nurses (APRNs: certified registered nurse anesthetists, clinical nurse specialists, and nurse-midwives) are on the front lines of these unprecedented times and are concerned for their patients and the unknown potential adverse effects of COVID-19, the effects on their personal and family’s health and well-being, and the communicability within the neighborhoods in which they live and work.

Nurses, NPs, and APRNs, are being asked to practice in ways that clearly ignore the tenets of evidence-based practice (EBP). It is unthinkable that nurses, NPs, and APRNs are given one mask to wear while caring for patients and asked to place it in a paper bag at the end of the shift and reuse the mask for one week! All nurses and NPs know that the practice of reusing masks is contradictory to every principle of infection control, which we all study in the first semester of our nursing education programs. Why would workforce practices be so inconsistent with EBP? What options do nurses, NPs, and APRNs have to advocate for themselves, their colleagues, and their patients?

Unprecedented times demand unprecedented measures to be enacted and implemented but NOT measures that threaten not only the nurses and NPs but the entire healthcare workforce. In a March 20, 2020, commentary on COVID-19, John Mandrola MD, a cardiac electrophysiologist, succinctly wrote, “Some of use will become ill and die. It’s a numbers game”. But why? Because of the lack of personal protective equipment (PPE)? Is it an expectation that healthcare workers must make the ultimate sacrifice directly related to a lack of PPE? It is unthinkable that a child will grow up without a mother or father, that families will be emotionally devastated by this pandemic because manufacturers in the United Stated are not producing enough PPE to protect the entire healthcare workforce.

Is the answer to “What options do we have” embedded in the principles of public health policy and advocacy for ourselves, our patients, our families, our communities? Morally and ethically, we cannot and will not say to our patients we cannot take care of you. However, we can loudly and clearly inform our elected officials to lead by creating and signing executive orders mandating the immediate manufacturing and dissemination of PPE for all healthcare providers. Call and continue to call daily, your elected state and national officials and make your voices heard now!

Now that I have raised your anxiety levels and hopefully, impelled your inner strength to advocate for yourself and all healthcare professionals fighting on the front lines of the COVID-19 pandemic, I want to share that I invited my colleague, Dr. Judith Haber, The Ursula Springer Leadership Professor in Nursing at NYU Rory Meyers College of Nursing, an internationally recognized advanced practice psychiatric nurse, to provide insights into maintaining our mental health throughout this crisis.

Dr. Judith Haber’s sagacious remarks follow:

As RNs, NPs, and APRNs we are being challenged every day as we commit to taking care of COVID-19 patients under the most arduous conditions. In doing so, our safety and well-being is being compromised—not only our physical health, but our mental health as well. Maintaining our well-being is crucial! Paying attention to our mental health needs is something we easily forget until we are overwhelmed by the stress of working to make a dent in this terrifying pandemic.

So here are some tips to promote your mental health as you strive to preserve some life balance.

Remember that you continue to have a hunger for real connection with family, friends, and colleagues.

Even as you are socially distant from your loved ones and play pals, you probably have a real desire to connect with people outside of your workplace. That is especially true in these uncertain times. I am finding that more and more people, including nurses, are asking to use videos on calls that were voice-only a few weeks ago. And it’s not about getting dressed up, in fact, it’s the opposite. People want to be seen as who they are, the more unplugged and authentic, the better. So, chat it up on Zoom, FaceTime, Facebook, or Google Chat, or Hangout.

Put the usual into the unusual. 

At a time when things feel anything but normal, we try to preserve a sense of normalcy. People, whether colleagues or friends, who used to have lunch together once or twice a week, are eating together over FaceTime. They are getting together at the end of the week for virtual happy hours or quarantine parties. Don’t feel guilty for taking some time to have fun. Getting together virtually de-escalates the stress you are experiencing at work so that you return to work better equipped to provide high-quality care to your patients.

Identify your favorite stress busters to do at home. 

Each of us has one or more favorite ways to relax and dial back the needle on our hectic work environments. Take your pick! Exercise, yoga, meditation, walking, running, knitting, puzzles, card games, and cooking are just a few of the many ways you can choose to de-escalate the stress of taking care of very sick patients, all too often without the protective gear you need to maximize your safety. You are entitled to relax and engage in activities that enhance release of your own mood elevating serotonin and norepinephrine neurotransmitters.

Be an advocate for yourself and others. 

The expression, “I have your back” has never been more important! As nurses, we need to look out for each other, share resources, provide words of encouragement, and give an elbow bump to a colleague who looks like they could use a lift. Asking somebody “how are you” has often been a conversation filler, until now. These days, each of us should go out of our way to make sincere inquiries about how your colleagues and their loved ones are doing today. Instead of the usual, expected reply of “I’m great, thanks”, people are being genuinely caring when asking this question.

Finally, advocating for yourself and your colleagues for masks, gowns, gloves, and other resources is so important even knowing they are in short supply…we never give up having a strong nursing voice that tries to make a difference!

Advocate for all healthcare providers.

Call your elected state and national officials and make your voices heard. We need PPE now! 

Reference

Mandrola J. COVID-19 and PPE: Some of us will die because of the shortage. Medscape. 2020. www.medscape.com/viewarticle/927206

Donna Hallas PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN is a certified as a pediatric nurse practitioner and pediatric primary care mental health specialist. She is a Clinical Professor and Director of the PNP program at New York University Rory Meyers College of Nursing. She has presented nationally and internationally on numerous research and clinical topics with the overall goal of improving health care outcomes for infants, children, adolescents and young adults. 

Her first book, Behavioral pediatric healthcare: A growth and developmental approach to intercepting abnormal behaviors, earned the prestigious American Journal of Nursing 2018 Book of the Year Award earning first place for Psychiatric and Mental Health Nursing and third place for Child Health.

Dr. Hallas is a digital editor for Contemporary Pediatrics and writes a monthly commentary which focuses on applying information in one or more journal articles to pediatric clinical practice. Here is a link to the PNP corner www.contemporarypediatrics.com/pnp-corner.

Dr. Hallas’ most recent research focuses on vaccine hesitancy. She and colleagues designed a web-based intervention study using the concepts of informed decision making and the influence of social media. The study was conducted using two populations: pregnant women  and mothers of newborns and young infants to determine the effectiveness of population-specific web-based interventions to reduce the incidence of vaccine hesitancy (Hallas, Altman, & Fletcher, 2018). The study was statistically significant for prenatal women and approached statistical significance for mothers of newborns and young infants. 

Please click on this link for a brief discussion by Dr. Hallas on vaccine hesitancy and the most recent measles outbreak: https://www.nyu.edu/about/news-publications/news/2019/october/one-question–why-do-some-parents-hesitate-to-vaccinate-their-ch.html.

Editor’s Note 3/27: This post was originally posted on Women’s Healthcare as part of the My Nurse Influencer program.

5 COMMENTS

  1. I also have a comment related to APRNs of which there are four; NPs, CRNAs, MWs and CNSs (Clinical Nurse Specialist. The latter was not mentioned as an APRN in the article and I can assure you we are here with our colleagues from the other three groups as well as the RNs being challenged to step outside of our element to assist n this crisis. We have been asked to fit test staff, work in the incident command center, audit charts to ensure PUI were screened correctly, work in the staffing center, act as PPE Czar and whatever else we can do to help.

    • Thank you so much for your feedback. We have worked with the author and have adjusted the blog to have more inclusive language around the group of APRNs.

  2. Do you even know what a CRNA is? Certified Registered Nurse Anesthetists are on the front line too! I recommend the author contact the AANA to get an education.

    • Thank you so much for your feedback. We have worked with the author and have adjusted the blog to have more inclusive language.

  3. Frontier Nursing University and our network of nurse-midwives and nurse practitioners are at the frontlines and leading efforts to ensure the health and safety of communities across the country. As the reach and impact of the COVID-19 virus continues to evolve, the health, safety and well-being of all our community members remains our priority. We are working in alignment with local, state and national agencies and government to actively and responsibly respond to this public health threat.

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