Reflections on 2020: The Year of the Nurse

Reflections on 2020: The Year of the Nurse Jan M. Foote, DNP, ARNP, CPNP, AP-PEN

The year 2020 was designated as the International Year of the Nurse and the Midwife by the World Health Organization (2020) to recognize the critical contributions that nurses and midwives make to global health and to highlight the need to invest in the nursing workforce. The designation honors the 200th anniversary of the birth of Florence Nightingale, the founder of both modern nursing as a profession and formal nursing education. Nursing is the lifeblood of every health system and nurses accounts for more than half of the global healthcare workforce. Nurses around the world are often the first and sometimes the only health care point of contact for individuals and communities, providing evidence-based care from birth to end-of-life.

As nursing organizations prepared to celebrate Florence’s birthday and the vast contributions of nursing to humanity, the COVID-19 pandemic swept across the globe. The convergence of the Year of the Nurse with the pandemic represents a poignant coincidence. Florence’s contributions to public health and epidemiology are clearly recognizable today in the measures advocated to contain coronavirus disease.

During the Crimean War, Florence witnessed even more communicable diseases (e.g., dysentery, cholera, typhoid fever, and typhus) than battle wounds. In her book, Notes on Nursing: What It Is, and What It Is Not (1860, 2020), Florence understood the human-environment relationship and offered guidance on creating an environment to prevent disease and support healing. Among her canons of nursing are those related to infection control including, but not limited to, clean air and ventilation (currently reflected in mask wearing and physical distancing), personal hygiene and the importance of hand washing, and environmental sanitation.

Although much is known about Florence Nightingale’s environmental theory of nursing (the first nursing theory), she was also a pioneering statistician, social reformer and founder of hospital epidemiology. Florence is renowned as “the lady with the lamp” owing to her devotion, compassion and diligence in making night rounds in the barracks while holding a lamp. However, Florence is also recognized by some as “the lady with the data” because she used statistics and groundbreaking data visualization techniques to drive improvements in sanitation and health care which led to better health outcomes and decreased mortality rates (American Statistical Association, 2020). She advocated for scientific data to inform health care decisions, the early beginning of a change in health care known today as evidence-based practice.

As of this writing, the United States has had over 10 million cases of coronavirus and nearly a quarter of a million deaths. On November 5, 2020, 49 states, New York City, the District of Columbia, Puerto Rico and Guam reported over 927,000 children have tested positive for COVID-19 with nearly 74,000 new child cases this week, the highest since the pandemic began (American Academy of Pediatrics, 2020). As pediatric nurses, we are focused on the health of children and their families. Severe illness and death related to COVID-19 appears to be less common among children compared to adults. However, more data is needed on the physical health effects, including long-term effects, of infection and multisystem inflammatory syndrome on children as well as the overall economic, social, developmental, educational, and psychological impacts of the pandemic on children and families.

Nurses are on the front lines of the COVID-19 pandemic, sometimes without enough personal protective equipment, risking their personal health and safety to care for COVID-19 patients. The pandemic has amplified the nursing shortage and highlighted the importance of cross-training. Some nurses have traveled across the country, come out of retirement, and/or volunteered to work on units where they had never practiced before. As hospitals found it necessary to expand inpatient capacity to care for COVID-19 patients (mostly adults), some pediatric nurses and pediatric nurse practitioners have been reassigned to acute care and critical care units (Philips et al., 2020; Renke et al., 2020). Nurses are also working behind the scenes to promote public health, lessen health disparities, and fight against the pandemic (e.g., testing, contact tracing, and educating communities).

Some PENS nurses have shared their experiences of practicing during this pandemic. For example, there has been rapid expansion of telehealth services and redesign of both clinic spaces and clinic processes to provide innovative, developmentally appropriate ways to safely care for children. PENS nurses are working harder than ever to promote pediatric and adolescent adherence and self-management. As always, they are encouraging and administering influenza vaccines while the world awaits a COVID-19 vaccine(s). They continue to coordinate care for children with endocrine diseases even as some children

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become infected with COVID-19. For hospitalized children with COVID-19, many are coaching hospitalists as they care for those with coexisting diabetes, adrenal insufficiency, and other chronic endocrine diseases. Notably, PENS nurses are supporting patients and caregivers by answering their questions about the pandemic while steering them away from misinformation and toward reputable sources.

The Year of the Nurse and the Midwife has evolved into more than was originally intended. There is heightened awareness about the nursing role and the importance of investing in the nursing workforce as nurses have become central to combating the worst health crisis of our time. It’s never been more important for nurses to lead, to practice to the full extent of their education, and for nursing voices to be heard in health policy decision-making. As I reflect on the profession of nursing in 2020, I am thankful for the pioneering work of Florence Nightingale and inspired by my fellow nurses who are caring for the ill, bringing comfort to the dying, and promoting public health around the world. I am also grateful for Loretta Ford, an internationally renowned nursing leader and co-founder of the first nurse practitioner program, who is celebrating her 100th birthday in December 2020. Let us honor all nurses and midwives who have contributed to humanity, especially those whose lives were lost during this pandemic.

Four PENS members and two other nurses (L-R Pam Mohr, Maggy Miller, Sherry Trunnel, Jan Foote, Susan Lathrop, Elaine Sullivan) visited in 2014 the Florence Nightingale Museum, which sits at the site of the original Nightingale Training School for Nurses in London.

References American Academy of Pediatrics. (2020). Children and COVID-19: State-level data report. Retrieved from https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/ American Statistical Association. (2020). Florence Nightingale: The lady with the data. Retrieved from https://thisisstatistics.org/florence-nightingale-the-lady-with-the-data/ Nightingale, F. (2020, first published in 1860). Notes on nursing: What it is, and what it is not. (160th anniversary edition). Philadelphia, PA: Wolters Kluwer. Philips, K., Uong, A., Buckenmyer, T., Cabana, M. D., Hsu, D., Chhavi, K., Hametz, P. (2020). Rapid implementation of an adult coronavirus disease 2019 unit in a children’s hospital. Journal of Pediatrics, 222, 22-27. Renke, C., Callow, L., Egnor, T., Honstain, C., Kellogg, K., Pollack, B., … Sinicropi, N. (2020). Utilization of pediatric nurse practitioners as adult critical care providers during the COVID-19 pandemic: A novel approach. Journal of Pediatric Healthcare, 34, 490-494. World Health Organization. (2020). Year of the nurse and midwife. Retrieved from https://www.who.int/campaigns/year-of-the-nurse-and-the-midwife-2020