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Learning Lessons from the Pandemic
BY LOUIS PILLA
With the COVID-19 crisis relenting, nurses can learn some valuable lessons. Here are some of the biggest takeaways.
As no other disease or event in memory, the COVID-19 pandemic has pressured the health care system—and nursing. And from that stress can spring valuable lessons for the profession. From preparedness to collaboration, mental health to scope of practice, lessons can be learned from more than a year of this pernicious enemy.
Readiness
Of the many lessons learned from the pandemic, “number one is preparedness,” says Ernest J. Grant, PhD, RN, FAAN, president of the American Nurses Association (ANA). Typically, he notes, disasters involve the prehospital setting and nurses in such areas as the emergency department or intensive care unit. They usually resolve in days or weeks and “you can see the light at the end of the tunnel fairly quickly.”
By contrast, a pandemic “affects the whole health care system,” Grant says. “Things that a normal disaster would not necessarily have had an impact on, this did. So it caught people unprepared.” Nurses need to be prepared and educated “so that nurses will know what their role is when the next pandemic comes along.”
Of the many lessons learned from the pandemic, “number one is preparedness,” says Ernest J. Grant, PhD, RN, FAAN, president of the American Nurses Association (ANA).
Besides staff, preparation needs to extend to supplies as well. At the pandemic’s outset, some supplies had not been rotated and were dry rotted, he says. What’s more, the United States had a dependence on other countries. “We were caught short-handed, so to speak, so it’s important that we also have some means to provide the necessary supplies and resources ourselves, so that we’re not dependent on other countries,” Grant points out. Some nurses, he notes, are still required to use N95 masks multiple days in a row before switching to a new mask.
It Takes a Team
Besides readiness, collaboration is another of the major lessons learned from the pandemic. “Definitely, it has taken a team effort,” says Grant. Addressing the pandemic has called on the efforts of health care team members ranging from physicians to the housekeeping staff, he notes.
In talking to nurses around the country, the most important thing they will take forward “without a doubt” is partnerships and collaboration, says Elizabeth Bridges, PhD, RN, CCNS, FCCM, FAAN, president of the American Association of Critical-Care Nurses (AACN) board of directors. That means collaboration not only with physicians and respiratory therapists, “but also all those other individuals whom we asked to step outside of their normal practice to come in and augment the care, particularly of acute and critically ill patients when we needed those members. That partnership is important because it’s broken down a lot of silos, and that’s a really important lesson going forward. We would not have gotten through this pandemic if we didn’t come together as a team.”
Mental Health and Moral Distress
Recognizing the massive mental toll that the pandemic has taken on nurses is another lesson learned.
With conversations occurring about moral distress and post-traumatic stress, “it’s really important that we don’t pathologize this experience,” says Bridges. Rather, such emotional difficulties can represent a normal reaction in light of the pandemic experience.
While working with individuals to mitigate moral distress is important, a system approach is also vital, Bridges notes. “You have to be in a healthy work environment where resilience is supported.”
Addressing moral distress can start in the nursing curriculum with instruction on ethics in nursing practice, notes Mary Ellen Glasgow, PhD, RN, ANEF, FAAN, dean and professor at Duquesne University School of Nursing. Nurses deal with ethical dilemmas that they may not have the knowledge or skill to analyze, she says.
“How are we preparing nurses when they are faced with morally distressing situations so we minimize posttraumatic stress disorder? What are preventive tips nurses can take? How can they manage these morally distressing situations, what can they ask for from their institutions that is appropriate?” Glasgow asks.
Nurses experiencing mental and physical fatigue should make sure to seek assistance, says Grant. A nurse should feel no shame, he says “to admit that perhaps you may need some help, especially if you’re seeing death and dying on the level that some of the members of the health care team have this past year. It definitely has been quite an emotional and physical strain on the body.”
Acknowledging APRNs
Employing the skills and abilities of advanced practice registered nurses (APRNs) represents another lesson learned from this pandemic. For decades, APRNs have fought for greater practice authority, and the pandemic seems to have finally brought their skills into long-overdue acknowledgement and use.
Some 23 states have granted APRNs full practice authority, notes the ANA’s Grant. Ultimately, he notes, having APRNs practice to their full authority will result in “a very strong health care infrastructure.”
That full practice authority needs to remain in place as the pandemic ends, notes Bridges. What is not needed, she says, is that once the pandemic ends, “we’re going to put those restrictions back on you.”
Tech Adoption
Another learning involves the adoption of technology. There was a lesson in the ability to “embrace technology and innovation,” says Grant, pointing to the use of telehealth.
While telehealth often has been used within the purview of large health care systems, the pandemic has shown a need to use tele-resources in settings that are not necessarily affiliated with a large corporate entity, says Bridges. This allows, she notes, for patients to remain in their own community.
“Risen to the Challenge”
With the pandemic shattering so many precedents, “this is really an opportunity to think differently,” says Bridges. That might involve such concerns as how partnerships are created with families; how to bring new nurses who may have had a different kind of nursing education into the health care environment; and how wellness needs to be a competency for nurses. “Just like everything else we learn, we need to be experts in selfcare,” she says.
Glasgow points to the courage of being a nursing student at this time. “They are certainly brave to go in and take care of people during a pandemic,” she says.
Nurses and other members of the health care team have “risen to the challenge and met this challenge and still are resilient,” says Grant, offering his thanks and praise for their efforts during the pandemic. Bridges also points to the critical nature of the team effort, but with a particular nod to nurses. “A bed in a hospital without the expertise of the care team, specifically a care team of nurses, is just a bed,” she says.
