The Impact of COVID-19 on the Nursing Workforce: A National Overview

The COVID-19 pandemic has had a significant and negative impact on the nursing workforce. Immediate and long-term actions must be taken to mitigate the adverse effects of the pandemic. Understanding these effects in various contexts is essential to conduct research, implement innovative interventions, and create supportive policies. This article provides a comprehensive overview of the issues in the framework of six key areas of the HealthImpact Workforce Strategy Model, including K-12 and second-degree students, pre-requisite nursing education, and pre-licensure nursing education; upskilling the existing workforce; retention and well-being; and migration of nurses. We also discuss expanding advanced practice registered nursing scope of practice; crisis standards of care; and the impact of telehealth. Exemplars highlight the issues, and document action and innovation in the domains of workforce strategy, education, research, and policy in these challenging times.

COVID-19 in Communities of Color: Structural Racism and Social Determinants of Health

Black, Indigenous, People of Color (BIPOC) communities have a disproportionally high prevalence of COVID-19 and, subsequently, a higher mortality rate. Many of the root causes, such as structural racism and the social determinants of health, account for an increased number of preexisting conditions that influence risk for poor outcomes from COVID-19 as well as other disparities in BIPOC communities. In this article we address Structural Factors that Contribute to Disparities, such as economics; access to healthcare; environment and housing concerns; occupational risks; policing and carceral systems effects; and diet and nutrition. Further, we outline strategies for nurses to address racism (the ultimate underlying condition) and the social and economic determinants of health that impact BIPOC communities.

Vaccination During the COVID-19 Pandemic: What Nurses Need To Know

In late 2019 a new virus emerged from China which would become the worst pandemic the world had experienced since the flu pandemic of 1918. Over one year later, the virus has infected over 100 million people and claimed the lives of over 2 million people. In this article, we first offer a brief overview about the COVID-19 pandemic. We review efforts to slow the spread and flatten the curve to contain the disease such as mask-wearing, hand hygiene, and testing. Unprecedented funding and collaborative efforts have resulted in highly effective and safe vaccines, rolled out in December 2020. We also briefly discuss the history of vaccine development and previous outbreaks and lessons learned, followed by new vaccine technologies; barriers related to vaccination; vaccine hesitancy; successful vaccination programs; and vaccine hesitancy in healthcare providers. We conclude with implications for nurses to consider as they serve as trusted sources of vaccine information in their roles as frontline workers.

Post COVID-19 Reimbursement Parity for Nurse Practitioners

Reimbursement parity of nurse practitioners (NPs) and physicians is appropriate now more than ever. Studies have demonstrated that NPs provide the same quality of care as physicians, yet they do not receive the same reimbursement. The rise in full practice authority states, as well as nurse managed clinics and retail clinics, has led to more NPs practicing independently. The COVID-19 pandemic opened a need for NPs to provide a greater amount of care in more settings, and thus led to temporary removals of practice restrictions to increase access to care. This article offers a review of the issues, such as “incident to” billing; direct and indirect reimbursement; and quality of care. We consider MedPAC and reimbursement policy, post COVID-19 policy solutions, and action steps to move forward to seek reimbursement parity. The COVID-19 pandemic serendipitously led to the removal of many restrictions on NP practice, offering an opportunity for NPs to work with MedPAC to achieve full reimbursement for care provided.

Rebuilding Community-Based and Public Health Nursing in the Wake of COVID-19

The COVID-19 pandemic has reset the table for a dialogue about health equity, public health, and the future of nursing. Experts anticipated that payment reforms would lead to a much-needed increase in community and public health nursing. Despite calls for the profession of nursing to take a leadership role in addressing the social determinants of health and health equity, data show that jobs for nurses in community-based clinics and public health have actually declined in the last decade. This article offers background on the ongoing decline in public health infrastructure in the United States, an analysis of workforce data on nursing jobs using the National Sample Survey of Registered Nurses from the years 2000, 2004, 2008, and 2018, and the National Association of County and City Health Officials from 2008 to 2019, as well as a discussion of why these findings are so troubling. We discuss policy implications for nurse educators related to curricula and clinical experiences, and for professional nursing organizations as they set goals to increase and improve nursing jobs in community clinics and public health settings. In conclusion, we note that the federal investments in community health centers and public health nursing provide a short window of opportunity to reverse the historic and ongoing decline and rebuild a stronger community and public health nurse workforce.

Through the Looking Glass: Reflections from Three School Nurses Amid the COVID-19 Pandemic

School nurses play a critical role as public health nurses and are guiding school communities through a global pandemic unlike anything seen in the past 100 years. Due to the coronavirus pandemic and worldwide shutdown, remote education became a necessity. In this article, three New Jersey school nurses share reflections about the COVID-19 pandemic. We illustrate the roles included in the National Association of School Nurses Framework for 21st Century School Nursing Practice, to describe school nurse contributions to address the COVID-19 community spread via contact tracing and care coordination. We describe school nurse advocacy through promotion of legislative inclusion in the state of New Jersey and efforts to mirror vaccine confidence. Our conclusion offers action steps to increase the presence of school nurses in key areas and build a more robust public health infrastructure.

Assessing Patient Ability to Exercise COVID-19 Transmission Based Precautions: A Proposed Clinical Tool

Clinical decision-making during the present pandemic has challenged healthcare providers to the limits of their endurance. Inpatient facilities are discharging patients who are positive for the COVID-19 infection, based on testing, and who may still be positive but have symptoms that have remitted. Even medically stable patients may not be able to exercise basic transmission-based precautions such as handwashing or wearing a face mask, and may increase the risk of infection spread to others upon discharge. This can present challenging decisions about when, how, and where to discharge COVID inpatients. This article addresses the behavioral health aspects of this problem, offering background information and proposing creation of a Transmission Based Precautions Inventory. This clinical tool will use chart information and a clinical interview to assess the capability of patients upon discharge to exercise the appropriate behavior-based precautions to prevent the spread of any contagious infection. The discussion includes an exemplar that illustrates the dilemma, followed by other metrics for scoring and development of the tool. Administration time of the tool would be approximately 15-20 minutes and responses would score immediately to inform discharge decisions. The need for such a tool is current; however, the usefulness of an efficacious inventory would persist beyond the present pandemic. In the conclusion, the author invites reader feedback to inform the development and implementation process.

Impact of COVID-19 Pandemic on Nurses: Where is the Financial Safety Net?

The COVID-19 pandemic placed many nurses in financial distress. Nurses House, Inc. provided nurses with financial assistance through an emergency grant supported by the American Nurses Foundation. In a three-month period between April 2020 till July 2020, Nurses House, Inc. distributed $2,734,500 to a total of 2,484 qualified grantees from across the United States. This article offers a brief review of literature to provide context about the guiding framework of the grant, Watson’s Theory of Human Caring, as an essential tenet to nursing and to the mission of Nurses House, Inc, and the financial impact of the pandemic. We discuss the methods, data analysis, and results of our study that analyzed demographic information from the applications of grant recipients. Regression analysis showed that regardless of income levels, nurses experienced financial distress. The discussion considers our findings in relation to such areas as age and full-time or part-time work status of grantees; reasons to apply, such as testing positive for COVID=19 (78%), work mandated quarantine (16%) and caring for a family member (6%); and study limitations. The conclusion offers implications for practice based on our analysis, which demonstrated that financial safety nets are both essential and helpful for nurses in times of crisis.