What changes can we make to improve hospital care during the pandemic? Better staffing? Better protective, safety measures? And what about lifestyle measures – are you rotating your staff in a manner that allows adequate rest, refreshment to withstand another shift treating Covid patients? Have you done everything necessary to protect and support nurses, the frontline care providers of the pandemic?
Prior to the pandemic, the transfer of virus and pathogens through scrubs worn in the hospital setting was documented, yet nurses have been and are being asked to treat Covid patients without protective gear. Regardless of OSHA definitions of protective clothing, scrubs are inadequate hospital uniforms for Covid care. External clothing designed to minimize contamination is necessary and should be changed when bodily fluids splash onto the provider to limit cross-contamination. In scrubs-only settings, fresh uniforms, although costly, will go a long way toward letting your staff know they are valued. The change will limit transmittal and transfer of the detritus from care to nurses’ cars,, homes and families. And, providing nurses with onsite showers, laundry, and change facilities – typically reserved for physicians – will allow nurses to follow known infection control safety protocols. Changing these practices will reflect a renewed sensitivity to Covid virus mutations as well as a reprioritization of nursing staff needs.
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Health administrators should review and rethink policies that shortchange frontline workers. Labor unions should not have to fight for common-sense changes. To those hospitals who allowed nurses to work sick, think about those workers mingling with other staff, taking breaks who infected others? Is this smart or considerate? Most hospitals were already short-staffed prior to Covid. Nurses were overworked then and now. The pandemic merely exposes this deficiency and highlights the juggling of resources. Rethink your staffing models – Staffing agencies serve emergency needs, but HR Departments need to rethink permanent nurse staffing and recruiting models. Wave staffing or a 4th “string” of semi-retired, career-changing professionals, readily available to serve upon notice is now needed, almost akin to military reservists. The CDC forecasts and Congressional testimony clearly advised of a future of more viral infections. Thus the ebb and flow of pandemic care is our new norm and will require new and nontraditional recruitment and retention strategies.
How nurses are treated in the workplace – if they are true partners and not handmaidens to docs – require changing workplace policies and associated budget allocations to reflect their value. If docs have showers and lockers, so should nurses. And, it should not require union intervention or OSHA complaints to correct known health and safety concerns. If docs have access to additional uniforms and laundry facilities without cost, so should nurses. If there are private dining rooms for docs, ditto. Nurses need to feel essential and should be treated as such. Rethink nurse staffing to accommodate not only pandemic surges but “normal” hospital needs. l admit these changes will be costly and will change the power dynamic in hospitals, but they will go far to improve care, reflect the value of nurses in the workplace, and reflect hospital reliance on nurse-driven care models.
Finally, in our post-pandemic, long-term strategic plans, let us address one of the most under-discussed issues highlighted by the pandemic – a disproportionate reliance on nurses, nurse practitioners to provide care beyond their existing scope of practice under an emergency order, with docs having the expectation care will revert back to old models after the pandemic. First, thanks to our brothers who inserted politics into healthcare, we have not reached vaccination rates to trigger herd immunity and this vaccine will keep morphing, changing. This is our new normal, and hospitals of the past are gone. With or without adequate physician supply, our hospitals need the type of advanced clinical and diagnostic care advanced practice nurses offer. Many of the changes in Covid treatment and care which reduce fatality levels were identified and tested by APNs, including changing the position of those on respirators. Patients need the clinical acumen and holistic diagnostic approaches offered by APNs within the care delivery setting. There are not enough APNs to manage telehealth services, which have become part of the new health norm as well. Healthcare delivery has changed and hospitals must change to keep their essential staff. Those norms steeped in culture, tradition within the workplace require review and change if hospitals expect to thrive as they meet 21st-century health challenges.
Footnote:. Deverick J Anderson, Rachel Addison, Yuliya Lokhnygina, Bobby Warren, Batu Sharma-Kuinkel, Laura Rojas, Susan Rudin, Sarah Lewis, Rebekah Moehring, David Weber, William Rutala, Robert Bonomo, Vance Fowler, Daniel Sexton. “The Antimicrobial Scrub Contamination and Transmission (ASCOT) Trial: a 3-Arm Blinded Randomized Control Trial with Crossover design to Determine the Efficacy of Antimicrobial-Impregnated Scrubs to Prevent Healthcare Provider Contamination.” Web (August 29, 2017)
Footnote: Joanne Spetz, Health Affairs blog. There Are Not Nearly Enough Nurses To Handle The Surge Of Coronavirus Patients: Here’s How To Close the Gap Quickly, March 31, 2020. https://www.healthaffairs.org/do/10.1377/hblog20200327.714037/full/
Footnote: COVID-19: INCREASED WORKSITE COMPLAINTS AND REDUCED OSHA INSPECTIONS LEAVE U.S. WORKERS’ SAFETY AT INCREASED RISK (February 25, 2021) http://www.oig.dol.gov/public/reports/oa/2021/1
Covid is back because it never left, Nada Elmikashfi, August 9, 2021, as found at https://isthmus.com/opinion/the-new-colossus/covid-19-is-back-because-it-never-left/
Xiong J, Zeng S, Xu H, Cao Y. Aggravated Respiratory Failure From COVID-19 Infection: Patient Care Management From Nurses in the Intensive Care Unit. Altern Ther Health Med. 2021 Apr 23:AT6813. Epub ahead of print. PMID: 33891568.