The world is facing a pandemic that does not seem to end. As hospitals continue to fill or become overwhelmed, nurses again find themselves in the same position they did last year. Nurses worldwide must shift and adapt their standard of practice as healthcare systems continue to evolve. Some of the new methods may be short-term, and some others are here to stay. This article will explore four areas in flux since the pandemic began: mental health issues, nursing shortage, telehealth, and models of care and education.
Mental Health Issues
Pre-COVID-19: Nurses were at risk for some mental health issues. Inpatient nurses were twice as likely as the general public to experience clinical depression. The Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative (INQRI) reports that 18% of nurses experience clinical depression, with one in five having symptoms.
The COVID-19 outbreak correlates with high anxiety, depression, stress and post-traumatic stress disorder (PTSD) for healthcare workers. Post-traumatic stress symptoms (PTSS) are prevalent in 70% of inpatient nurses, particularly those working with COVID-19 patients. For many, PTSD could last a lifetime. As important as self-care is for healthcare workers, in general, it’s crucial for nurses on the front lines of the pandemic. Resources are available from the National Alliance on Mental Illness for treatment of PTSD.
Nursing Shortage
The nursing shortage has been a significant concern for the past decade. Not enough graduates are entering the workforce to keep up with nurse retirements or the growing ranks of older Americans in need of healthcare. In addition, nursing faculty shortages and limited resources in rural areas exacerbate the deficit. Nursing strategies focus on recruiting, retaining, incentivizing, compensating and accommodating personal and professional needs.
The impact of COVID-19 on the nursing shortage is significant. A Financial Times article noted that slightly more than 15% of U.S. nurses resigned from their jobs during the first year of the pandemic. The article quotes Ernest Grant, president of the American Nurses Association: “Nurses are totally exhausted, both mentally and physically, after 18 months of this pandemic.” Seeing “so many deaths that could have been prevented by vaccines” was frustrating for nurses, said Grant.
Telehealth
Before COVID-19, many in the field considered telemedicine a bust. Industry leaders spent billions of dollars to provide the infrastructure, but healthcare professionals and patients had concerns about the quality of care. In addition, licensure across state lines and federal government policy with Medicare and Medicaid made it challenging to deliver health services until COVID-19 forced officials to adapt.
COVID-19 has changed telehealth dramatically. Patients receive care through video or phone visits, patient portal communication, wearables or monitoring apps. Nurses use it for almost all aspects of care – education, disease prevention, triage, clinical trial enrollment, symptom management, counseling and chronic disease management. Although telehealth is helping with health equity, especially in rural areas without specialists, patients must have a device, internet or technical knowledge to use it.
New Models of Care and Education
The coronavirus response highlights the limitations in our healthcare models in all care areas from hospital to home. Despite decades of work to move health records to electronic formats, officials struggle to obtain healthcare delivery organizations’ electronic health records (EHRs), particularly public health information. Often, they resort to outdated methods, wasting valuable resources that place a burden on healthcare.
Since the onset of COVID-19, leaders at all levels are focusing on EHR capabilities and healthcare analytics to improve care and public health outcomes. Nurses are contributing to solutions for use of data to improve communication and care. Shifts in care settings are creating new positions in nursing. Due to bed and staffing shortages, hospital-level care is becoming home-based in some places, with patients receiving acute care through models like Hospital at Home.
Nurses are adapting to pandemic-induced shifts in the healthcare industry. Prioritizing mental healthcare and staying aware of non-traditional care settings for career opportunities are among the steps they can take to navigate a challenging time and come out ahead.
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