Physical boundaries should not compromise patient care
White House coronavirus task force is missing a nurse
Before the coronavirus pandemic took over every facet of life, the World Health Organization (WHO) had declared 2020 to be the Year of the Nurse and the Midwife. This year was intended to be a celebratory year for all nurses as it marked the 200th anniversary of Florence Nightingale's birth, the founder of modern nursing who was also a statistician, scientist, and social reformer. However, 2020 has turned out to be an entirely different year for all of us.
As of Aug. 21, the coronavirus pandemic has killed over 795,000 people and infected over 22 million worldwide, including claiming the lives of many nurses. Nurses regularly deal with chaotic environments, unpredictable patient conditions, and death and disability. Still, working in health care has become more hazardous and stressful for nurses now, more than ever. The surge in inpatient care demands, the ongoing risk of infection to self and family members, and the physical and psychological demands of the job have put enormous strain on the profession. Nonetheless, nurses show up every day on the frontlines to take care of other people in need.
Nurses are the largest health care profession in the U.S., with approximately 4 million registered nurses. As the first line of defense for responding to the pandemic, nurses have valuable expertise and perspectives to offer in the COVID-19 response from the frontlines. Yet, we are often missing from important decision-making tables that affect our lives and work. For example, the current White House Coronavirus Task Force does not include any nurses, nor do most state or local coronavirus response teams. To respond adequately to the pandemic, we firmly believe that nurses should be added to all health-related commissions, panels, and task forces.
Nurses are needed at decision-making tables because of our unique superpower: our trusted relationship with patients. Nurses have routinely rated the #1 most honest and ethical profession in the U.S. What shapes, guides, and informs nursing work is The Code of Ethics for Nurses. The code is the nursing equivalent of the Hippocratic Oath. It shapes our values, obligations, and duties to the public. We believe this is the reason why the public selects nurses as the most honest and ethical profession for 18 years in a row. It is also why nursing voices are essential when it comes to making high-level decisions about the pandemic.
Nurses' work is diverse and spans the care of individuals, families, groups, communities, and populations of all ages across the lifespan. Acute and critical care nurses provide intensive hospital care to the sickest community members. School nurses understand that students' health is directly related to his or her ability to learn. Public health nurses investigate outbreaks, assist with contact tracing, and deliver education on self‐isolation and quarantine through hotlines and home visits. Psychiatric nurses respond to mental health crises and promote mental and emotional wellness in communities. These unique insights into patient care can benefit public health planning, public education, resource allocation decisions, and infection prevention measures in communities.
Nurses promote, advocate, and protect patients' rights, health, and safety using science and evidence-based practice. Personal Protective Equipment (PPE) shortages remain a critical issue for hospitals and clinics, and nurses continue to voice significant concerns about adequate and appropriate PPE. From the bedside to the national stage, nurses and nursing professional organizations are taking COVID-19 supply chain concerns to Washington to urge policymakers to use evidence in planning for an adequate supply of PPE.
In one case, an ICU nurse saw the need for Powered Air-Purifying Respirator (PAPR) for frontline health care workers to allow them to spend more time in the patients' room. Even though he has no fundraising experience, he started an online campaign to raise awareness of the need for PPE to provide optimal whole-person care to patients and raised more than $200,000 to purchase PAPRs for his unit. The advocacy role of nurses could help ensure that structural and process changes translate to a real-world patient and public health benefits.
The in-depth knowledge of the whole-person needs of patients would help policymakers consider all the implications of the pandemic and where resources are needed for public health problems beyond infection control alone. The code entrusts all nurses to collaborate with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. The nurses' foundational commitment to patient health - not cost, politics, shareholders, profits, appearances, or other competing incentives in health care - and the diversity of nursing practice areas make nursing expertise and perspectives a valuable resource in decision-making teams.
As COVID-19 cases skyrocket in the U.S. and a seasonal second pandemic wave looms closer, there is an opportunity to bring nurses to health policy decision-making tables that will benefit not only the sickest COVID-19 patients in hospitals but communities and the public as a whole. A trusted, patient-centered perspective of a nurse to the White House Coronavirus Task Force would ensure the right decisions are being made for the health and well-being of our communities.
Anna Dermenchyan is a critical care nurse and director in the Department of Medicine Quality at UCLA Health. Kristen Choi is a psychiatric nurse and assistant professor at the UCLA School of Nursing.