New Study Examines Economic Impact of Covid on the Nursing Work Force

New Study Examines Economic Impact of Covid on the Nursing Work Force

A new study shows that the labor market for the nursing workforce tightened throughout the first 15 months of the COVID-19 pandemic, in a period marked by falling employment and rising wages across the health care industry.

The paper, “Nurse Employment During the First 15 Months of the COVID-19 Pandemic,” funded by The Johnson & Johnson Foundation, The John A. Hartford Foundation, UnitedHealth Group, and The Robert Wood Johnson Foundation, is in the January issue of the journal Health Affairs. Using data from the Bureau of Labor Statistics and the Current Population Survey, the study identified and described the immediate economic impact of the pandemic on registered nurses, licensed practical nurses, and nursing assistants across the U.S. from April 2020 through June 2021.

Dr. Peter Buerhaus, Mark and Robyn Jones College of Nursing.

Dr. Peter Buerhaus, MSU Mark and Robyn Jones College of Nursing.

The authors found that the pandemic has had dramatic impacts on health care delivery organizations and the nurse workforce they employ.

“There has been so much written about the pandemic’s impacts on nurses, but this is the first analysis of the economic impacts using national data,” said Peter Buerhaus, the paper’s lead author, a professor in Montana State University’s Mark and Robyn Jones College of Nursing and director of the MSU Center for Interdisciplinary Health Workforce Studies.

Although the research team focused on the nursing workforce, the results also shed light on overall employment in major sectors of health care delivery. Overall employment throughout health care delivery systems – including hospitals, outpatient facilities, home health care agencies, physician offices, and nursing homes – experienced an “unprecedented” decline after the COVID-19 virus was identified and began spreading throughout the country.

But as employment gradually resumed in most settings, the health care labor market shifted. Overall employment in hospitals, home health, and physician offices had nearly bounced back to pre-pandemic levels by June 2021 with two exceptions: employment in outpatient facilities not only bounced back but exceeded pre-pandemic levels by October 2020, and nursing home employment continued a steady decline over the study period.

Nurses and the “Covid-19 Effect” on unemployment

For nurses specifically, the researchers found that in the early months of the pandemic, unemployment shot up in hospitals, physician offices, home health care, and outpatient clinics as patients canceled appointments and these organizations greatly reduced their operations. Between the first and third quarters of 2020, unemployment rates peaked. At their highest, approximately an additional 100,000 registered nurses, 25,000 licensed practical nurses and 90,000 nursing assistants were unemployed compared to pre-pandemic numbers.

The authors noted that unemployment has rarely been a problem for nurses in health care. For example, over the past several decades, the unemployment rate for RNs has rarely exceeded 1%.

“These findings are especially striking regarding the total supply of registered nurses,” Auerbach said. “We have gotten used to the workforce growing year after year – yet these data suggest we may be experiencing a plateau right now. That would have huge implications for the delivery of health care.”

Auerbach noted that nursing unemployment during the first 15 months of the pandemic varied by settings, with increases in unemployment higher in non-hospital settings.

Furthermore, unemployment spikes in the second quarter of 2020 were higher among registered nurses and nursing assistants of color than among white, non-Hispanic registered nurses and nursing assistants.

Real wage growth for the first time in a decade

In addition, the researchers found that the pandemic seems to have positively affected nurses’ earnings. After a decade of virtually no real wage growth, wage increases during the first five quarters of the pandemic were 9.5% for licensed practical nurses, 5.7% for nursing assistants, and 2% for registered nurses. Wage increases were highest in hospital settings and also higher among the lowest-paid registered nurses, licensed practical nurses, and nursing assistants.

“These data confirm anecdotal reports of rising wages among nurses and nurse aides in response to staffing challenges in both hospitals and long-term care facilities. It’s important to note regional and state variation in these effects as the pandemic flares locally and regionally in this time period,” Donelan said.

More disruption ahead?

Looking ahead, the researchers plan to continue analyzing monthly data on the nurse workforce through 2021. The team also plans to make new projections of the supply of the registered nursing workforce through 2030, taking into account two factors that could greatly impact the registered nursing workforce in coming years: interest in nursing as a career and retirement plans of older nurses.

“Regarding entry into the nursing workforce, it is unclear whether the pandemic will lead to increased or decreased interest,” Buerhaus said. “With regard to exit from the workforce, an estimated 660,000 baby boom nurses are still working during the pandemic, the vast majority of whom are expected to retire by 2030. If substantial numbers of these older registered nurses exit the workforce earlier than they had planned, the size of the nursing workforce could decrease more quickly and disrupt nursing labor markets throughout the country.”

The exit and entry questions bear careful watching, Buerhaus added. Buerhaus’s co-authors include Douglas Staiger at Dartmouth College; David Auerbach, external adjunct faculty at MSU; Max Yates, a recent MSU graduate; and Karen Donelan of Brandeis University.

The paper is online at https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2021.01289.

 

Nurse Educators and Regional Stakeholders Brainstorm Plans to Counter Tampa Bay Staffing Shortage

Nurse Educators and Regional Stakeholders Brainstorm Plans to Counter Tampa Bay Staffing Shortage

As the nurse staffing shortage in the Tampa Bay area is nearing crisis proportions, Florida nurse educators, hospital administrators, and health care officials met to confront the problem and plot a course of action.

A spring 2021 survey by the Florida Hospital Association (FHA) found that one out of four registered nurses and one out of three critical care nurses had left their jobs in the previous year. It also noted a 25 percent turnover rate, the highest over the past several years, and a projected deficit of 59,100 nurses in Florida by 2035. The Sunshine State is the third-largest employer of nurses in the country (second only to California and Texas), but the Florida Center for Nursing (PDF) latest projections suggest that by 2035, there will be a 12% drop in the number of actively employed RNs. Seniors are especially vulnerable to the crisis, as the Center anticipates a 30% shortfall of LPNs if the state doesn’t move to produce more nurses.

The issue is particularly critical in the Tampa Bay area on the Gulf coast, so the St. Petersburg College (SPC) College of Nursing recently gathered more than 50 regional stakeholders – including leaders from hospitals, education institutions, nursing associations, and government officials – to brainstorm solutions to reduce the decline.

Meeting “all in one room… made all the difference”

Louisiana Louis, DNP

Louisiana Louis, DNP, Dean of SPC College of Nursing

Stakeholders agreed on some specific action plans as well as general aims during the resulting session, Taking Action to Address the Critical Nursing Shortage in Tampa Bay. The meeting was hosted by St. Petersburg CollegePasco-Hernando State College, State College of Florida in Manatee County, and Hillsborough Community College.

Dr. Louisana Louis, MSN, DNP, Dean of SPC’s College of Nursing, observed, “Everyone has been having solo discussions on how to address the nursing shortage. This allowed us all to be in one room. It had not been done this way before, and that made all the difference.”

According to the U.S. Bureau of Labor Statistics, job growth for nurses in Florida is expected to grow by 21 percent, while 40 percent of nurses will approach retirement age in the next decade. Stressful working conditions caused by the pandemic are also creating an increase in turnover.

“In the middle of 2021, we asked hospitals to report vacancies and turnover,” said Cheryl Love, RN, Chief Clinical and Patient Safety Officer at Florida Hospital Association. “Overall, there was an 11 percent RN vacancy rate in Florida over 12 months, which is higher than the national rate of 9.9 percent. We need to add more (nurses) than a couple thousand per year to mitigate the projected workforce shortage.”

Stakeholders identified key challenges in need of solutions:

  • Retention and recruiting of experienced nurses and nursing faculty is increasingly difficult. Primary culprits include
    • Low morale and high burnout rates in the absence of a workplace culture that supports nurses and promotes job satisfaction and loyalty
    • Lack of recurring state funding has kept salaries too low to retain and recruit sufficient staff
  • Scarcity of clinical sites for nursing students has become acute since Covid

 

Tackling the crisis

To address these issues, participants set out a series of action plans, and SPC is already pursuing some of these ideas:

  • Increase and allocate recurring funding from the state for educational technology and to raise faculty salaries
  • Establish creative scheduling outside the 12-hour scheduling model for nurses to free experienced nurses to teach
  • Create dedicated partnerships for clinical experiences
  • Re-imagine clinicals to explore alternative experiences and add clinical capacity
  • Cultivate student engagement and look at student evaluation methods to ensure they are rigorous, fair and equitable

A gift last year from the Hough Family Foundation is allocated to enhance the college’s nursing simulation area so students get hands-on training to mirror situations they would see in a live clinical experience.

SPC College of Nursing Dean Louis remarked, “Another focus is getting more nurses out into the community. “We are creating a special cohort in the summer for students who were not successful in their last semester to give them another opportunity to graduate early,” she said. “And we are working on implementing an evening and weekend program within the next year, which will produce more nurses.”

Justin Senior, CEO of the Safety Net Hospital Alliance of Florida, added, “These needs require a thoughtful, all-encompassing approach to educating, training, recruiting, and retaining Florida’s present and future nurses.  We are confident that by addressing the nursing pipeline through investments in nursing educational and training programs and in nursing schools that we can avoid nurse shortages and strengthen the state’s healthcare delivery system.”

The FHA/Safety Net Alliance report also recommends that the state expand nursing schools and clinical training capacity, increase the number of nurse faculty opportunities, improve pass rates of the nurse licensing exams (at present, NCLEX pass rates in the state place it in the bottom ranks nationally), and take advantage of the robust influx of people moving to Florida by increasing funding for recruitment of nurses from outside the state.

Making Hard Choices: A Bioethicist On Crisis Standards of Care

Making Hard Choices: A Bioethicist On Crisis Standards of Care

As the omicron variant brings a new wave of uncertainty and fear, I can’t help reflecting back to March 2020, when people in health care across the U.S. watched in horror as COVID-19 swamped New York City.

Hospitals were overflowing with sick and dying patients, while ventilators and personal protective equipment were in short supply. Patients sat for hours or days in ambulances and hallways, waiting for a hospital bed to open up. Some never made it to the intensive care unit bed they needed.

I’m an infectious disease specialist and bioethicist at the University of Colorado’s Anschutz Medical Campus. I worked with a team nonstop from March into June 2020, helping my hospital and state get ready for the massive influx of COVID-19 cases we expected might inundate our health care system.

When health systems are moving toward crisis conditions, the first steps we take are to do all we can to conserve and reallocate scarce resources. Hoping to keep delivering quality care – despite shortages of space, staff and stuff – we do things like canceling elective surgeries, moving surgical staff to inpatient units to provide care and holding patients in the emergency department when the hospital is full. These are called “contingency” measures. Though they can be inconvenient for patients, we hope patients won’t be harmed by them.

But when a crisis escalates to the point that we simply can’t provide necessary services to everyone who needs them, we are forced to perform crisis triage. At that point, the care provided to some patients is admittedly less than high quality – sometimes much less.

The care provided under such extreme levels of resource shortages is called “crisis standards of care.” Crisis standards can impact the use of any type of resource that is in extremely short supply, from staff (like nurses or respiratory therapists) to stuff (like ventilators or N95 masks) to space (like ICU beds).

And because the care we can provide during crisis standards is much lower than normal quality for some patients, the process is supposed to be fully transparent and formally allowed by the state.

What triage looks like in practice

In the spring of 2020, our plans assumed the worst – that we wouldn’t have enough ventilators for all the people who would surely die without one. So we focused on how to make ethical determinations about who should get the last ventilator, as though any decision like that could be ethical.

But one key fact about triage is that it’s not something you decide to do or not. If you don’t do it, then you are deciding to behave as if things are normal, and when you run out of ventilators, the next person to come along doesn’t get one. That’s still a form of triage.

Now imagine that all the ventilators are taken and the next person who needs one is a young woman with a complication delivering her baby.

That’s what we had to talk about in early 2020. My colleagues and I didn’t sleep much.

To avoid that scenario, our hospital and many others proposed using a scoring system that counts up how many of a patient’s organs are failing and how badly. That’s because people with multiple organs failing aren’t as likely to survive, which means they shouldn’t be given the last ventilator if someone with better odds also needs it.

Fortunately, before we had to use this triage system that spring, we got a reprieve. Mask-wearing, social distancing and business closures went into effect, and they worked. We bent the curve. In April 2020, Colorado had some days with almost 1,000 COVID-19 cases per day. But by early June, our daily case rates were in the low 100s. COVID-19 cases would surge back in August as those measures were relaxed, of course. And Colorado’s surge in December 2020 was especially severe, but we subdued these subsequent waves with the same basic public health measures.

And then what at the time felt like a miracle happened: A safe and effective vaccine became available. First it was just for people at highest risk, but then it became available for all adults by later in the spring of 2021. We were just over one year into the pandemic, and people felt like the end was in sight. So masks went by the wayside.

Too soon, it turned out.

A haunting reminder of 2020

Now, in December 2021 here in Colorado, hospitals are filled to the brim again. Some have even been over 100% capacity recently, and a third of the hospitals expect ICU bed shortages during the last weeks of 2021. The best estimate is that by the end of the month we’ll be overflowing and ICU beds will run out statewide.

But today, some members of the public have little patience for wearing masks or avoiding big crowds. People who’ve been vaccinated don’t think it’s fair they should be forced to cancel holiday plans, when over 80% of the people hospitalized for COVID-19 are the unvaccinated. And those who aren’t vaccinated … well, many seem to believe they just aren’t at risk, which couldn’t be further from the truth.

So, hospitals around our state are yet again facing triage-like decisions on a daily basis.

In a few important ways, the situation has changed. Today, our hospitals have plenty of ventilators, but not enough staff to run them. Stress and burnout are taking their toll.

So, those of us in the health care system are hitting our breaking point again. And when hospitals are full, we are forced into making triage decisions.

Ethical dilemmas and painful conversations

Our health system in Colorado is now assuming that by the end of December, we could be 10% over capacity across all our hospitals, in both intensive care units and regular floors. In early 2020, we were looking for the patients who would die with or without a ventilator in order to preserve the ventilator; today, our planning team is looking for people who might survive outside of the ICU. And because those patients will need a bed on the main floors, we are also forced to find people on hospital floor beds who could be sent home early, even though that might not be as safe as we’d like.

For instance, take a patient who has diabetic ketoacidosis, or DKA – extremely high blood sugar with fluid and electrolyte disturbances. DKA is dangerous and typically requires admission to an ICU for a continuous infusion of insulin. But patients with DKA only rarely end up requiring mechanical ventilation. So, under crisis triage circumstances, we might move them to hospital floor beds to free up some ICU beds for very sick COVID-19 patients.

But where are we going to get regular hospital rooms for these patients with DKA, since those are full too? Here’s what we might do: People with serious infections due to IV drug use are regularly kept in the hospital while they receive long courses of IV antibiotics. This is because if they were to use an IV catheter to inject drugs at home, it could be very dangerous, even deadly. But under triage conditions, we might let them go home if they promise not to use their IV line to inject drugs.

Obviously, that’s not completely safe. It’s clearly not the usual standard of care – but it is a crisis standard of care.

Worse than all of this is anticipating the conversations with patients and their families. These are what I dread the most, and in the last few weeks of 2021, we’ve had to start practicing them again. How should we break the news to patients that the care they are getting isn’t what we’d like because we are overwhelmed? Here’s what we might have to say:

“… there are just too many sick people coming to our hospital all at once, and we don’t have enough of what is needed to take care of all the patients the way we would like to …

… at this point, it is reasonable to do a trial of treatment on the ventilator for 48 hours, to see how your dad’s lungs respond, but then we’ll need to reevaluate …

… I’m sorry, your dad is sicker than others in the hospital, and the treatments haven’t been working in the way we had hoped.”

Back when vaccines came on the horizon a year ago, we hoped we’d never need to have these conversations. It’s hard to accept that they are needed again now.
The Conversation

Nurses Can’t Afford to Neglect Self-Care

Nurses Can’t Afford to Neglect Self-Care

It has almost nothing to do with aromatherapy, candles, or even yoga.

As a nurse, you probably respond to the myriads of articles and social media posts on “self-care” with a dubious shrug. Authors of lifestyle content often imply that self-care is a specifically female pursuit—one that is synonymous with “self-pampering.” So, the 20th-century images of women lolling in bed nibbling on chocolates have been replaced with stock photos of women soaking in rose-petal baths, getting manicures, and serenely smiling through avocado facial masks.

It can be glorious to pamper oneself, but nurses struggling to combine 12-hour shifts with family obligations during a global pandemic—while paying off monstrous student loans—may feel they have more urgent priorities. Being urged to set aside some “me time” for journaling or dabbling in essential oils, though, is self-care through a marketer’s lens. Psychologists, nurse scientists, and other health practitioners have very different definitions of self-care, and studies that show it is no mere indulgence.

What is self-care?

Jean Harlow in bed eating chocolates. If only self-care was this easy!

This is awesome, but it is not self-care.

The World Health Organization’s definition might surprise some wellness influencers: “Self-care is a broad concept which also encompasses hygiene (general and personal); nutrition (type and quality of food eaten); lifestyle (sporting activities, leisure, etc.); environmental factors (living conditions, social habits, etc.); socioeconomic factors (income level, cultural beliefs, etc.); and self-medication.”

In its most minimal form, you advise patients to engage in self-care when you tell them why they need to take medications as prescribed, eat more vegetables, exercise, and floss their teeth. Nothing indulgent here, because at bottom self-care is simply an essential component of preventive care. So, as a starting point, at the very least you should practice what you preach. Not only for the sake of credibility; when you practice self-care, you function better.

And as a nurse, you will find that self-care can speed your recovery—or even help you avert—the most common occupational hazards that afflict nurses. Basic self-care practices can make you a less attractive target for the most common nursing woes.

Stress: The APA offers some useful advice on handling workplace stress, but this year, almost any health worker should consider therapy as well. A good therapist is much more than a nonjudgemental sounding board; s/he can teach you to heed and acknowledge your emotions as you navigate both workplace and personal relationships. Therapy won’t prevent you from experiencing stress, of course, but it can give you some formidable tools to increase your resilience and ability to cope.

Musculoskeletal injuries from lifting and maneuvering heavy burdens: Studies conducted over the past 10 years suggest that stretching exercises and moderate resistance training can reduce the likelihood of injuries. Regular exercise and proper orthopedic shoes will help your feet and the rest of your body when you have to stand for endless periods. However, if you are trying to avoid injuries, yoga might not be an ideal choice of exercise program.

Needlesticks and other sharps injuries: No amount of self-care will give you Luke Cage-like super-durability, but super-spy Jason Bourne has some helpful advice: “sleep is a weapon.” One excellent way to prevent accidents of all types is to practice decent sleep hygiene. When you are well-rested, you are more alert, your response time is faster, you’ll be better coordinated, and at much less risk of making dangerous mistakes.

Self-care helps you to function at your best, under all conditions

The approach to self-care for nurses has changed dramatically since Covid-19 hit. And, the mounting staffing crisis makes it clear that self-care practices should be part of every nurse’s toolbox. The ANA positions self-care as a means of attaining and sustaining nursing excellence:

  • Promote health and safety
  • Preserve wholeness of character and integrity
  • Maintain competence
  • Continue personal and professional growth

Avocado slices might possibly help reduce undereye puffiness, but bona fide self-care can ward off compassion fatigue, help you manage your resources when “crisis standards of care” are the order of the day, perform your tasks with accuracy, and make it easier to communicate and connect with co-workers and patients. Which makes the job more satisfying—especially as it can improve health outcomes. In a caring profession, following a proper self-care routine can make a world of difference.

Baby steps are fine!

Don’t try to do everything at once—even taking aim at one health goal is better than nothing, and it’s much more doable. Pick an area for improvement, like sleep hygiene, diet, exercise, regular physicals, podiatric care, or mental health support. In setting priorities, identify the greatest stresses you face from your job. Consider the issues that afflict you most on a daily basis, long-term problems that wear you down, resentments, anything that makes it harder to keep your head in the game.

Making changes usually is more effective when done incrementally, so don’t drive yourself crazy with New Year Resolutions. If lack of sleep is your greatest foe, try to start by taking 15-minute breaks a few times a week to shut your eyes and relax. Feet killing you? Make an appointment with a podiatrist now—and follow their advice. If your bugbear is workplace and/or family stress, take advantage of one of the few positive effects of the pandemic: you don’t even have to leave home now to see a therapist, so what’s stopping you?.

Once you begin, play it by ear. Self-care is both a professional and personal investment. And after a month of healthy eating, better rest, or CBT, go ahead and reward yourself with some actual pampering. Find time to stand in a meditative pose or joyfully leap on a picturesque beach, play computer games, or nibble chocolates while reading celebrity gossip; a little silliness might be a healthy prescription after two years in a non-stop pandemic.

UVM Study: Tired, and Not Feeling Heroic, Nurses See Pandemic as “A Marathon That Won’t End”

UVM Study: Tired, and Not Feeling Heroic, Nurses See Pandemic as “A Marathon That Won’t End”

Nursing as a profession received heightened attention during the COVID pandemic. Nurses are hailed as heroes, employed in dangerous front-line work, battling exhaustion and burnout. In reality, the experiences of individual nurses vary by type of position, geographic location and career experience.

Two qualitative studies led by nursing professor Marcia Bosek, D.N.Sc., RN, with nurse leaders from UVM Medical Center shed light on the true, lived experiences of Vermont-based nurses working during the pandemic. The research reveals emergent themes and exposes broad, societal questions related to the social contract between the public and health care professionals. It also gives nurses the opportunity to share and reflect on their experiences, which Bosek identified as a need.

“At the beginning of the pandemic, the chief nursing officer at UVM Medical Center told me that the nurses wanted to talk about their experience,” said Bosek, who serves as Nurse Scientist in the medical center’s nursing department. “What they were going through was so different and challenging. They had never experienced a pandemic, the hospital prevented visitors and protocols kept shifting.”

The research engaged hospital nurses in describing their pandemic experiences and the physical, psychosocial and financial impacts related to providing care. The first study took place early in the pandemic, May and June 2020. Three themes emerged: It was a rollercoaster ride; I am proud to be a nurse; we adapted to provide the best care.

One nurse stated, “Providing nursing care during the pandemic has been a rollercoaster you can’t seem to get off and something I never thought I would experience in my nursing career.”

Well-Trained and Creative

Respondents did not embrace the “hero” identity, as they were not working on ‘the front lines’ in a community experiencing a COVID-19 surge.  Rather than presenting as heroes, respondents emphasized that nurses are always prepared to provide care in situations like this, because “it’s what we’ve trained for!” They expressed feeling excited to “help others during such a tough time for everyone,” and concluded that, “we are amazing at what we do, we go into healthcare because we want to help people, and this has been our time to shine.”

No visitors allowed during this time created a perception that units were quieter and less chaotic. However, prohibiting visitors also limited communication, decision-making and family support at pivotal moments in a patient’s life. The nurses became creative in identifying workarounds to meet needs of patients, families and the health care team:

“I cared for a dying patient during the last hours. The family was not present… I found the patient’s phone and figured out how to play music… I was the only reminder in the room that this was a person with a life… now facing death… alone except for me.”

One difference observed between nurses who provided direct care to COVID patients and those who did not was that those not providing care for COVID patients expressed feelings of guilt.

Rollercoaster to Marathon

A follow-up study in December 2020 sought to determine whether Vermont nurses continued experiencing the same feelings, or if their experience had changed.

“Six months had passed since our original study and the pandemic continued. The research team wondered if nurses remained on their rollercoaster ride and what changes, if any, had occurred in their experience of providing care as the pandemic continued,” Bosek said. “We wanted to know: Are the nurses still fearful of the future? Do nurses remain proud of their ability to provide care?”

Four themes emerged from the December responses: It feels like a marathon that won’t end; you have to take care of yourself or you cannot care for anyone else effectively; our work takes more effort; it is challenging to not be angry.

“The rollercoaster became a marathon that won’t end. They went from an up and down scary ride to a trudging race with no clear, recognizable finish line,” Bosek said. “The use of the marathon metaphor begs the question as to whether the nurse can successfully complete this race or will fall into an undesired ‘did not finish’ category due to burnout or exhaustion.”

Recognizing a need for self-care was fueled by the recognition that nurses are responsible for their own family members, neighbors and co-workers. Without sufficient self-reserves, the nurses realized that they would not be able to meet the needs of those depending on their physical and psychological assistance.  “Self-care is a must… take time to take care of yourself.  At the end of your shift, reflect, take some deep breaths and move on. Remember that you are doing your best and that is enough,” one nurse wrote.

Instituting COVID precautions changed how nursing care was provided and challenged the nurses’ dedication. It became nurses’ responsibility to manage patients’ visitors and enforce masking rules. To reduce numbers of people in patients’ rooms, nurses took on tasks that licensed nursing assistants would typically do, such as giving baths, feeding and toileting.

“I’m in this marathon, I’m tired, I’m trying to take care of myself, I want to care for people, but it’s harder, different and takes more effort,” Bosek summarized. “Patients are more ill, not just from COVID but because they delayed care and require a higher level of nursing care, and nurses’ roles are expanded.”

One respondent wrote, “Life is different. People are different. Patients and families are different.” Another wrote, “Visitors have been helpful but mostly non-compliant with mask wearing or visiting hours policies. Puts more stress on…having to be the nurse and the mask police.”

“Hard To Not Be Angry”

As the pandemic continued, nurses noted their struggle to not be angry with people they perceived were making things more difficult for the nurses individually and collectively. They also expressed anger that people are nervous being near nurses for fear they will catch COVID, but they expect nurses to take care of them if they become ill.

“It is hard to go to work in a hospital every day when many Americans are not following CDC guidelines to contain the virus. The public expects nursing and hospital staff to risk their own lives to take care of them while they won’t even take simple precautions to protect themselves,” a respondent wrote.

Lastly, the nurses perceived that the hospital prioritized the organization’s financial outlook over the best interests of the nursing staff and patient care. “The hero stuff at this point doesn’t really sit true when administration starts worrying about our budget again and cuts corners,” wrote a nurse.

Based on these studies, the research team recommended examining larger societal questions related to the social contract between the public and health care professionals: “We have to talk about the idea that people in the community aren’t doing their part to stay well … and so nurses have to do more,” Bosek said. “Also, actions are needed to minimize the causes of nurses’ stress, such as staffing shortages, expanded role, decreased social interaction. It is unclear how effective meditation and yoga will be during a protracted pandemic.”

The research team presented at the Nursing Research Evidence-Based Practice Symposium in November 2021, and manuscripts are out for review. CNHS students, alumni and faculty also presented research at the symposium. Nursing professor Lili Martin, D.N.P., RN, PCCN presented findings from her study on Stress Management and Resiliency Training (SMART) for nursing students.

Nurse of the Year: Vaccine Icon Sandra Lindsay

Nurse of the Year: Vaccine Icon Sandra Lindsay

She lost two relatives of her own to the pandemic and worked on the frontlines when Covid cut short the lives of so many New Yorkers that hospitals needed morgue trucks to house the dead. So, Sandra Lindsay, DHSc, MS, MBA, RN, CCRN-K, NE-BC, the director of patient care services in critical care at Long Island Jewish Medical Center, knew what was at stake when she was asked to bare her arm for the first official Covid jab in the US on December 14, 2020.

This Nurse of Many Weeks has played her role as nursing icon with a very un-celebrity-like grace and lack of pretension. On top of her usual job duties, she has spent most of the year urging people to trust the evidence that the Covid vaccines work, appearing at Zoom town halls and other events in a tireless campaign to combat junk science and medical mistrust.

“It’s the everyday, ordinary people seeing me on the street or in different locations and recognizing me, even with my mask on … and coming up to me and saying, ‘Thank you….'”

—Sandra Lindsay, DHSc, MS, MBA, RN, CCRN-K, NE-BC

Just last month, nurse Lindsay readily agreed to the request of 9-year-old Desiree Mohammadi, daughter of a Queens pediatrician, and held her small hand as a pediatric nurse administered a Covid jab. Afterward, Desiree sent her idol a grateful thank-you letter. The photos and video of the nurse who was the first person in the US to be vaccinated for Covid-19 will be in textbooks soon, but she is already inspiring children to seek a better understanding of both science and nursing.

“I encourage people to speak to experts who can answer their questions, to access trusted science. I let them know that it’s OK to ask questions.”

The nursing profession may be too diverse for any one nurse to be seen as its “face,” but Dr. Sandra Lindsay is nonetheless a superb representative. The 53-year-old critical care nurse displays the qualities that inspire our trust in nurses. She communicates clearly and honestly, in a no-nonsense manner; her practice follows science and evidence, not opinions. With those who prefer to heed opinions, her approach is nonjudgemental*, and seeks to persuade without condescension.

“It’s the only job I know of where they pay you to learn.”

—Joan Blondell, as “Maloney” in Night Nurse (1932)

As for the “nursing public,” any nurse can take pride in Lindsay’s ongoing pursuit of education. If you’re a nurse, your last name doesn’t have to be followed by an ever-expanding alphabet of degrees and credentials, but those proliferating letters do speak to the long-overdue increase in respect for nurses. (Of course, if the general public was aware of the mathematical calculations an RN performs every day or knew how quickly the “average” nurse masters complex new procedures, technology, and treatments, they might be intimidated). Lindsay is also a fine example of nurse leadership. She cites evidence as the basis for her words and actions and bears her responsibilities with a quiet, natural authority.

And for aspiring nurses, whether immigrant or native-born, Lindsay is an exemplar of the classic American dream: if you are smart, determined, self-disciplined, and willing to work very hard, you don’t need wealth or family clout to make a difference in the world.

But perhaps the most significant reason that Dr. Lindsay is our Nurse of the Year is this: as Elvis did with the polio vaccine, she set an example that is saving lives. When NPR spoke with her last week, she shared the following anecdote:

Lindsay was at the Jamaican Embassy one day (she was born there and immigrated to the US when she was 18) when a woman came over and began to thank her profusely. She told Lindsay that she and her family had not intended to be vaccinated—until she saw Lindsay getting that first jab on TV. After seeing the nurse’s confident mien, she said, “We all went and made an appointment. So I want to thank you so much for inspiring us.”

For that alone, may Dr. Lindsay have the best possible 2022, and many more great years after that.

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