The consequences for nursing during the COVID-19 pandemic are serious and potentially long-lasting. Such are the conclusions of a major news report from the National Council of State Boards of Nursing (NCSBN).
Among the findings:
Over the past two years, approximately 100,000 registered nurses (RNs) left the workforce during the COVID-19 pandemic due to stress and burnout. This number represents a portion of the workforce NCSBN would not have expected to leave.
Another 610,388 RNs reported an “intent to leave” the workforce by 2027 due to stress, burnout, and retirement.
Some 188,962 additional RNs younger than age 40 reported similar intentions.
About one-fifth of RNs nationally are projected to leave the healthcare workforce.
“The data is clear: the future of nursing and the U.S. healthcare ecosystem is at an urgent crossroads,” says Maryann Alexander, PhD, RN, FAAN, NCSBN chief officer of nursing regulation in a press release. The research was gathered from a biennial nursing workforce study conducted by NCSBN and the National Forum of State Nursing Workforce Centers.
In normal conditions, the NCSBN would anticipate that some 150,000 RNs would have left the workforce during the last two years, due largely to planned retirements, as well as normal pursuit of education and career change, says Brendan Martin, PhD, director of research at NCSBN in an interview. But the data revealed that 330,000 RNs had departed, combining retirements and those who left the workforce due to stress and burnout.
“In terms of looking retrospectively, we were really floored by that number,” Martin says. With an aging population and an increase in patient demand related to COVID-19, “just treading water and maintaining current staffing levels isn’t sufficient. And so the fact that we have any drop-off, let alone double the number we would anticipate, was really problematic.”
COVID the “Accelerant”
The COVID pandemic, says Martin, brought to light enduring nursing workforce issues. “Many of the issues that are confronting the workforce are long-standing issues. The pandemic itself wasn’t necessarily the driver of a lot of the stress, of a lot of this burnout. It was the accelerant,” Martin says.
The research shows that feelings such as being emotionally drained, fatigued, and burned out were most pronounced in nurses with ten or fewer years of experience. That drove an overall 3.3% decline in the nursing workforce during the past two years, the NCSBN report says.
The number of younger nurses planning to leave poses a special problem suggested Martin. “We’re relying on them to essentially step into more leadership roles to form the backbone of the workforce for the next 30 to 40 years and to really mentor the folks coming up through the ranks.”
Currently, says Martin, there are about 4.6 million licensed RNs in the U.S., with a little over 900,000 licensed practical and vocational nurses.
Solutions from Many Stakeholders
Addressing this problem will take cooperation from many stakeholders, Martin notes. “The impacts of the pandemic were so wide-ranging and so widespread that there isn’t a single key stakeholder that needs to be involved,” he says. “Everybody needs to get involved because it’s about how we educate our future nurses. It’s about how we onboard our new career entrants. It’s about how we support our current workers. And then it’s also about how we leverage the expertise, the built-up knowledge, and the acumen of the older nursing cohort.”
“With intentional policy, there’s a potential to get ahead of the curve and to blunt the impact of some of the things that we’re seeing with intents to leave,” according to Martin. “But more important than that, if we change the way that we mentor new nurses entering the workforce, if we give them the appropriate support and the funding if we talk about mental health services for current nurses, I think that there’s a real potential to build a more resilient workforce. If we make this a more sustainable and enriching environment, I think we’re going to rebound. I really strongly believe that, and I think the research supports it.”
Resilience of Nurses
On a positive note, “We saw a larger proportion of licensed nurses employed in nursing and at the bedside than we have in past and recent cycles,” says Martin. “It was really the resilience of nurses, basically going into the heart of the storm, so to speak, during the COVID period. We saw that come up in the data. That’s not news to anyone. That’s long-standing, how dedicated nurses are to their craft.”
Dealing with COVID has been difficult for everyone. However, patients who have cancer face a more complex battle.
Gabriella Magarelli MSN, ACNP-BC, AOCNP, is the Director of Nursing, RCCA at Hackensack Meridian Health John Theurer Cancer Center at Hackensack University Medical Center in New Jersey and a Lymphoma Research Advanced Practice Nurse. Magarelli has been with the cancer center since 2004. She was a staff nurse from 2004-2010, then joined the Lymphoma Team, where she currently works.
“At the John Theurer Cancer Center, our patients are always our top priority,” says Magarelli. “During the pandemic, we remained involved in their care even when diagnosed with COVID.”
While oncology dedicated treatment needs to pause to treat COVID, Magarelli and her team are still active members of the care team, working closely with the primary medicine and infectious disease teams to safely and swiftly return the patient to their cancer treatment.
If a cancer patient was diagnosed with COVID, their immune system must not be further compromised through cancer treatment.
Gabriella Magarelli MSN, ACNP-BC, AOCNP
Factors to Consider for Cancer Patients with COVID
Magarelli notes that “there are lots of factors to consider. COVID symptoms, disease status, and types of therapy needed are often considered before continuing or holding cancer-directed therapy.” However, every patient is different, and every situation calls for further treatment, withheld or not. In some patients, pausing chemotherapies or other treatments that cause severe immune system suppression is not an option.
To safely continue care to patients in the inpatient and outpatient setting who also tested positive for COVID, Magarelli and her team protected the immunocompromised in many ways. Including screening patients before visits to assess for signs and symptoms, limiting visitors, and creating dedicated elevators and pathways for COVID-positive patients to travel in. In some cases, the team would use telemedicine check-ups instead of in-person visits.
Cancer patients are encouraged to get COVID vaccinated and boosted. Magarelli and her team are constantly educating their cancer patients to avoid large crowds, wear a mask in public, and alert the team immediately with any signs or symptoms of infections.
Any type of infection on top of a patient already who has cancer is difficult. However, Magarelli and her team faced new, more complex challenges when COVID began infecting her patients.
“COVID and cancer is a complicated combination and is ever evolving as we learn more about COVID and have new therapies to treat it,” she shares. “While general guidelines are in place, the multidisciplinary team looks at each patient’s care independently to determine whether to proceed with or hold cancer-directed therapy.”
There is More to Cancer Care Than Just Physical Treatment
Magarelli and her team emphasize communication with the patient, as having cancer and COVID can be a terrifying experience. Patients have strong relationships with their oncology team and lean on them for advice and support throughout the process.
The care team needs to remain actively involved with their patient, as open communication is, in Magarelli’s opinion, the best thing she can do for them throughout treatment.
Overcoming COVID while suffering from cancer is a difficult obstacle for the patient. Still, these new challenges have also taken a toll on the John Theurer Cancer Center oncology team.
“While I have experienced lots of healthcare challenges in my 17 years as an oncology nurse, nothing has compared to this,” she admits, “At the beginning of the pandemic, I remember feeling helpless, which goes against the very essence of what people go into nursing to do: ‘help people.’”
Pandemic Builds Strong Unity
However, in these trying times, Magarelli has felt a strong unity among healthcare workers.
They have all worked tirelessly to care for their patients, develop standard operating procedures and workflows, and develop testing and vaccines to combat the virus. “As the pandemic evolved and we learned more about COVID, it reignited my passion for medicine and research,” she adds.
From the moment she became a nurse in 2004 and started her career in oncology, Magarelli has always been proud to call herself a nurse. More now than ever, nurses and healthcare professionals acknowledge the selflessness, compassion, and hardworking nature of their colleagues. With COVID-19, the world’s eyes have also been open to this determination.
Thanks to Magarelliand her oncology team at the John Theurer Cancer Center, cancer patients diagnosed with COVID can continue their treatment with undivided support and attention.
“I could not be more proud of this profession and how everyone pulled together during the pandemic. As a result, 2020 was labeled the year of the nurse, and it could not have been more fitting.”
Nurse of the Week May Parsons – who delivered the world’s first Covid jab on December 8, 2020 – was among the recipients of the George Cross Award at Windsor Castle (a setting also calculated to cast the White House in the shade) on Tuesday. The award, created by King George VI to recognize brave civilians in WWII Britain, was bestowed in honor of UK health care providers’ “courage, compassion, and dedication in circumstances of extreme danger.” In addition to Parsons, the award was also presented to her sister and fellow nurse Joanna Hogg, the first person in Northern Ireland to receive the vaccine and one of the first nurses to administer the life-saving shots.
Parsons recently earned an MSc in Global Healthcare Management at the Coventry University School of Nursing Midwifery and Health and is a Modern Matron for Respiratory at University Hospitals Coventry and Warwickshire Trust. She moved to the UK from the Philippines in the early 00s and has been a nurse in the UK Midlands district for about 18 years.
A shot seen round the world
When her turn in the spotlight arrived in late 2020, the Coventry nurse found out just a day before her big moment. And initially, she said, “I assumed it [the shot] was going to be the first in the West Midlands. I didn’t realize until afterward that it was the first in the country, never mind the world!”
The choice of Parsons was apropos. As a committed participant in her hospital’s flu Peer Vaccinator program, she held a three consecutive year record for having administered more flu jabs than any other person on the staff, with a personal best in which she vaccinated 140 patients in a single day.
Parsons put her one-day warning about the history-making shot to good use. The person scheduled to receive the world’s first Covid jab was 90-year-old Margaret Keenan, so Matron Parsons visited her patient and tried to put her at ease before she bared her arm to the needle for the world to see. She told a Royal College of Nursing reporter, “I went to see Margaret to build a rapport with her, making sure that she was aware the vaccine was new, and that there’d be a lot of press there.” Parsons added little comforting touches the next day as well, encouraging Keenan to wear her favorite color and helping her get her hair right before meeting the cameras. She recalled, “She [Keenan] was keen to have it – she wanted to get back to normal, see her grandchildren and the rest of her family.”
“It’s all about integrity”
After the momentous public jab, Parsons dove into the Midlands rollout of the Covid-19 vaccine, “managing the vaccination hub – the flow, mixing the vaccine,” as well as “staffing – recruiting people, training them, making sure they’re assessed properly and have the right information to give to patients.”
As a nurse, her role in encouraging vaccination seems obvious to her. “As a nursing profession, we have a relationship with patients where they trust us. It’s important for the rollout because we want them to be able to say, ‘Tell me straight, what will this do to me?’ I say to my family: I’m not going to tell you to have it if I wouldn’t have it myself. It’s all about integrity.”
Like New York’s Sandra Lindsay, who received the first US Covid jab six days after her, Margaret Keenan has persistently failed to experience frightening or bizarre side effects from her historic jab. She has apparently not been surveilled via a sinister 5G network courtesy of Bill Gates, and her grandchildren must have been dismayed to learn that magnetic toys did not adhere to her skin. Instead, when she got her booster last September, Keenan, now 91 years old, enjoyed her moment of fame and expressed immense relief to see the efficacy of the vaccines.
After she and her famous nurse reunited for their booster shots and enjoyed their first hug, Keenan remarked, “I’m happy now that I can be free, it’s like the good old times. It was great to have May here, we have become a double act! It was such big news all around the world.” Then, with a lack of sympathy one might expect from a woman who never feared that forks and spoons might suddenly start sticking to her arms, she added, “Go and get the jab, it will save lives. I don’t really know what stops people from having it because it’s so quick. Do go and get your vaccination!”
Berg shot, edited and produced the video, but he credits its power to the ICU nurses who opened up to him about the toll the surge was taking on them and their community. He went to the ICU that day expecting the focus of his story to be an unvaccinated patient whose experience with COVID-19 left him wishing he had chosen vaccination. As he began speaking to nurses Chani Marcoux, RN, Britney Meunier, RN, Danielle Poulin, NP, and Kimberly Matheson, RN, he knew their stories were just as important because they not only were speaking for themselves, but for the patients they lost.
“The truth is I showed up for one day with a camera and the nurses and the front line care teams have been doing this for two years, putting their lives on the line,” Berg said. “It was important to them that people see the needless pain and suffering that patients, families and care teams were going through when effective vaccines were available. It was important to me that that story be told.”
When the Regional Emmy® was announced, Marcoux, Meunier, Poulin and Matheson took the stage with Berg to receive the award. Berg introduced the nurses, who received a standing ovation.
“Charlie really was able to portray and capture the message of what it’s like to be an ICU nurse during the pandemic and the importance of vaccination,” Meunier said. “Inviting us to be part of the Emmy ceremony was so special.”
“Just being acknowledged, not only that night but also with the number of times that video has been seen was emotional for us,” Marcoux said. “To us, this award is for the patients we lost, those who passed away without their families with only us there. They’re always on our minds.”
Since March 2020, community health workers (CHWs) have taken on an expansive role as essential workers to help on the frontlines of the COVID-19 pandemic. Now, CHWs in the state of Utah can receive hope and comfort in COVID-19 support sessions through the University of Utah College of Nursing.
The sessions are offered by Caring Connections, the College of Nursing’s not-for-profit bereavement care program, through a unique partnership with the Utah Department of Human Services. Originally funded by CARES Act funds, Caring Connections was asked to develop and implement peer-support groups for CHWs.
“The community health workers are an amazing resource for Utahns, particularly those in underrepresented communities of color,” says Kathie Supiano, Ph.D., director of Caring Connections. “They have themselves been disproportionately impacted by the pandemic. It has been gratifying to encourage their good work.”
COVID-19 support sessions for CHWs through Caring Connections are offered monthly, either virtually or in person, to CHWs across the state of Utah. Caring Connections works in collaboration with Latino Behavioral Health to provide the program in both Spanish and English.
Caring Connections also provides other COVID-19 support groups, including:
COVID-19 Grief Support
This group includes members of the community who may have lost a family member or friend to the coronavirus or who are grieving a death that was disrupted due to the pandemic.
COVID-19 Recovery Support
This group is for individuals who are still dealing with emotional struggles relating to long COVID symptoms. Members of the group can find support from others with similar experiences related to their illness.
All Caring Connections support groups are currently being held virtually. The groups meet once a week and are led by licensed health care professionals. There is no cost for Caring Connections COVID-19 Support groups, though registration is limited. If you are a CHW in Utah, you can register by phone at 801-585-9522.
“Since I was in, I think, about 4th or 5th grade I knew I wanted to be a nurse,” says Brittany Wilborn, RN. It took the mother of five nearly a decade, but Wilborn, our Nurse of the Week, knows how to persevere and how to pace herself. She has cleared the many obstacles in her path, developed an arsenal of leadership skills, and is steadily amassing a collection of nursing credentials. Over the past 10 years, she progressed from a CNA to an LPN, then an ADN RN. Before the ink had dried on her RN, she had gone on to enroll in a BSN program. And after that? She plans to become an FNP.
Wilborn’s nursing aspirations were born early in life. As a child in Galesburg, Illinois, when Brittany went to see her pediatrician, it was not the doctor, but the nurse who attracted the little girl’s rapt admiration. The APRN-to-be recalls, “I thought she was so pretty, and she was professional. The way she approached me and treated me, made me feel better about myself and the situation. That’s when I knew that I wanted to be a nurse.”
But she had a lot of living to experience first. After Wilborn graduated from high school in 2010, she enrolled at Carl Sandberg College to begin her studies and earn her CNA credentials. However, life had other plans for her. Brittany became pregnant and soon dropped out to give birth to twin boys. (Twin boys have a talent for stopping all sorts of things). For the next few years, she focused on mothering the boys through their Terrible Twos and had two more children. Looking back, Wilborn thinks she needed to do some growing up herself first. “Now I feel like it [dropping out of college] was an excuse that I was making,” she said, and added, “And I think it’s one that a lot of us, as parents, make. ‘Oh, the kids, oh the kids!” After giving birth to child number four, though, she decided it was time to move fully into independent adulthood and pursue that nursing career: “2014 is when my journey really began to take off. I became a CNA, started working, got an apartment, and moved out of my mom’s house….”
After earning her CNA, Brittany went on to complete Sandburg’s Licensed Practical Nursing program in 2018. However, as a woman of color she had been subject to so many non-criminal law enforcement encounters that the NCLEX-PN criminal background check was deeply intimidating. Anxious and overwhelmed, she went no further until Covid and an insightful instructor pushed her forward. While Wilborn was working as a CNA at the height of the pandemic, the nurse she was assisting told her, “I don’t know why you won’t be a nurse. Why won’t you take your boards?’ Then, Stacy Bainter, MSN, a Sandburg nursing faculty member, also urged her to go ahead. “I realized that [your history] doesn’t define who you are and what you’re capable of,” Wilborn says. And, with a conscientiousness typical of good nurses, she thought, “If (Bainter) believed in me and Sandburg believed in me to give me this degree, I owe it to them to at least apply for my nursing license and put it to use.” She also began to flex her leadership skills (valuable not only for nurses but to any mother of twin boys). Brittany joined Sandburg’s Black Student Association, became a student trustee for Sandburg’s Board of Trustees, and was selected as chairperson for the Illinois Community College Board’s Student Advisory Committee.
Today, Wilborn has five kids and a growing collection of degrees and certifications. She is now an RN with an associate’s degree (ADN), but that is just the beginning. Wilborn is pursuing her BSN now at a joint Sandburg/Chamberlain College program, and after that plans to enroll in the FNP program at Chamberlain College. If there are more obstacles ahead, Wilborn will find her way around them: “It’s necessary for me to keep going because I know that I can. It’s necessary because I feel like I shouldn’t limit myself. For some people, the ceiling, that’s their limit. And for others, the ceiling is your bottom.”
For more on Brittany Wilborn, RN, see her interview with local TV station KWQC.