As Nurse of the Week Charlotte Thrall, DNP, FNP-C, CNE, FAANP sat anxiously waiting in the emergency room at Mayo Clinic for news of her husband’s condition after a pickleball accident left him unconscious and unresponsive, her mind spun with uncertainty. Then, among the health care workers that began to fill the room, her eyes settled on a familiar face.
It was her former nursing student, Lexy Richards. Lexy was now a neurosurgery NP for the Mayo team treating Dr. Thrall’s husband.
Their unexpected reunion was bittersweet but welcome, and the following morning, Richards was at Billy Thrall’s bedside, reviewing imaging and lab work, answering whatever questions they had and doing everything in her power to make sure Billy and Charlotte, whom Richards had known since she was a student at Arizona State University’s Edson College of Nursing and Health Innovation, were taken care of.
“It was so humbling to be in a position where someone who taught you everything you know and who you respect to the highest degree is now in a position of vulnerability,” Richards said.
Fortunately, Billy did not require surgery. But having Richards to reach out to during his recovery was invaluable to Charlotte.
“Those first eight weeks of recovery were particularly difficult, and she was … I don’t even have the words,” Charlotte said.
Now, nearly 20 weeks out from the accident, Billy is making good progress. And Charlotte and Richards are still frequently in touch — though not always concerning Billy.
A clinical assistant professor and coordinator of the Family Nurse Practitioner program at Edson College, Charlotte first met Richards as her professor. Equally impressed by each other, they quickly developed a mentor-mentee relationship, with Richards serving on the leadership team for HopeFest, an annual community health care event Charlotte and her husband launched in 2012, and Charlotte writing a letter of recommendation for Richards’ application to medical school to become a neurosurgeon, mere months before Billy’s accident.
Richards received word that her application had been accepted while Billy was still recovering in the hospital. She’ll begin attending the TCU and UNTHSC School of Medicine in Fort Worth, Texas, this summer.
“Charlotte and her husband are exceptional people, and she has been hugely supportive of my career,” Richards said. “Even on a personal level, she was so supportive when my husband deployed to the military. My depth of gratitude to her will always be tremendous for all the ways she has shaped my life. It has been a gift for me to be able, in some small way, to help her and her husband through this experience.”
Charlotte and Billy met in Paris in 1984 on a service trip when she was 19 and he was 21. They’ve been married for almost 33 years now, and during that time, they have become well known for their various community outreach efforts in the Phoenix area, where Charlotte works as a nurse and Billy works as a nonprofit consultant.
It was around 2009 when Charlotte realized she wanted to be able to practice clinically in an independent manner, in order to better serve her community. So she enrolled in Edson College’s Doctor of Nursing Practice program and graduated in 2012. She began teaching for the college as an adjunct faculty member in 2013, then became coordinator of the Family Nurse Practitioner program in 2017.
While teaching in the program, Charlotte also served as a mentor to another student, Jonathan Helman. Like Richards, Helman served on the HopeFest leadership team and was moved by Charlotte’s example of care and compassion, both for her students and for the community.
“She’s one of those people you realize pretty quickly is a special individual,” he said.
Helman now teaches at Edson College himself, sometimes alongside Charlotte. He also works in a field very similar to Richards’ — neurology. And when it came time for Billy to transition from recovering at the hospital to recovering at home, Helman was more than willing to provide consult.
“When I heard what happened, I immediately wanted to give back, I suppose almost as a way to repay her for the incredible influence she’s had on my life,” he said. “I’m not just blowing smoke, I quite often think about the type of provider she is and try to emulate that in my everyday practice. She is one of most empathetic people I know. … She has touched so many lives, either directly as a practitioner and through her outreach efforts, or indirectly as a professor who is teaching students who will eventually go out and serve the community, too.”
Former classmates who have remained good friends, Helman and Richards frequently consult with one another about patients because of their closely related specialties. This time around, it was for the benefit of someone for whom they care deeply.
Despite the reason for this, their most recent collaboration, Charlotte feels grateful to have been able to observe them in action.
“They were a gift to us,” she said. “I would never have anticipated having to rely so much on former students to guide us through such a difficult medical situation, but I knew the kind of students they were, I knew how prepared they were and how well they had done, and I knew I could really trust them.
“There were moments I thought that I could actually see them utilizing some of the things that I had taught them, like motivational interviewing or compassionate care, and in my mind, I thought, ‘I need to tell them later what a good job they’re doing.’ I was just so grateful for them, and it really encouraged me and reminded me that what we do when we train people to be clinicians is really, really important. And there’s a reason why we want to do a good job. There’s a reason why the program is challenging. There’s a reason why we are so careful about who we select to be in the program. Because it matters every day to patients like my husband and the hundreds of others out there.”.
Psychiatric Mental Health Nurse Practitioners (PMHNPs) are board-certified advanced practice nurses who diagnose and treat mental health and substance abuse issues. PMHNPs work in outpatient and inpatient settings, providing assessment, therapy, and medications. PMHNPs are critical in any disaster, providing emergent mental health care and psychosocial support to new patients and continuing outreach and support to established patients. Most recently, the COVID-19 pandemic has initiated a global mental health crisis.
The pandemic mental health crisis is unique in its influence on millions impacted by isolation, job loss, financial strain, and grief. Approximately half of Americans feel that the pandemic harmed their mental health. In addition, millions of healthcare workers that cared for COVID patients are expected to suffer mental health issues for up to a year after the pandemic ends. This increase in mental health issues post-COVID will create an additional cyclical mental health strain on the healthcare system.
To meet the increasing and expected mental health and substance abuse issues, the practice landscape for PMHNPs has changed. Recognition of emergent and forecasted needs combined with a national shortage of psychiatrists has led to dramatic changes in the PMHNP role.
1. Expanded scope of practice
Many states aligned with the Centers for Medicare and Medicaid Services (CMS) to expand Advanced Practice Registered Nurse (APRN) practice flexibility, including relaxing physician supervision mandates. These changes allow the PMHNP to practice to the full extent of their certification—independently counsel patients, prescribe medications, and consult —without physician oversight.
2. Further defined patient populations
In addition to the traditional patient groups, COVID-19 defined the patient population into focused groups to monitor pandemic effects and needs. In the beginning, the elderly population were quickly identified as an at-risk group. Then, the pandemic revealed the health disparities among underserved populations, shedding light on this chronic problem in health care.
Throughout the pandemic, additional patient populations were identified and assessed for risk of increased mental health needs or substance abuse. These groups included: health care workers, school-aged children and teens, university students, the homeless population, and the institutionalized. The expansion of these societal groups provides a detailed assessment of physical, emotional, and support needs.
3. Lowered access barriers
Pre-pandemic barriers to psychiatric care included:
Limited access to care
Stigma associated with mental health care services
Cost of seeking treatment
Although telehealth was available, this service was limited due to insurance reimbursement and the cost of HIPAA-protected technology. During the pandemic, CMS expanded approval for telehealth services. Also, the Department of Health and Human Services (HHS) waived penalties for HIPAA violations associated with the use of technologies such as FaceTime, Skype, or WhatsApp.
Some mental health practices delivered care through drive-up clinics. These clinics continued pre-pandemic care to psychiatric patients by administering long-acting injectable medications, and safely participating in socially distant face-to-face appointments if telehealth was not an option. These drive-up clinics improved treatment and follow-up compliance throughout the pandemic.
Telehealth allowed better access to mental health services, and also allowed patients to be seen in their homes. This view into the patient’s home life provided valuable information about their surroundings, lifestyle, and support systems.
4. Innovative practice opportunities
COVID-19 created a need for PMHNPs to consult with school administrations. Children and teens transitioning from the traditional school day to a virtual day struggle with isolation, depression, and anxiety. A school-aged child with a pre-existing diagnosis (such as ADHD or other behavioral and learning disabilities) may struggle with changes in routine and environment. PMHNPs can offer consulting services to the school and to parents to help children through these challenging times. PMHNPs are also needed for the post-pandemic period for readjustment back to daily in-person school.
Many patients initially reported depression and anxiety to primary care providers (PCP). The PMHNP is a valued consultant for the PCP to initiate holistic therapies, medications, and follow-up for these patients.
During the peak of the COVID-19 assault on New York City, a pair of Yale DNP graduates quickly identified that the city was in crisis. They responded by offering Lavender, an online psychiatry office employing 14 PMHNPs to provide counseling services. (Also an ANA 2021 Innovation Winner). Lavender offers same-day inquiry response, and transparent pricing that is approximately 30% less than existing psychiatric practices.
The pandemic revealed gaps in the current healthcare system and created a mental health emergency. However, PMHNPs are prepared to provide needed services through an expanded scope of practice, telehealth services for patient counseling, and consulting services to schools and medical practices.
Andrew Penn, RN, MS, NP, CNS, APRN-BC, an adult and psychiatric nurse practitioner, is exploring how COVID-19 has changed humanity. Society transitioned from overscheduled bustling lives in society, to adapting to the isolation of working from home, home-schooling children, and a nonexistent social life. These unexpected changes have left us exhausted and wary of the future. He cautions us to slowly emerge from our isolation, give attention to self-care, and look forward to a promising, and transformed future.
Karen Jo Young wrote a letter to her local newspaper criticizing executives at the hospital where she worked as an activities coordinator, arguing that their actions led to staffing shortages and other patient safety problems.
Hours after her letter was published in September 2017, officials at Maine Coast Memorial Hospital in Ellsworth, Maine, fired her, citing a policy that no employee may give information to the news media without the direct involvement of the media office.
But a federal appellate court recently said Young’s firing violated the law and ordered that she be reinstated. The court’s decision could mean that hospitals and other employers will need to revise their policies barring workers from talking to the news media and posting on social media.
Those media policies have been a bitter source of conflict at hospitals over the past year, as physicians, nurses and other health care workers around the country have been fired or disciplined for publicly speaking or posting about what they saw as dangerously inadequate covid-19 safety precautions. These fights also reflect growing tension between health care workers, including physicians, and the increasingly large, profit-oriented companies that employ them.
On May 26, the 1st U.S. Circuit Court of Appeals unanimously upheld a National Labor Relations Board decision issued last year that the hospital, now known as Northern Light Maine Coast Hospital, violated federal labor law by firing Young for engaging in protected “concerted activity.” The NLRB defines it as guaranteeing the right to act with co-workers to address work-related issues, such as circulating petitions for better hours or speaking up about safety issues. It also affirmed the board’s finding that the hospital’s media policy barring contact between employees and the media was illegal.
“It’s great news because I know all hospitals prefer we don’t speak with the media. We are careful about what we say and how we say it because we don’t want to bring the hammer down on us.”
—Cokie Giles, president of the Maine State Nurses Associationnurses union
The 1st Circuit opinion is noteworthy because it’s one of only a few such employee speech rulings under the National Labor Relations Act ever issued by a federal appellate court, and the first in nearly 20 years, said Frank LoMonte, a University of Florida law professor who heads the Brechner Center for Freedom of Information.
The 1st Circuit and NLRB rulings should force hospitals to “pull out their handbook and make sure it doesn’t gag employees from speaking,” he said. “If you are fired for violating a ‘don’t talk to the media’ policy, you should be able to get your job back.”
The American Hospital Association and the Federation of American Hospitals declined to comment for this article.
While the 1st Circuit’s opinion is binding only in four Northeastern states plus Puerto Rico, the NLRB decision carries the force of law nationwide. The case applies to both unionized and non-unionized employees, legal experts say.
Hospitals and health care organizations often have policies requiring employees to clear any public comments about the workplace with the organization’s media office. Many also have policies restricting what employees can say on Facebook and other social media.
Hospitals say requiring employees to go through their media office prevents the spread of inaccurate information that could damage the public’s confidence. In Young’s case, the hospital argued that her letter contained false and disparaging statements. But the 1st Circuit panel agreed with the NLRB that her letter was “not abusive” and that its only false statement was not her fault.
Health care organizations have undisputed legal authority to prohibit employees from disclosing confidential patient information or proprietary business information, legal experts say.
“If you go to the media and say, ‘There are unsafe working conditions impacting me and my colleagues,’ that’s protected concerted activity.”
—Eric Meyer, FisherBroyles
But the 1st Circuit panel made clear that an employer cannot bar an employee from engaging in “concerted actions” — such as outreach to the news media — “in furtherance of a group concern.” That’s true even if the employee acted on her own, as Young did in writing her letter. The key in her case was that she “acted in support of what had already been established as a group concern,” the court said.
“I think employers with a blanket ban on talking to the media need to relook at their policies,” said Eric Meyer, a partner at FisherBroyles in Philadelphia who often represents companies on employment law matters. “If you go to the media and say, ‘There are unsafe working conditions impacting me and my colleagues,’ that’s protected concerted activity.”
Chad Hansen, Young’s attorney in a separate federal lawsuit alleging discrimination based on a disability against the hospital, said she has not yet been reinstated to her job. Young would not comment.
The hospital’s parent company, Northern Light Health, said only that its news media policy — which was amended after Young’s firing — meets the NLRB and 1st Circuit requirements and will not be further changed. The new policy created an exception allowing employees to speak to the news media related to concerted activities protected by federal law.
Speech rights under the National Labor Relations Act are particularly important for employees of private companies. Although the Constitution protects people who work for public hospitals and other government employers with its guarantee of unrestricted speech, employees at private companies do not have a First Amendment right to speak publicly about workplace issues.
“I hope this case keeps alive the right of health care workers to speak out about something that’s dangerous,” said Dr. Ming Lin, an emergency physician who lost his job last year at PeaceHealth St. Joseph Medical Center in Bellingham, Washington, after publicly criticizing the hospital’s pandemic preparedness.
Lin, who was employed by TeamHealth, which provides emergency physician services at the hospital, lost his assignment at PeaceHealth in March 2020 soon after saying on social media and in interviews with news reporters that PeaceHealth was not taking urgent enough steps to protect staff members from covid. He had worked at the hospital for 17 years.
In an April 2020 YouTube interview, PeaceHealth’s chief operating officer, Richard DeCarlo, said Lin was removed from the hospital’s ER schedule because he “continued to post misinformation, which was resulting in people being afraid and being scared to come to the hospital.” DeCarlo also alleged that Lin, who was out of town for part of the time he was posting, refused to communicate with his supervisors in Bellingham about the situation. PeaceHealth declined to comment for this article.
PeaceHealth’s social media policy at that time stated that the company does not prohibit employees from engaging in federally protected concerted activity and that they “are free to communicate their opinions.” TeamHealth’s social media policy, dated July 15, 2020, states the company reserves the right to take disciplinary action in response to behavior that adversely affects the company.
Lin, who’s now working for the Indian Health Service in South Dakota, has sued PeaceHealth, TeamHealth and DeCarlo in state court in Washington claiming wrongful termination in violation of public policy, breach of contract and defamation.
Dr. Jennifer Bryan, board chair of the Mississippi State Medical Association, who publicly defended two Mississippi physicians fired for posting about the inadequacy of their hospitals’ covid safety policies, said she faced pressure from her hospital for speaking to the news media without approval.
The medical association pushed its members to talk to the media about the science of covid, while employers insisted doctors’ messages had to be approved by the media office. That reflected a conflict, she said, between medical professionals primarily concerned about public health and executives of for-profit systems who were seeking to shield their corporate image.
Bryan predicted the court ruling and NLRB decision will be helpful. “Physicians have to be able to stand up and speak out for what they believe affects the safety and well-being of patients,” she said. “Otherwise, there are no checks and balances.”
Published courtesy of KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
The week before Brian Colvin was scheduled for shoulder surgery in November, he tested positive for covid-19. What he thought at first was a head cold had morphed into shortness of breath and chest congestion coupled with profound fatigue and loss of balance.
Now, seven months have passed and Colvin, 44, is still waiting to feel well enough for surgery. His surgeon is concerned about risking anesthesia with his ongoing respiratory problems, while Colvin worries he’ll lose his balance and fall on his shoulder before it heals.
“When I last spoke with the surgeon, he said to let him know when I’m ready,” Colvin said. “But with all the symptoms, I’ve never felt ready for surgery.”
As the number of people who have had covid grows, medical experts are trying to determine when it’s safe for them to have elective surgery. In addition to concerns about respiratory complications from anesthesia, covid may affect multiple organs and systems, and clinicians are still learning the implications for surgery. A recent studycompared the mortality rate in the 30 days following surgery in patients who had a covid infection and in those who did not. It found that waiting to undergo surgery for at least seven weeks after a covid infection reduced the risk of death to that of people who hadn’t been infected in the first place. Patients with lingering covid symptoms should wait even longer, the study suggested.
But, as Colvin’s experience illustrates, such guideposts may be of limited use with a virus whose effect on individual patients is so unpredictable.
“We know that covid has lingering effects even in people who had relatively mild disease,” said Dr. Don Goldmann, a professor at Harvard Medical School who is a senior fellow and chief scientific officer emeritus at the Institute for Healthcare Improvement. “We don’t know why that is. But it’s reasonable to assume, when we decide how long we should wait before performing elective surgery, that someone’s respiratory or other systems may still be affected.”
The study, published in the journal Anaesthesia in March, examined the 30-day postoperative mortality rate of more than 140,000 patients in 116 countries who had elective or emergency surgery in October. Researchers found that patients who had surgery within two weeks of their covid diagnosis had a 4.1% adjusted mortality rate at 30 days; the rate decreased to 3.9% in those diagnosed three to four weeks before surgery, and dropped again, to 3.6%, in those who had surgery five to six weeks after their diagnosis. Patients whose surgery occurred at least seven weeks after their covid diagnosis had a mortality rate of 1.5% 30 days after surgery, the same as for patients who were never diagnosed with the virus.
Even after seven weeks, however, patients who still had covid symptoms were more than twice as likely to die after surgery than people whose symptoms had resolved or who never had symptoms.
Some experts said seven weeks is too arbitrary a threshold for scheduling surgery for patients who have had covid. In addition to patients’ recovery status from the virus, the calculus will be different for an older patient with chronic conditions who needs major heart surgery, for example, than for a generally healthy person in their 20s who needs a straightforward hernia repair.
“Covid is just one of the things to be taken into account,” said Dr. Kenneth Sharp, a member of the Board of Regents of the American College of Surgeons and vice chair of the Department of Surgery at Vanderbilt University Medical Center.
In December, the American Society of Anesthesiologists and the Anesthesia Patient Safety Foundation issued these guidelines for timing surgery for former covid patients:
• Four weeks if a patient was asymptomatic or had mild, non-respiratory symptoms.
• Six weeks for a symptomatic patient who wasn’t hospitalized.
• Eight to 10 weeks for a symptomatic patient who has diabetes, is immunocompromised or was hospitalized.
• Twelve weeks for a patient who spent time in an intensive care unit.
Those guidelines are not definitive, according to the groups. The operation to be performed, patients’ medical conditions and the risk of delaying surgery should all be factored in.
“Long covid” patients like Colvin who continue to have debilitating symptoms months after 12 weeks have passed require a more thorough evaluation before surgery, said Dr. Beverly Philip, president of the society.
Now that covid has been brought to heel in many areas and vaccines are widely available, hospital operating rooms are bustling again.
“In talking to surgical colleagues, hospitals are really busy now,” said Dr. Avital O’Glasser, medical director of the outpatient preoperative clinic at Oregon Health and Sciences University in Portland. “I’ve seen patients with delayed knee replacements, bariatric surgery, more advanced cancer.”
At the beginning of the pandemic, surgical volumes dropped dramatically as many hospitals canceled nonessential procedures and patients avoided facilities packed with covid patients.
From March to June 2020, the number of inpatient and outpatient surgeries at U.S. hospitals was 30% lower than in the same period the year before, according to McKinsey & Company’s quarterly Health System Volumes Survey. By May 2021, surgical volumes had mostly rebounded, and were just 2% lower than their May 2019 totals, according to the May survey.
Oregon Health and Sciences University clinicians developed a protocol a year ago for clearing any patient who had covid for elective surgery. When obtaining patients’ medical history and conducting physical exams, clinicians look for signs of covid complications that aren’t readily identifiable and determine whether patients have returned to their pre-covid level of health.
The pre-op exam also includes lab and other tests that evaluate cardiopulmonary function, coagulation status, inflammation markers and nutrition, all of which can be disrupted by covid.
If the assessment raises no red flags, patients can be cleared for surgery once they have waited the minimum seven weeks since their covid diagnosis.
Originally, the minimum wait for surgery was four weeks, but clinicians pushed it back to seven after the international study was published, O’Glasser said.
“We are still learning about covid, and uncertainty in medicine is one of the biggest challenges we face,” said O’Glasser. “Right now, our team is erring on the side of caution.”
At Memorial Sloan Kettering Cancer Center in New York, doctors don’t follow a specific protocol. “We’re taking every patient one at a time. There are no hard-and-fast rules at this institution,” said Dr. Jeffrey Drebin, chair of surgery.
Clinicians work to find a balance between the urgency of the cancer surgery and the need to allow enough time to ensure covid recovery, he said.
For Brian Colvin, whose right rotator cuff is torn, delaying surgery is painful and may worsen the tear. But the rest of his life is on hold, too. A sales representative for an auto parts company, he hasn’t been able to work since he got sick. His balance problems make him reluctant to stray far from his home in Crest Hill, Illinois, the Chicago suburb where he lives with his wife and 15-year-old son.
Some days he has more energy and isn’t as short of breath as others. Colvin hopes it’s a sign he’s slowly improving. But at this point, it’s hard to be optimistic about the virus.
We honored Sandra Lindsay, DHSc, MS, MBA, RN, CCRN-K, NE-BC as Nurse of the Week just last week. Did we run out of outstanding nurses? No, our in-box is still overflowing with NotW suggestions (and please keep them coming!). However, after careful consideration, we bowed in the face of overwhelming evidence indicating that Dr. Lindsay is owed a two-week reign as Nurse of the Week. The nursing student who described her as “the [American] face of the Covid-19 vaccine” was merely being accurate, and the events of this week can certainly attest to Lindsay’s iconic status. What has Dr. Sandra Lindsay been doing since last Wednesday? Well, we can only account for perhaps a few hours last Friday and today — but it is clear that she will have to add Vaccination Icon Duties to her schedule from now on.
Last Friday, US President Joe Biden brought her closer to Elvis status (Presley was a dedicated crusader for the polio vaccine in the 1950s) by presenting the Jamaican-born Lindsay with the Outstanding American by Choice Award. “She represents the very best of us all,” said Biden during a special ceremony at the White House, and “pursued her dream of becoming a nurse to allow her to do what she wanted to do most: give back to her new country.” He also shared a bit more of Lindsay’s own pandemic story. “During the height of the pandemic, she poured her heart and soul into her work… With a grandson at home — prematurely — she did what she had to do. She kept her distance and kept him safe. He is safe, but she lost an aunt and an uncle to the virus.”
Linsday responded, “I came to this country for the opportunities – not only for myself but to be able to help others. As a nurse, I do everything to care for the sickest patients and lead by example. More than 24 years after becoming a naturalized citizen, I could never have imagined where I am today, at the White House receiving high honors from the President. It’s truly a privilege to be a part of this great nation and I will continue to lead and help those in need.”
After the White House ceremony, Lindsay was also asked to surrender her vaccination card, hospital badge, and a pair of scrubs into the custody of the Smithsonian Institution. The items will be on display at the Smithsonian’s Covid-19 historical exhibit (She naturally complied with the request, being as eager as all of us to see Covid-19 become History).
Lindsay had more Icon Duty on Wednesday, July 7, as she joined the ranks of Nurse Grand Marshals. For three hours, she presided over New York City’s Hometown Heroes ticker-tape parade. Lindsay was an obvious choice to lead festivities celebrating the courage and dedication of essential/healthcare workers caring for a city that is still trying to comprehend the loss of over 33,400 lives to the virus. “It is truly an honor and privilege to serve as the grand marshal in the Hometown Heroes ticker-tape parade and represent all health care and essential workers whose heroic efforts saved lives during the COVID-19 pandemic,” Lindsay said. Photos of the Grand Marshal smiling and waving from the back of a plush red convertible look suitably… iconic.
Dr. Lindsay, it is a pleasure to see a nurse knock The King back into his lane and take over as the US Vaccination Icon. Thank you!
The COVID-19 pandemic has brought rural healthcare systems to the brink. In 2020, at least 20 rural hospitals closed—a new annual record since 2005.
Even before the pandemic, rural healthcare systems have been fighting for their lives. A recent report from the U.S. Government Accountability Office (GAO) found that 101 rural hospitals closed from January 2013 through February 2020. The report found people in the closed hospitals’ service areas would have to travel substantially farther to access certain healthcare services—the median distance to access some of the more common healthcare services increased about 20 miles from 2012 to 2018.
In addition to putting patients at risk of losing access to healthcare, hospital closures strike at the heart of a community. Hospitals are major employers and communities lose jobs, businesses, tax revenue—and people. Doctors, nurses, pharmacists, and other staff employed by the hospital often have to leave the area. GAO found that the availability of healthcare providers in counties with rural hospital closures generally was lower and declined over time.
The crisis in rural healthcare has many causes and the solutions are far from simple. Luckily, our nation’s leaders are starting to take action through various legislative and regulatory approaches. For example, the American Rescue Plan Act of 2021 provides $8.5 billion to reimburse rural healthcare providers for healthcare-related expenses and lost revenues attributable to the COVID-19 pandemic.
Notably, a bipartisan group of Senators has introduced the Save Rural Hospitals Act of 2021, which would help curb the trend of hospital closures in rural communities by making sure hospitals are fairly reimbursed for their services by the federal government. The House has also introduced the Rural Hospital Support Act, bipartisan legislation that would extend and modernize critical federal programs that rural hospitals rely on to properly serve their communities. If passed, these acts would help these community lifelines keep their doors open as we continue to face the lasting repercussions of the pandemic.
Another important solution gaining momentum among policymakers: allowing advanced practice nurses such as Certified Registered Nurse Anesthetists (CRNAs) and other nonphysician providers to practice to the full scope of their education and expertise.
CRNAs are in the thick of responding to this crisis as the sole anesthesia providers in the vast majority of rural hospitals, enabling these facilities to offer surgical, obstetrical, trauma stabilization, interventional diagnostic, and pain management services. Numerous studies have demonstrated that CRNAs provide safe, cost-effectiveanesthesia care.
Importantly, President Biden’s proposed Fiscal Year 2022 budget calls for added funding for the U.S. Department of Health and Human Services (HHS) to protect rural healthcare access and expand the pipeline of rural providers like CRNAs, noting, “The discretionary request also funds efforts to increase the number of individuals from rural areas going to medical school or other training programs, and returning or staying in rural communities to provide care, with a focus on primary care physicians, nurses, nurse practitioners, nurse anesthetists, and other in-demand providers.”
Additionally, in March 2020, the Centers for Medicare & Medicaid Services (CMS) temporarily removed physician supervision of physician assistants and advanced practice nurses to increase the capacity of the U.S. healthcare delivery system during the COVID-19 Public Health Emergency. This allowed CRNAs to step forward as indispensable providers responding to this unprecedented crisis. The waiver was extended by 90 days in April 2021 and HHS has indicated it is likely to remain through the year.
We can help address the rural healthcare crisis by applying the lessons learned during this tragic, unprecedented year. We need to move forward using all of the resources available and make the commonsense measures taken during the pandemic permanent. As these underserved areas need all of the help and resources that CRNAs and other nonphysician providers can give, the barriers that were temporarily waived last year must stay down.
The COVID-19 pandemic has laid bare fundamental, systemic problems within the U.S. healthcare system that will not go away when the pandemic goes away. Clearly, the nation cannot continue down the same path and do what we have always done.