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Expect more nurses to take on leadership and public policy positions, says Dr. Stephen Ferrara, DNP, FNP-BC, FAANP, editor of the Journal of Doctoral Nursing Practice and Associate Dean of Clinical Affairs at Columbia University Medical Center. Speaking to DailyNurse, Dr. Ferrara described his work managing the treatment of non-COVID patients during the New York outbreak and shared his views on the impact of COVID on the nursing profession.
First, can you tell us a bit more about your work both at Columbia and with Jonas Nursing & Veterans Healthcare?
Stephen Ferrara: In my role as Associate Dean, Clinical Affairs at Columbia University Medical Center, my team and I develop systems and practices to ensure world-class patient care within our clinical locations—most recently that has included managing systems for screening and safety for our non-COVID patients. At Columbia, I serve as associate professor and manage the Columbia Doctors Nurse Practitioner Group, one of the country’s best nurse-run primary care services. I also teach health policy to the Doctor of Nursing Practice (DNP) students, and as Interim Executive Director of Jonas Nursing & Veterans Healthcare, I oversee our nursing scholars program, a group of exceptional nurses pursuing higher education in order to serve vulnerable communities in unique ways.
What have been the challenges of treating non-COVID patients during the height of the NYC outbreak?
SF: It is always our first priority to keep patients safe while providing the most comprehensive care possible. During the height of the outbreak in New York, the greatest challenge was supporting non-COVID patients in first assessing the need for in-person care and then managing the risk of infection against the potential consequences of their condition if gone untreated for a period of time. Education for patients and potential patients on telemedicine and other low-risk care options was also priority for us during this time. Since bringing patients into the office was no longer an option, we quickly transitioned to video visits to triage patient concerns, diagnose and treat minor acute issues and provide continuity of care for existing patients of the practice.
What sorts of adjustments have had to be made in caring for non-COVID health issues?
SF: The first step we had to take was ruling out COVID in patients with similar symptoms and ensuring we were keeping non-COVID patients out of the emergency room to begin with. We stood up a cold, cough and fever clinic which allowed streamlined patient flow, testing and procedures. We were able to rule out infections such as influenza and strep throat. While virtual visits had been part of our offering before the pandemic, they became standard procedure during the outbreak. Critically, we had to adjust staffing procedures and evaluate our supply of appropriate protective resources so that enough would be available for fellow healthcare personnel on the front lines.
What are your views on the impact of telemedicine?
SF: Telemedicine is making the way we administer care safer, more efficient, and potentially more accessible to all our patients. By conducting appointments virtually, we cut down the risk of spreading infection between patients in healthcare offices, and allow individuals who are mobility impaired to receive the help they need faster, from the comfort of their own homes. For the first time, we have the ability to assess patients’ home environment for safety which can help guide us in our treatment recommendations. Of course, in certain cases telemedicine cannot replace in-person examination or care, but with a decrease of patients coming into the office, these cases can often be given more focused attention than before. Additionally, not all patients have access to a smartphone or computer thus a significant barrier to care potentially exists.
In what ways do you expect the nursing profession will be changed by the US experience? What changes in healthcare do you think should/will remain in the long term?
SF: I think the critical role nurses play in our healthcare system, not only with hospitals, but in labs, clinics, offices, and from home, will become more apparent. Their insights and perspective on how we prevent, prepare, and treat situations like these will have lasting effects on the future of care. I believe we will see more nurses rise to leadership positions in our country’s healthcare institutions because of the value of their input, and look forward to the innovations and efficiencies that will follow. We will also see more nurses become increasingly involved in health policy based on their experience and recommendations.
Nurses make up the largest component of the healthcare workforce & have been rated as the most trusted profession per Gallup polling for the last 18 years in a row. As a result, we will see more nurses in elected positions throughout our local, state and federal governments. In terms of the changes brought on by this pandemic which should remain, I have seen this crisis open our eyes to the vulnerabilities of underserved communities and hope our attention remains focused on improving outcomes for these groups.
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