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Federal and state governments, national agencies, nursing schools, and hospitals need to create a better pandemic support structure for nurses, according to a new report from the Johns Hopkins Center for Health Security.

As nurses are expected to provide care in all sorts of extreme circumstances, what can be done to better prepare them and protect their wellbeing in a pandemic? This is the focus of the Johns Hopkins report, “Recommendations for Improving National Nurse Preparedness for Pandemic Response: Early Lessons from COVID-19.”

The Johns Hopkins report examines the effects of the pandemic on the nursing profession, and proposes immediate and long-term actions to effect improvements in seven key areas:

• Clear and uniform academic nursing standards

• Nurses who are educated, trained, and clinically competent

• Safe workplace environments

• Adequate access to PPE

• Regulatory consistency across states

• Nurses cross-trained for various clinical settings

• Regular, transparent communications

Provide Nurses with Better Protection

Ensuring nurses’ safety during a pandemic is a vital concern, and the Johns Hopkins report proposes that Congress and government agencies institute programs to more effectively manage the PPE supply chain and ensure “equitable distribution across public and private hospitals.” On a local level, individual hospitals must conduct a rigorous self-examination of their staff safety procedures. “It will be challenging to remedy the distrust and betrayal many frontline nurses feel as a result of not being adequately protected by their institutions during the COVID-19 pandemic,” say the authors of the report. To alleviate this situation, they consider it imperative that hospitals promote more nurses to leadership and decision-making roles. The advice of leaders with nursing expertise is an essential step toward attaining “the best possible health system environment for providing and receiving health care during emergencies.”  

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Improve Staff Management in a Pandemic Situation

COVID-19 has also turned a spotlight on staffing issues. Obtaining sufficient ICU staff has been especially problematic, the report notes, owing to the specialized skills required on such units. To improve their ability to meet emergencies such as the pandemic, the authors suggest that hospitals adopt an “expertise migration approach” in which ICUs and EDs follow a “model of ongoing nursing continuing education and pandemic preparedness [that] reconceptualizes the experienced nurse as a generalist.” The report takes note as well of the widespread inconsistencies among state executive orders concerning regulations and scope of practice for nurses and advanced practice nurses. To avoid such confusion in the future, the authors urge that states “adopt legislature (such as the Nursing Licensure Compact and Model Advanced Practice Registered Nurse Compact legislation) that will remove regulatory variability over nurse licensure and allow registered and advanced practice nurses to be rapidly mobilized and deployed across state lines during pandemics.”

Correct the Lack of Pandemic Coverage in the Nursing Curriculum

The report directs close attention to reinforcing the nursing education system in light of the pandemic experience. The authors found that students need far more robust training in emergency and disaster preparation. Nursing schools failed to sustain the expanded emergency preparedness curriculum implemented in the wake of 9/11 and were caught unprepared by the school shutdowns during the COVID-19 outbreak. In the current nursing curricula, the authors state, “what is frequently absent is education around concepts in public health emergency response, disease surveillance and containment strategies, and mass vaccination operations… and instruction regarding the proper selection and use of PPE.” They call upon the American Association of Colleges of Nursing to provide a “tool kit” for improving emergency preparedness content in all baccalaureate and graduate nursing programs, and advise that the three nursing accreditation bodies “require the inclusion of teaching and simulation on emergency preparedness and response.” To ensure the continuity of nursing education in COVID-type situations, they advise that schools and state boards of nursing “develop a plan for the continuity of clinical education during public health emergencies.”

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Research into nursing and emergency preparedness has so far contributed little to the study of pandemics. The report points out that funding is needed “to support research for pandemic planning in the nursing field,” and to encourage the training of nurse-scientists, “who are critical to strengthening the evidence base and improving the delivery of nursing care during a pandemic.” Among the short and long-term actions they propose are the creation of an emergency commission by the American Academy of Nursing and a CDC-directed “National Center for Disaster Nursing and Public Health Emergency Response to provide education and training, career development, and networking opportunities to early-career nurse scientists and nursing students.”

First Steps Toward Preparing Nurses for a Pandemic

DailyNurse spoke with a member of the reporting team, Tener Goodwin Veenema, PhD, MPH, MS, CPNP, FAAN, a specialist in emergency and disaster nursing education and a contributing scholar at the Johns Hopkins Center for Health Security. In an interview appearing on July 10, Dr. Veenema will discuss the COVID-19 first wave and the first steps toward building a pandemic training curriculum for US nursing schools.

Koren Thomas
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