The Year of the Nurses and the Midwife: Nursing professionalism shining in the frontline of anti-epidemic and to be strengthened in the future

In early 2020, an outbreak of coronavirus disease 2019 (COVID-19) became a difficult public emergency [1]. In the face of the epidemic, to solve the shortage of insufficient human resources in the initial period of epidemic prevention and control, the Chinese central government coordinated medical resources from all over the country and formed special national medical teams to assist Hubei. The medical staff of the whole country worked together to get through the crisis.

From January 24, 2020 to March 1, 2020, a total of 42,322 medical personnel nationwide was dispatched to Hubei, including 28,679 nurses, accounting for 67.76% [2]. With the unremitting efforts of the people and medical staff across the country, the epidemic prevention and control situation in China was gradually improved. By April 24, there were no severe and critically ill patients in Hubei, and on April 26, there were no known inpatients with COVID-19 in Wuhan [3]. It indicates that the battle of epidemic prevention and control has achieved an important victory. To win the battle against the coronavirus and protect the city of Wuhan, nurses became the main force on the front line. Under the leadership of the Chinese Nursing Association (CNA), nurses proved to be an excellent response to conquer the epidemic with the result that no nurse assisting COVID patients in Hubei were infected because of their strong professional qualities and skills [4].

At present, the epidemic is spreading all over the world as an enormous challenge for the world’s public health security, while ordinary people and medical personnel are becoming infected in many countries and regions. In view of the achievements made by our country in combating the epidemic, the CNA summarized our medical staff’s anti-epidemic experience [5], and we would like to outline professionalism and dedication of health workers in the frontline of anti-epidemic and priorities of development of nursing management, education and practice in prospect.

1. The key to Chinese medical staff’s success in anti-epidemic

1.1. A scientific and effective response method: classification management of patients

On February 7, 2020, the National Health Commission of the People’s Republic of China put forward the principle of “four concentrations”, that is, “concentration of patients, experts, resources, and treatment”, i.e. to treat the infected in dedicated facilities by medical specialists from all over the country and with all necessary resources, which is the principle and requirement for anti-epidemic work all over the country [6]. According to the principle of “four concentrations”, the four groups of people, including patients diagnosed with COVID-19, suspected cases, patients with fever that cannot be excluded from COVID-19, and close contacts of confirmed patients, will be concentrated respectively to accept classification management. Since the emergence of COVID-19 cases in December 2019, the number of newly diagnosed cases in China has shown a downward trend at the end of February, and the epidemic prevention and control work has achieved initial success [3]. It can be seen that China has contained the development of the epidemic within only two months, which has led to a positive trend. Therefore, the classification management of patients not only effectively controlled the source of infection, cut off the transmission route, but also improved the level of critical care. It is a scientific and effective way to deal with the COVID-19 epidemic.

1.2. A powerful weapon to overcome the epidemic: multidisciplinary teamwork

Facing the majority of middle-aged and elderly patients, the core principle of the medical team was multidisciplinary teamwork [7]. In addition to respiratory system involvement, patients with COVID-19 often have cardiovascular, digestive system and other multi-system involvement. Many patients also have underlying diseases such as diabetes and hypertension. In general wards, there are complex cases of systemic lupus erythematosus, post-renal transplantation, and orthopedic surgery. At the same time, considering the death cases are mainly in elderly patients with underlying diseases, organ system function protection is an important factor to reduce the mortality rate. Therefore, the multidisciplinary team included doctors and nurses in various specialties from cardiovascular, digestive, endocrine such as rheumatology, nerves, blood, etc., as well as the dedicated artificial lung (ECMO) team, blood purification treatment team, respiratory therapist team and psychotherapist team, escorted patients from all sides, improving the overall treatment level [8].

In addition, integrating traditional Chinese and Western medicine to fight the epidemic proved to be a key move [9]. Adhering to equal emphasis on traditional Chinese and Western medicine, and promoting complementary and coordinated development of traditional Chinese and Western medicine is a significant advantage of China’s health service. In the treatment of COVID-19, early intervention of traditional Chinese medicine and adherence to the integration of traditional Chinese and Western medicine have achieved remarkable results.

1.3. An important measure to fight against epidemic: the focusing on nursing

There is a Chinese proverb that says: Thirty percent treatment with seventy percent nursing care. It means nursing plays a major role in patients’ rehabilitation. Whether in Fangcang Shelter hospitals, isolation wards, or intensive care units, nurses were always there. The nurses carefully provided care, treated meticulously, and astutely observed the condition of patients with COVID-19. Together with the doctors, they contributed to the rehabilitation of patients, improving the cure rate. Among the medical staff who assisted in Wuhan, intensive care nurses accounted for three-quarters of the critical care staff. Conditions of severe and critically ill patients with COVID-19 change rapidly, often with multiple organ failure and multiple complications, which means that complicated treatment measures and extremely high professional skills of the nurses are necessary. These nurses reflected the importance of professionalism and scholarship of nursing.

At the same time, nursing is also an art. In the face of patients suffering from illness, nurses’ care and love for the patient through an encouraging smile, a warm word, a caring action, can guide the patient to receive treatment with a positive attitude, bringing hope to the patient. These embody the humanistic care of nursing, the fine art of nursing. Therefore, nursing as a science and an art, it is also a key factor in determining the quality of medical treatment.

1.4. The cornerstone of work: professional and responsible leadership

Leadership is an integral part of nursing practice. Leadership is the ability of nursing staff to use their own leadership knowledge, skills and attitudes to influence the attitudes, emotions, beliefs, etc. of other people in the organization, and to prompt them to take certain measures and behaviors to achieve the common goals of the organization [10]. Leadership embodies the value and autonomy of nursing as a profession. In the current epidemic situation, nurses are working on the front line, which integrates the various roles nurses have, such as educator, consultant, manager, leader, caregiver, and so on. Nurses must have the ability and skills to provide treatment, guidance and health education for patients, and also carry the obligation and ability to provide clinical guidance for young nurses. In addition, the nurses’ ability to empower, change, influence and lead others also plays an important role in providing treatment for patients. Therefore, professional and responsible leadership is the cornerstone for nurses to carry out their work in exemplary ways.

2. Prospects and reflections on future nursing management, education and practice

2.1. Increasing investment in nursing-related work

On April 7, 2020, the World Health Organization (WHO) designated the theme of this World Health Day as “Supporting Nurses and Midwives” and called on countries to invest in nurses and midwives to achieve universal health care [11]. The statement issued at the International Nurses Conference of the International Council of Nurses (ICN) also stated that nurses are the largest professional group in the healthcare field, and it is particularly important to encourage the government to increase investment in nursing talent. This includes high-quality education, human resources, fair pay and other guarantees [12,13]. Firstly, investment in nurse training needs to be increased. We should attach importance to the continuing education of nurses and the continuous updating of new skills and knowledge, and give nurses more opportunities to receive training and training to strengthen professional skills. Secondly, investment in nursing-related work is required. Investments to increase services led by nurses and midwives enable nurses and midwives to fully realize their potential. Thirdly, we should support nurses and midwives to promote health and prevent disease. Fourthly, in the growing need for universal access to healthcare, making midwives and nurses the core of primary healthcare, allows them to provide services and supervise community health workers. Fifthly, the government should invest in strengthening the leadership role of nursing and midwifery personnel. Sixthly, society should improve the salary and treatment of nurses, so that nurses’ income can be matched with the workload and work pressure.

2.2. Establishing a long-term good working environment

Between 2013 and 2018, the number of nurses increased by 4.7 million worldwide, but there is still a shortage of 5.9 million nurses globally. The WHO predicts the demand for registered nurses will increase by 36% in 2020 and that by 2030, the world will face a shortage of 9 million nurses and midwives. The reasons for this phenomenon are complex, such as a lack of understanding of the role of nursing, low social attention, hard work but unsatisfactory wages, and other factors. To fundamentally improve the lack of nurses, we need to establish a sustaining good working environment for nurses [14]. From the national social aspect, we must implement the protection of the vital interests of medical personnel, improve their occupational health, create a good working environment for all healthcare workers, and further establish the public’s professional appreciation for medical work. Medical colleges and hospitals should strengthen the ways to advance professional knowledge and skill training of all healthcare staff to improve their own internal professional value. Collaborating public media coverage, we should focus on the professional value of nurses in their daily work, which can help consolidate and enhance the recognition of the value of nursing in society.

2.3. Increasing public health nursing education

The sudden emergence of the COVID-19 epidemic once again made us aware of the importance of public health safety. Public health is a science and art that uses organized community activities to improve the environment, prevent disease, prolong life, promote physical health, and improve personal effectiveness. The realization of public health goals requires multi-disciplinary cooperation, including nursing. Nursing not only plays a role in disease prevention and treatment but also plays an important role in community services and emergency systems. Public health care is a vital part of disease control, providing individuals, families and communities with health promotion, disease prevention, early diagnosis and treatment, and limitation of disability. It can promote patients to exert maximum health effects and undertake the tasks of health promotion, disease prevention and health protection. We need to increase public health nursing education, improve the quality of personnel and the quality of public health care services, and support better health for all people.

In April 2020, the WHO issued the First State of the World’s Nursing 2020. There are 27.9 million nursing professionals worldwide, making it the largest occupational group in the health sector [15]. Nurses play a vital role in providing healthcare services and are an important pillar of the health service system. However, a global team of nursing staff charged to seek solutions for universal health coverage and sustainable development goals has not yet been formed. The reasons are worth reflecting on, and we should make efforts to change it. We hope that 2020 will be a year of profound significance and influence in the history of nursing. But even now, nurses can be extremely proud of their profession.

Appendix A. Supplementary data

The following is the Supplementary data to this article: