What Have We Learned About Nursing From the Coronavirus Pandemic?

To the Editor:

During the current coronavirus pandemic, the focus of the accolades has gone to nurses working in the acute care sector, where “real nursing” occurs as portrayed in television or in the movies. Over the past few months there has, however, been some increased recognition of the critically important role that nurses play in long-term care. Nursing home nurses are present 24 hours a day, providing care and serving as the eyes and ears of all other providers who intermittently evaluate residents in these settings. During the coronavirus pandemic quarantine, they provide enhanced care, as families are not able to visit. They also facilitate telecommunication with physicians, hospital staff, and families and friends of residents. This care is consistent with the role of nurses over time, which ranges from preventing illness and promoting health to caring for the sick and comforting the dying. Their courage, dedication, and resilience are something to be admired. Never have I been prouder to be a nurse.

There is, however, a price to pay for our work as nurses in this pandemic environment. Some have begun to think about retiring; some potential nurses are dropping out of nursing school or deciding not to enroll; some are deciding not to engage in clinical care for fear of their own health or the health of their families; some continue to work despite significant mental and physical health-related stress; and some have died or become chronically ill due to coronavirus disease 2019 obtained in the line of duty.^{1 , 2}

What do we owe the nurses in long-term care? First and foremost it is the availability of appropriate and sufficient personal protective equipment (PPE) to keep them as safe as possible while they are providing the intimate care necessary for residents within these settings. Availability of PPE for nursing staff is critical to residents as well – to prevent the spread of disease as staff move from one resident to the next. Further, ready availability of PPE provides an important statement to the staff, which is that we as a society care about keeping them safe and healthy.

In addition to PPE, nurses deserve to be recognized for their knowledge about the residents. Although telehealth is a wonderful alternative to face-to-face visits when those are not possible, telehealth visits are not ideal. The input from nurses and other members of the healthcare team is invaluable during or associated with telehealth visits. Nurses evaluate the function and behavior of their residents day by day, as opposed to the moment of time that a telehealth visit provides. This is especially important in post-acute and long-term care, where residents may present as lethargic one moment and later in the day blossom and engage in activities. Moreover, direct care workers and nurses in long-term care can provide the assessment information needed to diagnose and treat a resident following a more careful and comprehensive work-up.

Lastly, nursing home nurses deserve to be able to work to the full scope of their practice. There are not too many silver linings from the 2020 coronavirus, but one of them has been the release of some regulatory issues that limit scope of practice. For example, on April 9 the Centers for Medicare and Medicaid Services made it easier for providers to practice across state lines.³ Further, advance practice nurses can now order home health care services for patients, and we are all aware of the changes in allowing for telehealth visits across multiple settings. Nurses deserve to have these “waivers” remain as recognition of their training, skills, and ability as well as increasing access to care for all older adults.

In closing, remember to thank the nurses providing care to your residents. They are heroes but they are also human. They are tired and afraid but committed to the pledge they took as a nurse, the Nightingale pledge,⁴ and they are doing their best with limited staff and resources to provide care for the world's older adults.