A New Year, A New Resolution: Nurses Impacting America's Health Debt from the COVID-19 Pandemic

It is likely many will begin this New Year with some trepidation and skepticism as the past two years have been driven by crisis and chaos from the COVID-19 pandemic. The pandemic has exacerbated disparities that have existed for many generations and while we have been aware of these social determinants of health: low-income individuals, older adults, those living in rural areas and people of color; COVID-19 has disproportionately impacted these historically marginalized communities. The subsequent health debt as well as the accumulation of the impact of changes in health behaviors during the pandemic will have a long-lasting, negative effect on the health of Americans.

Beginning in early 2020, Americans began delaying or missing preventive screenings, delaying treatment of existing disease, foregoing chronic disease prevention and making changes in health behavior with activities such as increased alcohol consumption or decrease in routine physical activity.¹ By June 2020, an estimated forty-one percent of U.S. adults delayed or avoided medical care. ¹ A study conducted in two large healthcare institutions evaluating the impact of COVID-19 on screening and prevention services and initiation of new medical therapies showed that during February-May 2020 changes in outpatient LDL cholesterol and HbA1c testing fell 81–90% and initiation of medical therapy such as lipid-lowering agents and metformin decreased by 52-60%.² The National Association of Chronic Diseases Directors and Gallup Inc., collaborated to create a dashboard looking at health behaviors related to coping with the realities of the pandemic and found that approximately 43% of Americans report worse exercise habits compared to before COVID-19, 31% report worse dietary habits, and 31% report that financial hardship has prevented them from seeking health care. ¹

The consequent financial, physical, and psychological burden of the health debt created by COVID-19 has taken an immeasurable toll on our society. Disparities will not fade or diminish with the pandemic if we do not act with urgency. The year ahead and those following it will be defined by our ability to address issues such as disparities in health care, access to care, and adoption of health technologies.

The COVID-19 pandemic changed the practice and delivery of healthcare. Nurse-led initiatives allowed for deployment of health system resources to treat patients more effectively. Nurses answered the call for crucial changes in care delivery; policy shifts and pushed forward to develop innovative ways to meet patients where they were. To better understand the impacts of the pandemic on the nursing profession, the American Nurses Association, Johnson & Johnson, and the American Organization for Nursing Leadership partnered to conduct research to define a progressive path forward for nursing and ultimately strengthening care delivery and elevating the role of nurses as change agents and transformative healthcare leaders.³ Four thousand healthcare professionals and members of the general public were polled in mid-2020.³ In addition, a series of interviews were conducted with nurses and nurse advocates who led or were actively engaged on the front lines during the pandemic.³ The findings are summarized in an executive summary and three chapters of focused exploration in the domains of care delivery, organizational structure, and workforce of the future. The following are several of the examples within this document highlighting promising practices that are tangible actions that emerged from the research: alignment of care delivery to acuity and leveraging powerful health technologies, piloting nurse-led innovations, team-based care delivery and optimizing on-the-job training to extend specialized nurse capacity, creation of nurse-led command centers, and modifying practice policies to expand nurse capacity such as supervision requirements.³

As heart failure nurses, chronic disease prevention and management are the cornerstones in stemming the tide of health debt. We must actively continue to improve heart failure outcomes. As we begin this New Year, we each have the opportunity to address healthcare disparities.

Ashley Moore-Gibbs, DNP, RN, AGPCNP-BC, CHFN

Dr. Ashley Moore-Gibbs is a nurse practitioner at Sanger Heart & Vascular Institute in Charlotte, NC, at Atrium Health. She also serves as the Advanced Practice Provider (APP) Director for the Center for Advanced Practice's Cardiovascular APP Fellowship program. She is President Elect of the American Association of Heart Failure Nurses. Ashley has spent the majority of her career devoted to the care of heart failure patients and the education of nurses and allied health professionals providing care to them. She speaks regionally and nationally on heart failure management and has contributed to numerous publications.