Staffing shortages in hospitals have been a concern for some time, owing to the country’s aging population—but COVID-19 has only worsened the situation. In reaction to the pandemic, many of these institutions spent months stockpiling medical equipment and protective clothing, but the supplies are useless without staff. So, how do we handle the hospital staffing crisis?
Despite recent decreases in coronavirus infections across the country, many hospitals are still facing staffing shortages, and may continue to do so in the coming months. Healthcare workers are still under a lot of pressure, experiencing deplorable working conditions. Many of them are unable to take much-needed breaks due to severe personnel shortages, and suffer burnout as a result. The stress levels are so high that some are even considering leaving their professions entirely.
Adequate staffing levels in healthcare institutions ensure a safe work environment for healthcare workers and quality care for patients. Hospitals must be ready for potential personnel deficits and must have contingency plans and workforce management tools in place to deal with them.
COVID-19’s Impact on Healthcare Staffing
In 1999, the state of California enacted and implemented the first and only comprehensive U.S. legislation limiting the number of patients that nurses may care for at a time. Although several studies show how better staffing leads to improved patient outcomes, no other states have adopted this type of legislation.
There are many reasons why efforts to pass legislation governing hospital nurse staffing fail to get universal support from influential groups. The first impediment is a lack of local and timely evidence to support such laws. Another is the misconception that the country lacks nurses. Meanwhile, registered nurse graduations have more than doubled in the last 15 years.
The COVID-19 pandemic served as a stark reminder of the significance of adequately staffed health systems in delivering high-quality patient care, as well as the toll that under-resourced facilities have on workers’ well-being. The rising patient demand and diseases among healthcare professionals, particularly those of ethnic minorities, significantly impacted staffing in healthcare, worsening the staffing crisis even further.
Many hospitals responded to the surge in patient demand by canceling elective treatments and shutting down non-essential outpatient clinics, but dealing with the shortage of personnel was more difficult. Healthcare workers were repurposed, and students were onboarded at the worst-affected hospitals. Some states provided temporary allowances that permitted nurses licensed in one jurisdiction to practice in another during the heat of the crisis. Nurses were allowed to work across state borders and in areas with severe shortages.
What Can be Done About the Recent Healthcare Staffing Crisis?
While no one has the one-size-fits-all solution to staffing shortages, it’s fair to presume that healthcare providers would benefit from being more proactive than reactive in their staffing strategies.
The absence of flexible workforce management is now the most common cause for nurses leaving their first year of employment. Clinicians must sign up for shifts eight weeks in advance, and there is little leeway to readjust the schedule once it has been completed. Shift allocation is inefficient and largely reliant on manual systems, which undoubtedly isn’t suited to any last-minute changes.
Nurses and other clinicians prefer to specialize, but with further training and development, nurses may cover shifts in various departments and situations. While tenure in a department is frequently used to determine a schedule, this strategy results in nurses concentrating in one specialty and limits multidisciplinary training. It’s possible that tenure isn’t an excellent criterion for scheduling.
Pipelines for candidates
Though the number of registered nurses graduating yearly is at an all-time high, there is room for more. Other healthcare fields are still producing fewer professionals than there are jobs available. To recruit future healthcare workers, healthcare companies must be future-focused in their workforce planning, building stronger relationships with high schools, colleges, and training centers.
One of the most effective methods to guarantee that patients receive the treatment they require is to lower the likelihood of healthcare workers being sick. Infection prevention teams must make a concerted effort to offer timely and complete information to employees so that they can protect themselves.
Hospital executives must also change their workplace culture by encouraging employees and managers to speak out when they observe colleagues missing a chance to improve safety. It’s critical to reinforce the idea that everyone has the right to contribute to a workplace that is safer for other employees and patients.
Employing Digital Tools
One of the numerous advantages of telehealth adoption is that nurses, doctors, and other hospital personnel may care for patients online, while quarantined or recuperating from sickness. Furthermore, hospitals may centrally control all elements of their treatment operations thanks to digital health care delivery.
Staff can also use digital technologies to communicate between hospitals, e.g. during surges, to lend support at all levels. Critical care teams, in particular, can cross-cover patient spikes.
The staffing crisis in healthcare may continue for some time due to the ongoing COVID-19 pandemic, poor workforce management, and low adoption of digital transformation in the sector. The government also has a role to play in enacting legislation that regulates patient-to-health worker ratios. With adequate adjustments, the deficits can be filled and care delivery optimized.
The recent news of elite Olympic athletes prioritizing their mental health and their own physical wellness over their sport has focused a national spotlight on the complexities and the prevalence of mental health struggles. And while seeing people who are suffering from mental health issues is difficult, the athletes’ public struggles have opened a door that allows healthcare providers to raise the issue with patients and loved ones.
In some minority communities, mental health struggles remain taboo to discuss openly. People who are experiencing symptoms of illness such as depression, anxiety, or obsessive-compulsive disorder, or even life-threatening suicidal thoughts face a stigma that prevents them from even seeking care. When the issues are discussed, access to affordable and high-quality mental health providers can be a barrier to getting help, as can lack of insurance and any language barriers.
According to the OMH, mental health is a serious and common health issue with approximately 18 percent of the entire U.S. population having a diagnosable mental illness within any given year. Of that percentage, only 43 percent of people who need mental health care receive treatment or counseling. For minority mental health needs, the numbers are even more concerning. While 48 percent of whites receive care, only 31 percent of Blacks and Hispanics do. And statistics for Asians were even lower at just 22 percent receiving needed mental health services. Disparities in mental health care can lead to lack of treatment or ineffective treatment.
For most people, mental health treatment is effective and improves their quality of life. Whether people choose medication (psychiatric nurse practitioners are especially), talk therapy, or a combination of both, getting help can make symptoms abate significantly. In more transient cases of mental illness, for example depressive symptoms caused by a major life change, treatment can get someone back to feeling like their old selves and can improve their resiliency moving forward.
These care disparities have lasting impact. According to the American Psychiatric Association minority and white populations have similar rates of mental illness, with white populations being slightly higher in some instances. But when Black and Hispanic people have depression, for example, the effects are more persistent. And systemic racism plays a role in proper care. The report states that “Racial/ethnic minority youth with behavioral health issues are more readily referred to the juvenile justice system than to specialty primary care, compared with white youth.” If mental health needs aren’t addressed and youth don’t receive proper care, that can lead to a disciplinary cycle that impedes educational and employment opportunities.
As a healthcare provider, keeping conversations about minority mental health open and ongoing with patients and having easily accessible resources available can make all the difference to helping patients get the care they need. From understanding the different types of mental health professionals and what they do to addressing medications or alternative therapies in a comprehensive treatment approach can help patients understand the range of help available. And with a recent uptick in the availability and acceptance of virtual therapy appointments, accessing care is somewhat easier for people.
Raising awareness and broaching the topic about minority mental health is important to removing the stigma and helping people move toward care that works for them.
While the worst of the COVID-19 pandemic seems to be behind us, the spread of the Delta variant indicates that it’s not completely over yet. During the height of the pandemic, nurses worked on the frontlines all over the country, and some are just now sharing their experiences working in the ER during the height of COVID-19.
Rastisha Smikle, RN, works in an ER at a hospital in central Florida. Having worked as a nurse for more than 10 years, she answered our questions about what it was like in the ER during COVID-19.
As a nurse in the ER in Florida, what has it been like working there during COVID-19? How has it changed over the last year or so?
It was very challenging to work during the pandemic. In the ER, we are a patient’s first point of contact, and because of that, our staff is considered at a higher risk of being exposed to the virus. Although safety and infection control elements have always taken priority in our roles, the unknown factors of the virus’ transmission, ever-changing symptomatology, and treatment contributed to our challenges because of all the unknowns.
Patients were more fearful than ever; they often came in anxiety-ridden wanting testing because of recent exposures, which added additional challenges because the critical emergencies also relied on our care.
In some ways, things have gotten better. As we have learned more about the virus and therapeutic treatments, patients are being cared for more efficiently so that they can recover at home. Unfortunately, hospitals nationwide are busier than ever right now. The volume that we are seeing is higher now than we saw during the pandemic. It’s tough to say what that is.
Did your duties change during COVID-19?
My duties didn’t change per se, but the way we cared for patients did.
Before the pandemic, PPE like N-95 masks were not permanently a part of my uniform. Now, I wear an N-95 and face shield with every patient encounter. Because of the wide range of symptoms, we have to be extra diligent in caring for patients just in case they have the virus and aren’t aware of it yet. In addition, minimizing my exposure time with known Covid-19 patients is also an element that I have had to implement in my care. For the safety of myself and the other patients, swift patient care must be implemented with these patients when appropriate.
Employing the use of hospital phones has been a way that I try to fill in the gap. Throughout this time, I have learned how fearful patients are after they get the diagnosis. With these talks, I can extend some reassurance, listen to their concerns, and figure out thoughtful and effective ways to help them with the emotional challenges that often accompany the diagnosis and isolation.
Was it scary to work there in the beginning of the pandemic? Why?
There was a level of fear when it came to the unknowns. I had worries about getting the virus. But primarily because of my level of exposure in the ER, I was mainly concerned about others being around me. I isolated myself from family and friends, and my life was work and home.
There were times when we would care for patients with no known symptoms and later, we’d find out that they were positive for Covid-19. I would have mounting thoughts of whether I wore the correct PPE or if I was exposed in those moments.
We also had staff members contract the virus, which was scary. Thankfully, most of them recovered well, but seeing how careful other staff members were and finding out that they still contracted the virus was nerve-wracking. Every minor allergy symptom or cough would cause concern and anxiety about whether I was next. To combat those fears, I had to reshape my focus. Instead of being hyper-focused on getting sick, I began to fix my focus on doing my job well and providing the optimal patient care that I was used to. With this newfound focus, my anxieties slowly began to dissipate.
How do you keep yourself from bringing the stress of the job home? What do you do to relieve your stress?
Sometimes it can be challenging, especially after losing a patient. My go-to stress reliever is prayer. I have a solid spiritual foundation, and thankfully the organization I work for also provides spiritual support, if needed. As nurses, we are fortunate enough to work three shifts per week. I try not to take my days off for granted; I use that time to refuel. Therapy, exercise, and self-care activities have been essential to my mental well-being.
What are the biggest challenges of your job—especially during COVID-19?
One of the biggest challenges of my job is knowing that I have to be on my A-game at all times because the safety of myself and others depends on it. The unknowns that came along with COVID-19 made it challenging to do and be our best. For example, we didn’t always know the best course of action when treating some patients because everyone would respond so differently, which posed one of the biggest challenges. Thankfully, as time went on, we learned more about the virus, the treatment options that worked for others, and we eventually adapted very well.
What have been your greatest rewards during this time?
My greatest rewards have been seeing how the nursing and healthcare community banded together during the most challenging times. The support from our community members was also very inspiring. We often came into work with goodies from companies that wanted to encourage and thank us for our continued work.
Throughout my tenure for nearly 20 years as a nurse, nursing professor, and leader in higher education, I have learned a lot about the art of successful coaching. In both traditional, and non-traditional academic environments, no matter whether you connect physically in-person or virtually via video-conferencing, effective coaching can not only transform a nurse or student, but everyone they come in contact with, and ultimately an entire organization.
My proudest moments in leadership have been when I have helped my faculty have “light-bulb moments,” and deep moments of personal discovery. Discovering perceived versus actual obstacles in their teaching methodologies, and personal lives triggered powerful breakthroughs that left them forever changed. In a recent experience, it warmed my heart to have a team of faculty so passionate about student success and improved student outcomes, that they were willing to take a deep look at themselves and change anything that would hinder them from being the best professor that they could be. These faculty believed that transformed students started with transformed faculty. One particular cohort of nursing leaders I had the distinct pleasure of coaching were all geographically dispersed so we used a videoconferencing platform to meet as a group bi-weekly for 45-minutes, and one-on-one for 30 minutes for eight months.
During our meetings, I used evocative questioning and active listening to lead them on an individualized journey of discovery in personal and professional areas. The steps of the nursing process provided structure for our interactions. We started with the following:
Assessment: Defining where they are in their personal and professional lives, from a holistic perspective
Diagnosis: Identified area of opportunity for growth
Plan: Intentional action steps to achieve the goals
Implementation: Executing the plan
Evaluation: Reflecting on the journey, including personal and student outcomes
There were many lessons learned from this experience, but the greatest takeaway was that each faculty member personally experienced a fundamental internal shift and a personal transformation in their mindset and skillset and felt empowered to apply the lessons of their personal growth to student interactions and teaching methods. The application of the lessons they learned through my transformational coaching program not only enhanced their confidence in teaching, but also improved their coaching skills, student support, and student outcomes.
As an emerging nurse leader, I remember my mentor telling me that as I continued to teach nursing that my students would teach me more than I ever taught them. This was very true. The inspirational and empowering professional I desired to be for my students became an ever-evolving journey of self-discovery and becoming. I have been able to achieve extraordinary things throughout my nursing career because of mentors who allowed me to “borrow their belief” in me. Having someone to help you “unpack” personal and professional challenges, and change your perspective about adversity and obstacles has been priceless, totally life-changing, and essential for my growth. If nurse leaders seek to build more nurse leaders, mastering the art of effective coaching is critical.
The Future of Nursing 2020–2030 Charting a Path to Achieve Health Equity report, issued by the National Academy of Medicine Committee on the Future of Nursing 2020-2030, is addressing topics that will impact the nursing industry in the coming years. Sponsored by the Robert Wood Johnson Foundation, the report examined issues and topics foremost on the minds of those in the industry and brought forward recommendations to help guide important changes including scope of practice regulations, health and well-being of nurses, and better payment models.
Currently, 27 states restrict the autonomous practice of nurse practitioners, despite the nurses having the education and training to practice in such a manner. With advocates working to remove these remaining restrictions, Cunningham says the progress is happening, but slow. “Each state has regulations that govern advanced practice registered nurse scope of practice,” she says. “When we say APRN, there are really four groups of nurses we are talking about. Most commonly it is nurse practitioners, but also includes certified nurse midwives, certified registered nurse anesthetists, and clinical nurse specialists.” The report also looks at the institutional barriers for other nurses, including registered nurses (RNs) and licensed practical nurses (LPNs), to allow them to practice to the top of their education and training.
The restrictions have been loosening ever so slowly. “There has been considerable progress in this area, I will says that,” says Cunningham, “but it has taken a couple of decades. There are 27 states that don’t allow APRNs in those states to do things they are educationally prepared to do. Examples include prescribing medicine, diagnosing a patient, and providing treatment independent of a physician. Even when it is allowed, there are administrative burdens. It’s not a very nimble system.”
Increasing Access to High-quality Care
The Future of Nursing report did a lot of research on the elements and regulations that limit access to care in general and to the high-quality care offered by APRNs, says Cunningham. And while opponents say that non-physician providers are less likely to provide high-quality care because they don’t have the same training or clinical experience, Cunningham disagrees saying the data doesn’t show that quality of patient care is reduced. “Arguments are made against scope of practice being relaxed really are not keeping the patient at the center of the discussion and it should be at the center of the discussion,” she says. “APRNs bring specific skills and knowledge. In states with restrictions, patients have less access to primary care.”
What autonomous practice does, she says, is significantly increase access to care, especially in rural and underserved communities where physician care may be scarce or difficult to access. APRNs aren’t looking to practice brain surgery, says Cunningham. What they will do, and are trained to do, is provide high-quality primary care services.
At various times, changes to these rules have proven to be especially effective. Interestingly, Cunningham says the COVID-19 pandemic inspired eight states to suspend scope of practice restrictions as a key strategy to manage the pandemic care in the interests of the public and when the health of the nation was at risk. The strategy worked so well, some of those states have moved to make those changes permanent, she says. In 2016 APRNs also saw expanded practice regulations when the Comprehensive Addiction and Recovery Act allowed nurse practitioners to prescribe buprenorphine, a drug used to manage addiction, says Cunningham. The bill increased access to care in rural areas and helped keep patients with substance use disorder safe. When federal authority supersedes state regulations (such as this instance), says Cunningham, that should be looked at more closely as it gives evidence of how loosening regulations can protect public health.
Reducing Administrative Burden
Granting nurses autonomy also helps organizations stay nimble, says Cunningham. It allows them to move nurses where they are needed during times of crisis like COVID, without the extensive forms and processes typically required. COVID, says Cunningham, showed how being able to move nurses to different areas to treat patients or to cover for nurses who were called to a different area, was essential to patient health.
And while the immediate outcomes look positive, Cunningham says the data that emerges from the pandemic will tell a more complete story. “Reductions in mortality especially will be the kind of outcomes data that will be compelling to make this permanent,” she says. “The current recommendation is that all changes that were adopted in response to COVID should be made permanent by 2022. That’s a strong recommendation coming out of the report, but there’s good data to show this is a strong direction.”
Improving Care Access Through the Workforce
And the sheer number of working APRNs would offer a significant boost to primary care efforts where they are especially needed such as in rural or low-income areas. “For counties that are deficient in the number of primary care providers, meeting the needs of the population is important,” says Cunningham. “It creates more equitable communities.”
To remain focused on the patient, the report’s findings show many ways APRNs are trained and educated to improve patient outcomes. “We should be focused on the health of the nation,” says Cunningham. “The current situation is antiquated given the health concerns of the nation. It is not focused on the patient. We need to ask, ‘How do we improve the health of the nation?'”
The report finds removing restrictions also has other benefits. “The clinical piece of this,” says Cunningham, “is that it would be extremely empowering for nurses to do all the things they are prepared to do.”
Although Henderson says community health is covered in nursing education, the standards in place don’t reveal how often or how well community health and public health nursing competencies are covered in individual programs. Sometimes it’s just as one course or an elective course.
“We argue in the report that these areas of community health, public health, social determinants, and population health need to be comprehensively threaded throughout the curriculum,” Henderson says, “so it’s not an add-on. It’s baked in fundamentally into everything we do in our nursing practice.” As nursing education changes, schools and students will begin to collaborate more across disciplines.
Changing how nursing is taught and how students gain experience means more nursing students need to spend time working in various community settings. Nurses learn best through experiential learning, says Henderson, especially with community-based social issues. “Put students in the community and put students in settings where they are finding experts,” he says. And when students find the specialty that appeals to them, letting nurses deviate from the typical path will get them started quickly. “Telling nurses they need one to two years of med-surge under their belts is unnecessary,” says Henderson, “and we have to stop perpetuating that.”
Experience in the Right Settings
For nurses who know they aren’t interested in a med-surge path, those two years could be better spent gaining targeted skills. Immersing themselves with on-site community health work strengthens their commitment to the role.
“Without that kind of immersion, you are reinforcing stereotypes because what you read is not contextualized by what happens,” says Henderson. For instance, he says, nurses may read that “because you’re African American, you’re more at risk for ‘A'” or “because you live in this community, you’re more at risk for ‘Y.'” It’s not contextualized as to why any health impacts are happening, he says.
Nursing education depends on nurses understanding the socioeconomic influences of disease. Henderson says nurses who are immersed in a community may see that patients lack access to green spaces to exercise or may not feel safe in their neighborhood. They may see patients don’t have easy and affordable access to healthy foods.
“The context is the patients don’t live in a community that sets them up to eat healthy, exercise, and take care of themselves to reduce the risk for something like diabetes,” he says. “It has nothing to do with them being African American and has to do more with community conditions. You have to see that and experience it.” Henderson, whose own career was deeply influenced by his early work in community health, says nurses can’t address the health needs in a community without addressing the social needs. “The community is the teacher,” he says. “We go into a community with preconceived notions. But patient-centered care is community-centered care.”
Reading something in a book gives nursing students a theoretical background, but going out into the community, often sparks a passion about uncovering a solution to the root causes of some of the issues patients are facing. “There are downstream effects of that,” says Henderson.
Shift in Nursing Education
As nursing education changes to a community focus, nursing students will need faculty leaders who can talk to them about how to change approaches to tasks like screenings.
“One of the biggest hurdles is getting students out of the mindset of I have to get out to do a specific task,” he says. “It’s about what kinds of conversations are you having during the screening when you’re checking someone’s eyes. Are you learning about their home life? In community public health, you’re exploring the issues that are surrounding their lives and the issues that impact their wellness so you can focus on intervention and prevention.” Nursing students have to be taught about it in their classroom work so they can merge their knowledge and hands-on experience to examine the root causes of illness differently.
Workforce Preparation and Qualification
People want to work in the settings they are exposed to, says Henderson, so nursing students should work in settings that let them see a nurse’s role in schools, correctional facilities, public libraries, preschools, community health centers, homeless shelters, and public housing, and learn from the experts who work in those settings.
Sometimes, says Henderson, the best professional to explain those topics are the ones on the front lines, like the social workers or school counselors who see people for issues that might not be related to an immediate health concern, but that most certainly impact health. With a chronic nursing faculty shortage, allowing educators who don’t have a nursing degree might help fill some gaps in staffing and course content, he says.
Henderson says the Future of Nursing Report calls for including curriculum topics around nursing policy, structural racism, and health equity to help nurses over their entire careers.
And, Henderson says, the report also advocates for nursing schools to address racism in society and within its own professional structures. “Nursing as a profession for a long time hasn’t addressed how racism has impacted our own profession,” says Henderson. “We say in this report we want to go out and do all this good and improve health equity, but we still have to clean our own house a little bit and examine how nurses of color are still discriminated against within our own schools and our own workplaces. And we talk about that in this report and that’s crucial.”
Higher education also must take a new look at its environment. “Schools of nursing need to acknowledge the impact of structural racism has within their own institution and how that disadvantages nursing students and faculty of color,” says Henderson. “That means critical examination of curriculum policy practices, curriculum strategies, and how they allocate resources. Who has the power and what do those dynamics look like?”
Diversity and Equity
A diverse, inclusive, and equitable nursing environment needs to be clearly defined. “Many people say diversity and think just by being diverse, we are equitable,” Henderson says. “But that’s not the case. You can be diverse but not equitable. You can have diverse people at the table, but it’s not equitable if they aren’t valued and their voices aren’t heard.” Lots of groups are recognizing that, says Henderson, but now they have to decide how to act on it and raise awareness about it.
Continually advocating for change in nursing and working to keep uncomfortable conversations ongoing and productive encompasses topics both new and historic, says Henderson, and is the focus of the next decades of nursing education. “It’s about who is having these conversations,” he says. “If we keep having the same people at the table, we won’t get far.”
Hospitals remain the top employers for nurses, but they are certainly not the only places where nurses can find a fulfilling career. Some may find that their true passion is in helping others outside the confines of an inpatient setting. And luckily, that is possible. There is a great need nowadays for compassionate and skilled nurses who can serve people in the community setting. Listed here are just a few examples of specialty areas in community health that nurses may want to consider.
Hospice and Palliative Care Nursing
Hospice nurses provide comfort-focused care to patients who have a life expectancy of six months or less. Palliative care, though sometimes used interchangeably with hospice, is slightly different in that patients do not necessarily have to be in the terminal phase of their disease process. Palliative care nurses care for seriously ill individuals who are dealing with discomfort as a result of chronic diseases or treatments used to manage these diseases. Regardless of the technical differences between them, both hospice and palliative care nurses specialize in symptom management. Rather than focusing on curing patients, hospice and palliative care nurses promoting comfort, which may involve managing chronic pain, respiratory distress, or nausea, among other things. While some hospice and palliative patients are cared for in hospitals, many also receive care in their homes.
If you are skilled with IVs, then you might consider working as an infusion nurse. Infusion nurses start and maintain various kinds of intravenous lines. Not only do they administer medications, but they also provide monitoring for their patients to make sure that treatments are effective and are not causing any adverse effects. Those who have had a lot of experience with IVs in the hospital setting might find this type of nursing appealing. Many companies, including home health agencies and pharmacies, are hiring skilled nurses who can provide infusions to patients in the community.
Wound Care Nursing
Wound care nursing is a specialty area for nurses who have a passion for helping patients afflicted with wounds, some of whom have chronic and debilitating injuries that put them at high risk for infections. Among the people who require the services of wound care nurses include bedbound patients, diabetics, patients with chronic circulation problems, and patients who have had accidents or surgeries. If you are interested in this kind of nursing, you may also want to consider getting some type of certification in wound care nursing. Your expertise will be valued by many organizations and you may see patients in their homes as a traveling consultant for durable medical equipment companies and healthcare agencies that specialize in wound treatment.
Worker’s Compensation Nursing
Getting injured at work can affect one’s life in many ways. Depending on its severity, workplace-related injuries may affect more than just one’s physical health. Losing the ability to work can also cause mental and financial strain. As a worker’s compensation nurse, you will have the opportunity to help these individuals get their life back on track. You will have the role of a case manager who will ensure that your patients get the high-quality treatment necessary to restore them to their highest level of function.
When you think of an educator, you may picture someone who is in a classroom, lecturing and scribbling notes on a chalkboard. While nurses do teach in academic settings, there are also nurse educators who work in the community. These are nurses who may work for pharmaceutical or medical equipment companies that are selling highly technical products. The job of nurse educators, in these cases, is to assist other health care providers in understanding how these products work so that they can be safely utilized in clinical settings.
Public Health Nursing
Public health nurses wear many hats. They may go out and educate communities about preventing the spread of certain types of diseases. They may go into clinics to provide vaccinations. Other times, public health nurses may visit people in their homes to ensure that they are living under humane and sanitary conditions. In some cases, they may also function as medical case managers for underserved individuals in the community. Whatever they do, the main role of public health nurses is to safeguard and promote the health and well-being of the communities they serve.
One of the beauties of the nursing profession is the sheer diversity of available opportunities. Inpatient settings, like hospitals, are just one of the many places where nurses can share their talents and make a difference. Nurses have a lot of freedom in shaping the course of their careers and if you are looking for a change of pace, now could be your chance to do so. Who knows, you just might find your calling as a community health nurse.
What is a nurse practitioner (NP) and how is it different from your role as a nurse? According to the American Association of Nurse Practitioners, an NP is a master’s or doctorate-prepared nurse with the knowledge and clinical competence to practice as a clinician in acute or primary care settings. Becoming an NP is highly rewarding and requires effort, time, money, and managing more licenses and certifications.
So you are comfortable with your role as a bedside nurse, but you feel like you want or need something different. You can hold various nursing positions with a bachelor’s of science in nursing (BSN) if you aren’t interested in pursuing additional education. But, if you want more of a challenge, more responsibility, more independence, and higher education, then becoming a nurse practitioner may be the right pathway for you. Read on to see what it takes to become a successful nurse practitioner.
5 Necessities to Becoming a Successful Nurse Practitioner
1. Registered Nurse Licensure
The first step to becoming a successful NP is to become a successful registered nurse (RN). If you aren’t an RN already, there are options for second-degree BSN programs available. If you are an associate-prepared registered nurse, RN to MSN programs are available for you to earn your MSN and your BSN. If you are a bachelor-prepared RN, there are numerous NP programs online and in-person all over the country.
2. Know Your Specialty
Unlike physician assistant programs, nurse practitioners must decide on what specialty they would like to study before applying to their program. Most nurses will utilize their bedside experience to help decipher which focus they would like to pursue. Although this is not necessarily a requirement of an NP program, it is challenging to acquire advanced knowledge and skills in a field without that specific experience. NPs can decide later on a subspecialty if they choose to go down that path. NP specialties include:
Adult-Gerontology Acute or Primary Care
Family Acute or Primary Care
Neonatal Acute Care
Pediatric Acute or Primary Care
Women’s Health Acute or Primary Care
3. Consider Interests as Subspecialties
NPs can decide later on a subspecialty if they wish to focus on an even more niche area of care. Not all NPs subspecialize, but if a nurse has experience or interest in a subspecialty and they would like to practice as an advanced practice provider in that field, they can do so after graduation. Additionally, NPs can get post-graduate certifications to further their subspecialty education. Subspecialties include, but are not limited to:
NPs have varying levels of independence depending on their state of practice. In some states, overseeing physicians need to approve all decisions made by an NP. This style of collaboration is suitable for new graduates, but it can become tedious for more experienced NPs. In other states, NPs have what’s called Full Practice Authority (FPA) to order and prescribe as they see fit; this type of autonomy is excellent for more experienced NPs. However, it is still essential to know when to consult additional providers due to patient complexity. Regardless of their scope, NPs need to be effective autonomous providers with an increased level of accountability. It is crucial that an NP doesn’t rely solely on their overseeing physician to correct any potential mistakes made.
5. Clinical Decision-Making
NPs have a more in-depth scope of clinical decision-making than their RN counterparts. Not only do NPs need the knowledge base to make clinical decisions, but they also need the confidence to make those decisions. The increased responsibilities include, but are not limited to:
Managing acute, chronic, and preventative care
Counseling, planning/implementing treatment plans and palliative care
Understanding and utilizing appropriate diagnostic and screening protocols
Distinguishing between normal and abnormal findings
Prescribing medications within the state’s scope of practice
Delivering patient-centered, culturally competent care and empathetic relationships with parents and caregivers
As you can see, there is a significant difference in the role of a nurse and a nurse practitioner. Deciding whether or not you have what it takes to leap into a more autonomous medical role isn’t a decision to take lightly. It is important to remember that to be a successful nurse practitioner, you must be a successful nurse first. There is more required to being a good nurse or NP than simply having the foundational knowledge. Nurses must have the personal qualities and characteristics that are necessary for creating a career as a competent nurse practitioner.
The National Black Nurses Association is pleased to announce Ena Williams, MBA, MSM, BSN, RN, CENP, of Yale New Haven Hospital and Otis Rolley of The Rockefeller Foundation as the official keynote speakers for the 49th Annual Institute and Conference to be held virtually on August 4-8, 2021. The theme of this year’s conference is “Celebrating 50 Years of Innovative Community Service, Practice, Education, and Research in Nursing.”
Otis Rolley is the Senior Vice President, U.S. Equity and Economic Opportunity Initiative (US EEO) at The Rockefeller Foundation. Recognizing low wage workers as essential, even prior to COVID-19, Otis is directing all U.S. work focused on enhancing the ability of every working person to meet the basic financial needs of their family and have a path to a better future. With a focus on equity, Otis provides stewardship for U.S. grant making and investing that is aligned to strategic levers to fill key economic opportunity gaps in tax and budget policy design and implementation; access to capital and asset ownership; and worker coalition-building and advocacy.
Immediately prior to joining the Foundation in 2019, Otis served as a North America Managing Director for 100 Resilient Cities, a major project sponsored by The Rockefeller Foundation. There he provided urban resilience (economic, environmental Sustainability and community development) technical assistance and portfolio management for 29 cities throughout the U.S. and Canada. A true urbanist, Otis’ career has been dedicated to advancing equity, economic and community development in cities, and leading organizations in the for-profit, public, and non-profit sectors.
Opening Ceremony and 50th Anniversary Celebration: Equity First: Prioritizing People in Covid Testing & Vaccination
Thursday, August 5
6:00 pm – 8:00 pm
Ena Williams, MBA, MSM, BSN, RN, CENP, is the Senior Vice President and Chief Nursing Officer at Yale New Haven Hospital in New Haven, Connecticut – a 1541 bed ANCC 3-time Magnet ® designated, level I trauma, academic medical center. She has oversight of nearly 6000 nurses and clinical staff, with responsibility for practice, quality, workforce, nursing resources, patient experience and general operations. Ena assumed the role of chief nursing officer in 2018 and has since led the team through an ANCC accreditation of the Vizient Nurse Residency Program in 2018 which was recognized with 12 best practices. As CNO, she also led the team through the COVID-19 pandemic, leading clinical and operational teams across the health system, and caring for nearly 7000 COVID patients. Most recently she led the team through their 3rd Magnet designation.
Closing Keynote: Addressing Health Equity through Innovative Nursing Leadership
Sunday, August 8
10:00 am to 11:00 am
About the Virtual 49th Annual Institute and Conference
Expecting more than 500 nurses and nursing students to attend the conference, registration is now underway. To register for the virtual conference, members and nonmembers go here. More information about the conference and detailed agenda is located at https://www.nbna.org/conf.
The conference will provide the opportunity for attendees to receive up to 35 contact hours and attend two days of NBNA workshops, mentorship sessions, Under 40 events, development programs, lunch and learns, and so much more!
• Discuss the importance of a nurse’s ability to be resilient and practice self-care.
• Discuss disruptive trends in health care delivery and inequity in healthcare.
• Examine emerging opportunities for transforming the future of nursing through innovative
nursing/interdisciplinary practice, education, research, and policy advocacy.
• Identify new models of care to reduce inequities in health care and improve health outcomes for minority and underserved communities.
To join the conversation on social media, follow NBNA on Twitter, Instagram, and Facebook and use the hashtags #NBNACelebrates50Years, #NBNAResilient, #NBNAConference21.
About the National Black Nurses Association
Founded in 1971, the National Black Nurses Association (NBNA) is a professional organization representing 308,000 African American registered nurses, licensed vocational/practical nurses, and nursing students in 108 chapters and 34 states. The NBNA mission is “to serve as the voice for Black nurses and diverse populations ensuring equal access to professional development, promoting educational opportunities and improving health.” NBNA chapters offer voluntary hours providing health education and screenings to community residents in collaboration with community-based partners, including faith-based organizations, civic, fraternal, hospitals, and schools of nursing. For more information, visit nbna.org. Follow us on Instagram, Facebook, and Twitter! #NBNAResilient, #NBNACelebrates50Years, #NBNAConference21
Keisha Ricks, NBNA Marketing and Communications Manager [email protected]
Nurses—especially in the last year during the pandemic—have been experiencing burnout. Often, articles focus on what they can do to make themselves feel better. But what can their workplaces do?
Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse of Wolters Kluwer, Health Learning, Research & Practice, a Critical Care Nurse Practitioner at Penn Medicine Chester County Hospital, and a Clinical Adjunct Faculty member at Drexel University. She’s also authored and presented on many clinical and professional topics including a recently published eBook, COVID-19: Transforming the Nursing Workforce in the New Paradigm of Care.
She took time to answer our questions about what hospital leadership can do to prevent nurse burnout.
From a hospital leadership standpoint, what are some of the steps they can take to help prevent nurses from burning out?
Health care systems need to recognize that their most valuable commodity is their workforce. For years, health care systems have focused on patient well-being, but now many of those institutions are beginning to see the importance of focusing on workforce well-being too. Hospitals need to provide a safe environment for their workers, recognizing when they’re exhausted, burnt out and/or experiencing moral distress on the job. Safe environments should include the assurance of personal as well as patient safety and having adequate personal protective equipment, clinical decision support resources, and adequate staff to appropriately care for patients.
Staffing needs must be based on clinical acuity and severity of illness, not just on the number of patients. And having an agile workforce that can work in a variety of units as well as be shifted to other units when and where they are needed the most, is also a new essential, thanks to COVID. What we want, and need, are multispecialty nurses who can work across multiple units, not just single-specialty nurses working only with one patient population. Cross-training and upskilling staff to care for patients in a variety of units with a variety of care needs brings flexibility and efficacy to the workforce so managers will not need to overwork staff and can provide necessary time off.
Health care systems need to recognize when a member of their workforce is experiencing burnout and moral distress by having leadership and those trained in recognizing emotional distress available and on the unit to assess for it. Social workers and mental health workers are excellent resources to utilize for this kind of assessment. Taking the time to debrief and discuss what went right and what could have gone better in emergencies is a great opportunity to decompress after stressful situations. Many hospitals have instituted a moment of silence after a death where everyone in the room stops to acknowledge the life that was just lost.
Employee assistance programs (EAP) are good, but only if they can be easily accessed by those who need them. Too often EAP programs are difficult to find on the health care system website, and once they are found, the paperwork and or searching for an available care provider is incredibly challenging. EAP programs need to be made readily accessible and usable.
What should they do first?
The most important first step is to recognize that there is a problem with burnout. If staff are quitting, retiring early, or are becoming less engaged, there is a real problem. Be present! The leaders within the organization must be up on the units to experience what is going on firsthand. You need to find out if staff able to take breaks and leave the unit to have a meal. Are they able to sit down or are they constantly moving and up on their feet? Are they working as a team or as individuals? Health care is a team activity. It takes an interdisciplinary approach to provide the highest quality care and facilitate the best outcomes. If patient outcomes are not where they need to be, the first place to look is at your caregivers to see if they are exhausted, burned out, or experiencing moral distress.
What action steps should leaders recommend that nurses take? How can they get this information to them?
The question should not be what steps leaders should recommend to nurses to combat burnout, but how can health care organizations facilitate workforce well-being and prevent burnout? It is the obligation of leaders to assess the situation, make a plan, implement it, and then evaluate if the plan and interventions are working.
Start meeting with the staff, watch and listen to what they have to say, and start implementing these 10 steps:
Assess if the staff are burned out or experiencing moral distress.
Make employee assistance programs easy to access and utilize.
Adequately staff the patient care units with the right staff for the right patient populations.
Cross-train the workforce so they are more agile and can go when and where they are needed.
Provide adequate support systems, unit coordinators, unlicensed assistive personnel, and transporters.
Make sure the workforce takes their breaks and mealtimes.
Offer healthy food. Get a cart and take healthy options to the unit if the staff is too busy to get to the cafeteria at mealtime.
Give the staff time to debrief and collect themselves after a challenging situation.
Decrease documentation burden and make sure nurses have input on what is added to required documentation in the electronic health record.
Offer continuing professional development activities and career ladders to meet the staff’s professional needs.
Remember, nurses have family and financial concerns; offer care alternatives and financial counseling if and when it’s needed.
If nurses are already experiencing burnout, what should hospital leaders do? How can they help? And how can they let nurses know that their jobs aren’t in jeopardy if they need to take time off for their mental health because of burnout?
Take the time to see, hear, and experience what nurses are experiencing. You can’t do that from an office, so get up on the patient care units and look around. If the workforce doesn’t feel valued by the organization, they will leave, and there will be fewer caregivers left to care for the patients. Develop a “care without judgement model,” meaning that to whomever is in need of care—a patient, a nurse, or another employee—care will be delivered, without judgment. No one’s job should be at risk if they need to take time to step away and focus on self-care. You cannot be a good clinician unless you care for yourself first. Again, make it easy to access employee assistance and mental and physical health resources.
What should hospital leaders absolutely *not do when trying to prevent their nurses from burning out? What are the biggest mistakes they can make?
The biggest mistake health care leaders make is not recognizing that the health care workers are the most important commodity within their organization. Patient outcomes are optimized only if the staff feels valued, have adequate resources, are properly trained, and feel safe in their work environment—both physically and emotionally. Everyone on the health care team needs time to be able to take a moment to step away and recharge.
During COVID-19, what have been the biggest challenges that nurses are facing in terms of burnout? Is there anything that hospital leadership can do to help?
The biggest challenges have been fear and uncertainty. Fear that we initially didn’t know enough about the COVID-19 virus, and we might bring it home to our families or become infected ourselves, and fear that the death we experienced day after day wouldn’t stop. And uncertainty that we wouldn’t be strong enough to keep delivering care to our patients as we fought this seemingly unending pandemic. Yet we did. We looked fear and uncertainty in the face and said—”we will not be daunted!” That’s who we are—we are nurses, and our passion is to care for those in need.
Health care systems need to invest in workforce well-being, retaining the talent they have and recruiting new nurses to take the place of those who have left the profession. Care begins with those in our family. In health care, the workforce is our extended family.
The vaccine is a game-changer for nurses. The more shots in arms, the lower the number of patients we will see fighting for their lives because of COVID-19. Let’s trust in the science and use the evidence to educate people about COVID-19 and how to prevent it.
And finally, nurses need to invest in their own well-being so they can invest in caring for others.