Travel nurses are in great demand right now, as they are helping to relieve frontline workers during COVID-19. While health care facilities are doing everything they can to make environments safe, there are still specific risks that travel nurses are dealing with during this pandemic.
Georgia Reiner, Senior Risk Specialist, Nurses Service Organization (NSO), gave us the latest information about what’s happening with travel nurses, what the risks are, and what they can do to protect themselves.
Are hospitals throughout the country calling on travel nurses to relieve frontline workers? Is the main purpose to alleviate burnout of the frontline workers?
Travel nurses are in high-demand across the United States as hospitals work to treat surges of coronavirus (COVID-19) patients. This crisis arrived at a time when nurse staffing was already a concern due to a multitude of factors, including the growing health care demands of an aging population and nurses aging out of the workforce. Therefore, the demand for travel nurses seems to be primarily driven by a need to build up hospital capacity to handle the influx of COVID-19 patients.
Data from different staffing platforms show that throughout the pandemic, travel nurses are in highest demand in areas most impacted by the coronavirus, like New York and Washington State, and certain nursing specialties like ICU/Critical Care, ER/Trauma, and Med/Surg.
Certainly, as the pandemic continues, the sense of burnout among health care workers will intensify, and travel nurses will likely play an important role in helping to alleviate burnout.
This is a different situation for travel nurses. One risk is checking licensing in different states. What can travel nurses do to be sure that their license transfers? If it doesn’t, but frontline workers are still needed, are exceptions being made?
Before deciding to accept a job, nurses need to ensure that their licenses will allow them to practice in that state/jurisdiction. Multi-state licenses are available for nurses who meet the requirements, which include elements like background checks and education criteria. Temporary licenses are also an option—these are generally reserved for travel nurses who have accepted a job in another state and are awaiting their permanent license.
During the nationwide public health emergency due to COVID-19, some statutes and regulations regarding licensure portability may be relaxed or waived, so it is important for nurses to be aware of what the requirements are both during and following the emergency period. The National Council of State Boards of Nursing (NCSBN) has compiled information about the nurse licensure compact and emergency action taken by states, which is a great starting place for information.
When travel nurses are thrust into an unknown situation in a hospital/medical center that isn’t familiar to them, and they are working with systems they’re not familiar with, what’s the best way for them to cope? How can they avoid burnout themselves? Please explain.
Working in a new environment is inherently stressful. Getting used to new processes, technologies, hospitals layouts, and new people can be overwhelming under normal circumstances, and can be amplified during a crisis like COVID-19. Travel nurses should make sure to take time for self-care to preserve their mental health. This is a stressful time for everyone, so don’t be afraid to reach out to colleagues with questions and for support. Failing to make an effort to cope with these rapid changes can have a negative impact on personal wellness and patient care.
What about a nurse’s scope of practice? what can nurses do to make sure that they are acting in the scope of practice? What if the facility allows them to do more than their own state? Does their scope of practice relate to the state they’re in or the one they’re licensed in, or both?
As the COVID-19 crisis rapidly evolves, travel nurses may be given patient assignments outside of their typical practice areas and locations. When faced with situations that exceed the scope of practice for the state in which they are practicing, or the skills or knowledge required to care for patients, travel nurses, like all other nurses, should develop and implement proactive strategies to alleviate unsafe patient assignments. Nurses need to advocate for patient safety and for their nursing license by speaking up if an assignment does not fall under their scope of practice.
When the assignment is within a nurse’s scope of practice, but not within their realm of experience or training, saying “no” to the assignment could lead to dismissal. At the same time, if the nurse does not feel they are equipped to handle the assignment, they could potentially put patient safety at risk. In these scenarios, nurses should tell their supervisor that they have very limited experience in that area and should not be left in charge. The nurse should describe the task or assignment they don’t feel equipped to handle, the reason for their feelings, and the training they would need to be more confident and better prepared.
What changes have occurred during COVID-19 regarding travel nurses and the risks they face that you think should be permanent either for the near future or forever?
Currently, there are certain state and federal regulations, declarations, and orders that extend liability immunity in the fight against COVID-19. What’s not clear at this time is the breadth and scope of these regulations and orders.
For example, it is not clear if these orders and declarations extend to all providers in all areas of service or if such immunity will be limited and specific to certain types of health care providers. Since there is lack of clarity in terms of immunity, it is prudent for nurses to not presume they have any immunity.
Further, plaintiff’s counsel can file a lawsuit, immunity or no immunity, if the plaintiff’s counsel believes the client was injured and that injury was the direct result of the nurse or other health care professional providing or failing to provide professional services. In the best-case scenario, the suit brought against the nurse will be deemed baseless and their malpractice insurer will work to get the suit dropped/dismissed.
Is there any other information that is important for our readers to know?
The COVID-19 pandemic is still evolving, and there is much we still do not know about the virus. All nurses should continue to follow the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) for updates and guidance to help prevent the spread of the virus and protect themselves and their patients.
As the world continues to struggle with COVID-19, many are likewise struggling with the emotional and mental impact that comes with the uncertainty of the pandemic. Seniors, who are in the high-risk group for getting the virus, may be some of the most afraid.
We reached out to Julie Smirl, Assistant Professor in the Online Counseling program at Bradley University, for some ways that nurses can best help seniors during this trying time.
We’re experiencing something unlike anything any of us have ever gone through, and that’s obviously stressful, which weakens the immune system. What are the most important things that nurses can do right now to help protect the mental health of seniors during this scary time?
One important key element to improving mental health as a professional engaging with their clientele is using intentional active listening skills. In working with the senior population for many years, the feedback I have received from my clientele has been that they appreciated a professional taking time to listen to their story, sharing words of encouragement, and the act of human touch on decreasing one’s stress level.
RNs at this time have a unique opportunity to engage with their patients providing reassurance and human touch—even though protective gloves and masks are used, you can still engage in a kind word or touch on their shoulder, etc.—since family members cannot be present during this pandemic. Facing a grave illness and fears about one’s mortality, anxiety and depressive levels will increase. These simple daily practices of encouragement and touch can improve overall mental health symptoms when you come into contact with each of your patients. Keep in mind, some of the patients you are working with may have experienced other traumatizing events in their lives in the past, and this pandemic will trigger many detrimental responses that subsequently will impact their overall health and wellness.
What kinds of things can they say to seniors whom they come in contact with to help reduce their stress?
When talking with seniors, reassuring them that their responses are normal during these uncertain times is first and foremost. Sharing your own fears can assist in normalizing their feelings. Asking them how you can help them decrease their worries—as each person is different in wanting to know about their prognosis for example or having an opportunity to make final plans, if necessary—will help a person feel they have more control over their current health dilemma.
What additional actions can they take?
If they ask for other assistance make these available such as Pastoral Care departments, or legal assistance, financial aid, etc. can all lead to decreasing one’s stress levels knowing their COVID symptoms may impact their mortality rates and their families both physically, emotionally, and financially.
If nurses work in nursing homes/rehab centers—and seniors are potentially with someone who have been exposed—how can they help to keep seniors’ spirits up? What actions can they take?
Provide ways seniors can still participate, perhaps virtually, in activities can boost spirits. Provide activities that they can do in their room with their roommates. Find ways family and friends can connect through a window to their room, or technology/phones, etc. that they may not have personally will assist with social engagement. There are many games you can participate in keeping social distancing requirements in place.
What precautions should be in place to prevent the elderly from feeling lonely or isolated right now?
Having access to technology such as computers, smart phones, etc. is helpful so that they can connect with family and friends since they cannot leave the facility, and visitors cannot come to see them. Encourage them to call someone daily. Turn off the TV if they are focusing on the news all day—which can keep their anxiety and depression levels high. They can check once or twice a day to receive the news. Sitting out on their patio keeping social distancing guidelines and wearing masks, can still provide a boost to their moods and distract intrusive thoughts.
Suppose nurses do home health care. What can they do to make their senior patients feel better?
Similar to being in a hospital, residential, or home settings, encourage them to connect daily with a friend or family member to create connections with others. We are social beings by nature and being isolated can increase anxious and depressive moods in anyone.
What are some things that nurses should never be doing in these kinds of situations?
It is not helpful to tell someone who is scared or hurting, that they should not feel that way. This invalidates their feelings about what is occurring both internally and externally in response to stimuli. Feelings are important as they provide a label for our perception of what is occurring in our lives from our worldview and also lets other people know what our perspective is on what we are experiencing. Taking time to understand your patient’s cultural background can also provide helpful information on how to approach your clients without incurring more harm to their mental health by acting contrary to their cultural belief system.
What else should readers know?
Taking time with each patient who is an older adult can have a very positive impact. Often, they are afraid and cannot hear or see well. If professional caregivers are hasty in their movement during the provision of procedures they are performing, not taking time to explain each step they are taking, then anxiety levels will increase. Fear or flight/fight responses will have a negative effect on patients’ ability to build up their immune system and will potentially deplete one’s ability to recover.
With the rise of urgent care clinics as an alternative to going to the emergency room, many people are left unsure which to visit when they experience a medical issue. The choice is important, as while urgent care clinics are often much cheaper, they are unequipped to deal with certain emergencies and will refer you to an emergency room anyway. While the line between urgent and emergency medical issues is not always easily apparent, here are some ways you can tell whether you need to go to the emergency room or urgent care.
Pain is a troubling symptom, and either urgent care or the emergency room might be the right answer depending on its severity and location. Some pain, such as ear pain from a suspected ear infection, a sore throat, or other concerning but not alarming pain can be seen by urgent care. Severe pain, however, especially if stemming from the chest or abdominal area, should be looked at in an ER. This type of pain could be indicative of a cardiovascular event, appendicitis, tumor or cyst, or other serious condition. Even severe leg pain could be an emergency, especially if you are unable to easily walk because it could be a sign of deep vein thrombosis (DVT). DVT occurs when a blood clot forms in the deep veins of your body and if not treated promptly could result in required amputation.
In general, injuries that are not life-threatening can be taken to urgent care while anything life-threatening should be seen as an emergency. Simple or suspected broken bones can often be mended at an urgent care clinic, while complex fractures should go to the emergency room. Most animal bites, including insect stings and bites, can be handled by urgent care, although severe, life-threatening bites, such as to the head or neck, should be taken to the ER. For sprains or strains, you should go to urgent care, while anyone who is bleeding severely should be taken straight to an emergency room.
Most illnesses will not require a trip to the emergency room. Fevers, flu symptoms, coughs, vomiting, diarrhea, and most bacterial, viral, and fungal infections can be handled at an urgent care clinic. Even dehydration, which is often brought about by infections, can be treated at urgent care. If you have reason to believe the illness symptoms you, a family member or a friend are experiencing could be fatal, such as being unable to breathe, then an emergency room visit is warranted. If someone falls unconscious, you will also want to take them to the emergency room.
Slurred Speech or Confusion
Anyone who is suddenly experiencing slurred speech, confusion, vision loss, trouble speaking, or understanding others should be taken to an emergency room immediately. These are signs of a stroke, head trauma, or other brain damage that must be addressed immediately in order to have the best chance of restoring normal function. Other signs of a stroke include weakness in one arm or leg, drooping on one side of the face, and trouble walking or staying balanced. Strokes usually only affect one side of the body, with the left side being more common. Head trauma can have other symptoms such as pupil dilation, difficulty sleeping or awakening from sleep, light and sound sensitivity, and more.
A minor allergic reaction can be sent to an urgent care clinic. Minor reactions can include rashes or minor respiratory problems caused by pollen, pet, or other environmental allergens. A major reaction will require a visit to an emergency room and typically involves not being able to breathe or experiencing severe swelling. The difference between the two usually can be discerned based on the severity of the reaction and whether the person has had contact with a known life-threatening allergy. If you are not sure what is causing the allergic reaction, you will likely be referred to an allergist after the reaction is brought under control to determine your health needs moving forward.
Generally speaking, the severity of your symptoms should help you determine whether to go to an urgent care clinic or an emergency room. When searching for a good clinic make sure you are trying to find the one nearest to you. For example, if you live in Illinois you might search for Urgent Care in Oak Brook. If you live in New York City you might search for a local CityMD, or Texans might search for the nearest Texas MedClinic. Certain symptoms or issues, however, are more likely to warrant going to one or the other. When in doubt, you can call your primary provider to see what they suggest.
In 1982, the famed gospel songwriter Andrae’ Crouch wrote a song with lyrics that contain the following words; “How can I say thanks, for the things You have done for me? Things so undeserved, yet, You gave to prove Your love for me; The voices of a million angels, could not express my gratitude. All that I am, and ever hope to be, I owe it all to Thee.” While the song is giving God the glory, the words are apropos for nurses that we all love and respect. During the first week of May each year, we honor our “angels” and tell them “thanks for all that they have done and continue to do for us”. While this year is no exception, what makes this Nurses’ Week especially meaningful is the light that the COVID-19 pandemic has shone on the sacrifice of these angels. When asking people what nurses mean to them, the following quotes were shared with me.
“I love nurses because people who need a nurses’ touch can always count on the nurse to give them exactly what they need, at the exact time that they need it.”
“Nurses can alleviate an individual’s stress, anxiety, and in some instances pain. The soft voice of a nurse can almost mask a person’s pain.”
A nurse will give you hope when there is no hope. A nurse must have a quality of care that stems from humility and all of the other branches that come from that humility will heal a patient.”
The most poignant comment comes from 11-year-old Pearson G. Paige who stated: “I love nurses. A nurse is something special. Nurses are cool. Nurses are nice.”
While people brag about our beloved Florence Nightingale, I want to turn your attention to a few of our African American nurses that have made a difference in not just the African American community, but in the world as a whole.
Meet Anna Knight, born in 1874 and from the state of Mississippi who taught herself how to read and write before attending nursing school. It is believed that Anna Knight would encounter knocks at her door from family members of victims of “botched hangings’” because God would not allow them to die that way. These “patients” were bought to Ms. Knight for her to nurse them back to health. Anna was known as a Christian woman who was strong in her beliefs and thus became one of the first African American missionary nurses to ever travel to India to care for others. When she returned from India, she established a school and church in her native Mississippi and eventually became an administrator of a hospital for blacks in Atlanta.
While there were many who officially practiced nursing before 1879, Mary Eliza Mahoney has been noted as the first African American “registered nurse”. She is credited with co-founding the National Association of Colored Graduate Nurses and is one of the original members of what is now known as the American Nurses Association.
While many of us saw and loved the movie “Harriett,” little is mentioned in the movie about Harriett Tubman being a nurse. Not only did she free more than 300 slaves, but she also worked tirelessly as a union army nurse. One of her last acts of valor was the establishment of the “Harriett Tubman Home for the Aged” in 1908, which cared for the aging African American population.
Twice named the “Army Nurse of the Year,” Dr. Hazel W. Johnson-Brown not only faced discrimination as an African American nurse but beat it by earning a master’s and PhD degree in her specialty. She was one of the first African American women to lead the Army Nurse Corps, in addition to being promoted to brigadier general and was one of the only African Americans to teach in the PhD program at George Mason University in the late 1990s.
Continuing to serve not just the nation, but at Howard University as the Vice-Chair of the Board of Visitors, Dr. Bernadine Lacey also served as the Bronson School of Nursing’s founding director at Western Michigan University. She established a community program which skyrocketed. In her honor, The Bernardine M. Lacey Endowed Chair was created with the help of a $1.5 million anonymous donation in 1998. Lacey’s specialty in caring for the underserved follows her as the clinic at the Creative Center for Non-Violence (CCNV) Shelter on D Street in Northwest Washington is the recipient of a clinic that Dr. Lacey started over 20 years ago.
There are many that we could list within the arena of nursing that have focused on the healing of those within our African American community. Let us not forget to recognize those who cared for us when the “living room” was the triage area for many makeshift surgeries, procedures, obstetric and gynecological procedures, in addition to the emergency room for “many a patient.” You see there are many “nurses” who did not go to school to become a nurse but were still “nurses,” such as mothers who have nursed their children back to life. Nurses are also grandmothers who raised their multiple grandchildren and gave them “life.”
The story is told by a friend of mine who stepped on a 2×4 board in which a nail was lodged. His grandparents were one of the first “male and female nursing teams.” Subsequently, his grandfather put him on the table and told him to look at his grandmother, while he pulled the nail out of the nine-year-old’s foot.
The grandmother then took over and placed a piece of salt pork over the area which then leached out the rust from the nail and then ordered “bed rest” for the rest of the day. He stated that during her shift, she evaluated and cleaned the foot, eventually taking the bandage off, in which he noted that the salt pork had pulled out all of the impurities.
Another story is told of a young boy who was catching bees with a jar. Subsequently, he was stung by the bee and had an allergic reaction. The neighbor next door, took a cigarette, broke it in half, got the tobacco out, wet it, and placed it on the sting. Immediately the swelling went down, and the pain went away.
As black people, we have learned how to “nurse” in so many ways. We have learned how to take care of each other mentally, physically, emotionally, and spiritually. How many churches have been filled with the mothers of the church acting as “psychiatric nurses” for many?
However, as we honor our nurses during this Nurses’ Week, we honor them as never before, realizing their importance, their value, and their worth during this unprecedented time in our nation’s history. To all of our nurses who have worked tirelessly, worked back to back shifts, turned patients “prone” due to COVID-19, cried with family members, attended 10 person funerals, and have ultimately paid for illnesses with their own lives, we salute you. Your sacrifice has not gone unnoticed, nor has it been made in vain. Thank you for what you do every day, all day, for people that you don’t even know. Thank you, thank you, thank you. May GOD repay you 100-fold for what you give to others each and every day.
The Center for American Progress recently published a piece by Connor Maxwell about how people of color have a greater risk of getting the coronavirus because of structural racism.
Maxwell, Senior Policy Analyst for Race and Ethnicity Policy, Center for American Progress, took time to answer our questions about how and why this is occurring as well as what nurses and other health care workers can do to help.
Why are people of color getting the Coronavirus at higher rates than their white counterparts?
Inequality is magnified in times of national hardship. Occupational segregation has concentrated people of color in frontline essential jobs in industries such as food processing and retail, health care, sanitation, and transportation. Housing segregation has also largely restricted people to densely populated urban areas where crowded grocery stores, public transit, and laundromats are common. Together, these factors contribute to increased racial disparities in coronavirus exposure and infection rates.
Please address the issues with social distancing as well as the economic, health care, and housing systems and how they are contributing to people of color being at greater risk for contracting the virus.
Social distancing is much more difficult for people experiencing occupational, domestic, and urban crowding. People of color are more likely to work in busy food processing plants, grocery stores, and other facilities where maintaining proper social distancing is almost impossible. They are also more likely to live in densely-populated urban areas with less spacious housing and multiple generations under one roof. These factors, combined with insufficient access to accurate and timely information about coronavirus and free testing and treatment, can increase the risk of contracting the virus.
What can state and local governments do to help reduce the risk for people of color?
Here are a few things that state and local governments can do to help reduce the risk for people of color:
- Ensure adequate testing and treatment in areas most vulnerable to the virus.
- Ensure the collection of demographic information upon testing citizens.
- Establish a taskforce at the state level to monitor trends and provide guidance on how to reduce the racial disparities in their state.
Is there anything that nurses and other health care workers can do in order to help reduce the risk for people of color getting the Coronavirus?
Nurse and health care providers need to ensure they are equitably testing individuals coming in seeking health care. They should also support information about COVID-19 being translated in multiple languages so that all patients have access to relevant and important information about how to protect themselves against contracting the virus.
What else is important for nurses to know about this?
Contracting coronavirus is not the fault of individual actions or behavior, but of structures and systems that increase exposure and limit social distancing in communities of color.
Nurses in the United States are facing unprecedented hardships that increase the risk that they will experience burnout. Health care workers, especially nurses, often experience high levels of stress due to the long hours they put in and the sheer number of patients that they interact with.
Avoiding burnout is necessary for a long career in nursing and it is important that nurses do their research when it comes to methods for preventing burnout. While there is a pharmaceutical answer in the use of antidepressants, this method merely treats the symptoms that can lead to burnout. For many nurses, the answer lies in a more natural path that will give them the tools they need to combat burnout holistically.
Health care workers have been shown to be particularly susceptible to experiencing burnout due to the fact that they are expected to perform patient care with consistent and constant empathy and patience. This can lead to emotional exhaustion which, coupled with the physical exhaustion that comes with working in the medical field, eventually morphs into what we know as burnout. Naturally, the stresses of this line of work can lead to fatigue that impacts motivation in the workplace and a misplaced sense of failure.
One of the best tools available to nurses in the fight against burnout is the development and strengthening of resiliency skills. When nurses possess a solid foundation of resiliency skills they are better equipped to bounce back from a particularly intense shift more easily and are able to maintain their ability to work effectively. Taking breaks during shifts, scheduling time to hang out with coworkers outside of work, and learning how to say no to taking extra shifts if they need breaks are all ways to increase resiliency.
The prevalence of burnout and resiliency’s effectiveness in combating it has led to the development of nurse resilience programs designed to arm nurses with the proper tools before they begin their careers. Through cognitive-behavioral training, stress inoculation therapy, and various other methods, nurse resilience programs are effective in preparing nurses for what lies ahead of them in their career and can be invaluable in the fight against burnout.
Taking Care of Mental Health
Another natural proven method for nurses avoiding burnout is simply taking care of their own mental health and well-being. While it might seem like obvious advice, for those working in high-stress environments like health care can find it far too easy to forget to take care of themselves. Self-care is vital for nurses who want to dodge burnout, and even something as simple as keeping a journal to acknowledge positive things that happen in life can be enough to stymie burnout.
Many nurses suffering from burnout experience feelings of inadequacy, low self-worth, and depression. It is important that nurses recognize that these feelings, while they can be intense, do not represent the reality of the situation and do not reflect their actual performance or capabilities either at work or life in general. Quieting that negative inner-voice is an effective way for nurses experiencing burnout to boost their self-esteem and sense of self-worth.
Learning how to practice mindfulness meditation is another excellent natural way to look after one’s own mental health in even the most stressful of situations. Mindfulness meditation has a whole host of benefits from helping to increase attention and concentration to improving practitioners’ heart rates and blood pressure, all of which can help to manage stress and fight off burnout. While there are plenty of books on the subject, there are also a multitude of free resources available online that are secular, simple, and can get a struggling nurse on the right track.
Looking Towards Nature
Should building resiliency skills and working on maintaining good mental health fail to do the trick, spending time in the great outdoors has also been proven to help prevent occupational burnout. Engaging in physical exercise outdoors helps to reduce fatigue and improve overall cognitive function and can result in a marked reduction in tension, depression, and anger. While nurses do indeed have wildly busy schedules, making an effort to set aside time for themselves in the outdoors can yield incredibly positive results for them.
If a nurse finds themselves unable to break away from the concrete jungle, there are still ways in which stress can be reduced naturally without going outside. Taking the time to unplug from technology frequently can reduce stress and allow for moments of silent self-reflection untainted by the constant and looming force of the internet and social media.
Finally, nurses that are looking for a way to combat burnout but are wary of getting a pharmaceutical prescription to manage its symptoms can always turn to mother nature. Cannabidiol, or CBD, is a compound found in cannabis that has no deleterious or psychoactive effects and is becoming a popular stress-reduction tool for many. While the science regarding CBD is still in its infancy, there is a huge amount of anecdotal evidence that points to the compound being an effective treatment for stress and a host of other symptoms and disorders.
At the end of the day, nurses and health care practitioners are some of the most important people in a functioning society. It is vital that they receive all possible help when fighting against burnout, whether that comes in the form of resilience training, mindfulness practices, or spending time with mother nature.