As of May 1, 2020, well over 3 million people worldwide had been confirmed positive
for Coronavirus Disease 2019 (COVID-19) and over 220,000 had died. (Johns Hopkins
University and Medicine 2020) As the International Year of the Nurse and the Midwife
2020 (World Health Organization 2020) continues alongside the devastating outcomes
of COVID-19, nurses are experiencing unprecedented challenges to deliver safe and
equitable care to all populations in need. This is particularly true for those living
in rural areas, the poor, and others impacted by harsh social, environmental, or economic
determinants. (World Health Organization 2020, International Council of Nurses 2020)
There are close to 28 million nurses globally, accounting for nearly 60% of the healthcare
workforce and delivering about 90% of primary healthcare services internationally.
(World Health Organization 2020) In many parts of the world, a nurse is the only health
professional that many in underserved areas are able to access. Nurses spend far more
time with sick persons than any other interdisciplinary partner and have consistently
been acknowledged as the most trusted profession. Given the sheer quantitative force
of the nursing profession as the frontline responders to the pandemic and their proximity
to the communities they serve, there needs to be rapid policy reform and investment
in nurses and nursing to ensure their optimal contribution and continued wellbeing
amid the myriad consequences of COVID-19 now and beyond the flattening of the curve.
Now – at the height of the pandemic – is the opportunity to translate our acknowledgment
of nurses into real-time organizational and governmental support, increasing the potential
for measurable and improved health outcomes in the face of COVID-19.
Prior to the Year of the Nurse and the Midwife, several reports called for expanded
autonomy for nurses and increased recognition of their potential to impact health
through expanded scopes of practice in clinical, education, research, and decision-making
domains. (All-Party Parliamentary Group on Global Health 2016, World Health Organization
2020) Using the primary recommendations of, Nursing and Midwifery: The Key to Rapid
and Cost-Effective Expansion of High-Quality Universal Health Coverage, (Crisp et
al., 2018) a report of the World Innovation Summit for Health (WISH) Nursing and Universal
Health Coverage Forum 2018, we put forward timely suggestions to improve the current
state of health by addressing policy gaps that will more effectively contain and manage
the COVID-19 pandemic - as well as future public health and humanitarian crises –
by leveraging the skills of the global nursing workforce.
Redesign existing services and introduce new and innovative services that maximize
the contribution made by nurses and midwives, enabling them to work at the top of
their license. (Crisp et al., 2018) Nurses and advanced practice nurses are, in many
cases, playing lead roles in COVID-19 testing, triage, and management both in acute
care and community-based settings. This is happening in some countries but needs continued
widespread adoption. Such models will provide an extra layer of support to all care
teams across the system and free up specialists for more urgent clinical consultation.
The creation of nurse-managed testing clinics and nurse-led models of education and
training can contribute to public health awareness about the need to abide by social
distancing, hygiene, and quarantining prevention practices to mitigate spread and
preserve population well-being. Removing practice barriers at local and national levels
promotes nurses working to the full scope of their licensure, commensurate with their
training and skillsets, forging approaches to support effective disease management
even beyond the impact of COVID-19. In addition, leveraging the nurse workforce in
this manner will prove integral to health promotion, disease prevention, health literacy,
and early detection across the health system and in the face of future public health
emergencies.
Develop a comprehensive workforce strategy that maximizes the contribution of all
professions and health workers. (Crisp et al., 2018) Investment in nurses needs to
be strategized across all aspects of the profession. For instance, increased fiscal
allocation to nursing schools is required to prepare the next cadre of frontline advocates.
During the COVID-19 response, nursing students, with just-in-time training and under
supportive supervision, can be employed in administrative, testing, telemedicine,
and patient education roles to fill care gaps. Students can also be used to communicate
with and track older persons and those with chronic conditions to decrease the negative
impacts of social isolation and identify physical decline early.
Maximizing the contribution of nurses is imperative, for example, leveraging the role
of nurse practitioners. Empirical data consistently shows that nurse practitioners
demonstrate cost-effective and favorable outcomes on a number of quality measures,
and have high levels of patient satisfaction. (Laurant et al., 2018, Martin-Misener
et al., 2015) Many state governments in the United States have supported full practice
authority for nurse practitioners and temporarily removed the requirement for collaborative
practice agreements with physicians to optimize scarce human resources for health
to address population needs in the context of COVID-19. On a global scale, the recent
International Council of Nurses’ Guidelines on Advanced Practice Nursing 2020 (International
Council of Nurses 2020) provide governments, policy-makers, and other stakeholders
with the information needed to better understand the advanced practice nursing role
and their myriad contributions to the health of individuals and communities. Their
practice scope to diagnose, treat, evaluate, prescribe, and consult is critical to
filling the gap amid both the pandemic and the broader global healthcare worker shortage.
Enact supportive legislation and regulation. (Crisp et al., 2018) Optimizing the nursing
workforce requires empowering nurses through immediate amendments to policies that
dictate practice and interprofessional partnerships. Systems need to take steps toward
legislation that safely increases the tasks and roles of nurses, including nurse prescribing.
National and international nursing associations should actively participate in COVID-19
response task forces, input for nursing scope expansion to meet health system needs,
and active engagement in redefining professional nursing roles in a state of health
disaster. The inaugural State of the World's Nursing 2020 report calls for increased
investment in education, jobs, and leadership to ensure nurses are supported and their
contributions optimized across settings. (World Health Organization 2020) In support
of such a goal, schools of nursing globally should reaffirm their commitments to community
and public health through regulations that ensure curricular emphasis on epidemic
prevention and response, as well as leadership and management training, for all current
and future nurses.
Raise the profile and status of nursing and midwifery. (Martin-Misener et al., 2015)
This recommendations is, perhaps, one of the most vital. We – as a system and healthcare
community – must continue to encourage nurses to take on leadership roles in all settings
and at policy tables. More than ever before, COVID-19 has raised the visibility of
nurses’ contributions to the global public. They are: first responders, researchers,
community liaisons, intensive care experts, ethics experts; and healthcare coordinators,
managers, and mobilizers of resources. Making effort to ensure a transparent and honest
communication of who nurses are and what they contribute during COVID-19 will promote
nursing as a desirable and challenging career option now and in the future, helping
to close the healthcare workforce deficits and strengthen the nursing frontline for
the long-term.
Without immediate attention to the intelligent deployment and utilization of nurses,
the COVID-19 response and the mitigation strategies for future inevitable pandemics
will be suboptimal. Policy makers, interdisciplinary partners, and other critical
stakeholders must support changes that allow nurses to innovate, lead, and maximize
their contribution to society. The far-reaching consequences of COVID-19 have shown
that we need widespread, rapid, and intelligent investment in nursing through informed
action that fully leverages the healthcare workforce. Our communities and the health
of populations worldwide depend on these urgently needed policy reforms and increased
investment in nursing now more than ever.