In the weeks as the COVID‐19 health crisis unfolded, several challenges to responding
effectively became evident. I focus on three of these challenges to illustrate how
nursing research provides answers during crises: restricted access to health care,
surging demand for health care personnel, and the moral distress that health care
providers face.
To limit virus transmission, most ambulatory providers converted to telehealth encounters
instead of in‐person encounters. To facilitate this change, an early policy response
to the coronavirus by the Centers for Medicare and Medicaid (CMS) expanded the number
of services that would be reimbursed when furnished via telehealth (Centers for Medicare
and Medicaid, 2020). The field of telehealth first emerged as an approach to expand
access to patients in remote settings. Fathi, Modin, and Scott (2017) reviewed the
emergence of telehealth in the United States and how it increased health care access.
There is a solid record of nursing research providing evidence on the comparative
effectiveness of telehealth. A systematic review and meta‐analysis synthesized 43
studies comparing telehealth interventions delivered by registered nurses (RNs) and
allied health professionals with standard face‐to‐face interventions (Speyer et al., 2018).
The research showed that telehealth may be as effective as face‐to‐face.
The influx of patients with COVID‐19 symptoms into hospitals requires more health
care providers than usual due to the high fraction of hospitalized COVID‐19 patients
requiring critical care and the time‐consuming regimen of donning and working in personal
protective equipment. Here, an effective response combines national and institutional
initiatives. Swift action by Centers for Medicare and Medicaid (2020) reduced physician
supervision requirements over nurse practitioners, certified registered nurse anesthetists,
and physician assistants. This practice at the “fullest extent possible” of these
advanced practitioners has been well supported by empirical evidence (Institute of
Medicine, 2011). Such expanded use of these advanced practitioners increases available
health services by them directly as well as by reducing physicians' supervision responsibilities.
At the institutional level, how can hospital managers respond effectively to surging
health care demand? Nursing research demonstrates that care settings value professional
nursing knowledge and skill achieve better patient outcomes (Aiken et al., 2011; Lake
et al., 2019). In these settings, nurses are expected and supported to fully utilize
their knowledge and skill, to coordinate care within the health care team, including
physicians, respiratory therapists, and unlicensed assistive personnel, and to be
partners in planning for disaster response. A key institutional metric is the staffing
level of RNs. The research evidence is consistent that better‐staffed hospitals achieve
superior patient outcomes (McHugh et al., 2016; Shekelle, 2013). Multiple, rigorous
studies have documented lower patient mortality in hospitals with better educated
RNs (Aiken et al., 2014; Kutney‐Lee, Sloane, & Aiken, 2013). Enlightened hospitals
have been recruiting nurses with a Bachelor of Science in Nursing (BSN) degree or
encouraging their RNs who entered the profession with an Associate or Diploma degree
to complete the BSN. Therefore, hospitals can best prepare for a pandemic‐related
surge by establishing safe staffing levels, professional environments, and high educational
expectations for their RNs.
Even in a well‐staffed hospital with a supportive professional environment, aspects
of COVID‐19 disease confront health care providers with unique risks and emotional
strain. Because the virus is highly contagious, health care providers face constant
worry for themselves and their family members of contracting the virus. The visitor
restrictions in hospitals make the health care providers the only people available
to offer emotional support and comfort to all hospitalized patients during their illness
and, for those who do not survive, while dying. These risks and strain present ethical
dilemmas to nurses whose desire to meet their professional ethical obligations may
conflict with their personal values and priorities. The ethical strain is compounded
by the emotional strain. How can nursing research address this deep strain? Nursing
ethics research suggests that having a positive ethical climate and institutional
support for dealing with ethical issues are key elements to managing ethics stress
and ethical concern (Ulrich et al., 2007).
In a time of profound upheaval, risk, and strain, it is reassuring to have evidence‐based
solutions to the challenges confronting our health care system and its clinicians.
National policy responses and institutional preparedness offer complementary approaches
that have empirical support from nursing research. If the temporary regulatory changes
enacted by CMS and the institutional readiness succeed during the COVID‐19 pandemic,
a silver lining may be their flourishing as the “new normal” in the postpandemic era.