We are at the halfway mark in the Year of the Nurse and the Midwife, the global proclamation to acknowledge the critical role nurses and midwives play in ensuring the health of the world's population. What began as a year of celebration has, for nurses, turned into a brutal struggle that has impressed the public in an entirely different way.
Nursing is hard work no matter the setting-ask community health nurses who brave inclement weather and challenging home environments to visit needy clients; ask nurses who work in nursing homes caring for fragile elders, many of whom require as much care as those in hospitals yet must do without hospital resources. And don't ask nurses who work in hospitals unless you're prepared to hear a litany of grievances, including burdensome reporting and computer technology, rapid patient turnover, and little time to do "real" nursing. Hospital nursing has become increasingly "nurse unfriendly," and more nurses feel "used up," morally distressed, and burned out. And then came COVID-19, bringing new definitions of "seriously ill" and "busy shift."
Nurses' work has become powerfully visible. Every day, images of nurses clothed in layers of gowns and face masks have filled television screens and the front pages of newspapers. They show nurses at patients' bedsides monitoring ventilators, proning patients, and adjusting the numerous IV pumps hanging from poles like branches on a tree. And in too many cases, nurses are performing perhaps their most important role-being present and serving as surrogate family members at the end of their patients' lives. Our cover image this month by Ohio artist Jim Leitz depicts an exhausted and dejected health care worker, conveying the artist's perception of the suffering the COVID-19 pandemic is inflicting on those at the bedside. (See more about Leitz in On the Cover.)
There has been huge public support and accolades for nurses and other health care workers, and rightly so. However, bestowing a "hero" title does little to offset the dangers that nurses are facing every minute they spend without adequate personal protective equipment (PPE) while they care for patients who have COVID-19. The U.S. Department of Health and Human Services declared a public health emergency on January 31, but the president did not declare a national emergency until March 1, wasting a month that could have been used to secure resources. The loss of a month in mobilizing for a pandemic has had grave results for health care workers: a report by the Centers for Disease Control and Prevention (CDC) dated April 14 noted that 9,282 health care workers had confirmed COVID-19 and 27 had died; and the numbers of sick and dead health care workers continue to add up.
It's hard to completely fault hospitals for not having enough supplies for a pandemic surge, or, in looking for guidance, for following the CDC's advice, however unvetted and ill conceived, to stretch the supply of PPE they did have. (See AJN Reports.) Some hospitals made Herculean efforts to secure equipment when federal response lagged. But one can fault hospitals for reprimanding nurses who sought to provide PPE for themselves and their colleagues or, worried about their reputation, fired those who spoke out publicly about the lack of PPE. Especially repugnant are those hospitals that, to avoid liability and workers' compensation claims, made frontline nurses who contracted COVID-19 prove they did so on the job.
But nurses are pushing back and speaking out. The New York State Nurses Association has filed suit against the state and several hospitals over failure to protect workers. National Nurses United demonstrated at the White House on April 21 (see In the News) and is opposing hospital lobbyists who are fighting a provision in a COVID-19 bailout bill that would set standards to ensure nurses are protected. Several other unions are joining these efforts, noting in a joint statement that "nurses are not willing to unnecessarily lose their lives, leaving their patients and families behind, just because employers and our government would not invest in the highest level of protections."
By all accounts, if our leaders had acted a month earlier, we may have had more resources and many people-nurses and patients alike-might not have died. In her editorial in the BMJ, Fiona Godlee's remarks about the UK's National Health Service (NHS) could just as easily apply to us: "It is impossible not to feel let down by political and healthcare leaders who, while sloganning and clapping for the NHS, have so evidently failed to protect those working within it."