As I write this, two days after the inauguration of President Joe Biden and Vice President Kamala Harris, I marvel at how quickly this new administration has begun to confront the many problems it faces. President Biden has already signed several executive orders, among them (finally!) a national plan to address the COVID-19 pandemic that includes implementing the Defense Production Act to ramp up vaccine and personal protective equipment (PPE) production, strengthening the public health workforce, and mandating face coverings on properties under federal jurisdiction.
This new beginning led me to think about what the nursing profession's priorities will be once the pandemic is no longer its primary focus. On a recent call with AJN's editorial board, there was much discussion about whether our shared experiences as nurses during this crisis might unify us-all of us, in all roles and settings, in the various unions and organizations-to address the complex issues facing nursing.
Like our nation, we need to address racial inequities, not only in education and practice settings, but also in terms of who receives funding and in what areas of research. Nursing schools also face many challenges. How will nursing education ensure a competent workforce with limited clinical placements? And, given the growing number of applicants to nursing schools, will there be enough faculty to teach them?
Ensuring an adequate hospital workforce, of course, will be a huge issue. We know many nurses are "aging out," and the International Council of Nurses (ICN) has reported that we're facing a worse global nursing shortage than previously predicted. The ICN notes that "developed countries need to wake up to the fact that 17% of their nursing workforces, that's 4.7 million nurses, will be considering taking retirement over the next decade." Additionally, some younger nurses say the pandemic has pushed them over the edge-that staffing that was barely sufficient before COVID-19 became totally inadequate during the pandemic, compounding nurses' moral distress at being unable to meet patients' needs and giving rise to a sense of hopelessness and failure. Our own WikiWisdom report describes this (see "Frontline Nurses Say 'Never Again,'" December 2020). Short staffing, exhausting multiple 12-hour shifts, and feeling unprotected because of inadequate and ever-changing PPE standards have many nurses rethinking work in the acute care setting. Some are leaving because they don't believe conditions will improve after the pandemic wanes. An especially poignant remark was reported online in The Lily from a young nurse who quit because, "I realized my voice was too small to fix things." Nurses in other settings-in mental health, community and public health, school-based health, and long-term care-are also challenged by a chronic lack of resources.
We have addressed deficiencies in nursing homes in the past, and in this month's issue, two articles highlight how we care-or don't-for those in long-term care. In Reflections, one nurse gives a firsthand account of her horrific experiences in a nursing home during the pandemic. In Policy and Politics, 22 nursing gerontology experts weigh in on deficiencies that were greatly exacerbated by the pandemic, which they say "reflects the long-standing ineffective policies and practices in nursing homes that have put profits before people." This shouldn't be surprising since 70% of nursing homes are run as for-profit companies and many barely meet minimum staffing standards. The authors call on the Centers for Medicare and Medicaid Coronavirus Commission for Safety and Quality in Nursing Homes to rewrite the standards "to ensure that every resident in our nation's nursing homes receives adequate professional nursing (RN) care."
And in "Missing the Care in Health Care," a heartbreaking case report illustrates how fragmented our health system is, even when someone has access. Too often, there is no real caring, and "patient-centered care" are just words on a website.
This will be nursing's postpandemic challenge: to identify how, with all our competing organizations, unions, and special interest groups, we can come together in this pivotal moment to remodel our health system into one that will restore and heal our profession, and provide the user-friendly, responsive, equitable, and efficient health care the public deserves.