While flare-ups of new infections subdue hopes of a quick end to COVID-19, speculation is rife about the "new normal" ahead, especially among nurses as they contemplate the future of a profession battered by the pandemic.
Nurses have been hailed as heroes for their work in tirelessly caring for victims of the pandemic at the risk of their own health. The accolades, however, come at a price. Researchers examining the toll of COVID-19 on health professionals have found high rates of depression, anxiety, insomnia, and posttraumatic stress disorder (PTSD) in nurses, and among those choosing to retire or leave the profession, many cite COVID-related burnout and moral distress.
Marni Kellogg, a researcher and assistant professor of nursing at the University of Massachusetts Dartmouth, believes the prevalence of COVID-19-related PTSD among nurses is likely to worsen the current nursing shortage. Citing unpublished data from her recent research, Kellogg told AJN that "nurses caring for COVID-19 patients experience high levels of stress and anxiety, and about one-third (33.6%) have considered leaving their position or nursing entirely."
Nevertheless, COVID-19 has also catalyzed greater public recognition of the magnitude of nurses' roles in health care-as well as some positive trends. A 2020 survey of nurses, physicians, health care administrators, and members of the public conducted by the American Nurses Association, the American Organization for Nursing Leadership, and Johnson and Johnson found that respondents in each category uniformly viewed nurses as more important than a similar survey found in 2016. The 2020 respondents, however, continue to believe that nurses overall are underutilized and undervalued.
The heightened public awareness and respect for the role of nurses also appears to have triggered in nursing schools what has become known as the "Fauci effect," so named after infectious disease expert Dr. Anthony Fauci, a top adviser to the Trump and Biden administrations on COVID-19 response. Initially measured as a dramatic increase in medical school applications, the Fauci effect is also being seen in a surge of applicants to nursing programs. The American Association of Colleges of Nursing reports that enrollment for entry-level baccalaureate programs increased by 5.6% in 2020 alone.
Another boost to the profession may come from regulatory changes authorized on an emergency basis to cope with the pandemic. To create more care options for patients, the scope of practice for advanced practice registered nurses (APRNs) was widely expanded when states with restrictive APRN regulations suspended or waived practice agreement requirements. Additionally, federal legislation allowed Medicare to directly reimburse NPs and clinical nurse specialists for home health care that had previously been covered only if ordered by a physician. Though these regulatory changes were authorized solely as temporary emergency measures, APRNs and advocates see them as strengthening the case for national full practice authority and reimbursement parity for NPs.
It is too soon to know which COVID-related trends will wane with the pandemic and which will prevail to influence health care and nursing practice in the future. Among areas to watch are expanded use of telehealth, development of clinical competence across specialties, improvements in intradisciplinary communication and teamwork, the move to online classes and increased reliance on simulation in nursing education, changes in staffing models, and the surge in utilization of travel nurses. These are all strategies adopted in response to the pandemic that have the potential for lasting impact on the nursing workforce, education, and practice as the profession moves toward a new normal.-Karen Roush, PhD, RN, FNP-BC, news director