Happy Birthday, Florence Nightingale! The founder of modern nursing was born 200 years ago today. Thanks to the International Council of Nurses, we’ve been celebrating International Nurses Day on Florence’s birthday since 1965. Florence would be amazed by all the innovations in process, technology and education. She’d likely also wonder about the work that still needs to be done by and for nurses – but she’d be especially proud of how nurses around the world are risking their lives every day on the front lines of the COVID-19 pandemic. We’re proud of them, too, and salute them not only during the World Health Organization’s (WHO) Year of the Nurse and Midwife, and on International Nurses Day, but every day.
Numbers Don’t Lie
In its State of the World’s Nursing 2020 report, WHO reveals that the global nursing workforce is now 27.9 million strong, with 19.3 million professional nurses. But it also points to a huge, ongoing worldwide challenge: the unequal distribution and retention of nurses. WHO estimates there will be a shortage of 5.7 million nurses by 2030, mostly in the African, Southeast Asian and Eastern Mediterranean regions. It’s asking governments of all countries to focus on three goals to strengthen the role of nurses:
- Fund a rapid acceleration of nursing education
- Create a minimum of six million nursing jobs by 2030
- Increase nurse leadership and influence
But COVID-19 won’t wait for more nurses, education and reform. Nurses have been working, becoming infected and dying alongside physicians and other healthcare professionals since the virus first struck. As of this writing, WHO reports 4.2 million confirmed cases of the novel coronavirus, and more than 286,000 deaths. WHO, the CDC and other organizations have offered guidance to healthcare workers to better protect themselves and their patients. But many providers, including nurses, are making do with whatever they have right now, in a desperate effort to save lives and send recovered patients home.
Entela Kolovani, an Albanian doctor who has been fighting COVID-19 cases in her country since early March, says, “Nurses are the real heroes. They carry out the most difficult tasks and most of the workload. Nurses, most of whom are women, are our greatest supporters, working endless shifts with special protective equipment on, which is very hard to keep on while working. Their work never ends, from making up the beds of patients, to performing therapies, taking tests and filling in documents. I am so deeply grateful to them.”
Nurses are the Crucial Connection – But Need More Protection
The role of nurses in battling COVID-19 is critical and inevitable, since they make up the largest segment of healthcare employees. According to Joann Sands, clinical assistant professor in the University of Buffalo (NY) School of Nursing, nurses are the glue of the COVID-19 treatment process. “…they are a vital link between the patient and the rest of the health care team. Nurses are with their patients for their whole shift, and through assessment and critical thinking are able to notice subtle changes in their patients that could indicate they are decompensating or getting worse, or getting better. They are able to determine the human response to the medical problem.”
It’s been widely reported that nurses are reusing PPE due to inadequate supplies. By early April, more than 100 healthcare workers worldwide had died of the novel coronavirus. “We believe that the lack of PPE and the problems of supply is undoubtedly linked to the high infection rates and some of the deaths we have seen as well,” said Howard Catton, head of the International Council of Nurses (ICN). From the United Kingdom to Zimbabwe to the U.S., nurses have refused to work because they could not protect themselves, which runs counter to the selflessness that’s the hallmark of their profession.”
A lack of PPE isn’t the only COVID-19 challenge facing nurses. The unimaginable scale of the infection has led to longer hours, in turn creating physical and psychological strain and eventual burnout. Some are working in unfamiliar areas, and with limited options for patient care. When they do get time off, many nurses add to their stress by staying away from their families, to protect them from possible infection. The American Nurses Association Code of Ethics says that nurses “have a duty to take the same care for their own health and safety” as they offer to others. So with no end in sight to the pandemic, what’s being done to help nurses?
Give Them What They Need
Polly Dunford, President and CEO of IntraHealth International, says nurses and other frontline health workers don’t necessarily need brand new solutions, just ones that work. She recommends that NGOs seek:
- On-the-job protection – PPE, equipment, and up-to-date COVID-19 info and skills
- Relief from burnout – shorter shifts, free child care, temporary housing, virus testing
- Immediate solutions with long-term impact – maximize existing networks, use input from frontline workers, advocate for national health policies.
In Australia, nurses in emergency departments are applying the HIRAID framework – History, Identify Red flags, Assessment, Interventions, Diagnostics – to improve assessment in all their emergency care. Johns Hopkins School of Nursing Professor Cynda Rushton helped initiate the virtual Frontline Nurses Wikiwisdom Forum, where nurses can share their challenges and experiences during COVID-19. Nurse Ajo Jose in Delhi, India has been creating educational videos to teach nurses how to safely wear one protective mask all day. Ugandan midwife Harriet Nayiga maintains her practice by calling and texting her young female patients at home, worrying about the ones she can’t reach. WHO is creating an integrated plan for healthcare workers in low- and middle-income countries to respond to the COVID-19 pandemic, focused in the Philippines and Sri Lanka.
Johns Hopkins Professor Rushton calls nurses “…often the last thread of compassion for patients,” now even more so as they care for isolated COVID-19 victims. She beautifully sums up our tribute to nurses all over the world, “I think this pandemic only highlights and elevates the central role that nurses serve in health care. We’re seeing the many different ways nurses can contribute, adapt, and take the lead.”