Planning for the future

In this Year of the Nurse and Midwifery, the COVID-19 has put nurses front and centre, and created many opportunities for action and advocacy. It has also underscored the importance of ensuring our workforce is well prepared and supported.

As well as being competent in infection control principles, managing the pandemic requires multiple considerations. National Institutes of Mental Health report that of the one in five individuals who already have mental health conditions there is a need for personal, professional, and policy measures to address this burden. Many experts are concerned that there may be an increase in experiencing symptoms of post-traumatic stress disorder and profound and complicated grief due to the large numbers of deaths, including deaths in exceptional circumstances.

Many healthcare systems have highlighted a decrease in activity for heart attack and stroke. This is a surprise, particularly for heart attacks, where we would have anticipated an increase with exposure to COVID-19. A potential explanation is that people stay away from the hospital to avoid exposure to COVID-19. This is particularly concerning as we know revascularization strategies are time-limited and suffering loss of valuable myocardium and brain cells is cause for worry.

It is likely after the pandemic lifts there will be more people who are sicker, have forgone regular follow-up appointments and been unable to access therapies. Although telehealth has provided an important strategy, it is unclear if this has substituted all clinical interactions. Health systems and nurses will likely have to prepare for a re-entry time where the risk of COVID-19 remains, however our activity for non-emergency activity increases. We also need to emphasise the need for timely medical attention for emergencies, such as heart attack and stroke. The impact on patient care volume may well be sudden and profound.

COVID-19 has changed the way we provide care. Working with gowns, gloves and shields is not usual in many clinical settings. For many nurses, they feel that they are somewhat removed from patients. However, we have seen many examples of nurses going above and beyond, particularly to link patients with family members.

The process of lessening isolation restrictions across the world varies but should be driven by the fundamental principles of monitoring the COVID-19 pandemic. These include:

• sustained reduction in cases for 14 days
• hospitals are able to manage demand
• adequate testing available and opportunities for quarantine
• adequate screening and tracing strategies.

This will require coordination across communities and jurisdictions such as public health departments working with industry.

It is estimated that COVID-19 will be with us for many months until we have an effective vaccine. This is highly chastening. All around the world the way of working, living and even dying has changed. Working through this crisis requires nurses to be innovative, flexible, responsive and responsible.

Over the last two weeks we have followed the data, and reflected on how we need to adapt our practise and respond to a range of resource and ethical challenges. Over the next two weeks we will continue our journey with COVID-19, learning more examples of dealing with complex cases and strategies to increase the strength of health systems.

We need to learn critical lessons to ensure that we are stronger in facing the next health challenge that is ahead of us. Most importantly, we need to do a better job of taking care of all essential healthcare workers.

We began our course with discussion of Florence Nightingale, who was also noted for her skills as a statistician creating coxcomb pie charts on patient mortality in Scutari that were highly influential in epidemiology and advocating for health reforms. As we reflect on lessons this week and reflect on Florence Nightingale’s legacy, there are many inspirational lessons. She stated:

“To be ‘in charge’ is certainly not only to carry out the proper measures yourself but to see that everyone else does so too.”

At this time when we need to contain this raging pandemic, it is critically important that we not only maintain our infection control practices, but ensure others around us do the same.