The Journal of Continuing Education in Nursing

Original Article 

COVID-19: Perspectives From Nurses Across the Country

Jean Shinners, PhD, RN, NPD-BC; Sheri Cosme, DNP, RN, NPD-BC

Abstract

The COVID-19 pandemic that is sweeping across the globe has impacted all health care professionals in multiple ways. This article surveyed a cross-section of the nursing profession from across the United States from the ANCC Practice Transition Accreditation Program® and ANCC Commission on Accreditation in Practice Transition Program. The article summarizes how they responded to the pandemic, addressed challenges, and learned valuable lessons. [J Contin Educ Nurs. 2020;51(7):304–308.]

Abstract

The COVID-19 pandemic that is sweeping across the globe has impacted all health care professionals in multiple ways. This article surveyed a cross-section of the nursing profession from across the United States from the ANCC Practice Transition Accreditation Program® and ANCC Commission on Accreditation in Practice Transition Program. The article summarizes how they responded to the pandemic, addressed challenges, and learned valuable lessons. [J Contin Educ Nurs. 2020;51(7):304–308.]

At the writing of this article in mid-May 2020, there were 1.4 million confirmed COVID-19 cases in the United States and 4.3 million worldwide. At the beginning of the pandemic, acute care settings in high population areas such as Seattle, New York City, and San Francisco, were the most affected. However, within 2 weeks of COVID-19 spreading across the United States, a federal response was activated to help mitigate the pandemic from expanding. During this time, all health care organizations were challenged to activate emergency action plans to prepare themselves for the upcoming surge of positive COVID-19 patients. Long-term care facilities, home health agencies, and private practices also were forced to rethink their model of care to meet the demands of the pandemic. Regardless of direct involvement, all health care organizations and those supporting health care workers were tasked with quickly assessing their disaster and emergency plans.

Members of the American Nurses Credentialing Centers' (ANCC) Practice Transition Accreditation Program (PTAP) Commission on Accreditation (COA-PTAP) was one group that had to react quickly to the pandemic. The COA-PTAP is composed of a variety of national experts who govern the ANCC PTAP and Nursing Skills Competency Program (NSCP). The Commission is responsible for setting standards, awarding accreditation, and addressing the appeals process by the ANCC Board of Directors. The current commission includes nine members who represent a variety of critical roles in health care. Commissioners meet monthly to conduct business. Annually, the Commissioners travel to ANCC headquarters in Silver Springs Maryland, for an in-person meeting. Due to workplace demands and travel restrictions, this year's annual in-person COA-PTAP meeting was held virtually. During early discussions with Commissioners, it quickly became clear the pandemic was affecting our organization in a variety of ways. Whether commissioners came from “hot spot” areas that had a large volume of COVID-19 patients or from facilities that were not yet seeing COVID-19 patients, everyone was directly involved with reviewing and updating disaster plans.

The Commission quickly realized we had representation of nurses from across the country who could speak to their role during this pandemic. In mid-April, the Commission was asked to respond to three questions:

  1. What has been the biggest challenge for you in your current role during this crisis?

  2. How did you address this challenge?

  3. What lesson learned or words of wisdom would you want to share with others?

The response to these questions provides a snapshot of how the pandemic has impacted nursing in different settings across the country.

Responses

Sheri Cosme, DNP, RN-BC, Director, Practice Transition Accreditation Program® (PTAP) and Nursing Skills Competency Program American Nurses Credentialing Center

Question 1: What has been the biggest challenge for you in your current role during this crisis? Our biggest challenge during this pandemic has been “not knowing what we don't know” from accredited ANCC Practice Transition Accredited Programs® participants. The ANCC-PTAP team started to hear “chatter” from the accredited programs on major organizational changes, such as furloughing program directors and suspending residency and fellowship programs. As the accrediting body, some of these changes started to concern us because some of the significant modifications being made did not align with current standards and criteria. We believe in honest and transparent communication with the accredited programs, so when we started to hear this, we knew they needed guidance.

Question 2: How did you address this challenge? The ANCC PTAP team and COA-PTP requested that all 156 of the accredited ANCC PTAP programs submit an update on their current status through an action plan. A majority, 93% of the accredited programs, reported no significant changes or minor changes to the accredited program. The minor change most reported by programs was the implementation of technology (e.g., Zoom and Google® Meet) to conduct didactic classes. Programs also reported increased rounding, resilience education, and increased access to one-on-one support by program directors. Themes identified by programs reporting major changes included furloughing the program director, suspending the current cohort, and not hiring for upcoming cohorts.

The ANCC Team has helped programs address both minor and major challenges by reaching out to accredited organizations and being responsive to calls and emails as constituents navigate these uncertain times. Throughout this pandemic, open, honest, and transparent communication has been essential.

Question 3: What lesson learned or words of wisdom would you want to share with others?

  • Don't be afraid to ask for data to make decisions. No one, even accreditors, can work in a silo. We need data to make decisions.
  • Be open, honest, and transparent; always keep communication channels open.
  • In uncertain times, innovation has emerged as a beacon of hope. Some of the best practices implemented by programs during this pandemic are ideas and strategies that will change the landscape of how a residency or fellowship is conducted in the future.

Jean Shinners, PhD, RN, NPD-BC, Executive Director, Versant Center for the Advancement of Nursing

Question 1: What has been the biggest challenge for you in your current role during this crisis? Because Versant® is a virtual company located in multiple health care organizations across the country, my daily routine has not changed significantly. I continue to work with clients in virtual online platforms and continue to do research in the area of nurses in transition. Two significant issues have been brought to the forefront. The first is the challenge our high-impact clients face transitioning and educating staff to care for unfamiliar patient populations requiring highly skilled interventions. The second challenge relates to our student nurse capstone program. The student nurse capstone program is for nursing students during their last semester of their academic education to initiate early transition to practice. As soon as COVID-19 looked like it was going to impact the entire country, most organizations responded by cancelling student clinical hours. There was a real fear that they would put students at risk as well as overwhelm other caregivers. On the other hand, organizations were ramping up staff to deal with the anticipated surge of COVID-19 patients.

Question 2: How did you address this challenge? Versant met as a team to look for options that would not necessarily follow our usual process but would focus on rapid competency validation. In a matter of days, we designed a highly efficient program, Accelerated Competency-Based Staffing in a Time of Crisis, geared toward nursing students, nurses transitioning to other clinical areas, and retired nurses returning to work to rapidly validate competencies in their area of practice. Based on previously identified best practices for transitioning health care professionals and working with clients and academic partners, the team worked together to design and develop a focused transition program that was ready for implementation within a few weeks of inception.

The publication of the policy brief, U.S. Nursing Leadership Supports Practice/Academic Partnerships to Assist the Nursing Workforce During the COVID-19 Crisis (April, 2020), has helped to support the goals of the program—to use a collaborative effort between practice and academia to provide needed staff to perform safe, consistent care as a response to this crisis.

Question 3: What lesson learned or words of wisdom would you want to share with others?

  • When looking for solutions, get all team members involved and appreciate the unique perspective members can bring to a “wicked problem.”
  • Be willing to change your usual practices to accommodate an unusual situation. As long as decisions are rational and defendable, put them on the table for discussion.
  • If working in a virtual environment, plan for weekly sessions with no set agenda. Use the time to catch up with other team members, check in, listen, and provide any support needed.

Lya M. Cartwright-Stroupe, DNP, APRN, CPNP, NEA-BC, West Virginia University Hospitals, Manager of Nursing Research and Professional Development, and Magnet® Program Director, Transition to Practice Program Director

Question 1: What has been the biggest challenge for you in your current role during this crisis? The biggest challenge was to ensure the safety of the nurse residents and patients. The organization wanted to continue the high-quality patient care that is always given to patients. The team's communication with nurses was a challenge before the pandemic and continues to be a challenge during the pandemic because of restricted face-to-face interactions and limited access to emails outside the organization. In-person workshops cannot be held, so the team had to find avenues to deliver content without meeting face-to-face.

Question 2: How did you address this challenge? The nurse residents at the organization are continuing to complete new employee orientation and nursing service orientation using a virtual platform. The residents then are assigned to work on the unit with a preceptor for the assigned orientation timeframe. Leadership determined that it was important to maintain normal status as much as possible during this time. This assures graduate nurses are receiving the education and training needed to ensure safe patient care.

The residency program's team has increased communication with nurse residents using the communication app SLACK. Communication and information are sent to nurse residents who can access this on their cellphones. This offers opportunities for support from the program's leaders and peers from anywhere at any time.

The nurse residency program content is still delivered with a virtual platform instead of face-to-face meetings in classrooms. Case study content continues to cover required concepts; however, topics within case studies have been changed to reflect patients who are being treated for COVID-19. The wellness aspect of the program is related to dealing with the stress of working, being alone, and financial burden, etc., during this uncertain time. Discussions are under way to explore ways to continue simulation with standardized patients using a virtual platform.

Question 3: What lesson learned or words of wisdom would you want to share with others?

  • Continually reinvent the nurse residency program–do not be complacent.
  • Find creative ways for residents to communicate and learn.

Dawna L. Cato, PhD, RN, NPD-BC, President, Transition to Professional Practice Nurse Consulting, SCorp

As an independent nurse consultant, the COVID-19 pandemic has significantly impacted my professional role. For the past 3 years, my work has primarily been in China. My international work has been one of the most fulfilling roles I have had in my 25 years of nursing. I have had the opportunity to significantly elevate the professional identity of China's nurses, as well as improve their confidence and competence to deliver safe quality care. In 3 short years, we have transformed care delivery and implemented nurse-led quality and safety committees, as well as bedside shift reporting; used Situation, Background, Assessment, and Recommendation (SBAR) and Acknowledge, Introduce, Duration, Explain, and Thank you (AIDET) communication tools; and opened a 600+ bed hospital to include a full simulation laboratory and evidence-based practices. Thus, with the COVID-19 outbreak and subsequent halt to travel, my global impact quickly narrowed to my home office.

As nurses, we are inherently adaptable and flexible during disruptive change. Educational nursing programs in academia and practice demonstrated the capacity to rapidly adapt delivery modes of education to distance and online modalities. However, China is significantly challenged with transforming education to an online platform. Historically, China has been resistant to online learning and primarily continues with traditional face-to-face delivery, especially in rural areas outside of Beijing and Shanghai.

During this time of global crisis, nurses around the world are called on to support international colleagues by sharing best practices, wisdom, and acquired knowledge related to COVID-19. My current focus is related to learning international best practices related to COVID-19 responses and to share these practices across global boundaries via online and alternative delivery.

The professional identity of nurses has been launched to the global stage, and we must rise to meet the challenges of the future. My role as an international advisor on the ANCC's PTAP adds a global voice to our response to COVID-19. We can have a significant impact if we remain resilient, supportive, and optimistic of what we can achieve with our collective voices and support from international colleagues.

Christine Young, MSN, MBA, RN, NEA-BC, Chief of Hospital Based Services and Chief Nursing Officer, Akron Children's Hospital

Question 1: What has been the biggest challenge for you in your current role during this crisis? The COVID-19 pandemic has created unprecedented challenges for health care leaders. As chief nursing officer, one of the biggest challenges that I have had to address is workplace safety for health care workers, specifically around personal protective equipment (PPE). The nationwide shortages of PPE require that conservation measures be implemented that are unfamiliar and frightening to staff. Guidelines for use of PPE and isolation also are changing frequently, which has caused confusion and anxiety. Health care workers are fearful of being exposed to COVID-19 due to the lack of PPE and are concerned for the health and safety of themselves as well as their families.

Question 2: How did you address this challenge? As a nurse leader, I am responsible for supporting a safe working environment amidst the pandemic. To address the challenges surrounding PPE, I commissioned a team of nurse educators and quality nurses to develop a PPE Champion and Coach Program. The goal of this program is to provide frontline resources to support and coach staff on proper PPE and isolation usage, techniques, and conservation measures. Champions and coaches are regularly updated as protocols rapidly change and can disseminate new information in real time in the patient care areas.

Question 3: What lesson learned or words of wisdom would you want to share with others?

  • Nursing staff have been displaced during the pandemic due to the reduction in elective surgeries, outpatient visits, and school closures. Displaced nurses are members of the labor pool and were selected as coaches for the organization.
  • Coaches focus on staff utilization and application of PPE, and there are also unit-based champions who serve as resources on their own units. In less than 3 weeks, the education was created, and 182 nurses were trained and deployed as coaches and champions.
  • The program has decreased the anxiety for health care workers through standardized education and resources.
  • The program demonstrated that leadership acknowledged the concerns from the frontline staff and put practices in place to protect them as much as possible within the limitations that have resulted from the pandemic and PPE shortages.
  • As with any type of crisis, but especially with the COVID-19 pandemic, visible and responsive leadership is critical to maintaining an engaged work-force.

Melinda Cooling, DNP, MBA, APRN, NEABC, OSF Healthcare, Vice President, Advanced Practice, Chief Clinician Executive, St Gabriel Digital Health

Question 1: What has been the biggest challenge for you in your current role during this crisis? Health care leaders have been speaking of disruption for several years; however, it came in rare form this year as the COVID-19 pandemic. The pandemic required a new type of leadership not only personally but also within our organization. The biggest challenge as a leader has been the speed and agility to make quick decisions to create programs that meet our patients and communities where they are in their health care journey.

Question 2: How did you address this challenge? Speed and agility are not a traditional competency of health care. Health care organizations tend to be very conservative and take a lot of time to make decisions. There are also silos of leadership structures that may not have to interact as much during normal situations, but COVID-19 has forced more collaboration and learning how to work together in new ways outside the normal decision making structure. It has been helpful for me to interact with new leaders and receive feedback on how I also can do better when implementing rapid change. I am consistently evaluating what is working well and where the opportunities are. Although COVID-19 has disrupted all levels of operations, it has given us the opportunity as health care leaders to learn new skills, become agile, tackle change management and culture, fail fast, and learn to make a seamless health care experience for our patients.

Question 3: What lesson learned or words of wisdom would you want to share with others? The unseen benefit of COVID-19 is how much the virus has moved health care in a matter of weeks versus years:

  • It has forced us to be courageous about new digital strategies to care.
  • As a leader, take advantage and start to think outside the box in how care can be delivered differently in the future and provide excellent outcomes at a sustainable cost that still offers a superior experience.
  • Celebrate your successes and failures, as failure is what drives your mind to innovate and create the future. Be courageous!

Anjelica R. Jackson, MHA, BSN, RN, PHN, MICN, Emergency Department, Providence Saint Joseph Medical Center, Burbank, California

Question 1: What has been the biggest challenge for you in your current role during this crisis? First, as a charge nurse in a large emergency department, seeing staff getting emotional about not letting family members in to see their loved ones is difficult to fathom and even more so when it goes against what we know as nurse-patient advocates. Second, the biggest challenge is being there for my colleagues as a leader when I know they are feeling defeated by this pandemic. The defeat is the emotional roller coaster that is associated with the day-to-day challenges that are ever changing.

Question 2: How did you address this challenge? By making exceptions to the rules is one way I have addressed challenges. I put myself into the shoes of the family and I allowed them to say, “Goodbye and I love you,” whether it was in person or video calling. We did not know if this would be the last time they would see each other, so by doing this we allowed the patient, family, and nurse a better peace of mind. The other big challenge was addressing staff feelings of defeat. This is one of the hardest things I have done as a young leader in my department. Being an active listener and letting them vent about all the difficulties they are faced with was one way that I could contribute to ease their way in such a difficult time.

Question 3: What lesson learned or words of wisdom would you want to share with others?

  • Understanding that not everything is black and white.
  • We must be able to adapt to constant change, in both our work and personal lives.
  • As someone who aspires to be a manager one day, I have learned the importance of being there for my colleagues—the “active listener”—and showing them that we are all in this together. Being the active listener is sometimes more healing then trying to provide answers or solutions.

Conclusion

All of the participants responded by putting the focus on the work they and their organizations are doing as a team to identify issues and areas for improvement from the unit to the system level. With a patient-centered, nurse-safety focus, take charge teams are creating a vision of what's possible and setting goals to get the job done. In most situations, communication skills have been tested, and nursing leadership is learning that open communication is the key to resiliency and creating an environment of support. When challenged with improving processes in the midst of a pandemic, we all learned just what nurses can do! Nurses all over the world have had to act as change agents implementing new practices to ensure the safety of not only their patients but also safety for themselves, their peers, and their families.

Because at the time of writing this article health care remains in the midst of the pandemic, there will be future opportunities to look back to see what worked and what did not. Research is needed to thoroughly investigate the experience of working during a global pandemic to strengthen current practices and provide new directives for future use.

Reference

Authors

Dr. Shinners is Executive Director, Versant Center for the Advancement of Nursing, Hobe Sound, Florida, and Dr. Cosme is Director, Practice Transition Accreditation Program® (PTAP) and Nursing Skills Competency Program, American Nurses Credentialing Center, Silver Spring, Maryland.

All of the participants are current commissioners for the American Nurses Credentialing Center's PTAP.

The authors have disclosed no conflicts of interest, financial or otherwise.

Address correspondence to Jean Shinners, PhD, RN, NPD-BC, Executive Director, Versant Center for the Advancement of Nursing, 6084 SE Orange Blossom Trail, Hobe Sound, FL 33455; email: jshinners@versant.org.

Received: May 04, 2020
Accepted: May 18, 2020

10.3928/00220124-20200611-05

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