COVID-19 for Nurse Practitioners: The Good and The Bad

COVID-19: What started as an epidemic in the Hubei Province of China has devolved into a worldwide pandemic. As of April 20, COVID-19 has infected over 2.4 million people across the world and has caused unprecedented actions to be taken by many nations to flatten the curve. This novel strain of coronavirus has become one of the defining events of the 21st century—and we will be seeing the effects long after it’s gone.

This event has pushed our contemporary lifestyle to its limits and caused an overload of the world’s healthcare infrastructure. Right now, the United States is experiencing the highest number of infections compared to any other nation, which has had rippling effects across our economy. Unemployment claims have risen past 22 million; many local businesses are teetering on the edge of permanent closure; and thousands of families have already experienced loss from this virus.

This article focuses on the impact—the good, the bad, the ugly—of COVID-19 on our front line workers, including nurse practitioners (NPs). It’s impossible to express the true gratitude we feel for them, especially as we hear about their unsafe working conditions.

The Bad News for Nurse Practitioners: PPE Shortages & Mental Health Risks

Washington State declared its first confirmed case on January 20th; the first community-spread case was reported on February 28th; and by March 11th, the Washington State Nurses Association were receiving reports of personal protective equipment (PPE) shortages.

Nine early accounts from nurses shed light on the first state affected with this virus. One critical care nurse who gave an anonymous interview to ProPublica on her experiences treating the novel coronavirus described some truly frightening scenes.

“It’s a health warzone,” explained the nurse. “Never in a million years did we think when we were in nursing school that our employer would not provide us with the PPE they are legally obligated to provide us with, to care for those patients.”

She described having to mostly use paper surgical masks with no eye protection, even when working with COVID-19 patients awaiting tests. Other healthcare workers in the area confirmed they were being asked to reuse disposable masks and to clean and store their own face shield.

Some nurses in Washington State had elected to fill out an ADO form, which stands for Assignment Despite Objection. The Washington State Nurses Association (WSNA) described one ADO form they received that said: “Continue to be asked to reuse single use masks for COVID-19 modified droplet patients and wear ill-fitting gowns that fall off shoulders. Goggles not available.” These forms are available to healthcare workers who feel uncomfortable with the assignment given; however, there are reports of nurses and physicians being disciplined or terminated for submitting one.

The lack of PPE has severely compromised our healthcare workers. Our nurses and physicians are being constantly exposed to the virus, and thus, are falling victim to the virus they are trying to treat. The fact that our healthcare workers are also being overworked and overstressed right now will only contribute to more becoming ill, and hundreds have already sacrificed their lives to this. I want to highlight this memorial that Medscape is updating with any new deaths of healthcare workers due to the pandemic.

Furthermore, healthcare workers may also face mental health issues long after this has ended. They are experiencing immense stress right now, and while stress on the job is not a new thing, the pandemic is an entirely new monster.

Many healthcare workers are already describing a sense of dread and uncertainty they have with bringing the virus home. They report deep sadness as they watch patients, both old and young, die entirely isolated from their families. These experiences may lead to lasting PTSD, anxiety, and depression.

The Good News for Nurse Practitioners: Expanded Practice Authority & Telemedicine Use

I think in times of strife and uncertainty, it’s important to look for the silver linings in the situation so we have something to lean on when times get tough. Despite all of the suffering from healthcare workers and citizens alike; there is some good.

For starters, I want to put focus on the relaxation of scope of practice for nurse practitioners in some states. This has been an issue that NPs have fought against for years now, and many states still prevent NPs from exercising all of their training and education. Due to the COVID-19 outbreak, some states have taken measures to open the scope of practice and remove the more restrictive measures.

States like New York, Kentucky, Louisiana, New Jersey and Wisconsin have suspended all prerequisites for NPs. Many other states that had restrictive prerequisites have suspended some, but not all restrictions. Down the road, this instance may be used to cite the quality of care provided by NPs and lead to more permanent acceptance of our scope of practice.

Another advancement in the healthcare industry is telemedicine. This has been a growing method of practice for years now, and many NPs have used it as a way to advance or transition their careers. After the arrival of COVID-19, the majority of the workforce was forced to move to a virtual workplace, healthcare providers included. The usage of telemedicine has played an important part in flattening the curve.

Nurses and physicians are still able to provide a normal check-up and can recommend those that are experiencing any COVID-19 symptoms to stay home and monitor their symptoms. This also enables those that have a chronic health issue, or are in the high risk groups, to stay safe at home while still receiving their much needed health services. Furthermore, this helps keep our healthcare professionals safe from contracting COVID-19, as many of them are serving on the front lines and exposing themselves to the virus continuously.

What Can You Do to Help NPs and Other Healthcare Professionals?

There are a lot of unknowns with this situation. Many of us have experienced stress and fear, myself included. Let’s rally together, appreciate the small wins, and support our healthcare workers!

If you are one of the many who are lucky enough to be working from home; please stay at home. That is one of the best things you can do to help the healthcare workers, fellow citizens, and country. Of course you can leave for essentials or for exercise, but please follow CDC guidelines and wear a cloth mask over your mouth and nose. This will help keep you safe, as well as others in case you’re an asymptomatic carrier.

For those who are still working in non-medical essential fields, continue covering your face with a cloth mask and wearing gloves. Make sure you disinfect your workspace throughout the day.

I implore anyone reading this article to donate to one of their local COVID-19 relief funds. Despite the social distancing measures, we can still come together as a unified force to beat this and show support for those that are fighting for us. Moreover, consider sewing some cloth masks to donate to your local hospitals and medical institutes, or look into food drives for the poor and underserved.

However you want to devote your time and efforts into making this situation better is up to you; but please do so from within your home. We will get through this together, and we will come out of this stronger and more unified than before.

As for healthcare workers, what can I say that you’re not doing already? Thank you, thank you, thank you. Please know that you are heroes, and I hold you close in my thoughts.

Melissa DeCapua, DNP

Melissa DeCapua, DNP

Writer
Dr. Melissa DeCapua is a nurse practitioner working at Microsoft on organizational behavior and culture change. She began her career in psychiatry and fine arts, and these skills fuel her passion for user experience (UX): building programs, conducting qualitative research, and designing services. By night, she continues to advocate for nurses through lobbying efforts, blogging, and volunteering. For more about Melissa, check out her website and follow her on LinkedIn and Twitter.

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