The Year of the NurseJun 24, 2020 07:00AM ● By Med Magazine
By Alex Strauss
Two hundred years after the birth of Florence Nightingale, the World Health Organization designated 2020 the International Year of the Nurse and Midwife. But it's no surprise if you didn't know. In fact, thanks to COVID-19, what was supposed to have been a celebratory year has all but slipped by without much celebration. The timing of Certified Nurses Day on March 19th was particularly unfortunate. That was the week most states began to see their first cases of coronavirus.
In South Dakota, Nurses Day at the state legislature and other nurse-centered events also had to be scrapped. Not that many of the region's nurses could have attended; they were too busy doing their jobs.
"If there is anything good thing that has come out of COVID, it is an improved sense that nurses are so important and that physicians and nurses have to be a team," says Deb Fischer-Clemens, President of the South Dakota Nurses Association and Director of the Avera Center for Public Policy. "I think more physicians are recognizing how important it is to have that nurse at the bedside assisting them every way they can."
Fisher-Clemens says the value of this mutual appreciation goes way beyond fostering a positive working environment. She believes that relationships between nurses and physicians, nurses and administrators, and nurses and other nurses or uncertified caregivers will be critical for navigating the uncharted waters of South Dakota's healthcare future.
"The bottom line is that you have to talk about and support your nurses, which includes making sure that they can feel safe" says Fischer-Clemens. "We have to demonstrate that we understand how important their role is to all of us. It is only becoming more so."
South Dakota's Nurse "Shortage"
Despite what some healthcare employers have experienced, Fischer-Clemens says there is no real shortage of nurses in South Dakota - yet. There were more than 21,000 active LPNs and RNs (about 16,200 full-time equivalents) in the state in 2018, which was up by about 4 percent from the previous year. On paper, the numbers are good.
What the state does have is a shortage of certain kinds of nurses - nurses willing to work in hospitals, work in rural areas, take overnight shifts, work weekends and holidays, and staff tough departments like ICU and Emergency.
"Having the right mix of new and experienced nurses that are working nights, weekends, and holidays is becoming a greater and greater challenge and it's getting worse," says Fischer-Clemens.
"For ICU and Critical Care and ER nurses especially, we really have to emphasize the value that they bring and the satisfaction that comes from having made someone better. We have to emphasize the importance of their role in these challenging situations and we do have to pay for it."
The necessity for competitive compensation is a given. But when that hits its ceiling, appreciation and support become even more essential. And it is magnified in the time of COVID.
"It is a tough thing to be caring for COVID patients," says Fischer-Clemens. "The donning of protective equipment, the concern you have every minute that you could do something wrong and get the virus, the worry every day that you could take something home to your family...The stress has become exponential during this crisis. I worry a lot that some are going to leave the profession."
If the projections are true, she may be right. RegisteredNursing.org puts South Dakota seventh on the list of states most likely to have a serious nursing shortfall by 2030. If it happens, it will likely hit the state's rural and elderly populations the hardest.
In Support of Rural Nurses
Carol Stewart, Graduate Program Director and Assistant Professor of Nursing at Mount Marty College in Yankton, says convincing new nurses to take jobs in rural areas is an even bigger challenge now than it used to be.
"Unless they have family ties there, a lot of younger nurses do not want to come to the middle of nowhere where there is not much action," says Stewart. Stewart served as Director of Nursing at an Avera facility before moving into academics in 2009. She still practices as an NP part-time through a Milbank staffing agency and is the recipient of this year's Nursing Practice Award from the South Dakota Nurses Association.
Like Fischer-Clemens, Stewart believes that support is key for growing and keeping a nursing staff, especially in rural areas. "Because of staffing shortages in these areas, you are usually expected to work long hours and you have to do more with less, which can create burnout."
But there are upsides to working in a small town; the trick is to help students see them. "Often, when students get into rural areas, they find that they like it," says Stewart. "They become nurse generalists, so they get to do everything. The opportunity to use all of your skills is appealing to some people."
That is one reason that Mount Marty's nursing curriculum now includes a rural rotation. Stewart would like to see more partnerships between rural practices and academic institutions so that more nurses can experience small-town practice.
For nurses who do make the leap to rural practice, Stewart says comprehensive onboarding, opportunities for professional development, and access to education can help keep them there. But appreciation and a positive culture may be the biggest draw of all. She agrees with Fischer-Clemens that COVID has helped in this regard.
"Sometimes it takes bad things to bring people together," says Stewart. "The camaraderie that I see now is more like I remember 20 years ago. COVID has created that."
New Models of Care
COVID has also created new ways for nurses to use their expertise. Fischer-Clemens predicts that the shift toward more telehealth because of the pandemic is likely to have long-term implications for nursing in South Dakota.
"Personally, I think families will be more reticent to bring a loved one to a long-term care facility and I think we are going to see a big increased need for home care," she says. "Virtual care can work well in that setting, and we need nurses who are going to be directing that care."
Even hospital nurses may find themselves increasingly in front of cameras. As an example, Fischer-Clemens points to the approximately 200 COVID-positive Avera patients receiving virtual care at home with the help of nurses.
"Nurses always have to have great communication skills, but the nurses providing virtual care also have to be very technically savvy," says Fischer-Clemens. "It takes a special skill set to be able to interact with patients in that way."
Monument Health is another example of how hospital-based nursing may change in the wake of the pandemic. The Rapid City Hospital is moving toward a team nursing model, where an RN will lead a group of nurses, including unlicensed assistants like CNAs, who provide the hands-on care.
"We started using this model with COVID patients first," says Monument's Chief Nursing and Performance Officer, Nicole Kerkenbush. "Now that we have gone through this experience, we see it as a good way to tackle a problem that we have been dealing with for years now. We have to use our resources to the top of their license or top of their training."
As the region moves into the post-COVID era, workloads begin to normalize, and furloughed nurses return to work, Fischer-Clemens says one thing that will not change is the need for these critical workers to feel valued.
"It is going to take some very special nursing to be a part of this transition to the new norm," she says. "We are going to have to help people through that because it's going to be tough."