COVID-19 Pandemic Discussion Essay

COVID-19 Pandemic Discussion Essay: Organizational Policies and Practices to Support Healthcare Issues
Competing Needs of Resources During the COVID-19 Pandemic on the Development of Policy

The coronavirus 2019 (COVID-19) pandemic has rocked the national healthcare system to its core. Nurses have been

hailed as heroes for putting themselves in harm’s way in an attempt to save lives. In the early stages of the COVID-19

pandemic, personal protective equipment (PPE) was scarce. Nurses faced a tremendous ethical dilemma. Healthcare workers

had to decide to continue without adequate protection or leave the hospitals critically short-staffed. This discussion will

address how the COVID-19 pandemic has caused nurses and patients to compete for resources and policies that have been

developed to address the shortfalls.

How Competing Needs of Nurses Versus Patients May Impact Policy Development

Registered nurses have a moral and ethical obligation to provide the best care possible to their patients, even in the face

of danger (Culberson, 2020). The COVID-19 pandemic put the nursing profession to the test. Before the emergence of

COVID-19, PPE was primarily disposable. Masks and gloves were routinely changed after each patient. In the early weeks

of the pandemic, it was discovered much of the national stockpile of medical PPE was expired (Centers for Disease Control

and Prevention, 2020). Some of the stockpile items were already starting to degrade. Hospitals scrambled to obtain PPE for

their front-line employees, but many times these items were not available or a limited supply would be offered at an

exorbitant price. Policies would need to be implemented to address how hospitals would handle the limited amount of PPE.

A shortage of nurses has been ongoing (Broome & Marshall, 2020). With the additional pressures of a pandemic,

finding additional staff became a concern for most healthcare facilities. States would need to develop policies to address the

critically low availability of nurses. Nurse travel agencies tried to fill the void, but hospitals watched the price of travel

nurses double, then triple, within weeks of COVID-19 sweeping the nation. By November 2020, hospitals offered incentives

of up to $10,000 a week for travel nurses (Hawryluk & Bichell, 2020). Nurse- patient ratios reached unprecedented numbers,

and in Illinois and New York, nurses were routinely having up to nine patients each (Lasater et al., 2020). In this situation,

nurses had to make an ethical decision. Would the nurse accept an assignment that was not a safe nurse-patient ratio, or

would they refuse the assignment and force another nurse to work a double shift potentially? According to the American

Nurses Association (2020), there may be times during a crisis that a nurse must decide, based on their moral grounds to

maintain professional integrity. Each state has different laws regarding a nurse’s duty to provide care when faced with a

dangerous situation. Each nurse is responsible for knowing the laws that govern their practice in the event of a crisis.

Limited Resource’s Impact on the Development of Policy

Instead of policies being put in place to protect nurses and patients during the COVID-19 pandemic, guidelines were

developed that relaxed regulations that protected nurses. These changes were implemented in an attempt to relieve the

critical shortage of staff. California, which is known for having the most comprehensive laws regarding nurse-patient ratios,

removed those restrictions on March 30, 2020, to address the evolving COVID-19 pandemic (Lasater et al., 2020). In an

attempt to allow more nurses into a state’s workforce, some states permitted nurses licensed in other states to obtain

temporary provisions to practice in other states. The Centers for Disease Control and Prevention posted on their website that

if nurses could not obtain adequate PPE, bandanas may be worn as a last resort (Centers for Disease Control and Prevention,

2020). Nurses have continued to be thrown under the proverbial bus throughout the COVID-19 crisis. Instead of lawmakers

committing to protect this vital workforce, policies have continued to be implemented that remove much of the limited

protection that nurses have. Nurses have a moral and ethical obligation to care for patients and need to speak up about

barriers that compromise patient care and nurse welfare (Kelly & Porr, 2018). Hospitals and lawmakers are responsible for

ensuring nurses are protected while fulfilling their duties (Broome & Marshall, 2020).

Policy Development to Address PPE and Nurse Shortage at a Northern Virginia Hospital

At the beginning of the COVID-19 outbreak, a Northern Virgina regional trauma center required nurses to reuse

disposable PPE. At the beginning of the COVID-19 pandemic, the facility would not allow nurses to use homemade face

masks, but relaxed that policy as their PPE supply dwindled. New hospital policies stated disposable masks were to be worn

until the masks were falling apart. Disposable respirators that could be washed were sent to a company to be disinfected,

then reissued to staff for continued use. As more and more patients became critical, the patients’ need for care was

competing with the nurses’ needs to have adequate PPE, safe nurse-patient ratios, and a reasonable work schedule. Travel

nurses were secured to help offset the significant increase of COVID-19 patients. The hospital continues to look for ways to

add nurses to their roster.

References

American Nurses Association. (2020). Nurses, ethics, and the response to COVID-19 pandemic.

https://www.nursingworld.org/~495c6c/globalassets/practiceandpolicy/work-environment/health–

safety/coronavirus/nurses-ethics-and-the-response-to-the-covid-19-pandemic.pdf

Broome, M., & Marshall, E. S. (2020). Transformational leadership in nursing: From expert clinician to influential leader.

(3rd ed.). New York, NY: Springer.

Centers for Disease Control and Prevention. (2020). Considerations for Release of Stockpiled N95s Beyond the

    Manufacturer-Designated Shelf Life. https://www.cdc.gov/coronavirus/2019-ncov/hcp/release-stockpiled-N95.html

Culbertson, R. (2020). Attaining the Quadruple Aim of Worker Well-Being in the COVID-19 Crisis: Competing Ethical

Priorities. Journal of Healthcare Finance, 46(4), 77-84.

http://www.healthfinancejournal.com/index.php/johcf/article/view/223/225

Hawryluk & Bichell. (2020). Need a COVID-19 Nurse, That’ll Be $8,000 a Week.

https://www.medscape.com/viewarticle/941641

Lasater, K. B., Aiken, L.H., Sloane, D. M., French, R., Martin, B., Reneau, K., Alexander, M., & McHugh, M. (2020).

Chronic hospital nurse understaffing meets COVID-19: an observational study.

BMJ Quality & Safety. DOI: 10.1136/bmjqs-2020-011512

Kelly, P., & Porr, C. (2018). Ethical Nursing Care Versus Cost Containment: Considerations to Enhance RN Practice. OJIN:

The Online Journal of Issues in Nursing, 23(1). DOI: 10.3912/OJIN.Vol23No01Man06

Discussion: Organizational Policies and Practices to Support Healthcare Issues
Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.

For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?

In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.

To Prepare:

Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1.
Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined.
By Day 3 of Week 3
Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.

By Day 6 of Week 3
Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.

response 1

I enjoyed reading your post and agree with you that occasions arise when nurses face ethical dilemmas arising from competing resources available for patient care during the COVID-19 pandemic. The third provision of the ethical code for nurses (3.4) outlined that nurses have the professional responsibility of promoting the culture of safety (American Nurses Association, 2015). However, some facilities put nurses who are at the frontline in a tight situation by exposing them to the coronavirus infection through awkward policies that do not promote both nurses’ and patients’ safety. These facilities do not provide adequate PPEs for the care of these infected patients, and in most cases, the nurse to patient ratio is overwhelming.

In as much as the government and healthcare establishments are trying to stem the tide of the rising infection rate, the policies they make do not support the nursing staff in the discharge of their duties due to some competing needs. Hence nurses are occasionally facing the ethical dilemma of putting themselves in danger while caring for the COVID-19 patients. Employers have a duty to their employees to provide adequate PPE, and any harm that may come to patients through lack of PPE and personnel to safely care for patients is a failure of institutions and systems, not of individuals (Morley et al., 2020). If employers provide adequate PPE and appropriate guidance on how to use it, and reasonably address and mitigate the additional foreseen risks that caring for patients with Covid‐19 present, then nurses and others will continue to provide patient care that is more aligned with the usual risks that health care workers knowingly take on when they enter their professions.

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Retrieved from https://www.nursingworld.org/coe-view-only

Morley, G., Grady, C., McCarthy, J., & Ulrich, C. M. (2020). Covid-19: Ethical Challenges for Nurses. The Hastings Center report, 50(3), 35–39. https://doi.org/10.1002/hast.1110

response 2

Excellent post and I agree nurses are faced with more ethical dilemmas because of the COVID pandemic. A major burden COVID has brought is more critical patients with limited resources; especially in emergency rooms and intensive care units (Chamsi-Pasha et al., 2020).

At the beginning of this pandemic, my workplace issued every staff member one face mask and told staff this mask needs to last 3-4 weeks. We were also given a paper bag to store the mask in. If the mask got soiled and staff member needs a replacement mask, they are to notify their manager. The Unit Manager would then issue a new one, along with writing down the employee’s name. Weeks later, a staff member contacted a local news channel to report the issue. Soon after the news report, Unit Managers distributed two additional masks to all employees throughout the hospital. In a recent article by Vordos et al. (2020), social media influencers created a task force to address the lack of PPE by using 3D printers. This did help solve the problem in their area. Unfortunately, it’s a national issue. In my area, local businesses were donating supplies to the hospital.

In nursing school, we were taught to be patient advocates, but who’s advocating for nurses. When an issue is present, we have three opinions; avoid the problem, face the problem but handle it poorly, or lastly face the problem and handle it well (Ulrich, 2018). I’m thankful one nurse spoke up; all it takes is the right person and the right audience to create a change.

References

Chamsi-Pasha, H., Chamsi-Pasha, M., & Albar, M. (2020). Ethical dilemmas in the era of COVID-19. Avicenna Journal of Medicine, 10(3), 102–105. https://doi-org.ezp.waldenulibrary.org/10.4103/AJM.AJM_119_20

Ulrich, B. (2018). From the Editor. Speaking Up for Nurses and Patients. Nephrology Nursing Journal, 45(5), 407–410.

Vordos, N., Gkika, D. A., Maliaris, G., Tilkeridis, K. E., Antoniou, A., Bandekas, D. V., & Ch. Mitropoulos, A. (2020). How 3D printing and social media tackles the PPE shortage during Covid – 19 pandemic. Safety Science, 130. https://doi-org.ezp.waldenulibrary.org/10.1016/j.ssci.2020.104870

response 3

I enjoyed reading your post and appreciate your argument that questions whether the decisions being made by many healthcare organizations in response to the high numbers of COVID-19 patients in hospitals that seem to “relax” the rules that were in place to ensure safety to allow for nurses to be spread thinner to allow for ever-increasing patient numbers. It seems to me that these approaches are quite reactive in nature, which I would argue needs to be corrected sooner rather than later to avoid a catastrophic loss of nurses due to illness and/or burnout. Heath et al., (2020) notes that large amounts of physical and psychological stress are experienced by healthcare workers during the COVID-19 pandemic related to the ever-increasing demands placed upon them as an attempt to keep up with the pandemic situation; Heath et al., assert that in response to this healthcare workers are adapting, though much of the adaptation may likely be harmful to their resilience capabilities. Heath et al. also state that this will become a catastrophic situation if the maladaptive responses are not mitigated soon, and potentially could lead to evidence-based best practice divergence or worse, burnout of staff.

To promote ethical nursing practice, organizations should shift decision-making processes, especially regarding the nursing care of patients, to follow a collaborative model that includes all levels of stakeholders, especially nurses (Rushton, 2016). Nurses are the most visible and present providers in the entire healthcare system; they are the direct link between patient and organization. It is the nurse’s responsibility to provide ethical care, yet all too often, providing ethical care directly contradicts the policies of an organization, or worse, the organization changes policy to meet demand, such as the situation you describe in your post, but this new policy diverges from ethical considerations nurses are bound to follow (Kelly, 2018). I admire your conviction and commitment to standing up for changing what should not become the status quo.

Leslie

References

Heath, C., Sommerfield, A., & von Ungern‐Sternberg, B. S. (2020). Resilience strategies to manage psychological distress amongst healthcare workers during the COVID‐19 pandemic: a narrative review. Anaesthesia, 75(10). https://doi.org/10.1111/anae.15180

Kelly, P., Porr, C., (January 31, 2018) “Ethical Nursing Care Versus Cost Containment: Considerations to Enhance RN Practice” OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 6.

Rushton, C. H. (2016). Creating a culture of ethical practice in health care delivery systems. Hastings Center Report, 46, S28–S31. https://doi-org.ezp.waldenulibrary.org/10.1002/hast.628

Essay 2

COVID 19 Burnout is affecting hospitals and healthcare systems across the The United States and the globe. Burnout occurs after a person has reached beyond their limit of mentality, emotionally, and physically (Queen & Harding 2020). Persistent stress of patient care increased workloads and acuity all compounded often lead to a sense of powerlessness that subsequently causes burnout (Croke 2020). Hospital administrators and nurse leaders equally can feel drained and anxious in tackling the ongoing patient care deficits and preventing and treating staff burnout.

There are several interventions that have been implemented across the globe that can have a lasting impact on individual nurses and on nursing as a profession. Interventions that will remain beyond the reaches of COVID 19. Hospitals and healthcare providers that implement interventions to prevent staff burnout focusing on individual well-being have systematically less turnover and increased patient satisfaction (Croke 2020).

A few interventions that hospitals and healthcare industry leaders can be but not limited to. First, leaders can listen both actively and empathetically to nurses hearing their individual challenges and struggles (Foster 2020). Secondly, hospital leaders can develop and promote a RISE (Resilience in Stressful Events) team at their institutions focusing on debriefing nurses after stressful events such as but not limited to a patient demise, loss of a coworker. Finally, nurse leaders can promote shared governance and develop an evidence–based unit tool kit that focuses on meaningful recognition, including nurses with decision making, and provide greater support and involvement daily (Croke 2020).

Leadership needs to be cognizant of the potential of nurses and other health care professional’s ability to become burnt out from the increased demands related to COVID –19, equipment shortages or challenges, risk of infection, perpetual isolation, elongated hours (Queen &Harding 2020). Nurse leaders now more than ever need to educate staff on becoming observant of the early warning signs of burnout. Burnout has significant consequences for nurses and hospitals that have a direct effect on patients and the entire population (Foster 2020). To prevent burnout hospital leaders and administrators must create and enact policies helping nurses realize that the administration is fully aware of the strain on them and that their administration is genuinely concerned for their wellbeing. Increasing nurses’ overall sense of value, sense of community, and resiliency (Foster, 2020).

References:

Croke, L. (2020). Organizational and personal strategies to support well‐being and address burnout. AORN Journal, 112(2), P8–P10. https://doi-org.ezp.waldenulibrary.org/10.1002/aorn.13154

Foster, S. (2020). Burnout: a continuing problem. British Journal of Nursing, 29(12), 721. https://doi-org.ezp.waldenulibrary.org/10.12968/bjon.2020.29.12.721

Queen, D., & Harding, K. (2020). Societal pandemic burnout: A COVID legacy. International Wound Journal, 17(4), 873–874. https://doi-org.ezp.waldenulibrary.org/10.1111/iwj.13441

response

I agree that nursing burnout is a problem, even more so now with the COVID-19 pandemic. My brother works in ICU with COVID-19 patients, and he told me the other day that the hospital is making nurses work their shifts even when they are sick and febrile because otherwise, they would have no staff to take care of the patients. I was shocked. Talk about burnout; not only are the nurses unable to get off work for vacation, but they also cannot even get off work due to being sick. I think this is an ethical issue. Nursing staff are silent with these concerning issues due to fear, pressure from the administration, or not wanting to appear incompetent (Kelly & Porr, 2018). When nurses do not stand up for concerning issues, the healthcare organization will continue to abuse them. Nurses that come to work sick cannot take care of their patients correctly and give them the care they deserve; they are doing themselves and their patients a disservice. In this situation, superior leadership is much needed. Leaders need to act in the best interest of their co-workers and stand up for what is ethically right, not support mandates that have been imposed upon them due to the hospital worried about the bottom line (Broome & Marshall, 2021).

Thank you,

References

Broome, M. E., & Marshall, E. S. (Eds.). (2021). Transformational leadership in nursing (3rd ed.). Springer. https://doi.org/10.1891/9780826135056

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/OJIN.Vol23No01Man06

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