Discussion Reply- Meghan

Nursing advocacy for safety is elevated during Covid-19

Meghan FitzGerald

If you study the history of nursing advocacy it almost always centers on the patient. And data shows nursing advocacy covers two themes:  empathy with the patient (understanding, being sympathetic, and feeling close to the patient) and protecting the patient (care, prioritization of health, and protection of rights) (Davoodvand, 2016).

I sit on the board of a major US healthcare system where I'm also a member of the quality and safety committee. I get to see our medical and nursing teams upfront and close as they advocate for millions of patients. The daily briefings about our front line employees and patients during COVID-19 was awe inspiring. At the same time, I anonymously volunteered on the frontline of my local hospital where I saw a new level of nursing advocacy emerge with regard to safety.

The first example of advocacy is quite basic and core to our field which is provider safety. As leaders and peer we must ensure all healthcare providers have the right training, equipment, protocols and support to do their jobs safely. Nothing else matters if our staff and colleagues are not safe. It's where the saying; put your own oxygen mask on first comes from. 

COVID-19 upended the US supply system for supplies with the most dire being the N95 mask or respirator. By way of background, normal levels of  N95 production in the US are 1.5 billion annually which surged to 3.0 billion within weeks forcing us to tap into a scarce and rocky global supply chain.  Prior to COVID-19 researchers modeled a hypothetical scenario where if 20-30% of the population became infected with the an unknown flu, the need for respirators could hit 7.3 billion in a maximum case scenario (Carias, 2015) and that drill came true. We often study safety scenarios but actually allocating resources and time becomes more difficult in a strained system with competing priorities. Do we spend budget on prenatal planning for mothers at risk or deploy those monies into a what if scenario for a warehousing billion masks hypothetic virus? Of course the answer is both but that isn't the reality on the ground. 

Every night, the news covered the perils of front line workers including long shifts and whether they had the right protective gear to do their job. And it was clear the supply chain was severely disrupted in several locations especially in surge areas like New York and Seattle.  

The advocacy for the front line nurse was swift and dire. Seeing nurses on national television wearing used masks, bruised eye sockets and handmade protective gear was a national call to action.

Within days, 3M kicked production into high gear, planes began to arrive with masks, retailers like under armor and even hockey manufacturers started cranking out masks in addition to sporting gear. This public policy response harkened back to when 911 first responders in New York ran into burning buildings and perished. No one forgave policy makers or officials for allowing fire fighters dying while saving lives. You don’t hurt or mess with first responders.  

The public cared deeply about front line nursing and came to their aid. And ironically a few weeks later it was the field of nursing who returned the respect and care to their patients and the public. When there is a matter of national policy requiring a trusted source, there is no one better than a nurse or pediatrician. 

On the side of this personal protective equipment issue, there was a big debate about whether the public needed to wear a mask. The field of nursing came out strong telling the public to wear a mask. I remember sitting at home watching the Surgeon Generals animately directing the public not to wear a mask. My Mom skeptical asked if he was correct and I said no way.  He was directionally right for the wrong reason which set public health advocacy back months. We needed the limited supply of masks for first responders not because the mask lacked efficacy.     I wrote and op ed and went on television to amend the advice and advocate the right policy.

During every interview, the broadcasters often highlighted that I was a nurse; not a professor, author or Fortune 25 executive. In an emergency, my street crew was my nursing license. I also used my advocacy to champion that hospitals not under siege from COVID-19 must continue to see patients that needed necessary surgery. The data I was reviewing showed that cancer screenings, urgent and cardiac procedures and biopsies were being put off. (See meg interview: https://cheddar.com/media/overwhelmed-hospitals-face-economic-damage-amid-coronavirus-pandemic (Links to an external site.))

And the American Nurses Association was equally swift in their advocacy for patients by partnering with the American Medical Association issuing a formal plea with the public in the name of science to wear a mask.

These two examples around safety during a national emergency show that nurses are empathetic to and protective of their patients. And these traits translate into effective advocacy. And this advocacy was highly valued and appreciated by the public who went on the advocate for the nurse in a time of need.  

                                                    References 

Carias C, Rainisch G, Shankar M, et al. Potential demand for respirators and surgical masks during a hypothetical influenza pandemic in the United States. Clin Infect Dis. 2015;60 Suppl 1(Suppl 1):S42-S51. doi:10.1093/cid/civ141

Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016). Patient advocacy from the clinical nurses' viewpoint: a qualitative study. Journal of medical ethics and history of medicine, 9, 5.

Goodman, T. (2014). The Future of Nursing: An Opportunity for Advocacy. AORN Journal, 99(6), 668-671. doi: 10.1016/j.aorn.2014.03.004

https://www.nursingworld.org/news/news-releases/2020/ana-ama-and-aha-urge-the-public-to-continue-taking-steps-to-stop-the-spread-of-covid-19/