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Recommendations for Improving National Nurse Preparedness for Pandemic Response: Early Lessons from COVID-19

Recommendations for Improving National Nurse Preparedness for Pandemic Response: Early Lessons from COVID-19
Tener Goodwin Veenema; Diane Meyer; Sue Anne Bell; Mary Pat Couig; Christopher R. Friese; Roberta Lavin; Joan Stanley; Elena Martin; Michael Montague; Eric Toner; Monica Schoch-Spana; Anita Cicero
Date posted:
June 10, 2020
Publication type:
The Johns Hopkins Center for Health Security
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The rapid evolution and spread of the COVID-19 pandemic have revealed insufficiencies in the US health system to respond to a public health emergency, resulting in healthcare worker infections and deaths.1 Nurses have played and will continue to play a pivotal role in the response, yet compelling evidence from nurses in the field reveals a lack of access to personal protective equipment; inadequate knowledge and skills related to pandemic response; a lack of decision rights as they relate to workflow redesign, staffing decisions, and allocation of scarce resources; and a fundamental disconnect between frontline nurses and nurse executives and hospital administrators. These issues were brought to light in a recent survey conducted by the American Nurses Association, which found that 87% of nurses fear going to work, 36% have cared for an infectious patient without having adequate personal protective equipment (PPE), and only 11% felt well-prepared to care for a COVID-19 patient.2 The efforts put forth by frontline nurses in caring for patients and ensuring the sustainability of health system operations during the COVID-19 pandemic, despite these challenges, is inspiring. However, there is a critical and compelling need to identify and understand the gaps and inadequacies in the US health system that have contributed to a lack of pandemic readiness, both within and outside of the nursing workforce, including in emergency planning and the procurement and allocation of resources such as PPE and ventilators.

In this report, we describe the myriad factors that influence nursing workforce development and training for pandemic response as well as the safety and support needed during pandemics at the government, system, organization, and individual levels. In addition, we identify some of the relevant stakeholders who can influence decision making at these levels. We also identify gaps and propose short- and long-term recommendations for ways to improve the readiness, safety, and support of the national nursing workforce for COVID-19 and future pandemics. These recommendations include:

  • The US Department of Health and Human Services should examine existing federal preparedness and response strategies to identify the roles and responsibilities of nurses during a pandemic (eg, medical countermeasure dispensing) and work with experts in nursing pandemic response to develop a plan for ways that nurses can train to execute these roles during a pandemic.
  • Key stakeholder groups and program staff should identify each federal agency’s capacity for advancing the emergency preparedness and response knowledge base in the nursing workforce and integrate this information into their subsequent strategic plans.
  • Healthcare accreditors should implement metrics that measure whether a facility has the plans, procedures, and human resources needed to surge the nursing workforce during a pandemic.
  • Healthcare accreditors should include education and training for nurses on pandemic preparedness as a specific requirement beyond the all-hazards approach now required to evaluate a healthcare organization’s emergency preparedness.
  • The Human Resources and Services Administration should fund nursing workforce development for public health emergency preparedness and response.
  • Building on the model of the Centers for Public Health Preparedness and the Public Health Emergency Response Research Centers programs, the Centers for Disease Control and Prevention should fund a National Center for Disaster Nursing and Public Health Emergency Response to provide education and training, career development, and networking opportunities to early career nurse scientists and nursing students.
  • Schools of nursing should develop robust metrics for evaluating nurse preparedness, which should be implemented across academic and life-long learning programming.
  • The American Association of Colleges of Nursing should release revised curricular Essentials and a tool kit for schools and universities to facilitate the inclusion of emergency preparedness and response content across all baccalaureate and graduate academic programs.
  • Hospitals should conduct and include nurses in emergency preparedness drills and exercises, such as those required by the Joint Commission, the Assistant Secretary for Preparedness and Response’s Hospital Preparedness Program, and the Centers for Medicare and Medicaid Emergency Preparedness Rule.
  • Hospitals should endeavor to establish and maintain crisis leadership skills in nurse administrators, managers, and executives who can help foster and champion nurse preparedness and response at the highest levels of leadership.
  • The National Academy of Medicine, along with the Robert Wood Johnson Foundation and in collaboration with nursing organizations, should convene a national workshop of interdisciplinary subject matter experts in 2020 to explore the lessons learned from the national nurse response to COVID-19 and to expand and illuminate the recommendations contained in this report.



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