President-Elect Biden, don’t forget the nurses

One of my very best friends lost both her mother and father to COVID-19 seven days apart in a New Jersey long-term care facility. Banned from visiting and ignored by administrators, she shared that the one thing that sustained her through her tragedy were her daily calls with her parents’ nurse. At no point in history has it been more important for the country to recognize the critical role nurses play as leaders in the U.S. health care and public health systems.

Although the 7 PM clapping salutes and superhero memes are encouraging and kind — nurses need to be recognized as the leaders; they are in this response. The ongoing COVID-19 pandemic has clearly illustrated nurses’ versatile and important roles, from conducting disease surveillance and contact tracing to caring for children in our nation’s schools to providing critically ill patients care for a novel disease in hospitals experiencing prolonged stress. For eighteen years in a row, nurses have been ranked as the most trusted professionals. They have strong relationships with their patients and with the communities they work in. 

The efforts put forth by frontline nurses during the COVID-19 pandemic have been inspiring, especially considering challenges such as the shortages of personal protective equipment (PPE) to keep them safe and insufficient staff to care for patients. These challenges will be exacerbated in the coming months as COVID-19 cases are rising exponentially. 

Hospitalizations are increasing in nearly all 50 states, 22 of which are seeing their highest numbers yet. Hospitals, particularly those in rural and underserved areas, struggle to accommodate the rise in cases, with many nearing capacities due to lack of bed space and health care workers. If current trends continue, the number of COVID-19 deaths could climb by an additional 200,000 people by February.

COVID-19 has revealed deep chasms within an already fragmented and overpriced U.S. health care system, resulting in significant excess mortality and morbidity, glaring health inequities, and an inability to contain a rapidly escalating pandemic. Nurses need to stand up, lean in and have their voices heard.

Last week, President-elect Biden announced members of the newly formed COVID-19 task force, a group made up entirely of doctors and health experts, signaling his commitment to using science to bring the raging pandemic under control. The task force is actively working on 200-day plans to bring the virus under control, including the expansion of testing and contact tracing, vaccine distribution and acceptance, and personal protective equipment procurement. Nurses will play a crucial role in advancing these plans, but their seat at this table sits empty right now. It is tough to stand by and watch, never mind understand how nurses, with more than 3.8 million nationwide, three times as many RNs in the U.S. as physicians, and rendering the majority of daily care COVID-19 patients every day, continue to be overlooked and undervalued.

We strongly urge the Transition Team to appoint a nurse to the COVID-19 task force and place nurses on newly formed teams to strengthen national public health emergency preparedness and response for future pandemics. The nurse should be directing COVID-19 response and recovery efforts. We must focus on containing the virus, implementing evidence-based public health interventions that we know work, increasing our national supply of PPE, and encouraging people to protect each other as a healthy society does collectively. Nurse educators, nurse executives, and nurse scientists can provide leadership and guidance during a highly divisive time where the fundamental tenets of science and public health are being challenged. When the President-elect takes office, he should appoint expert nurses to multiple government positions where our knowledge and skills can guide sustainable public health programs.

Second, as the numbers of newly diagnosed cases continue to increase at an alarming rate, hospitals are approaching crisis across the U.S. to accommodate this surge, tele-nursing should be implemented where experienced ICU nurses mentor nurses in small and rural hospitals. Earlier in the pandemic, more health care workers were available to be reassigned or redeployed as elective procedures and medical services had been suspended. This is no longer the case and employing tele-nursing and allowing nursing students, under the supervision of a licensed nurse and with proper PPE, to aid in the response could both help bridge staffing gaps. Traditional models of nursing practice need to be immediately revisited to accommodate these changing standards. 

Third, the role of nursing leadership in the national vaccination campaign will be paramount. Transparency around vaccine safety and strong community relationships will be needed to increase vaccine acceptance. As trusted members of their communities, nursing leaders can push back on false information, provide vaccine health education, be role models for vaccination acceptance, and encourage the development and implementation of robust vaccination programs. 

Finally, institutions should commit to digesting this pandemic’s difficult lessons and better prepare the nursing workforce for the next public health emergency. Nurses are a critical component of the disaster and public health workforce, and actions taken now by nurse leaders contribute to public health preparedness, surge capacity, building community resilience, and ultimately to the nation’s health security. Nursing leadership is vital to building health security for future public health threats.

Tener Goodwin Veenema, Ph.D., is a contributing scholar at the Johns Hopkins Center for Health Security and a Professor of Nursing at the Johns Hopkins School of Nursing and in the Department of International Health at the Bloomberg School of Public Health. Diane Meyer, RN, MPH, is a Managing Senior Analyst at the Center for Health Security and Research Associate at the Bloomberg School of Public Health.