Nurses make up the largest workforce within health care in the UK. Health and care systems locally, nationally and internationally are going through unprecedented upheaval in the wake of the COVID-19 pandemic, labouring under the volume of patients and struggling with a lack of essential resources.
Nurses are among the first people present to provide care during periods of crisis. It was nurses who led the response to AIDS in the early 1980s, the Ebola outbreaks, measles epidemics, polio, diphtheria, whooping cough, meningitis and the public health challenges that they all bring and COVID-19 is no different. Nurses have led and are leading the COVID-19 response globally.
Now, the public are becoming much more aware of the role of the nurse as result of the pandemic however, much of that work is not that much of a departure from what it is that nurses do in ‘normal’ times. The job nurses are doing right now is not really any different than the practice they were doing all of the time, it is the intensity of need that is different. Nurses are leading in ways that are remarkably similar to their usual work, during a crisis however, their visibility and a recognition of that work is heightened.
The pandemic amplifies the neccessity for team-based care, infection prevention and control practices, a focus on the person and family-centered care along with other skills that practice nurses practise day in and day out up and down the country. On a daily basis practice nurses experience, deal with and manage crises that impact on nurses, patients and their families. The scale of this may be different than those issues experienced as a result of the pandemic but this is why nurses are ready to and prepared to lead as they draw on their past experiences, this speaks directly to the strengths of nurses that they have developed and honed of the years.
As the COVID-19 crisis unfolds, there will be an increased demand for nursing expertise and leadership as next steps will focus on recovery and here the skills and expertise of the practice nurse will be much in demand. All of this is unfolding as people still require health screenings, vaccination programmes, support and interventions that are required to manage chronic conditions including an increase those people who present with mental health issues. The practice nurse has a central role to play in addressing current and ongoing health challenges, it has ever been the case.
As was the case with the 2018 measles outbreak, practice nurses were at the heart of communicating and collaborating with the community, key to this was the dissemination of evidence-based information and outbreak control. Communicating transparent, evidence-based steps to prevent COVID-19 meant that practice nurses promoted the dissemination of information, they helped to reduce fear and stigma and promoted health-saving practices in ways that individuals understood and were more inclined to act upon and share with others – this is at the heart of the role of the practice nurse.
New ways of working (or developments on current ways of working) have emerged and expanded, for example, a progression in telehealth technologies that are improving access to healthcare for patients and families. If this growth in technological use can be done now, then there is no reason why nurses with appropriate support cannot continue to innovate and use these technologies even more widely after the crisis. There has been increased interagency collaborations and dialogue, increased links with community groups, this kind of coordination work must continue. Recognition of nurse practitioner autonomy has come to the fore demonstrating how important this is for increasing access to high quality care for individuals and communities.
Much learning has occurred, nothing should go back to normal as normal was not working however, practice nurses need to be given the tools they require so as to provide safe and high-quality care. Where there are inadequate resources (and this includes staffing), nurses need to speak up and advocate for themselves, the cost of inaction, as this pandemic has clearly demonstrated, is colossal. Practice nurses cannot take care of patients and their families if they do not also focus on taking care of themselves. The Nursing and Midwifery Council's (NMC) (2018), non-negotiable Code of Conduct, makes clear the nurse's primary commitment is to the patient, as well taking account of their own safety and the safety of others.
Future proofing is key and this will require investment. Investing in nurses so to enhance their knowledge and skill sets, brings with it positive outcomes and will secure our preparedness for future pandemics and there will future pandemics. Corless et al (2018) reported in 2018 that the world will see another pandemic in the not-too-distant future; that random mutations occur often enough in microbes helping them survive and adapt; that new pathogens will certainly find a way to break through human defences and that there is the increased potential for intentional or accidental release of a synthesised agent.
The Royal College of Nursing (2017) suggests that advocacy means to ensure that people, particularly those who are the most vulnerable in our society, can have their voice heard on those issues that are important to them; that they are defended and their rights are safeguarded; and their wishes have been genuinely considered when any decisions are being made about their lives. The practice nurse, with the patient at the centre of all they do are true advocates during a crisis or as is part of their day job, what you do truly matters and makes a difference. By now, many people are aware of the role that all nurses play on the front line of this pandemic, let's all of us keep it this way.