As the tidal wave of the COVID-19 pandemic pulls back, it is important to assess its aftermath. The pandemic highlighted the contribution of nurses carrying out their primary directive, which is caring for the sick. A shortage of nurses predated the pandemic and was already having an impact on the provision of nursing care. Then, the pandemic created a demand for more nurses in all health care areas, but specifically at the bedside.
At the beginning of the pandemic, nurses were furloughed and laid off as elective surgical procedures were canceled, and non-COVID patients stayed away from health care facilities. Older nurses retired, and others were given early retirement options. When the need for more nurses grew as the pandemic progressed, many of these early retirees did not return to the workplace.
The lack of personal protective equipment at the beginning of the pandemic placed nurses at risk for contracting the virus. The stress and lack of support resulted in nurses quitting their jobs. For the pandemic’s first year, there was no vaccine available to protect the nursing workforce, so nurses were concerned not only for their own sake but haunted by the possibility of the transmission risk of bringing the COVID-19 infection home to their family and loved ones.
Nurses were also feeling the stress and strain from the lack of effective medications and treatments for their patients. Nurses working at rural hospitals or critical access hospitals have struggled with the impaired ability to transfer patients to larger hospitals that are better equipped to provide specialized care to their patients. The inability to transfer patients who need a higher level of care and may be losing valuable time is painful for the bedside nurse, who may feel helpless. An additional stress factor is that operating room nurses are required to assist in surgical procedures that they have not been trained in due to the inability to transfer the patient.
The COVID-19 pandemic has inspired some people to pursue a nursing career, but there are limitations on the process, to becoming a nurse even when there is a sufficiency of candidates. First, it takes time to become a nurse due to the amount of training and instruction involved. Second, there is little flexibility in accommodating the number of nursing students. The number of admissions to nursing schools is actually down due to constraints on the number of students each school can accept. Also, there is a nationwide shortage of nursing faculty. Qualified nursing faculty are even harder to generate and train than nurses per se.
Joining a compact
During the height of the pandemic, under a State of Emergency, the Vermont Board of Nursing (BON) responded by calls for maximizing the safety, continuity, and educational integrity of Vermont nursing education programs, even where doing so required suspension of BON Administrative Rules intended to achieve those goals in nonemergency contexts. Nursing school directors in Vermont were granted latitude to execute necessary changes without prior notice or specific approval from the board. The directors could exercise professional judgment in the use of alternative facilities, instructional modalities, clinical sites and simulation laboratories to meet curricular objectives so nursing students could seamlessly complete their studies, graduate, and enter the workforce without delay. But the State of Emergency has expired, and the temporary measures have been reversed without any permanent changes to increase the nursing workforce.
As a policy response to the nursing workforce issue, Vermont has joined the Nurse Licensure Compact (NLC) with 38 other states. The compact allows for improved and efficient onboarding of licensed nurses from other states within the compact to enter into practice in Vermont as nursing licensure requirements are uniform across the compact. On the other hand, Vermont nurses can enter into practice in other compact states and leave the state. There is no overall increase in the size of the nursing workforce.
As the receding waters of the pandemic pull away from the shore, what features do we see on the altered landscape that remain. A smaller nursing workforce, a more fragile health care system, and a nursing education and training system which is still geared to the prepandemic era. The temporary measures taken to facilitate nursing education that have been reversed without proof that the old ways were superior. Overall, there have been no permanent changes to augment the nursing workforce, only temporizing measures. The potential consequences are easy to envision. There will be another pandemic and we will be less prepared to provide adequate numbers of nurses than we were two years ago.
Office of Professional Regulation (2020). https://sos.vermont.gov/opr/
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