The Role of Nurses in Pandemics
“The world needs millions more nurses.”
Pandemics—like the one we’re in the midst of now—can spur uncertainty, but they’re not unbeatable. Time and again our communities have shown solidarity and women in medicine have put themselves on the front lines in order to combat the spread of illness. We’re sharing the stories of some of these women to lift us all up.
2020 is the “Year of the Nurse and Midwife.” As nurses account for more than half of all the world’s health workers, and 91% of nurses are female, we wanted to dedicate our final installment of the pandemic series to these women in medicine.
Throughout history, nurses have stepped up to take care of those in need during times of great uncertainty, often putting their own lives at risk in the process. According to a 2018 policy brief by the American Nurses Association (ANA), nurses are the key to preventing and containing widespread illnesses, and their role in a pandemic begins even before a disease has had the chance to cause widespread devastation.
Not only are nurses often the first to recognize symptomatic patients, they’re “prepared for the leadership roles in policy decisions of health systems and government agencies, and can prepare for, identify, respond to, and direct recovery efforts from global pandemics that require an informed, internationally coordinated response,” says ANA.
1918 Influenza Pandemic
Nurses have played a pivotal role in pandemics of the past. As we discussed in an earlier article, the pandemic of 1918 was critical to the evolution of the nursing profession. Because there was no treatment or cure, the heroes of the time were those that offered palliative care to alleviate sufferers’ symptoms—nurses.
As Carole Kenner, a registered nurse with a doctorate in nursing and dean of The College of New Jersey’s School of Nursing, Health, and Exercise Science told The Philadelphia Inquirer, the 1918 influenza pandemic was when the door to nursing as a profession was opened:
“This was the beginning of the division of the practical nurse, as we know it today, and the registered nurse. The hospitals were overwhelmed. We realized that everyone couldn’t be trained at the same level. The practical nurse was given maybe three to six months of training and was geared toward being in the communities. At the same time, it opened doors for the nursing profession. There was a lot of need for people to have special skills. That wasn’t recognized prior to the pandemic.”
It also increased both the visibility and the popularity of the nurse’s role. People began to realize that nurses were the frontline medical professionals and outnumbered doctors. “The status of nursing was raised, and...their role in health, [especially] in community and public health, was also more visible.”
Ebola Outbreak of 2014-2016
As the frontline workers, nurses are often the most at risk for contracting the disease they’re fighting.
This was certainly true during the Ebola outbreak of 2014-2016. The CDC reports that nearly one in ten of Liberia’s healthcare workers died due to Ebola, and TIME found that in the Lombardy region of Italy, the infection rate was 12% for health workers compared to 1% for the general population.
Given that health care workers were becoming sick due to a lack of protective gear like gloves, gowns, and masks (PPE), it became especially important to protect those on the front lines of the outbreak with the equipment they needed. According to Ellen Johnson Sirleaf, the former President of Liberia and the World Health Organization Goodwill Ambassador for Health Workforce, “By working with partners to scale up distribution of protective gear, we were able to lower the rate of Ebola infections amongst health workers.”
But wearing PPE posed its own problems. As we mentioned in a piece on Ebola, immune survivors of the disease could work inside the ebola treatment units for three hours or more compared to the mere hour other staff could handle before the heat in the PPE became too intense. As one nurse recalls:
“PPE [is] difficult to walk and to bend in. With daily temperatures in the region reaching 100 degrees Fahrenheit, we were instantly drenched with our sweat. Our goggles fogged up, hampering visibility; double gloving interfered with our dexterity, and our hoods made the use of a stethoscope impossible. Patient assessment was sub-par and care was limited. Our patients could not see our faces, limiting [our] ability to show empathy and establish human connections.”
Despite these physically difficult and emotionally taxing conditions, nurses provided the much-needed care to their patients.
The Ebola outbreak showed us that nurses constitute the majority of the task force when responding to pandemics. As such, they need to not only be properly protected from the start, but given institutional support to ensure that they are well-trained, well-prepared, and ready to step into an epidemic response role.
Modern Challenges & COVID-19
According to The State of the World’s Nursing 2020, a report by the World Health Organization (WHO) in partnership with the International Council of Nurses (ICN) and Nursing Now, today there are just under 28 million nurses worldwide, with 80% of the world’s nurses found in countries that account for half of the world’s population.
The global shortage of nurses was estimated to be 5.9 million in 2018, with 89% (5.3 million) of that shortage concentrated in low- and lower middle-income countries. Africa, South East Asia, the Eastern Mediterranean region, and some parts of Latin America are being hit the hardest by this shortage.
Via WHO
That’s why the WHO is calling for governments to invest in nursing, citing the investment as a benefit to society, not a cost. “The world needs millions more nurses,” said ICN’s President Annette Kennedy, “and we are calling on governments to do the right thing, invest in this wonderful profession and watch their populations benefit from the amazing work that only nurses can do.”
The report also provides much-needed data and evidence behind its calls to advance nursing practice, strengthen nursing leadership, and educate the nursing workforce for the future. By ensuring all governments take the necessary steps to ensure there are enough nurses over the next ten years, countries will be better equipped to respond to global health emergencies like COVID-19.
Furthermore, despite advances in science, technology, and healthcare that have made the world safer and healthier in many ways, modern developments like urbanization, global transportation, climate change, human encroachment, and even social media are putting the world at risk of more, and more frequent, pandemics.
Due to the lack of preparedness we’ve seen in response to the current global health crisis, the WHO has said that global health agencies need to develop plans that will provide appropriate and timely responses to pandemics in the future—and that nurses must be involved in that planning process.
“The best response to a potential global pandemic is prevention,” states ANA, “Early recognition of novel infections will be enhanced by the development of linkages between community and clinic nurses and the initial point of contact with the infected individual.”
The Steps Ahead
In addition to ensuring nurses are more heavily involved in the development of pandemic response plans, nurses need to be given more leadership roles. The WHO’s report found that when countries enable nurses to take leadership roles, including the implementation of nursing leadership programs and having a government chief nursing officer (or equivalent), conditions for nurses and public heath improve.
For women in medicine, we will need to develop workforce policies that address the fact that the nursing workforce is still predominantly female. We will need to address the gender pay gap as well as encourage flexible and manageable working hours.
“[This report] comes as the world witnesses unprecedented political commitment to universal health coverage. At the same time, our emergency preparedness and response capacity is being tested by the current COVID-19 outbreak and mass population displacement caused by conflict. Nurses provide vital care in each of these circumstances. Now, more than ever, the world needs them working to the full extent of their education and training," says the report.
As we’ve seen in the past, pandemics—and women’s roles in them—will shape the future for women in medicine and propel us to a stronger future.