By Lori King, DNP, RN, APRN-BC
A great deal has changed in healthcare in preparing for and navigating the COVID-19 pandemic. The momentum and need for change will likely continue for up to 24 months according to some
reports. Along with these changes, the
attitudes, ideas, and priorities have shifted in addressing a broad spectrum of issues across unique environments.
Our priorities have changed.
The crazy thing is that many of these issues and the changes which have been necessary, have also been heavily debated for many years among individuals in healthcare, political groups, professional groups, and elected leaders at the state and national level. Yet, in the face of a crisis, we have moved quickly to do what’s right and necessary, regardless of the past.
At the federal level,
regulatory changes have allowed for expansion of telehealth which has been long debated and underutilized. Now, health systems are reorganizing care delivery to ensure access to care for patients while protecting the healthcare workforce and preserving PPE. There have been “not so subtle”
hints from CMS that while changes are in response to the pandemic, it is not likely that things will return to how they were.
Additionally, state regulatory bodies have followed suit in
lifting regulations and rules. As one example, states have been leveraging emergency language allowing nurses to work across state boarders and allowing advanced practice nurses to avoid cumbersome and often difficult to gain collaborative practice agreements where currently required by law. A refreshing change- as this issue has been debated over several years with some states still maintaining these unnecessary legal requirements. They only impede access to care -
especially in their rural areas.
Access to appropriate PPE is a huge issue for health systems nationwide and globally. Honestly, in the 26 years of my nursing career, I cannot remember ever having to worry about whether or not we had the PPE needed to care for our patients. Now, this equipment is a precious commodity - a much different story and quite honestly a disturbing feeling to those of us in healthcare. It must be addressed.
Then there are the historic, all-consuming, tough to tackle issues of staffing- especially with healthcare workforce shortages in most areas of the country. Nurse-to-patient ratios in COVID-19 surge areas are soaring. Still, nurses, physicians, and other healthcare professionals are traveling without question to these facilities to work for days on end, with high patient loads. The heated concerns regarding mandatory staffing ratios and others like floating, rest breaks, training and orientation, and scheduling are all being upended in areas where surges are occurring.
Additionally, healthcare workers are not necessarily maintaining positions in their area of specialty anymore and are quickly being redirected to areas where they are most needed. This is a stark change from our contemporary views where members of the healthcare workforce take great pride in their specific care areas of expertise and where questions of safety are often explored given we cannot be experts in everything. They are now needed, pulled, placed, asked, or otherwise required to work in areas that are completely out of their comfort zone as flexibility is crucial to success.
Furlough’s and layoffs were last on our mind in a world with a well documented healthcare workforce shortage.
Doctors,
nurses, and other healthcare professionals have all been impacted - while many chose healthcare professions because of the security of the workforce. We tout things like “you can get a job anywhere” and “there will always be a need for doctors and nurses.” Now,
hospitals are in a position where these steps are necessary for their financial health. The financial impact of the pandemic now presents a climate none of us dreamed would have ever occurred.
In addition to positioning healthcare environments and workforce for what can only be arguably predicted, employers have made
changes in benefits to accommodate the needs of the workforce. Actions taken by employers include increased paid sick days, hazard pay, extra shift bonuses, laundry services, hotel stays, childcare options, eldercare, wage replacement for furloughed employees, quarantine pay, and PTO loans.
Some changes and decisions have been implemented temporarily and some may be long term or even permanent. Regardless, the lessons we are learning from the crisis will surely make an impact and a responsible approach will consider the future of how our systems will operate, and under what rules, regulations, and guidelines.
Sick leave policies are one area that have needed a close review by healthcare employers. These policies are closely watched and have long been called out by unions. They will gain a great deal of organizing traction - if they haven’t already. Policies that include restrictions in the use of sick days and then tie utilization to disciplinary action should be re-examined. While these policies are designed to curb high call off rates, they can also put a workforce at risk by encouraging employees to return to work when they are ill or potentially not take sick days when it is appropriate and necessary.
Given the unique nature of our various healthcare environments and the populations they serve, it is not practical to think that any needed change should be globally applied. It could however be assumed by some - including unions that likely now have expectations on newly implemented employer benefit practices such as hazard pay.
An employer’s future approach on maintaining or adjusting the changes they have made will be incredibly challenging and important. Employers are now faced with the heightened emotional state of the workforce and must define what is needed to position the system for any future crisis.
Questions in the boardroom are abundant, no doubt. Financial concerns, population needs and community perception, union demands or threats of organizing, anticipation or management of patient surge, when and how to implement elective procedures, planning for PPE and protection of the workforce, re-staffing once furloughed and eliminated positions reopen, etc.
What does the future look like?
A great deal is yet to unfold for healthcare and we remain in the midst of a pandemic. Things are moving fast and confident predictions of what to expect are extremely hard to come by. Yes, our priorities have changed.
