NRS 451 how nurse serve as advocates for their employees DQ

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NRS 451 how nurse serve as advocates for their employees DQ

NRS 451 how nurse serve as advocates for their employees DQ


DQ1 Discuss
how nurse leaders serve as advocates for their employees. Describe how advocacy
for employees affects patient care and outcomes.

DQ2 Discuss
barriers caused by an organizational culture that can be encountered by nursing
leaders that can make them feel powerless.

Nurses on the Frontlines of Mass Casualty Events

As the largest sector of the health care workforce, nurses are vital to the provision of care in any setting and circumstance, including pandemics. Although physicians provide much needed in-the-moment medical treatments such as prescriptions and surgery, nurses are there for the long haul; the labor-intensive, time-consuming care essential for recovery and rehabilitation. Historically, nurses have played a central role in the care of individuals stricken with deadly illness when there is no effective medical intervention, including the Spanish flu epidemic, severe acute respiratory syndrome coronavirus (SARS-CoV), H1N1, Ebola, and Middle East respiratory syndrome coronavirus (MERS-CoV) outbreaks. A fully informed, skilled workforce is essential to adapting to a rapidly changing work environment, synthesizing information, making complex decisions, and providing high quality care. This is especially true when faced with a mass casualty event (MCE). MCEs fall into 2 distinct categories: “big bang” single incident, immediate impact events such as an earthquake or bombing, and “rising tide” events that slowly develop and have a prolonged impact, for example, pandemics.

In the course of performing care during pandemics, nurses must make challenging decisions. Known for their compassion and commitment to service, nurses have perished when caring for patients during mass infectious outbreaks. ,  Nursing staff are repeatedly exposed to the virus and must have adequate training and equipment to protect their life and safety. Preparedness for pandemics and other disasters is essential to protect nurses and nurses should be part of the discussion. ,  However, when frontline nursing staff are besieged and beleaguered as events overwhelm health care institutions, nurse leaders must spearhead efforts to provide a voice and advocate for them.


A pandemic that began in November 2019 has spread globally in what may be the largest pandemic ever. The disease, named COVID-19 by the World Health Organization (WHO), likely began through contact with animals creating the environment for a zoonotic transmission from animal to human. Now recognized as having the ability to disperse quickly through human transmission, scientists realize COVID-19 can be spread via human transmission during the 2- to 10-day incubation period, before a person exhibits symptoms. ,  The majority of patients are male and have mild symptoms of dry cough, dyspnea, and fever, which spontaneously resolve. For others, COVID-19 can evolve to include severe pneumonia, septic shock, organ failure, and acute respiratory distress syndrome. Some persons remain asymptomatic, never realizing they have the virus.

Coronaviruses commonly occur in the human population. ,  ,  They are responsible for up to 30% of annual respiratory infections including the common cold and have been thought to be inconsequential. ,  ,  Over the past 3 decades, however, zoonotic coronaviruses have led to deadly global epidemic outbreaks in the human population. The outbreak of SARS-CoV in 2002 and MERS-CoV in 2012 put the world on notice that coronaviruses are serious threats to global public health. SARS-CoV and MERS-CoV have largely similar clinical manifestations; However, MERS-CoV has prominent gastrointestinal (GI) symptoms and often acute kidney failure. Of note, coronaviruses are enveloped, single-stranded ribonucleic acid (RNA) viruses that have spike-shaped glycoproteins on the envelope that are responsible for attaching to a host cell. In SARS-CoV, the host is the angiotensin-converting enzyme 2 (ACE2) found primarily in the lower respiratory tract in lung epithelial alveolar cells. ,  For MERS-CoV, the host is dipeptidyl peptidase 4 (DPP4) found in the lower airway, gastrointestinal tract, and kidney. COVID-19 (CO—corona, VI—virus, D—disease, 19—2019) is thought to be closely related to the SARS-CoV, so the coronavirus causing COVID-19 is known as the SARS-CoV-2.

Many of the treatment challenges with COVID-19 are the same as for earlier outbreaks of coronaviruses. For those contracting SARS-CoV, 20% to 30% required mechanical ventilation, and 10% perished, whereas 50% to 89% of MERS-CoV patients require ventilation, and 36% die. Patients with COVID-19 who progress to a more critical stage are most often admitted with severe hypoxic respiratory failure. In the United States, the American Hospital Association (AHA) projected in February 2020 that 4.8 million residents could be hospitalized with COVID-19, A total of 1.9 million would be admitted to an intensive care unit (ICU), and 960,000 would require ventilator support. It was feared that the 62,000 full-featured mechanical ventilators and the 99,000 older ventilators that are of questionable use would not be enough. Additionally, hospitals would be overwhelmed with patients while dealing with shortages of beds, equipment, and staff. ,  During the SARS-CoV outbreak, 3% of US health care workers developed the disease as part of the 21% worldwide even though barrier precautions were widely implemented. Coronaviruses have been shown to last on metal, glass, or plastic for up to 9 days when not efficiently disinfected.

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Protecting Frontline Staff

Recent research conducted among nurses caring for patients experiencing coronaviruses and other contagions suggests that nurses have definite concerns and challenges. ,  ,  In a qualitative study of nurses working during the MERS-CoV outbreak, 4 major themes were uncovered: experiencing burnout owing to heavy workload; relying on personal protective equipment for safety; being busy with catching up with the new guidelines; and caring for suspected or infected patients with caution. Kang et al. noted that infectious disease outbreaks cause a high level of fear and distress among nurses. Nurses also reported feeling unsupported by uninformed or misinformed peers and family, and lonely when caring for infected persons in isolation. This was further supported by Wilkinson and Matzo who identified a sense of staff unity/teamwork in the face of challenges as a primary resource needed by nurses in a disaster. These authors suggest that outcomes of care under catastrophic events lead to increased problems due to stress, including changes in mood and/or sleep patterns, eating disorders, substance abuse, and avoidance behaviors. Wilkinson and Matzo also report on several research investigations that suggest nurses are less willing and able to respond to infectious disease outbreaks related to a fear of contagion. Obstacles to willingness included personal health problems, fear for family and themselves, childcare/eldercare responsibilities, pet care, availability of protective equipment, medicines, and education and training in disaster preparedness. Several authors cite the need for staff to be fully informed and skilled to perform effectively and feel safe during disasters. The already strained resources of hospitals, including chronically overcrowded departments and insufficient staffing, also add to the challenges for nurses.

According to Bhadelia, when learning from previous pandemics, there are 3 decisions to make when faced with a large number of people who need care for a novel disease. These include: how to quickly identify infected people; how to isolate and care for them; and, how to keep health care workers safe. National nurse and physician chief executive officers (CEOs) are leading efforts in these three areas. In early March, the CEO of the American Nurses Association (ANA), Loressa Cole, reached out to Congress requesting a “definitive statement” on transmission of COVID-19 from the Centers for Disease Control and Prevention (CDC) that was not based on supply chain and manufacturing challenges, but rather based on clear evidence-based protocols to protect the nation’s 4 million registered nurses. Nurse leaders from several nursing organizations were also invited to the White House to share their insight on the needs of nurses during the current COVID-19 crisis. Finally, the ANA, American Academy of Colleges of Nursing and several other nursing entities have developed free education for nurses on best practice in caring for patients with the COVID-19 virus. , 

Despite these national efforts, local health care facilities are challenged as COVID-19 spreads. Nurses need assistance from nurse leaders in their own place of work. Nurses need to feel supported and empowered. They need an advocate. A case study follows in which a chief nursing officer (CNO) council at 1 health system collaborated with the chief medical officer, chief quality officer, infection prevention, and human resources to create a model of success for empowering and safeguarding nurses.

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