HJNO Sep/Oct 2021

NURSING DURING A PANDEMIC 30 SEP / OCT 2021 I  HEALTHCARE JOURNAL OF NEW ORLEANS   providers for COVID patients besides physi- cians, are in short supply. We need more ICU beds, but we don’t have available manpower to staff them. Staff, space and equipment are all in short supply. Crisis standards of care are used nation- ally to guide the use of healthcare resources for accomplishing the most good for the greatest number of people. It is a moral concept known as utilitarianism. In the case of provision of healthcare during a crisis, it provides a framework for how leaders should decide on uses of scarce resources. Let’s say a COVID-19 patient comes into the emergency room and needs an ICU bed, but there are no more staffed ICU beds avail- able. The admitting physician would have to look at all the patients using the ICU beds and evaluate them against this new arrival to determine who has the least chance of survival. If one of the current ICU patients has the least chance of survival in this sce- nario, they would lose their ICU bed, be moved to a regular medical-surgical bed, and the new arrival would get that ICU bed. You can imagine the effect of these kinds of decisions on doctors and nurses who must carry out the standards. No one wants to be put in the position of playing God, deciding whose life is more worth saving than some- one else’s. It is the worst ethical dilemma anyone in the caring professions ever faces. Yet, here we are, faced with making these decisions based on a patient’s physiological functions. No one wants that to happen. And while the standards are only supposed to be activated by the governor, many believe that individual hospitals may be forced to make these types of decisions as their institutions become overwhelmed. It is a safety net that was designed but never imagined to be used. THE CURE By now, readers are probably throwing up their hands and, like the marvelous chil- dren’s character Henny Penny, shouting she must go tell the king the sky is falling. Well, the sky may be dark and ominous, clouds are roiling, and thunder and lightning are during the pandemic, but to improve health outcomes and health equity in Louisiana for generations to come. Nurse educators have provided essen- tial leadership and expertise in assisting the board to pass emergency rules to extend the temporary permits granted to new gradu- ate nurses who have been unable to take the NCLEX-RN examination due to the closure of Pearson-Vue testing sites in the state. Additionally, they assisted LSBN staff to identify ways in which senior nursing students could meet clinical practice hour requirements to graduate early. Nurse administrators have done their part too. They lobbied to have all medical- surgical hospital units declared as critical in order that RNs/APRNs could provide mod- erate clinical laboratory point-of-care test- ing. Additionally, they were instrumental in communicating the statutory authority for RNs to administer and manage anesthetics to intubated patients in critical care settings, which is essential in caring for COVID-19 patients. LSBN was also able to take emer- gency action to allow nurses enrolled in our Recovering Nurse Program to attendAAand NAmeetings online and to delay payment of fines and fees during the health crisis. Individual nurses are also responding to the call to give more. Especially among our Advanced Practice Registered Nurses, they are being called to work as intensivists in ICUs and overseeing the nursing care of critically ill patients. Other examples of ded- ication and teamwork have been reported from all regions of the state. Nurses, exempt from stay-at-home orders, are determinedly caring for patients while worrying about unknowingly exposing family members; nurses are creatively connecting isolated patients to their loved ones anxiously await- ing word; nurse faculty have front loaded clinical hours and days, evenings and week- ends to ensure students graduate early or on time to take on new challenges; and nurses in all areas of healthcare have pivoted to step into new roles to lend a hand. I’m struck by the many characteristics nurses share everywhere. Rainmay be pouring down, but the sky is not falling. My profession, those wonderful nurses who are with us when we enter the world and who will be there at our end of days, are responding to patients’ needs just as they always have. They may be exhausted and overwhelmed. They may be catching catnaps in whatever spaces they can find. They may be frustrated and angry. They know that we must fix the system and come up with a better way to plan for future crises, but they will be there for the patients. The reason I know this is because I have spent my entire 47-year career watching my colleagues find solutions to every nursing dilemma that has challenged the profession. Here is just some of what I know has gone on in Louisiana during the last 18 months. I will start with the unique group of men and women who make up the Board of LSBN. Nurses and the public often think of LSBN only in terms of its work in licensing and discipline of nurses, but we collabo- rate with many organizations to advance professional practice, write public health policy and engage in rulemaking that sup- ports nurses engaged in all areas of nursing practice and education. We are guided by ethical considerations of what is right and wrong, demonstrating integrity and hon- esty and acting with respect and dignity in our care for patients, clients and students. We have passed emergency rules for relax- ation of APRN/MD collaborative practice agreements, permitted RNs to adminis- ter and manage anesthetics for critically ill patients under the order and direction of a licensed prescriber and assisted with crafting the language in Governor Edwards’ Executive Proclamations. Tavell Kindall, MD, our board president, has developed an active telehealth practice to continue to serve his patients during the COVID-19 pandemic. Additionally, he was appointed by Gov. Edwards to the Nursing Subcom- mittee of the Louisiana COVID-19 Health Equity Task Force to investigate health dis- parities that challenge minorities and vul- nerable populations in Louisiana, not only