A nurse forum has become a refuge for nurses -- a safe place to connect and discuss the COVID-19 crisis. Some reach out with ideas and hope, while others share grave concerns.
All of this is happening on the Frontline Nurses WikiWisdom Forum, an online crowd sourcing platform reserved for nurses that encourages conversation without fear of retribution from employers or others. Nurses monitoring the nurse forum plan to harness data from the current crowd sourcing phase and publish a report when the pandemic passes. [caption id="attachment_76262" align="alignleft" width="300"]
Cynda Rushton, RN[/caption] Cynda Hylton Rushton, PhD, RN, FAAN, professor of clinical ethics and nursing and pediatrics at the Johns Hopkins University School of Nursing, spearheaded the forum because of concerns that many nurses are feeling isolated and reluctant to share their perspectives in their own organizations. "We wanted to create a space where nurses could come together and actually learn from each other and be supported by each other," Rushton said. "At the same time, they could help shape the future by thinking about how we can learn from this experience and be better prepared for the next pandemic or next crisis." Rushton said nurses are the front-line providers who are trying to adapt to the ever-changing environment. "This is a platform that allows us to harness that wisdom," Rushton said.
Get a preview of nurse forum
Nurse forum visitors who aren't signed up can get a glimpse of conversations. On April 20, for example, nurses were responding to the question: "Based on your experience as a front-line nurse dealing with COVID-19, what are your challenges, ethical dilemmas and fears?" One nurse responded COVID-19 was by far the biggest challenge of her nursing career. She and her husband are both nurses and worried about being able to keep working and raise their children. Other nurses discussed the needs for more personal protective equipment stockpiling and ongoing training for a crisis of this magnitude. Nurses are sharing a broad range of personal experiences. While some contemplate leaving their careers or jobs, others focus on the incredible camaraderie in the midst of this history-making pandemic, according to Rushton. Common themes include that front-line nurses are afraid of putting their families at risk, according to Theresa Brown, RN, clinical faculty at the University of Pittsburgh School of Nursing and author of "The Shift: One Nurse, Twelve Hours, Four Patients' Lives." [caption id="attachment_76263" align="alignright" width="200"]
Theresa Brown, RN[/caption]
"Nurses are sharing their frustration," Brown said. "As one said, like the 'lowest common denominator,' by which this nurse meant that nurses were not given PPE that doctors were given."
Her role in the forum includes developing ideas, promoting the site, responding to posts, helping nurses feel supported and setting the framework for the final report. "Nurses also feel the lack of nursing leadership in preparations for and ongoing management of the pandemic," Brown said. Brown said she is surprised at the specificity of nurses' concerns.
"Different workplaces seemed to have very different rules about PPE, taking care of COVID+ patients, wearing N95 respirators, or even having N95 respirators available," Brown said. "These differences reflect the leadership vacuum at the top."
The forum is revealing inconsistencies from government down to the bedside. For example, several nurses have commented that the CDC is constantly changing its guidelines, sometimes based on what equipment is available. "The CDC should always be giving guidance based on the ideal," Brown said. "They can supplement that with ways to cope outside the ideal, such as in light of equipment shortages. But the ideal should always be considered the goal. However, no one is consistently being the voice of the ideal and that is a problem for all front-line staff."
Nurses from all walks can join
The forum is open to all nurses. "We'd really be interested in hearing from a diverse group of nurses in different environments because I'm sure the issues are a little different depending on their roles," Rushton said. "Yet, there are probably some similarities as well." It's easy for nurses to join. Once enrolled, they can post comments or comment on other people's posts. They also can flag their favorite topics. Regardless of how they participate, nurses should feel safe about speaking freely.
"I think there is a hesitancy for some nurses to feel they could post without worries about retribution from their organizations," Rushton said. "That's part of the reason we really wanted to limit this to nurses, so they can share honestly."
Nurses don't have to use their full names on their posts. "We really want this to be a resource for people but also a call to action," Rushton said. "We're hoping our front-line folks will help shape that direction," The crowdsourcing phase of the forum will last through the Covid-19 pandemic crisis. An algorithm will help identify "crisis leaders" from the online conversations. Those nurses will work with the forum's moderator to shape important ideas for a "Never Again" report. The report will be published by the American Journal of Nursing and distributed by the John Hopkins School of Nursing. "Collecting nurse voices in this forum is key to creating a unique document with solutions based on nurses' insights," Brown said. "One nurse said we need 'less data capture and more thinking' and the goal of the WikiWisdom forum is to incorporate the flavor of that idea. The stories that nurses tell are powerful -- I know that from my own writing -- and this forum is an opportunity to use that power to better prepare us for the next time. I believe there will be a next time and we want to do everything we can to keep nurses, physicians and patients as safe as possible."
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