A nurse practitioner survey sheds light on how NPs have dealt with balancing the pandemic’s impact and their patients’ everyday needs.
More than 80% of nurse practitioners who responded to a recent nurse practitioner survey by the American Association of Nurse Practitioner (AANP) said their practices are better prepared to deal with the COVID-19 pandemic than when it started.
Nurse Practitioner Survey Points to Struggles
About one-third of the approximately 4,000 NPs who responded to the AANP nurse practitioner survey between July 28 and August 9, 2020, report their practices are ready for surges in COVID-19 cases. The AANP’s most recent survey data suggests 86% of NP practices are able to accommodate patients for non-COVID-19-related, in-person care.
Even access to personal protective equipment (PPE) and viral testing appear to be more readily available than early in the pandemic, according to the AANP. But nearly 80% of those surveyed cite delays in COVID-19 testing results, which is a barrier to their implementing effective local pandemic responses.
Another potential concern is more NPs report they are testing positive for COVID-19. In an earlier AANP survey conducted in May, less than 2% of NPs said they had tested positive for the virus. In the latest survey, the percentage that tested positive rose to 5%.
And while lack of PPE is not as much of a concern as in May, about 18% of NPs still say they do not have the necessary PPE.
Nearly 17% of NPs were furloughed in the pandemic’s beginning and while the majority have returned to work, 4% were still furloughed at the end of July, 3% were laid off or terminated and 1% had closed their practices.
NPs listed the most beneficial changes impacting their ability to care for COVID-19 and other patients as federal telehealth waivers, expansions to services covered, and reimbursement rate increases.
According to the nurse practitioner survey executive summary, NPs report “…the most important activities over the next six months will be funding for COVID-19 research (87%), continued investment in vaccine development (84%), and additional funding for healthcare providers and support staff (84%).”
To gain insight on what individual NPs are experiencing, we asked NPs in different roles and places in the U.S. what’s going on in their practices and going through their minds.
Elda Ramirez, PhD, RN, FNP-BC, ENP-C
Elda Ramirez, Professor of Clinical Nursing at the University of Texas Cizik School of Nursing in Houston, and an emergency NP in multiple emergency room facilities in the city, said she hasn’t experienced PPE shortages.
“Interestingly, in my setting there was lots of PPE,” Ramirez said. “We were very well prepared in Texas.”
She said the issue of COVID-19 testing hasn’t impacted her practice, either.
“I have to assume that any patient can be COVID-19 positive,” Ramirez said. “I have to [assume that] to protect myself and to protect them. It doesn’t matter if they’re COVID-19 positive or not. I’m going to care for them all. In caring for patients, we learn to adapt and mold ourselves to whatever those patients need.”
Working the front lines during pandemics and other disasters is nothing new to nurses. Ramirez said she worked through Hurricane Katrina and Hurricane Harvey and was a new nurse in the era of the human immunodeficiency virus (HIV), working in a hospital that catered to HIV patients.
Nurse mentors taught Ramirez back then how to safely care for HIV patients in much the same way that nurses care for COVID-19 patients today.
“This is what my nursing instructors taught me: ‘Elda, there’s this bug out there. We really don’t understand it, but we know that we have to wear protection,’” she said.
Stacia Hays, DNP, CPNP-PC, CNE, FAANP
Stacia Hays is a Pediatric NP in Gainesville, Fla. She is responsible for overseeing the pediatric NP program at the University of Florida College of Nursing and practices at a federally designated rural health clinic outside of Gainesville, in the town of Archer. Four NPs staff the clinic, which is run by the University of Florida.
By mid-spring, Hays said, patient visits started to drop.
“On the adult side, a lot of our patients with chronic illnesses weren’t coming in,” she said. “They were really scared. On the pediatric side, parents were really worried about bringing their healthy kids in for their well visits and for the immunizations.”
The fear caused a drop in peds visits. “March and April weren’t too bad, but starting in May, we saw those numbers plummet,” said Hays.
Regular patients started coming back to the clinic in early July. The clinic staff takes each opportunity with patients to provide education and reassurance that they’ll be there if patients need them, she said. But they also are using telehealth more often, Hays said.
Still, telehealth can be challenging in rural populations. Not everyone has internet access, for example.
Hays said during the first few months of the pandemic PPE was available, but supply was limited.
“We were only given a certain number of N95 masks and regular masks, so we’ve had to use those sparingly and reuse them,” she said. “We really didn’t have a way to replenish any kind of gowns, so we haven’t been using them.”
COVID-19 testing was available but a bit disorganized, according to Hays. And getting to testing, even if it’s reasonably close for most people can be challenging for those in rural areas, she said.
“We decided not to be a testing center because when this all started, if one of your patients tested positive, your whole clinic had to be shut down for two weeks,” Hays said. “Everybody had to be on quarantine. In a rural population, we’re the only care that people can get for 15 to 20 miles. That was a huge risk for our patients.”
Workplace exposure isn’t a concern for Hays, who said she has taken care of patients in isolation since graduating as a pediatric nurse in 1993 and has never contracted what her patients have had.
And she believes “re-imagined opportunities” will arise for nurses post-pandemic.
“Now we have permission to really stretch and be innovative and think outside the box,” she said. “Before, I think nursing as a whole was kind of ‘Yeah, you can be innovative but we want you to stay in these parameters.’ Now the doors are wide open and we are expected to step out. Now politicians and legislators and community leaders are all looking to us to lead because we’ve been there. To me, that’s really exciting.”
Robin Arends, DNP, CNP, FNP-BC, CNE, FAANP
Robin Arends, an NP based in rural Sioux Falls, S.D., works at Avera eCARE as a telehealth provider for residents at long-term care facilities. Her job is tailor-made for a pandemic, and business is brisk because of the increased need for virtual solutions.
Telehealth became vitally important during the pandemic for keeping residents in nursing home facilities and out of hospitals, where they might be exposed. Another important goal with telehealth has been to limit the number of people going into nursing homes to deliver care, according to Arends.
“[During the height of the pandemic] we saw a lot of acute conditions,” Arends said. “We have maintained a high number of people that we’re seeing in telehealth. We’re even providing backup care remotely, monitoring vital signs [and more] from afar and alerting nursing staff and intervening a little faster, so we’re able to prevent negative consequences.”
Telehealth is a much-needed service line into facilities like long-term and acute care, she said.
“We’re seeing how telehealth can really help during a pandemic,” Arends said. “You can do a lot of the care virtually. We’re listening to the heart, looking at the ears, we can do a very thorough assessment remotely with the telehealth equipment. Then, we’re ordering diagnostics, interpreting them, and treating patients while keeping those high-risk individuals safe and in their environment.”
The NPs and other providers at Avera eCARE work virtually alongside on-site long-term care nurses.
“We don’t take over,” Arends said. “We work in collaboration with them, so we have a very strong network where we’re working with the facility nurses, our nurses, the patient’s primary care provider, and any specialists they may have on the case.”