Look to nurses to help accelerate the transformation of health care

The chaos and crisis of the Covid-19 pandemic have forced remarkable transformations in the U.S. health care system. Nurses — as they have done in public health emergencies from the frontlines of war to the frontlines of deadly infectious diseases like tuberculosis, HIV/AIDS and Ebola — have been innovators in helping reshape clinical practice throughout the Covid-19 response.

From the use of virtual and augmented reality to accelerate the training of nursing students to chief nursing officers stepping up to lead interdisciplinary teams dedicated to the Covid-19 response, new and established approaches have surged to meet rapidly shifting needs in health care.

While everyone longs for a restoration of pre-Covid life, a return to business as usual would be a misstep for nursing and for U.S. health care.

One clear takeaway from the pandemic so far is that it has unlocked new momentum in the delivery of care to patients, with notable advancements powered by nurses. Examples include nurse-led command centers that deploy health system resources to treat patients more effectively, creative partnerships that connect homebound individuals to highly trained health practitioners, tighter collaborations between points of care and the academic institutions that prepare nurses to practice, and more.

Quantifying the effects of these developments thoughtfully and rigorously can ensure that adequate investments continue to propel solutions that have positive effects on health well beyond the pandemic. Capturing the new momentum unbottled during the past two years and felt throughout health care is important as well.

Our organizations — Johnson & Johnson (L.B.), the American Nurses Association (D.H.) and the American Organization for Nursing Leadership (R.B.) — joined forces to better understand the advances nurses led during the pandemic, the factors that made this progress possible, and their public health impacts. To do this, we polled 4,000 health care professionals and members of the general public in mid-2020 to evaluate the myriad effects of Covid-19 on nursing, and this year captured the individual experiences and perspectives of nurses across disciplines and health care systems.

The findings of the quantitative and qualitative explorations present a clear roadmap for health system leaders, policymakers, academics, community organizers, and nurses themselves to build on the nurse-led advancements of recent months. The qualitative portion, in particular, concludes that the following steps forward are crucial:

Identify the gaps and appoint nurse leaders today. Appointing nurses to leadership positions — executive teams, operations committees, boards, and the like — is one key to ensuring that their perspective is heard and their pragmatic and innovative solutions are fully leveraged. Putting in place chief nursing informatics officer (CNIO) and other health IT positions for nurses will help infuse effective technology into health systems and improve efficiency. Software enables CNIOs to foster a culture of data-based decision-making to optimize care delivery during the pandemic and beyond.

Emily Barey, the vice president for nursing at Epic, the nation’s largest electronic health record vendor, noted that “it’s one thing to decide that not all Covid-positive patients will be admitted and some will be remotely monitored at home, but it is another thing to actually develop a highly reliable and safe workflow, map the handoffs, determine what technology could help, train clinicians, and measure the impact.” Nurses not only facilitate these crucial decision processes, but also sit at the center of their implementation.

Grow the pipeline of new nurses. Building a nursing workforce for tomorrow’s needs should involve planning at the national level. Broader educational opportunities outside of traditional acute-care settings, as well as diversified continuing education, will help create more professional pathways for nurses, fill the expanding roles nurses will play across the health care continuum, bolster their skills, and reduce attrition. Nurses of many backgrounds, demographic identities, and skill sets are increasingly essential to meet the dynamic health needs of the U.S., now and into the future.

Embrace nurse-led experimentation within health systems. Nurses are often innovators of new products, technologies, and care models because of their proximity to patients and intimate knowledge of common clinical challenges. Adopting heightened risk tolerance can fuel “fail fast” pilots that lead to new models of care. A spirit of innovation must be actively infused in health systems: C-suites should commit to pilot-driven cultures in their organizations and to nurse-led solutions that can be embraced by creating clear, actionable processes through which nurses’ ideas are submitted to a team for vetting.

A good example of such a system in action is the Center for Innovations in Care Delivery at Massachusetts General Hospital in Boston, in which nurses played central roles in developing and testing products and processes. Health care systems should publish case studies detailing which tested models have and have not worked.

Rethink systems and policies that hinder community-level access to care. To expand access and reduce health-based inequities, health care providers must meet patients where they are. This means embracing and intensifying the kinds of initiatives that empowered nurses to develop and deliver care at the curbside and through community centers, schools, or retail partners during the pandemic. This should also translate into wider adoption of modern tools, like virtual health, digital “front doors,” community and mobile health sites, and more — along with the reimbursement structures and scope of practice regulations in nursing that underpin patient access. During the pandemic, 20 states instituted waivers that expanded nurses’ scope of practice. As of July 2021, 15 of those states have kept those waivers in place, while five states have let them expire.

Atrium Health, headquartered in Charlotte, North Carolina, used a federal government waiver issued during the pandemic to quickly ramp up a virtual hospital that expanded its reach to patients in need. Led by one of the health system’s chief nursing executives, this virtual installation has served more than 40,000 patients since its inception, helping bring treatment to individuals “displaced” from traditional health care pathways by Covid-19.

The decade ahead will be defined by the U.S.’s ability to address issues like ongoing disparities in health care, access to care within communities, and uneven adoption of health technologies such as telehealth, electronic health records, patient portals, and the like with the same urgency, resourcefulness and innovation we’ve applied during the Covid-19 crisis. Nurses are at the center of these efforts. Let’s prioritize, preserve, and accelerate nurse-led advancement which, in turn, will support outcomes, drive new care models, and help build a more equitable health care system as we work toward a “new normal.”

Lynda Benton is the senior director and lead for Johnson & Johnson Nursing. Robyn Begley is a registered nurse and chief executive officer of the American Organization for Nursing Leadership. Debbie Hatmaker is a registered nurse and chief nursing officer of the American Nurses Association.