Report calls for broader scope of practice for nurses, better support for equity, mental health

Hospital Administration

The COVID-19 pandemic spurred massive disruptions to the economy and labor market that have yet to abate. It also particularly underscored the plight of workers in one of the widest-held occupations in the country nurses.

Over the past year, those on the front lines have reported increasing rates of burnout, declining mental health and distrust and disengagement from the organizations employing them. Some are considering leaving their roles for jobs not involved in direct patient care or retiring.

But demand for nurses will only grow, and so will the demands of the job, according to a report published Tuesday from the National Academy of Medicine and Robert Wood Johnson Foundation. They face a population that’s both aging and seeing increasing behavioral and mental health conditions, and in the workplace will likely help tackle health care policy and equity issues.

For the profession to meet the needs of the population over the next decade, a substantial increase in the amount, type and distribution of nurses across geographic areas, specialties and care settings is needed, the report’s authors argued.

To ensure an adequate nursing workforce, here are the key initiatives recommended that nursing schools, employers and policymakers adopt:

Permanently broaden scope of practice

The pandemic spurred a number of states to temporary roll back restrictions for nurse practitioners  who typically work in primary care settings — allowing them to prescribe medications, diagnose patients and provide treatment without the presence of a physician.

Permanently granting full practice authority to nurse practitioners across the U.S. would eliminate a key barrier affecting workforce capacity, according to the report.

Full practice authority is already allowed in 23 states and the District of Columbia. Eight states rolled back their restrictions during the pandemic and some are moving to making the changes permanent.

The committee in charge of the report recommended all changes to institutional policies and state and federal laws adopted in response to the pandemic that expanded scope of practice, telehealth eligibility, insurance coverage and payment parity be made permanent by 2022.

Until all nurses are permitted to practice to the full extent of their education and training, we will continue to see significant and preventable gaps in access to care,” Regina Cunningham, CEO of Hospital of the University of Pennsylvania, said Tuesday during a webinar discussing the report.

“Since government leaders concluded that removing these restrictions was beneficial in expanding the public’s access to care during the pandemic, it seems counterproductive to reimpose those barriers,” Cunningham said.

Strengthen education and equity

Nurses with a bachelor’s and doctorate degrees are in particular need, along with those in certain specialties with existing shortages, such as primary care, long-term care, behavioral health and public and community health, the report found.

That’s in part because nursing education programs have traditionally emphasized training for care in hospitals rather than other settings. Those programs should increase their coursework and hands-on experience for students in community settings, primary care facilities, rural health clinics and other similar, smaller points of care.

Nursing programs should also familiarize students with the technology that will likely be embedded in their practice in the coming decade through training on new tools including telehealth and AI.

Effectively preparing students for the challenges they’ll face regarding health equity, racial disparities and social determinants of health is also crucial, as is building a diverse nursing workforce.

Nursing roles are overwhelmingly held by women, and faculty in nursing programs are overwhelmingly white and female. The workforce must better reflect the populations it serves, and has a long way to go. Leadership can play an important role in acknowledging the history of discrimination and implicit bias in healthcare, and its crucial those higher-up roles are increasingly held by nurses of diverse backgrounds, the report’s authors noted.

Promote, track and manage mental health and well-being

Numerous reports have shown an uptick in burnout and mental health issues among nurses throughout the pandemic. In the future, they’re expected to face more health and social justice issues in the workplace that will make their jobs even more emotionally taxing, according to the report.

Nurses from underrepresented groups also reported facing a “diversity tax” — characterized as being asked to serve on diversity committees and other activities that are often uncompensated and unrewarded. Those demands can worsen burnout, and equity initiatives shouldn’t be treated as separate from everyday work activities and responsibilities, the report said.

In order to support their current and future workforce, employers have to provide adequate space and support — something they haven’t excelled at.

In an April survey from the Kaiser Family Foundation and Washington Post, 60% of front-line healthcare worker respondents said the pandemic has negatively impacted their mental health. Some 18% said they needed mental health services or medication but didn’t get them. Many cited being too busy or unable to get time off work, feeling afraid or embarrassed or not being able to afford it.

“Policy makers, employers of nurses, nursing schools, nurse leaders, and nursing associations all have a role to play to this end,” according to the report.

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