"In his first days in office, President Biden has shown us that he is listening to the concerns and the expertise of nurses by taking immediate action on the worker health and safety protections and broader public health protections that we have been demanding," Castillo said.
"We are particularly pleased that the president signed strong executive orders to protect worker health and safety and to improve the medical supply chain," she said.
Biden has promised to use the Defense Production Act to ramp up personal protective equipment supplies and restore national stockpiles, along with doubling the number of drive-through testing sites, creating a national pandemic testing board, and investing $25 billion in COVID-19 vaccine distribution.
In addition to the executive orders on worker health and safety and the medical supply chain, NNU pointed to critical and necessary measures in additional executive orders and actions signed by the president in his first weeks in office. These include commitments to:
Provide paid sick and family leave and extend this leave to more workers, including the removal of the healthcare worker exemption. Nurses and other healthcare workers have not been eligible for the paid sick and family leave that Congress passed last spring.
Increase federal support to increase healthcare capacity and respond to surge situations.
"Nurses have been on the front lines of this pandemic since it began," Castillo said. "For nearly a year, we have been exhausted both physically and emotionally, and consistently and unnecessarily put at risk at work. Hundreds of nurses have died due to lack of protections at work. The actions that President Biden has taken … have given us relief and hope after a traumatic year. We're ready to get to work to make this COVID-19 response plan a reality."
Clinical collaboration is beneficial for the patient, staff, and the organization.
Elevated emphasis on patient-centered care has brought an increased awareness of teamwork in healthcare, and the chief nursing officer (CNO) plays a critical role in establishing and maintaining an effective teamwork culture, one nurse leader says.
Research has shown that teamwork in healthcare—good communication, inclusivity, and awareness of other team members' responsibilities—leads to higher job satisfaction, better patient outcomes, reduced turnover, decreased healthcare costs, and, particularly in the current pandemic environment, less burnout.
"Effective teamwork occurs when all members of the team are bringing their best efforts and have the flexibility to use their expertise to achieve a common goal," Thomas says. "The hallmarks of effective teams—from players on a soccer field to the multiple disciplinary professionals in the ICU—is mutual respect and communication."
Some of the best teamwork examples she's seen include use of pastoral care in the ICU to lead discussions with families about a patient’s end of life; nurse practitioner (NP) school-based health centers where integrated behavioral health, dental, and primary care are all delivered in one setting; and senior care clinics where pharmacists meet with patients to co-manage medications, spot interactions, and discuss side effects along with the patients’ primary care nurse practitioner or physician.
Solid, effective teamwork is beneficial for the patient, clinical staff, and the organization as a whole, Thomas says.
The patient
"When deployed effectively, patient-centered, team-based care can lead to improved care coordination, increased patient/family engagement in care, improved outcomes, and decreased healthcare costs," Thomas says. "By integrating providers onto a care team who have relevant expertise to the patient’s needs, the patient benefits from more targeted and efficient healthcare delivery."
For example, a patient with complications from type 2 diabetes might benefit from the integration of a nutritionist onto the team to support healthful eating while a primary care provider manages the patient's medication and primary care needs, an ophthalmologist addresses ocular health, and a podiatrist ensures foot health and monitors for nerve damage.
"We need to do away with outdated care models, and [we need to] support efforts that put patients at the center of the team," she says. "This includes supporting teams that respect the perspectives and expertise of clinicians and other professionals most relevant to the patient’s health. With this kind of thinking, we can deliver culturally competent care that addresses the real needs of patients, while allowing NPs and nurses to strengthen patient outcomes and access to care."
Clinical staff
For clinical staff, effective teamwork brings increased job satisfaction and, particularly in the current environment, reduced incidence of provider burnout, Thomas says.
"When clinicians are working within a well-coordinated and multidisciplinary team, they have strong lines of communication with other healthcare professionals, mutual accountability for shared clinical outcomes, and a network of support," she says. "These are the ingredients that improve job satisfaction, which reduces burnout and—most importantly—delivers strong outcomes for patients."
Burnout is a major issue for clinicians nationwide; a pre-COVID-19 report by the National Academy of Medicine shows that 35%-54% of bedside nurses and physicians experience severe symptoms of burnout. The added burden of COVID-19 has created even more of a burnout crisis.
Effective teamwork can counterbalance burnout rates, Thomas says.
"Studies have shown that when providers are working in environments that support their ability to speak up about challenges, have their viewpoints and concerns acknowledged and acted on, are respected as equal partners in the care of patients, and are authorized to bring their full complement of knowledge and skill to their patient care, burnout risk is lessened," she says.
The organization
At the organizational level, integrated, multidisciplinary care teams can result in less staff turnover, higher patient outcome and patient-satisfaction scores, and increased provider investment in overall patient outcomes that lead to improved care, she says.
"An example shared by one of our members was related to orthopedic joint replacement," Thomas says. "Instead of each clinician focused only on their task—the surgery, the physical therapy, the wound care—the team took overall accountability for joint health, recovery, and infection prevention. The rates of complications and lengths of stay decreased, and patient outcomes improved."
Matching the team to the care is important, she says. "Not every element of care requires a multidisciplinary team," she says, "but incorporating core principles of teamwork can apply to cross-systems care and care transfers, too."
Actions outside of hospital walls also are supporting teamwork in healthcare settings, such as the growing number of states—of which Massachusetts is the latest—that allow NPs to practice independently.
"I was on a call recently with NP leaders from Minnesota and Nevada who have had full practice authority for nearly a decade. Each shared how the flexibility under full practice authority created added opportunities and how the removal of bureaucratic links made way for more meaningful communication, coordination, and referral," she says. "By adopting full practice authority, Massachusetts joins a growing list of states that encourages all of its clinicians to work to the top of their profession, creating teams that are built to put patients—not a subset of clinicians—first."
Breaking down silos
In recent years, many in the healthcare industry have called for an increase in teamwork and a breakdown of traditional professional silos. Nurses, and other healthcare workers, dealing with the COVID-19 crisis helped break down those silos through necessity.
"It's changed the whole notion of what 'type' of nurse you are. The whole specialty aspect went out the door," she says. "During COVID, if you were an ambulatory nurse, you would help [with] inpatient care. If you were with the Department of Defense—Army, Navy, Air Force—they came to help inpatient. If you were a Department of Education nurse, like a school nurse, you came, and you helped. I think it changed the whole notion of, 'That's that type of nurse, or they work over there.' I think it's solidified the fact that we're all one profession. Although you have to socially distance, we've become closer than we've ever been."
Thomas echoes this sentiment.
"One commonality I've found in all my conversations is an unprecedented sense of comradery and unity among all healthcare providers, which has been nice to see," she says. "Another one that's been welcomed is the increased level of incredible innovation and cooperation among the providers throughout the COVID response."
For example, NPs went to help in New York when Gov. Andrew Cuomo signed an executive order that allowed them to practice without a collaborative practice agreement.
"We immediately had 4,000 nurse practitioners go for temporary assignments in New York, and as they care for patients, they share critical information about the virus," Thomas says. "The information sharing has allowed NPs in all the types of care settings to better respond to COVID cases, whether they experienced an uptick or not."
Under the new program, newly licensed FNPs will receive post-graduate training at community health centers across Los Angeles.
The FNP residency program is designed specifically for community health centers, directing added high-quality healthcare to more underserved populations in Los Angeles County.
FNPs are educated to offer primary healthcare services to patients of all ages, addressing a wide variety of illnesses and injuries, as well as overall wellness. FNPs operate at a higher level of autonomy, and do not require the supervision of a physician. NPs can pursue many different specialties, and about two-thirds of aspiring nurse practitioners earn certification as FNPs, according to American Association of Nurse Practitioners data.
California is undergoing a major shortage of primary care physicians, according to the California Health Care Foundation, so CCALAC, which serves about 1.7 million patients, most of whom live below the poverty line, partnered with Cal State LA to develop a pipeline program specifically designed for community health centers. CFIN, which serves as a center for nursing excellence, also places an emphasis on caring for diverse, underserved urban populations.
The 8-month program, only the second FNP program in Los Angeles County, provides intensive training and on-the-job experience to FNP residents, while supporting the needs of health centers and their patients, according to a press release.
The inaugural program cohort of nine residents is training at five community health centers in Los Angeles, including Via Care Community Health Center, where Deborah Villar is CEO.
"FNPs are essential to our community clinic model," Villar said. "Along with helping meet the demand for healthcare services for low-income families in East Los Angeles, our family nurse practitioners assess not only the physical aspects of patient care, but also the mental and psychosocial needs as well. This is especially important for our patients that often face poverty and violence in addition to poor health."
Residents are recent graduates of Columbia University School of Nursing, North Park University in Chicago, Azusa Pacific University, Sonoma State, Johns Hopkins University, UCLA, UC San Francisco School of Nursing, and Cal State LA. All are licensed FNPs who hold master's or doctorate degrees in nursing and additional certification beyond a regular nursing degree.
Once the program is complete in August, clinics may extend an employment offer to residents.
"This is a win-win situation," said Louise McCarthy, CCALAC president and CEO. "We set new FNPs up for success and create a pipeline of qualified primary care providers within the community health center setting."
Study also calculated how many hours nurses must work to afford their rent.
Nurses in Hawaii are the best-paid in their profession, according to a comparison conducted by Business.org.
Aloha State nurses make an average of $104,060, putting them at 89% more than the average wage for all other occupations, topping the list of the best-paying states for nurses in 2021.
Washington, D.C., ranks last on the list, where nurses, with an average salary of $94,820, make just 5.6% more than the city’s average salary.
Over 2.9 million nurses work in the United States, making an average salary of $77,460 annually, according to the most recent numbers from the U.S. Bureau of Labor Statistics. That salary is 45% more than the average salary for all other occupations across the country. Nurses in 15 states make more than the national average.
The study compared the average nursing salary to the average income in each state to find the percentage difference, and calculated how many hours nurses need to work to afford their rent.
Nationally, nurses work an average of 29.5 hours to be able to afford a month’s rent. The national average income requires 42.7 hours of work to afford rent, which means nursing requires 13.2 hours less of work than the average occupation to afford rent every month.
California pays the highest wage per hour for nurses, at $54.44, but comes in third in the rankings, with an average nursing salary of $113,240, putting nurses at 84.8% more than the average wage for all other occupations.
South Dakota has the lowest wage per hour for nurses at $28.63—which is nearly half what they make in California. Nurses in the Mount Rushmore State average an annual salary of $59,540, placing them at 38.7% more than the average wage for all other occupations. It comes in 30th in the rankings.
Of the 267 study participants, nearly 70 were registered and advanced practice nurses, along with resident physicians, resident chaplains, attending physicians, medical center faculty, and hospital administrative/managerial clinical staff at The Ohio State Wexner Medical Center.
Participants demonstrated a significant 27% reduction in burnout after completing the Mindfulness in Motion program, and resilience significantly increased while perceived stress decreased, said Maryanna Klatt, PhD, lead researcher and a professor in the department of family and community medicine at Ohio State.
"Our study shows that when an organization invests preventively in a program like Mindfulness in Motion for any faculty and staff, it makes a real difference when a crisis like an unexpected pandemic happens," Klatt said.
Because burnout affects physical, social, and mental well-being, the effects of reducing it for frontline healthcare providers can impact patient care. Therefore, reducing burnout and perceived stress, while increasing resilience for healthcare providers, is important.
A mindfulness program has been in place at Wexner Medical Center for decades, said Beth Steinberg, associate chief nursing officer, critical care and emergency services at Wexner, who implemented the program in surgical intensive care and neonatal ICU and who was a researcher involved in the study.
But COVID-19 required the program to adjust to the challenging circumstances, Steinberg said.
"We had to figure out very quickly how to get to people who couldn't get off the unit anymore, who couldn't take an hour to do this mindfulness program once a week," Steinberg said, "so Maryanna developed five-minute mindfulness bits that people could listen to on their phones, they could listen to as they came into work, and they could listen to on a break."
Many nurse managers at the organization also have implemented these videos during morning or shift-change huddles, she said.
Since then, Klatt also has developed two-minute audio messages.
Implementing a mindfulness program is imperative to healthcare staff’s mental health, Steinberg said.
"There are a number of online programs that are out there now … that will allow folks the ability to just step outside themselves for a minute, to be able to think, and to understand what's happening," she said.
"I think nurse leaders have to understand that we can't afford not to give our providers, our nurses, [and] our caregivers back some time to take care of themselves," Steinberg said. "The time it takes to give people back a little bit of their mental health is going to be well worth it."
While there is much research on individual changes that mindfulness programming can achieve, the Ohio research differs in that the study focused on an organizationally sponsored program.
Organizational buy-in likely helps account for the program's success, Klatt said.
"When someone feels that their employer is invested in them and cares about them, good things happen," she said. "Mindfulness is important on both the organizational and the individual level."
The next step for this research will be a pilot study with the Ohio Hospital Association in 2021 to train other hospitals to use Mindfulness in Motion.
Editor's note: This story was updated on January 18 at 1:46 p.m.
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