New study illustrates the 'dramatic success' of the coronavirus vaccine early rollout, researcher says.

Nearly 140,000 deaths and 3 million cases of COVID-19 were averted in the first five months of the vaccination campaign in the United States, a new study says.

The 50 states and Washington, D.C., experienced an average of five fewer deaths from COVID-19 per 10,000 adult residents as a result of early vaccination efforts through May 9, according to the study. Adjusting for population size, New York saw the largest estimated reduction, with 11.7 fewer COVID-19 deaths per 10,000 adult residents.

The study, published online by the journal Health Affairs, is one of the first to assess the impacts of state-level vaccination campaigns to address the COVID-19 pandemic, according to a press release from RAND, a nonprofit research organization that, along with Indiana University researchers, conducted the study.

"This study brings into focus the dramatic success of the early months of the nation's coronavirus vaccine rollout," Christopher Whaley, senior author of the study and a policy researcher at RAND, said in the release.

"The findings provide support for policies that further expand vaccine administration to enable a larger proportion of the nation’s population to benefit," he said.

The pandemic has caused enormous suffering and more than 600,000 deaths in the U.S.—and more than 4 million worldwide.

While access to and use of vaccines has varied substantially across states and sub-populations during early stages of the U.S. vaccine campaign, COVID-19 case numbers and deaths have fallen sharply since vaccination programs began.

Researchers from RAND and Indiana University created models to estimate the number of COVID-19 deaths that would have occurred in the absence of vaccinations.

By the week May 9, 2021, about 550,000 people had died of COVID-19 in the US. Researchers determined that, without the vaccinations, that number would have reached 709,000, the study says.

"Our study suggests that without the vaccinations of early 2021, the cumulative number of COVID-19 deaths in the U.S. would have been nearly 1.2 times higher than their current level," researchers said.

The economic value of the lives saved during the study period is estimated to be between $625 billion and $1.4 trillion. Through the end of 2020, the U.S. federal government had allocated $13 billion dollars for vaccine development and manufacturing.

"Our results suggest that further efforts to vaccinate populations globally and in a coordinated fashion will be critical to achieving greater control of the COVID-19 pandemic," said Sumedha Gupta, first author of the study and an economist at Indiana University-Purdue University Indianapolis.

Physicians charge the newly named American Association of Nurse Anesthesiology is 'title misappropriation.'

The American Society of Anesthesiologists' (ASA) claims that the American Association of Nurse Anesthesiology's (AANA) recent name change is "deceptive" and "title misappropriation" is unnecessarily creating turmoil within the industry at a time when they all should be working together, the nurse group says.

"The notion of being pushed by the American Society of Anesthesiologists that rebranding and changing the name of the AANA will somehow mislead or harm patients or create discord among providers is absurd at best and false and inflammatory fearmongering at worst," the AANA said in a prepared statement.

The name change is part of a yearlong rebranding effort to advance the science of nurse anesthesiology and advocate for Certified Registered Nurse Anesthetists (CRNAs), the AANA said in announcing the change.

"Our new name tells the story of who we are, what we do, and what we stand for," said AANA president Steven M. Sertich, CRNA, MAE, JD, Esquire.

But the name change from the American Association of Nurse Anesthetists, which went into effect August 14, ultimately risks patient safety, the ASA charged in a press release condemning the move.

"Many physician anesthesiologists value our nurse anesthetist colleagues and the important work all of us do together every day. We also know nurse anesthetists value and recognize the importance of our physician-led, team-based model of care—a model ASA is dedicated to preserve and enhance along with our shared commitment to patients," said ASA president Beverly K. Philip, MD, FACA, FASA.

"AANA's title misappropriation is a deceptive use of established medical terms and is part of their continuing push for nurse-only practice, which can jeopardize our patients’ safety and well-being," she said. "It also misleads the public and engages in the pretense that nurse anesthetists' education and training are equivalent to that of physicians."

Throughout the medical and nursing communities and certifying boards, “anesthesiology” and “anesthesiologist” are accepted as the terms for a medical specialty and a medical physician, according to the ASA, which laid out several examples, including:

• ASA, the American Board of Anesthesiology, the American Board of Medical Specialties, and the American Medical Association affirm that anesthesiology is a medical specialty and professionals who refer to themselves as “anesthesiologists” must hold a license to practice medicine.
• The New Hampshire Supreme Court upheld a ruling in March 2021 by the New Hampshire Board of Medicine to limit the use of the term “anesthesiologist” to individuals licensed to practice medicine.
• The Council on Accreditation of Nurse Anesthesia Educational Programs defines “anesthesiologist” as a doctor of medicine (MD) or doctor of osteopathy (DO) who has successfully completed an approved anesthesiology residency program.

But as advanced practice nurses, CRNAs practice in every setting in which anesthesia is delivered and are the primary providers of anesthesia care in rural and medically underserved areas, according to the AANA.

As with other advanced practice nurses, CRNAs have expanded the nation's critical care workforce, particularly during the COVID-19 pandemic.

"As advanced practice nurses, CRNAs are proud to be part of America’s most trusted profession—they do not equate or present themselves as physicians. When anesthesia is administered by a nurse, it is recognized as the practice of nursing," the AANA statement said.

"Far from adding confusion, the new name, American Association of Nurse Anesthesiology, brings clarity to who CRNAs are, what they do, and their vital role in America’s healthcare system," according to the statement. "It accurately and strongly communicates that the AANA represents members of the nursing profession who provide anesthesia and are experts in anesthesiology."

More healthcare pay research could 'better inform public opinion' around policies and spending, public policy expert says.

Most Americans believe nurses and healthcare aides are underpaid, according to a new study about the public's attitude toward healthcare and its workers.

In contrast, only 11% of Americans think doctors are underpaid, while about half say they are paid the right amount, according to the study from the University of Chicago Harris School of Public Policy and The Associated Press-NORC Center for Public Affairs Research. Most of the country also thinks physical therapists and pharmacists are paid appropriately.

Nurses earn an average of $80,010, according to the U.S. Bureau of Labor Statistics, while healthcare aides' average earnings are $25,330.

"Most of the public clearly believes doctors are paid about the right amount or are overpaid, but many Americans don't have an accurate sense of doctors' salaries," Joshua Gottlieb, an associate professor at Harris Public Policy, said in a press release. "More research on healthcare workers' pay could better inform public opinion around healthcare policies, spending, and the government's role in shaping contemporary labor markets."

Americans' views of the Affordable Care Act (ACA), a single-payer system, and a government-provided public option for healthcare have not shifted significantly since the COVID-19 pandemic began.

ACA supporters are more likely to favor government funding to increase doctors' salaries—23% vs. 13%—than those who oppose it. Likewise, they are more likely to support funding to increase the number of doctors—73% vs. 42%.

Most Americans believe the ACA had no effect on the pay of doctors or nurses, but about one-third think the law created a windfall for hospital and insurance executives. They also think that both hospital and insurance executives are overpaid, and three-fourths of the public doesn’t trust hospital executives to do what is right for them and their families, the study said.

"The results show the usual partisan divides when it comes to the ACA and other major healthcare reform proposals but highlight a bipartisan consensus around the pay of healthcare workers," said Trevor Tompson, AP-NORC Center director. "These findings provide some evidence that policies designed to improve pay for nurses and healthcare aides or lower the salaries of executives could be popular with both Democrats and Republicans."

The study's other key findings include:

• Most Americans support increased government funding for lowering out-of-pocket costs for patients (74%) and for expanding government health insurance coverage for low-income people (59%).
• More than two-thirds of those who support a public option (69%) favor increasing the number of doctors, compared to 40% of those who oppose a public option.
• Nearly three-fourths of the public (72%) supports allowing the federal government and private insurance to negotiate for lower prescription drug prices.

Children's Minnesota has placed itself at the forefront of diversity, equity, and inclusion for the sake of its patients and staff, chief nursing officer says.

Long before COVID-19 revealed disparities in healthcare, Children's Minnesota in Minneapolis, Minnesota, had been working for more than five years to eradicate disparities by improving diversity, equity, and inclusion.

"This is not new for Children's Minnesota," says Caroline Njau, MBA, BSN, RN, NEA-BC, the hospital's chief nursing officer (CNO) and senior vice president of patient care services. "Our organization has taken a trendsetting approach to diversity, equity, and inclusion … so we can make healthcare better for every patient."

Being respectful of a patient's cultural, spiritual, and psychosocial values demonstrates cultural competency, enabling "healthcare workers to understand their patient's expectations about the care, treatment, and services they receive," according to a Joint Commission report on cultural diversity.

HealthLeaders talked with Njau about why diversity matters and how her hospital is embracing cultural competency.

This transcript has been edited for clarity and brevity.

HealthLeaders: From the patient's perspective, why is diversity in the healthcare setting so essential?

Caroline Njau: We serve people when they need us the most. Nobody plans to really be in a hospital setting or even in a clinic setting at any one point, and I think about the people that we serve, and how different our populations are. If you show up at a hospital setting, you look for a resemblance of what the world looks like to you. It's important to match the patient populations that we serve because it's an expectation.

If we have a child who we're caring for at Children's Minnesota that comes from a [particular] community, and we have a nurse who's similar or who is familiar [with] or of the same community, the time it takes to make a connection is significantly faster than if you have somebody who does not have this perspective.

It makes the overall care we provide much, much better; much, much more meaningful; and a better experience. That's why diversity matters.

HL: Can you give an example of how you're diversifying Children's Minnesota's nursing workforce?

Njau: One example is through our internship program. We have metrics that we've set on the internship program in which it needs to achieve a certain rate of diversity within the candidates. They end up becoming our future workforce as nurse[s].

HL: Why is diversity important to a hospital's nursing staff?

Njau: Diversifying is not just saying, "Let's go out there and get people." You have to get the right people who are qualified and equip them with the right skill sets to make sure they do a great job in providing safe, effective care that also matches the perspective and the experience of the community.

For nurses or any care member within the hospital setting to stay at Children's, there has to be something that they look forward to and a sense of belonging, especially now, when there are so many healthcare places. Back in the day, there was probably one hospital per county; now, we have hospitals and clinics everywhere and for somebody to choose to stay within our organization, the sense of belonging is even more important and that creates that retention factor.

The things we do internally to create an inclusive culture that fosters that belonging are as important as it is to diversify the workforce. That's how I look at it; it's a journey, not a destination.

HL: What are some of the unique backgrounds and experiences that should be included when a hospital or health system is working to create more diversity in its staff?

Njau: Diverse experiences are very important. As a nurse, or any provider, somebody here at Minnesota Children's might have practiced in a different setting than a pediatric setting, and by allowing that person to work in that position, they bring a different perspective.

I emphasize a lot on race. It's very important because people see that quickly and that's going to be one of the ways to really break the systematic racism that we have experienced for many, many years.

Diversity in education gives different perspectives. Nurses are prepared differently, and healthcare roles are prepared differently with different curriculums and that brings a richness to the care we provide.

Gender diversity is highly important, especially in a healthcare setting. We want to diversify by gender because there is a [patient] expectation that, "We'll see somebody who looks like me," from a gender perspective.

Now, our patients and our families have become more savvy; they look for those things. All those dimensions of diversity are critical in helping create a more robust experience for our patients.

HL: What are some of the risks that hospitals and health systems take when they lack diversity?

Njau: I see it a lot when you have homogenous societies where there isn't a different perspective and where you tend to not learn from others' experiences and continue to have the same way of thinking, the same culture—good or bad—and the same decision-making that might not propel the organization to keep making improvements.

It becomes more of a status quo—'this is just the way we do things,' 'this is the way things are always done,' 'this is who always makes the decisions,' 'we always look like this'—and that doesn't help propel improvement.

Accepting status quo really means that you do not see yourself as an organization that should be continually improving and that's why diversity is so important. Because that difference in perspective,  having multiple people look at things differently, propels a case for improvement, and that means that we continue to make healthcare even better.

HL: What should nursing schools be doing to bring a more diverse workforce into the healthcare system?

Njau: Looking at the pipelines where the nursing schools are getting their students. One thing that nursing schools should be doing is looking to partner with the K-12 education system, diversifying where we accept students from, and how we speak about the career to K-12 from a nursing perspective.

If your nursing college matches your [homogenous] city, you're not seeing the bigger world. It might mean that you look at a different community or county that is more diverse to try to see how you can bring in those students to your institution.

HL: How about nursing school curriculum? Are there ways to tackle disparities through nursing instruction?

Njau: Nurses have a big role to play in reducing disparities and preparation in nursing school helps make those improvements. The curriculum [has to] look at things differently.

If you look at a treatment, it may look similar, but to different communities and different groups, the outcomes look different. Let's talk about myself; there are medications that don't react very well with me compared to others. It doesn't mean that medication is wrong; it just means that there are other offerings that I could be offered that will make my care better.

In teaching those things in nursing school through the curriculum, [you ask,] what are the options, what are the questions you might ask to make sure that you're being effective and not just say, "Hey, here's a medication for you. It should work because it always worked." Let's talk about effectiveness from [each patient's] perspective.