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New Questions, More Questions, The Same Questions: How Covid - 19 is Impacting the Profession

      Alpha, Beta, Delta, and now the Mu variant continue to cloud how we will see past the grip the pandemic has on the public's health, safety, and economic stability. Variants create more questions. And while we are building a tool chest filled with knowledge, each time one variant spreads across a country, the path forward is never immediately clear. What remains certain for the profession— amongst this uncertainty— is that attention must be placed on investing in the nursing workforce. From supporting nurses’ physical, mental, and emotional health to considering education and training in the future, there is a need to refocus and seek more data. To find innovative solutions that will create a path forward for the profession, we must first start with the questions we will need to answer. From the Academy's lens, it comes back to our mission and our focus on leadership, innovation, and science.

      Leadership

      What will be the experiences of future nursing leaders and how will they shape their decision-making?

      According to the Center for Interdisciplinary Health Workforce Studies (2018), trends in the third quarter of 2018 predicted growth in the nursing workforce. For the first time since 1999, registered nurses (RNs) who were under the age of 35 exceeded 1 million— outnumbering RNs over the age of 50 (). A two-year study housed at Montana State University (MSU) is examining COVID-19’s effects on the nursing workforce, which have and will continue to influence inflection points on the entire pipeline. Led by Academy Fellow, Dr. Peter Beurhaus, professor in the MSU College of Nursing and director of the MSU Center for Interdisciplinary Health Workforce Studies, along with co-researchers Dr. Douglas Staiger, professor of economics at Dartmouth College, and Dr. David Auerbach (incoming Honorary Fellow of the Academy), senior director of research and cost trends at the Massachusetts Health Policy Commission, the 2022 report will aim to answer the question, “now what?” (
      Montana State University News Service
      MSU to lead study examining COVID-19’s effect on U.S. nursing workforce.
      ). While we await that study, the pre-pandemic workforce trends do give critical insight into who will be the decision-makers for the profession in the next five to 10 years.
      Each generation and its leaders are shaped by the social movements and healthcare emergencies of their time. From war to the HIV or Ebola epidemics, nursing leaders have had to adapt and change. As the profession grew so did the body of evidence in real-time. The need to remain nimble was an underlying thread. Today, the Generation X cohort (ages 41-56), more so, and the Millennial cohort (ages 25-40) of nurses will be the ones who will be called upon to lead, having experienced the social injustices of the last two years, the implications of the COVID-19 pandemic on the public's long-term health and mental health, as well as the rising demand to address the environmental determinants of health. How will their experiences shape their leadership style and decision-making process? How will they support the youngest generation in the profession? Nurses who recently joined the workforce (Generation Z, ages 6-24) have had the beginning of their careers shaped by a global pandemic that asked them to do more with less, often putting their safety at risk due to a national shortage of PPE and working under exhausting conditions. If anything, I'm hopeful that the next generation of nurses will continue to put their mental, physical, and emotional well-being front and center; a true mark of progress for our profession.
      I do know that we must continue to have conversations, consider the diversity of our leadership, and learn from each other now. We must be careful not to lose the rich body of evidence, personal stories, and information that will support nursing leaders in the future. Two of our Academy Fellows, Dr. Janice Phillips and Dr. Beverly Malone (a Living Legend), noted in their work that “diverse leadership can serve as particularly important role models, provide guidance and mentoring for other nurses, influence the allocation of resources, and shape policies aimed at eliminating inequities” (

      Phillips, J.M. and Malone, B. (2014) Increasing racial/ethnic diversity in nursing to reduce health disparities and achieve health equity. https://pubmed.ncbi.nlm.nih.gov/24385664/

      ). This year, the Academy's Institute for Nursing Leadership Signature Event, “Moving Conversation to Action: Championing Health Equity” will feature Living Legend General Clara Adams-Ender and Fellow Dr. Ronald Hickman during the opening session for a candid and inspirational discussion on the challenges and successes they have faced on their leadership journeys; guiding takeaway points for the audience on authentic leadership, and how they are wielding their leadership to create opportunities for diversity in education, research, and practice. The Academy will continue to have these conversations and add more assets to a leader's toolbox.

      Innovation

      What will the pandemic teach us about the speed and scalability of innovation?

      Our profession will continue to claim a larger space in healthcare innovation. From advances in telehealth services to creating simple, yet revolutionary devices, we contribute to the design thinking that propels innovations that are both remarkable and practical. We must support those who we teach and mentor to push the envelope and establish partnerships with other disciplines, industries, and policymakers. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report calls for all public and private health care systems to incorporate nursing expertise in novel strategies that support initiatives focused on social determinants of health and health equity (). The question ahead is what will need to change to scale a particular healthcare innovation and how quickly can it be publicly accessible?
      On August 3, 2021, I had the chance to participate in a listening session with National Institutes of Health (NIH) Director, Dr. Francis Collins, and biomedical organizations on the Advanced Research Projects Agency for Health (ARPA-H). Similar to the Defense Advanced Research Projects Agency, this entity at NIH would be able to speed research and create biomedical breakthroughs. Its goal would be to build “high-risk, high-reward capabilities (or platforms) to drive biomedical breakthroughs—ranging from molecular to societal—that would provide transformative solutions for all patients” (

      National Institutes of Health. (n.d.). Proposed Advanced Research Projects Agency For Health (ARPA-H). https://www.nih.gov/arpa-h

      ). In this forum, I inquired about diversity in this work. In the Academy's comments on ARPA-H, the organization focused on funded research and how it could prioritize disparity gaps and research that looks at all communities.
      Knowing the interest in speed and access, I am excited to discover what models will be submitted to our Edge Runners program when we reopen the submission cycle later this year. We will have an opportunity to highlight how nursing is innovating in new ways.

      Science

      How will the pandemic impact the nursing scientific community and how will it shape research questions?

      At the time of this writing, the National Institute of Nursing Research is considering a path forward for its 2022-2026 Strategic Plan. They have been collecting information from constituents and stakeholders since spring. The Academy and the Council for the Advancement of Nursing Science submitted comments. We championed the need to have a research focus on health equity in the plan. We also discussed the importance of preparing the next generation of nurse scientists. As the letter states:
      it is well documented in the research community that a stronger investment must be made in recruiting, retaining, and advancing scientists from underrepresented groups. From the NIH-Wide Strategic Plan for Fiscal Years 2021–2025 to the NIH's Minority Health and Health Disparities Strategic Plan 2021–2025, the call to increase capacity-building efforts for diverse scholars will not only bolster scientific discovery but improve health for all. With these cross-cutting strategic plans as guides, the NINR can help focus on the nursing profession.
      Many have wondered how the profession will continue to grow the body of research that creates our science and who from the profession will choose a research career? The pandemic has created further financial constraints on students and will only further influence the decision of some to pursue a PhD in nursing. Where will the funding come from and how will it be sustained over time?
      As I reflect on these questions, I know that they represent similar struggles that every generation has faced, but with different levels of intensity and new challenges we could not have imagined. The Academy is working to create a space where we can grapple with these problems and convene a multigenerational body of leaders who see things differently. We can create new opportunities that we have not considered before. I have seen this happen throughout my Academy presidency. Living Legends and new Fellows speaking on panels together, the Diversity and Inclusivity Committee standing up bystander training to support real change in the Academy, changes to the Fellow Selection Process that helps eliminate bias, and creating a vision for the organization's nimble governance. These efforts were from a diverse group of leaders. The questions of what lies ahead may be daunting, but the Academy has the leaders who will support each generation on their path to finding the answers.

      References

        • Center for Interdisciplinary Health Workforce Studies
        Third Quarter 2018 Data Now Available.
        2018 (.)
        • Montana State University News Service
        MSU to lead study examining COVID-19’s effect on U.S. nursing workforce.
        2020
        • National Academy of Medicine
        Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.
        2021 (.)
      1. National Institutes of Health. (n.d.). Proposed Advanced Research Projects Agency For Health (ARPA-H). https://www.nih.gov/arpa-h

      2. Phillips, J.M. and Malone, B. (2014) Increasing racial/ethnic diversity in nursing to reduce health disparities and achieve health equity. https://pubmed.ncbi.nlm.nih.gov/24385664/