Leadership in Times of Crisis – Part One

In April 2020, the Harvard T.H. Chan School of Public Health invited me back to its Voices in Leadership webcast, which focuses on effective leadership to create positive change in public health. It was my second guest appearance on this prestigious platform and coincides with my appointment as a Visiting Fellow at Harvard University. (You can take a look at my first Voices in Leadership interview, here.)

During the coronavirus outbreak, the series has shifted its focus from leadership in general to the specific challenges of leadership in times of crisis. I was privileged to share my thoughts on the central role nurses play in these times, as well as the critical imperative to ensure their needs are met – both physically, with personal protective equipment (PPE), and psychologically, with resources to protect their mental health and well-being.

You can view the webcast, here.

Below is a more concise Q&A:

Q. In the next six months, what is the single most important thing we can do in the United States to have a meaningful impact on the COVID-19 pandemic?

A. First things first, we need to implement a two-prong approach: One – the ability to test for the virus, track cases and isolate every infected person in our nation. This is critical to ensure that a second wave of the virus, which could strike alongside the flu, isn’t as deadly. And two – we need to open up our health care delivery systems to care for people with and without COVID-19. Elective surgeries are needed now. Vaccinations are needed now. Care for populations with co-morbidities such as respiratory disease, cancer, heart disease and diabetes is needed now.

Q. Everywhere we turn, we are hearing about the lack of personal protective equipment for health system workers. Has this gotten any better? What should be done to adequately protect nurses?  

A. There is still a shortage of PPE for health system workers. Many nurses still do not have adequate PPE. There is no excuse for this and it goes without saying that we need to ramp up production of this critical equipment. Nurses are doing the best they can to protect themselves, their colleagues and their patients. It’s unacceptable that they must put their lives on the line and jeopardize the health and lives of their families and their communities. 

Q. What are some of the other practical challenges nurses face, such as furloughs or licensing barriers?

A. Nurses are being furloughed and so are other health workers. It is truly mind-boggling that this is happening – in the middle of the biggest global health crisis in a century. These employees MUST be brought back to work. There is so much for them to do! They can collaborate with health administrators, public health departments, community-based clinics, schools, and small businesses to test for the virus, track cases, isolate the infected and educate the public. 

In addition, nurses must be able to work at the full scope of their practice and licensure. We need nursing expertise, innovation and evidence-based solutions now more than ever. America’s advanced practice registered nurses are stepping up as essential providers, answering the call. They bring a unique range of specialized skills, education and a holistic philosophy to patient care. Many states have relaxed or removed unnecessary regulatory barriers so APRNs can practice at the top of their skills, education and training. Other states should do the same.

The pandemic requires a broad, coordinated effort among stakeholders across the health care continuum, including state governments and state boards of nursing.

Q. How concerned are you about undertreated illness right now? And are there specific groups we should be particularly worried about?

A. I am very concerned. Those of us in public health know that people with non-communicable diseases such as asthma, cancer, cardiovascular disease and diabetes are more likely to die from coronavirus than their healthier counterparts.

We need to be concerned about populations that suffer from these diseases in general, but especially now with an infectious disease that has no cure no vaccine. Coronavirus is affecting huge numbers of black and brown people. The infection and death rates are disproportionately higher than among other populations.

The take-home message is the same one we’ve been repeating over and over for months now: we must TEST for the virus, TRACK cases, and ISOLATE everyone who is affected or exposed.

Sadly, race and gender disparities, socioeconomic disparities and health inequities are commonplace in our country. Social determinants of health must be considered, especially in light of this deadly pandemic.

Q. When you think about black and brown populations disproportionately impacted by COVID-19, do we need to adopt a different approach? 

Yes. We need to do a better job of meeting these populations where they are – through trusted members of their community. This includes their houses of worship, local businesses, barber shops and beauty parlors. We must educate about COVID-19 – what it is, how to get tested, what to do if you are infected, how to isolate, how to care yourself, where you should seek care.

As a nation, we must adopt culturally relevant care that is adequate, accessible, adoptable and affordable for all. This is especially critical since our economy has crumbled. We have to go back to the basics.

Q. In the next six months, what is the single most important thing we can do internationally to have a meaningful impact on the COVID-19 pandemic?

A. Again, it comes down to three essentials: testing, tracking and isolating. The virus will continue to be a pandemic until we get it under control in all nations impacted, and that is certainly not the case right now. Countries must put systems in place that can care not only for COVID-19 patients, but also for everybody else. They must be ready for seasonal flu, malaria outbreaks, EBOLA, measles, the list goes on depending on the region and the nation.

Q. Have any countries gotten it right?

A. Yes, I feel like New Zealand has, Germany has, South Africa has, Australia has. It’s important we study what these countries have done. In South Africa, for example, nurses fought with the government to get their PPE. Their message was simple: no equipment means no nurses means no health care delivered. Those nurses made it clear. And the powers that be stepped up and did the right thing. As a result, everyone’s protected.

Q. This is the Year of the Nurse and Midwife. Recently, the World Health Organization reported a shortage of nurses. How can this shortage be addressed both in the short and long term?

A. Stop furloughing and laying off nurses! Ensure they are practicing to the full scope of their knowledge, skills, abilities and licenses. The same with APRNs. If we don’t do this we face a global shortage of more than 6 million nurses by 2030.

Q. How worried should we be about nursing burnout right now?

A. Very worried. Fighting against a pandemic like this Covid 19 is like fighting a war, and when you are in a war, constant stress and anxiety have you living on the edge, worried about yourself, your patients, your family, your community. Add economic burdens and lockdowns and you run the risk of extreme behaviors and mental disorders. We must ensure that we care for the caregivers.

Q. Are there examples of nursing leadership we can look to for hope during this time of crisis?

Around the world, in every country, nurses are leading the fight against COVID-19. This crisis has been quick and unprecedented, but nurses have risen to the challenge. They assess the situation, determine a plan of action and implement that plan in the face of unbelievable odds. We ROCK! It’s time to tear down the barriers to our practice, here in the United States and worldwide. Let us do what we have been educated and trained to do!

It’s clear that extraordinary times call for extraordinary leadership. In my next post, I’ll take a deeper dive into leadership in times of crisis – what makes a good leader, the importance of uniting rather than dividing, and how we can marshal our collective strengths to meet our obligations to one another.

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