‘An epidemic of nonstop.’

According to Provision 5 of the American Nurses Association (ANA) Code of Ethics, “the nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.” Yet all too often, nurses are viewed as heroes, and this heroization, while perhaps well-intentioned, may exacerbate a reality in which nurses put caring for others ahead of caring for themselves.

Amid the COVID-19 pandemic, we saw a worsening of an issue that has long plagued the nursing profession: “an epidemic of nonstop” in which the lack of basic self-care such as bathroom and meal breaks has become the norm and nurses literally “work until they drop.” The many stressors associated with the COVID-19 pandemic further heightened the need for nurses to care for themselves.

Workplace benefits and financial protections vary widely for nurses.

Approximately three-quarters of all health care workers, including nearly 90% of nurses, are women. COVID-19 brought to light the gaps in benefits among these workers.

In order to support nurses whose ability to work had been affected by the pandemic by providing them with direct financial assistance through emergency grants, the American Nurses Foundation partnered with Nurses House, a national nonprofit organization that provides temporary financial assistance to nurses who are out of work due to illness and injury.

A team of researchers from the Center for Nursing at the Foundation of New York State Nurses reviewed applications for these grants in order to examine the financial impact of the COVID-19 pandemic on nurses across the United States. Applications for direct financial assistance reveal that nurses typically are the breadwinner in their family, often supporting adult children and/or grandchildren, and live paycheck to paycheck.

No national standard for sick leave or paid family leave.

The grantees’ common experiences with a lack of workplace benefits to support sick leave or leave to care for a family member reflected the lack of a national standard. This lack of a federal standard allows workplace benefits to be determined by employers, states, or localities. The type of benefits, whether they are paid or unpaid, their duration, and what they include varies widely. Many employer benefits require accrual, may not be available to part-time or per diem staff, and don’t match the length of time that the federal laws allow.

The federal government introduced the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act or C.A.R.E.S Act in 2020 to provide emergency short-term paid sick time and extended paid family leave. FFCRA allowed large private health care employers an exemption, thereby leaving 17.7 million health care workers at risk for not having access to this paid leave. Under the C.A.R.E.S Act, one time Economic Impact Payments allotted $1200 per adult and $500 per dependent minor children for households with a yearly income of $75,000 for single households and $150,000 for married couples.

The U.S. Bureau of Labor Statistics cites the 2020 median annual RN salary to be $75,330. A further breakdown of salary by work setting showed that many nurses working in an acute care setting who earned over $75,000 exceeded the cut-off for an individual to receive the federal funding. Nearly half of nurses impacted by COVID-19 seeking financial assistance (49.6%) worked in the acute care setting.

According to a report published by the AARP in July 2020, 13% of health care workers had already been laid off, 31% had reduced hours, and 32% had received reduced pay. As of May 2020, 266 hospitals reported furloughing staff to remain financially stable. Although many have been gradually bringing staff back as procedures and non-COVID admissions resume, this trend continued throughout 2020 and well into 2021.

A call for legislation to protect nurses’ financial, mental, and physical health.

As the largest contingent of health care workers, nurses need to engage legislation at the local, state, and federal levels and collaborate with our state and national professional organizations to address the health and financial well-being of registered professional nurses.

Added to our legislative agenda should be policies that name and provide assistance directly to nurses. At the federal level, disaster planning should identify provisions for disaster pay, paycheck protection, and loan and mortgage forgiveness, as well as extended job or disability protection for those who become sick while taking care of others.

At the local and state level, we should introduce these ideas to our representatives or inform them of measures that can aid nurses. The COVID-19 pandemic should serve as a call to action for nurses to expand the legislative agenda and call for our leaders to promulgate regulations that will protect the financial and physical health of these professionals.

During the pandemic, many issues became apparent, particularly the urgent need for nursing care in responding to a global health crisis. The ANA has outlined a number of public advocacy agendas such as mental health and hazard pay, personal protective equipment and decontamination, and increasing the nursing workforce. The organization has called on Congress to protect nurses, and is actively engaged with policy makers to identify and enact legislation and regulation that support nurses.

Nurses need support in the forms of financial stability, self-care, childcare, and long-term health care, particularly during and after disasters. It is time to support nurses as much as they have supported our communities during the COVID-19 crisis.

Authors

Jennifer Pettis, MS, RN, CNE, is the acting director of programs for Nurses Improving Care for Healthsystem Elders (NICHE) at the NYU Meyers College of Nursing and adjunct faculty member for State University of New York (SUNY) Empire State College (ESC) School of Nursing and Allied Health. She is a member of the Alzheimer’s Association of Northeastern New York board of directors, the New York State Auxiliary Board for Nursing, and the Foundation of New York State Nurses board of directors and honored to serve as the Alzheimer’s Association Ambassador to senate majority leader Chuck Schumer.

Deborah Elliott, MBA, BSN, is the executive director of the Center for Nursing at the Foundation of NYS Nurses and executive director of Nurses House, Inc. She serves as the secretary of the National Forum of State Nursing Workforce Centers board of directors, and is co-lead of the Future of Nursing New York State Action Coalition. Deborah is honored to be a founding board member of the Nurses Middle College – Capital Region, a college prep charter high school that prepares students for the rigors of nursing school.

Nancy Michela, DAHS, MS, RN, is associate professor of nursing at Russell Sage College in Troy, NY, and director of the RN-BSN nursing program. She also serves as an adjunct instructor for the Lally School of Education at the College of St. Rose. She serves on the board of directors for VNA of Albany and is an executive committee member and succession planning member for Delta Pi Chapter, Sigma Theta Tau international (STTI).

Noreen B. Brennan, PhD, RN-BC, NEA-BC, is the chief nursing officer at NYC H+H/Metropolitan and an adjunct faculty member at Pace University.  She is a board member for the NYU Nursing alumni board, Nurses House, and the New York Organization of Nurse executives and leaders. She holds certification in nursing administration and advanced and adult medical–surgical nursing from the American Nurses Credentialing Center (ANCC).

Mary Anne Gallagher, DNP, RN, Ped-BC, is the director of nursing for the Center for Professional Nursing Practice at New York-Presbyterian and adjunct faculty at Adelphi University. She is a certified pediatric nurse, and is board of directors secretary for Nurses House, vice-president of NYU Rory Meyers College of Nursing’s alumni association, and a New York Academy of Medicine fellow.