Employment Trends for LPNs and RNs in the United States During the COVID-19 Pandemic

Goals

To understand the employment trends for LPNs and RNs in the United States during the COVID-19 pandemic. This information may be used to inform hiring incentives for a geriatric care facility.

Interventions specific states in the US have made in the employment of LPNs and RNs since COVID-19 include lax licensing and oversight laws, expanded scope of practice, leveraging on the skills of nursing students, employment of foreign nurses, as well as reaching out to retired nurses.

This other post provides a high-level overview report on Hiring and Staffing at Senior Care Facilities.

1. Lax Licensing & Oversight Laws

• According to the National Conference of State Legislatures (NCSL) report, several states, including South Carolina, Arkansas, and Iowa, are issuing emergency nursing licenses to bolster the fight against COVID-19. For Georgia, Texas, and Alaska, medical health practitioners including nurses, are receiving expedited out-of-state licenses so that they may help the states deal with COVID-19.
• Delaware and Colorado, through a reciprocal licensing push, are permitting nurses licensed in other states to start practicing in the state immediately. Furthermore, some nursing students in Delaware are allowed to practice without a license.
• In Louisiana, the State Board of Nursing is extending or reinstating expired permits for RN applicants, while allowing Advance Practice Registered Nurses (APRN) to practice in new sites they had not initially disclosed to the board.
• Michigan is allowing its nursing students to be licensed or registered as healthcare professionals to volunteer to support the state’s response to the COVID-19 pandemic.

2. Expanded Scope of Practice

• Florida has allowed qualified nurses to independently execute primary care practices without the presence of an attending physician. Governor Ron DeSantis signed this into law, only permitting nurses with completed graduate-level coursework and 3000 hours of logged experience could qualify.
• NCSL notes that Michigan has extended the scope of work for its LPNs and RNs, allowing them to “provide more care than they would under typical circumstances”. California is also allowing its nursing practitioners and students to provide a wider scope of care in response to COVID-19.

3. Leveraging the Skills of Nursing Students

• The state of Louisiana has begun expediting the graduation dates for nurses. Health Affairs supports this move, as it asserts that students close to graduation have already been equipped with the required clinical skills to care for patients combating COVID-19.
• Idaho, on the other hand, is allowing students with basic nursing training to work as unlicensed assistive personnel under its nurse apprenticeship program. Health Affairs offers that nursing students in their early years of training may act as healthcare navigators, helping patients with mild symptoms to COVID-19 testing areas.

3. Employment of Foreign Nurses

• According to Forbes, the US could run out of healthcare workers, especially nurses who are at the front-line of the COVID-19 pandemic. Reuters supports this assertion, as it reports that hospitals in New York and Connecticut are looking to fill hundreds of temporary nursing positions.
• American Association of International Healthcare Recruitment asserts that it received requests for 5,000 nurses in New York alone. Due to visa restrictions, they are currently unable to immigrate to the US. Forbes reports, however, that the US Department of State’s Bureau of Consular Affairs is working on expediting the immigration process for foreign medical workers.

4. Recall of Retired Nurses

• New York, Colorado, Delaware, Iowa, Tennessee, Louisiana, New Jersey, and California are some of the states that have appealed to retired nurses to resume practice to support the states’ healthcare systems deal with the COVID-19 pandemic.
• For Delaware, only healthcare professionals, including nurses, that have been retired for less than 5 years will be allowed to practice. New Jersey allows temporary reactivation of licenses for recently retired health professionals.

Challenges that LPNs and RNs Encounter in Their Provision of Services During the COVID-19 Pandemic

Challenges, pain points, or fears that LPNs and RNs encounter in their provision of services during the COVID-19 pandemic in the US include shortages of personal protective equipment (PPE), staffing strains, as well as the impact on mental health.

1. Shortage of PPE

• Modern Healthcare cites that the acute shortage of PPE has put nurses at risk, as more are becoming infected with the virus and are unable to provide care. The article further asserts that nurses can potentially infect other patients, their family members as well as colleagues without proper protection.
•  Vox details an internal communication from New York-Presbyterian/Weill Cornell Medical Center that directed the staff to only wear masks where “clinically indicated“. The health workers were unhappy with the lack of PPE.

2. Staffing Strains

•  Ernest Grant, president of the American Nurses Association, notes that the best practice of one-on-one care has strained the nurses providing care to COVID-19 patients. He notes that a nurse offering care to an acute case of COVID-19 can only do so for one patient, at most two. This leaves more work for nurses in non-acute care.
• Modern Healthcare also reports that nurses who have tested positive for COVID-19 but are asymptomatic are still practicing. This, the article notes, is because the nurses need an income and overrun hospitals need to utilize all the manpower at their disposal.
• The retirement of experienced baby boomer nurses is also causing a strain on the staffing needs for hospitals. Maggie Hansen, the Chief Nurse Executive and Senior Vice President at Memorial Healthcare System in Hollywood, Florida, asserts that baby boomer nurses are “desperately needed” for their experience and to lead younger nurses in providing care to COVID-19 patients. However, their advanced age makes them highly susceptible to COVID-19, which will affect their ability to offer care or leadership to less experienced nurses.

3. Impact on Mental Health

• The World Health Organization (WHO) reports unprecedented levels of overwork by nurses with no room for rest and without support. Giorgio Cometto, the HR Coordinator for Health Policies and Standards at WHO, notes that nurses receive limited considerations for their mental health and well-being.
• Futurity reports that nurses are overwhelmingly facing moral distress– a notion where they feel like they are compromising on their integrity as they feel unable to provide the level of care they are accustomed to.
• Cynthia Rushton, a professor at the John Hopkins School of Nursing, adds that moral distress adds to the post-traumatic stress of nurses in the long-term. Moral distress or injury, she further asserts, accumulates over time, thus it is important for mitigating measures against moral distress to be applied immediately.
• Rushton and colleagues created the Frontline Nurses WikiWisdom Forum, a platform for nurses to share challenges they are experiencing in the frontline battle against COVID-19. A link to the forum can be found here.
• Moreover, nurses are said to be struggling with how to balance the “endless” needs of their patients vis a vis the needs of their family and loved ones. Rushton posits that nurses are asking themselves whether they are exposing their families to infection by returning home every day, as the stakes are high and the situation uncertain.