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Extended & Expanded role of Nurses

Article · August 2021

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Ms Asmat Parveen
Islamic University of Science and Technology
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Extended & Expanded role of Nurses during Covid 19 Pandemic & Nursing Challenges.

Ms. Asmat Parveen

PhD scholar, RN/RM, M.Sc MSN,
Neuro Sciences, PGDHHM, CCN
A. Professor/HOD MSN Founder principal
IUST constituent Nursing Colleges
Introduction
As the number of confirmed COVID-19 cases accelerates, nurses on the front lines of the
health care response find themselves making high-stakes decisions for patients and their own
personal lives. “We know that nurses are the backbone of health care, and often its heart and
soul. The COVID-19 pandemic is testing all of us, but nurses are on the front lines. The
nurses have knowledge, experience, and take challenges about working on the front lines of a
pandemic like situations. We know nurses are overworked, understaffed, possibly
heartbroken and anxious, but always courageous. Nurses’ roles are now more important than
ever. Nurses are often the last thread of compassion for patients. They’re the ones doing the
screenings, taking care of the critically ill, implementing triage protocols, communicating to
families, and attending to the dying.

Nurses in every role are impacted. They’re being asked to work in areas of the hospital that
aren’t their normal specialty. They’re providing tele-health consultations. They’re being re-
deployed to learn new skills and take new roles—as safety officers, and taking care of
critically ill patients. They’re making triage plans operational. We’ve had to reallocate our
resources in profound ways, and nurses are innovating and leading in the midst of the crisis.
That shift leaves nurses feeling like they’re abandoning their individual patients. They’re not
able to provide the level of care they’re used to. The gap between what they can do and what
they believe they should do creates moral distress, a sense that they’re compromising their
integrity. They’re very complex. Nurses always have obligations to the patient in front of
them, but the pandemic imposes so many limitations. It might be that nurses can offer
knowledge and skills to relieve patient’s symptoms, or provide options for palliative care or
spiritual support, or simply listen to fears and concerns. At the same time, nurses have to
consider how to benefit more people. This often means making room for sicker patients by
discharging patients who would under other circumstances be admitted. Moment-to-moment
decisions are required on how to use equipment, medications, and resources when there
aren’t enough for everyone. We always begin with patients as our first priority in our
professional ethical framework. That doesn’t mean we don’t have obligations to our own
well-being and families. Nurses are grappling with questions like, “Am I potentially causing
harm to my family by coming home from work every day?” and “How do I balance the needs
of my loved ones with the endless needs of patients?”The stakes are very high, and
unfortunately there are no good answers. Part of being able to find integrity here is accepting
the reality of our current situation and living with uncertainty—acknowledging we’re making
decisions under constrained and difficult circumstances.

Challenges faced by Nurses in daily life and during COVID 19.

1. Shortage of PPEs: Healthcare workers rely on personal protective equipment to protect

themselves and their patients from being infected and infecting others. But shortages are
leaving nurses and other frontline workers dangerously ill- equipped to care for COVID-19
patients, due to limited access to supplies such as gloves, medical masks, respirators, goggles,
face shields, gowns, and aprons. Without secure supply chains, the risk to healthcare workers
around the world is real.

2. Shortage of nursing staff: Nurses face tremendous work-related stress, burnout due to
workload, and long working hours due to the acute shortage of trained nursing staff. Long
working hours, overtime and work overload affects the physical and psychological wellbeing
of the nurses. While more than 90% of nurses have MSD (musculoskeletal disorder), 61%
also experienced neck pain sometimes. Most recurring pain area (51%) is leg ache, followed
by knee pain (51%). Similarly, 51% nurses complained of upper and lower back issues, 41%
reported to have taken leave(s) for 1-3 days whereas 7% nurses have taken leaves for 4-6
days in a span of two months to manage the pain, indicating an evident productivity loss to
the organization.

Also 88% of nurses work for 8-10 hours a day along with doing overtime at least twice or
thrice a month. Similarly, 74% of the nurses stand for more than 4-6 hours a day at a stretch,
causing stress on their lower limbs. While 20% of nurses reported performing double-shift
duty at least twice a month, 26% of nurses were requested to work on their off-days twice a
month whereas 10% of nurses were called on duty more than twice a month on their off-days.

3.Workplace mental violence: Workplace violence is widespread in healthcare settings.

Huge amount of workload and responsibilities on the staff during COVID 19 can lead to
disturbed mental peace which will ultimately lead to less efficient care. Multiple tasks can
pose a problem in a healthcare unit. Workplace mental violence can be also in the form of
threat of getting exposed to virus, verbal abuse, hostility and harassment, which can cause
psychological trauma and stress. At times verbal assault can escalate to physical violence. In
a healthcare setting, the possible sources of violence include patients, visitors, intruders and
even co-workers.

4.Safety : Concerns regarding personal safety and security at workplace and in the
community as well as concerns regarding the safety of family members.

5. Meeting Patient Expectations: Patients have very high expectations but because of
budget and staffing cuts during COVID 19, nurses can’t always meet these expectations. This
puts immense strain on nurses who have lots of patients to look after. Hearing their patients
are unhappy with their level of service can affect morale and put nurses under a great amount
of negative stress.

6. Workplace Hazards: Nurses regularly work with needles, sharp tools and heavy
equipment which might be infected during this COVID 19. To help avoid infection and
accidents, all staff should be trained properly and always follow rules and regulations to
ensure they aren't injured, along with their colleagues. Any potential hazards should be dealt
with immediately. For example, wet floors can cause serious accidents. As nurses are busy,
it's easy to forget to check the floor for potential dangers but wearing appropriate footwear
can help reduce the chance of an accident happening. Healthcare shoes with effective slip-
resistant grip are excellent on slippery floors and help you stay on their feet.

7. Personal Health: Working in healthcare during COVID 19 is a stressful occupation and

can cause stress-related health problems. It's important for you to relax and take time away
from work to help you unwind. Along with being mentally exhausting, working as a nurse is
physically strenuous. Many nurses suffer from back problems and sore feet. Working 12-hour
shifts is physically demanding but wearing specially-designed shoes can ease problems and
keep nurses on their feet at all times. Healthcare shoes are created specifically for healthcare
professionals. They provide slip-resistant grip, comfortable insoles and excellent support -
features you need when working in a hospital.

8. Lack of Synchronicity: Disharmony and lack of teamwork during this COVID 19 is an

emerging challenge in the heath-care sector. Harmonious relationship amongst healthcare
workers is an essential requirement for the healthcare system. Nurses bear the indirect
opprobrium of every dreadful incident which occurs in the hospital. If the patient is not
satisfied by the care rendered in the hospital, all the blame is accrued to the nurses, even if it
is not her fault.
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Inadequacy in the care rendered may vary from ineffective medical care to non- availability
of doctors, and yet nurses are being blamed. Non-availability of equipments in hospital which
in turns affects the quality of care. Although the responsibility is not necessarily of nurses,
yet nurses are ultimately responsible for patient care environment in their wards.

Conclusion: Nurses have the same obligations to self as to others. Investment in one’s well-
being is not optional, it’s a moral mandate. It’s not only post-traumatic stress but this feeling
in some people that they’re acting against their own consciences in certain actions during the
crisis. The fallout of that is significant moral distress or moral injury, which accumulates over
time. And we can’t wait to take measures to manage that distress. We must begin now. We
want to provide recommendations from frontline nurses to inform our health care system’s
future responses to crises so we are never unprepared in the way we are with COVID-19.

Bibliography:

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with novel corona epidemic in India, Srinagar March 31 , 2020.article in GK.
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5. Hameric, spross and Hanson: advanced practice nursing-and integrated approach;1st
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