Even before the start of the COVID-19 Pandemic, it was well-known that the U.S. was facing a health care provider shortage. This trend was verified in a June 2020 report by the Association of American Medical Colleges^, which estimated the U.S. faces a potential physician shortage of 37,800 to 124,000 by 2034.

Partly because of this growing need, nurses are increasingly serving as primary caregivers in hospitals and clinics across the country. There are more than 3.8 million registered nurses in the United States and nurses comprise the largest component of the nation’s healthcare workforce^*.

Necessity is not the only reason more patients are turning to nurses for primary care. Nurse-midwives and nurse practitioners have a core focus on promoting optimal health, not only caring for the sick but also providing guidance to assist in long-term health. This model of care forms a partnership between nurse and patient with a focus on promoting ongoing health in addition to treating illness. The focus on health maintenance is a core characteristic of the practice of nurse-midwives and nurse practitioners. A study on the prevention of chronic disease by Ritsema TS, Bingenheimer JB, Scholting P, et al.⁺ concluded that “across all conditions, NPs provide health education to patients more frequently than physicians.” Midwifery care as defined by the American College of Nurse-Midwives includes health promotion, disease prevention, wellness education and counseling, and full-scope primary care services including maternity care. Midwifery care has been shown to decrease cesarean section rates, decrease interventions and decrease preterm birth^^.

Midwifery and nurse practitioner care do not replace physician care. Health care services are complex and one type of provider cannot provide all services needed. It takes a team of different types of providers to provide the full complement of services needed. One study demonstrated that patients receiving care from primary care physicians received only 55% of recommended chronic and preventive services. The gap is attributed to physicians being overworked. The study further estimated that 50-70% of preventative services and 25%-47% of chronic care services could be done by nurse practitioners or physician assistants. By working together, we can assure that patients receive all of the recommended and preventive and chronic care services^**.

Nurses’ expertise and versatility were brought into focus during the height of the pandemic. As hospitals and clinics overflowed, the healthcare system was stretched to its limit. Nurses were called on to assume additional responsibilities and leadership roles, such as organizing drive-through testing and vaccination sites or directing clinics. Some traveled, leaving their families for weeks or months at a time to care for patients in locations both rural and urban where additional care was most needed.

While provider shortages have been amplified during the pandemic, this shortage was a known issue before the pandemic and will persist after. Most at risk due to the provider shortage are those in underserved populations and rural communities. The previously mentioned report by the Association of American Medical Colleges concluded that “If underserved populations were to experience the same health care use patterns as populations with fewer barriers to access, current demand could rise by an additional 74,100 to 145,500 physicians. This analysis underscores the systematic differences in annual use of health care services by insured and uninsured individuals, individuals in urban and rural locations, and individuals of differing races and ethnicities.”

Frontier Nursing University is proud to be a leader in the changes needed to address healthcare provider shortages. Frontier’s mission is “to provide accessible nurse-midwifery and nurse practitioner education to prepare competent, entrepreneurial, ethical, and compassionate leaders in primary care to serve all individuals with an emphasis on women and families in diverse, rural, and underserved populations.” Our students are graduate-level students seeking advanced nurse practitioner and nurse-midwifery degrees. For many, taking two years off work to pursue an advanced degree is not an option. They must be able to continue to work where they live while pursuing advanced degrees at the same time.

FNU was founded in 1939 in rural Hyden, Kentucky, and our impact, though significant, was limited in scope due to our remote location. In 1989 we introduced a distance learning model that allowed students nationwide to attend FNU from their home communities, requiring only a few trips to campus. Today, 70% of FNU’s more than 2,500 students live in health professional shortage areas (HPSA) as defined by the Health Resources and Services Administration (HRSA), demonstrating the potential impact of FNU graduates within these underserved communities.  

Many of our 8,000 alumni have been serving on the front lines of the pandemic. Some have worked as travel nurses in pandemic hot zones, while others delivered the first vaccine doses by boat to remote villages in Alaska. Some developed procedures to help patients avoid crowded lobbies. Others accomplished the remarkable feat of opening their own clinics during the height of the pandemic. Meanwhile, FNU’s distance learning model allowed the majority of our students to continue their progress without interruption.  

The pandemic has brought to light much of what we already knew. It has further demonstrated the need for change in our healthcare system and proved that nurse-midwives and nurse practitioners must play increased roles in the health and well-being of our communities. The pandemic reminded us that primary care services provided by advanced practice nurses and nurse-midwives are safe and effective. It is now more clear than ever that nurse-midwives, nurse practitioners, and physicians must work together to attain optimum health outcomes for our country.

^ IHS Markit Ltd. The Complexities of Physician Supply and Demand: Projections From 2019 to 2034. Washington, DC: AAMC; 2021.

*Smiley, R.A., Lauer, P., Bienemy, C., Berg, J.G., Shireman, E., Reneau, K.A., & Alexander, M. (October 2018). The 2017 National Nursing Workforce Survey. Journal of Nursing Regulation, 9(3), supplement (S1-S54).

+Ritsema TS, Bingenheimer JB, Scholting P, et al. Differences in the delivery of health education to patients with chronic disease by provider type, 2005–2009. Prev Chronic Dis 2014; 11: 130175. - PMC - PubMed

^^ Loewenberg Weisband Y, Klebanoff M, Gallo MF, Shoben A, Norris AH. Birth Outcomes of Women Using a Midwife versus Women Using a Physician for Prenatal Care. J Midwifery Women’s Health. 2018 Jul;63(4):399-409. doi: 10.1111/jmwh.12750. Epub 2018 Jun 26. PMID: 29944777.

**Altschuler J, Margolius D, Bodenheimer T, Grumbach K. Estimating a reasonable patient panel

size for primary care physicians with team-based task delegation. Ann Fam Med.

2012;10(5):396-400. doi:10.1370/afm.1400

++IHS Markit Ltd. The Complexities of Physician Supply and Demand: Projections From 2019 to 2034. Washington, DC: AAMC; 2021

Health care organizations rely on Nurse leaders to manage teams, patient care, and promote organizational goals. In order to meet these goals, a successful Nurse leader must possess certain qualities such as...

Good communication. In healthcare, effective communication can literally be the difference between life and death. 

Nurse leaders should make themselves accessible and establish an environment that promotes an open-door policy so Nurses feel comfortable discussing issues or concerns. Team meetings is another great way to keep regular communication throughout shifts. 

Accountability. Nurse leaders are responsible for creating and maintaining a culture of accountability.

According to Duquesne University, some of the steps to creating a culture of accountability include:

• Building trust: The foundation for successful workplace accountability is trust. Employees who trust each other are more willing to accept and act on constructive criticism rather than assuming it is ill-willed.
• Developing strong communication skills: Individuals who use an assertive communication style can express information in an honest, open, and direct manner. The assertive communication style is not aggressive in tone, but instead is respectful and avoids blame and criticism.
• Developing clear expectations: The American Nurses Association (ANA) outlines the expectations and responsibilities for all Nurses including the overall responsibility for their patients and practice. Nurse leaders should continually remind Nurses of the expectations of practice.
• Modeling accountability: A workplace that has leaders who accept responsibility and hold themselves and others accountable creates a culture of accountability. Nurses who are leading teams of Nurses must be open to feedback and criticism. 

Emotionally Supportive. Without empathy, you can't build a team or nurture a future generation of leaders. 

Empathy in healthcare means more than just being a sounding board. It requires conscious effort to take a step back and respect a coworker's feelings, needs, and concerns. This process requires a skill set that can be developed with time, practice, and instruction. When healthcare workers can discuss and cope with their emotions, they can better care for their patients and avoid or manage stress that leads to burnout.

Goal Getter. A great Nurse leader is always striving for excellence, and that requires evaluating how the organization is doing, identifying priorities for improvement, setting measurable goals, leading teams to achieve them, and then celebrating those achievements.

Adaptable. The role of a Nurse will always be evolving and changing. Nurse leaders must possess the ability to be flexible and adapt to new environments, technologies, policies, and as we've seen over the last year with COVID-19, global health issues.

These qualities are important throughout the entire Nursing industry, regardless of where you are in your career. Even if you aren't a manager, you can use these leadership skills to motivate your team to be more efficient and productive.

Since Nurses spend so much time on their feet, they need durable shoes that can provide ultimate comfort and support. From sneakers to slip ons, here is a list of the best shoes for Nurses this year!

1. Hoka One One Arahi 4

2. adidas Men's Ultraboost

3. Alegria Debra Professional

4. Crocs Bistro Clog

5. The Cloud

6. Clove Shoe

7. Dansko Professional Clog

8. New Balance Women's 411 V1 Walking Shoe

9. Dansko Paisley Sneaker

10. Brooks Levitate 4

Healthcare workers across the country are fighting tirelessly against COVID-19. They're wearing head to toe PPE around the clock. They're hot and frustrated while wearing it, and… they also lose their identity. Patients just see masks, suits, gloves, and goggles. Hospital staff wants this to change.

"Share Your Smile" and the "Button Project" are just 2 examples of a small, but positive movement. To look less intimidating to patients, healthcare heroes are attaching large photos and buttons of their faces, to their PPE.  

The goal of these projects is to eliminate or reduce a level of fear and anxiety for patients, especially children, who find comfort in seeing the smiling faces of healthcare team members.

San Diego respiratory therapist Robertino Rodriguez started the "Share Your Smile" idea. Rodriguez said, “Yesterday I felt bad for my patients in ER when I would come in the room with my face covered in PPE. A reassuring smile makes a big difference to a scared patient. So today I made a giant laminated badge for my PPE so my patients can see a reassuring and comforting smile.”

The movement is catching on amongst health care workers. Peggy Ji, an ER Doctor in Los Angeles, wrote on Instagram, "I was inspired by Robertino Rodriguez who works as a respiratory therapist in this COVID pandemic. I didn’t have a preprinted photo or a color printer so my polaroid will have to do. I wanted to bring a personal touch to caring for patients through my PPE. My hope is that our patients will know there’s a reassuring smile under this mask, and that we’re here for them."

Nurse Derek also posted a photo of himself and fellow coworkers on Instagram saying, "thought it was a beautiful way to bring ease to our patients during this stressful time. Thank you to all the healthcare workers out there for battling on the frontlines."

The Button project holds the same meaning and started at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

Adelaide Vienneau, Director of the Children’s Hospital Family Resource Center (FRC) said, “When we were asked to take the lead on this project, I immediately said, ‘yes.' The FRC team likes finding solutions for staff and providing resources to assist patients and families in having the best possible experience during their health care visit. We are delighted with the anecdotal comments on how the photo buttons have been well-received.”

Any time in the hospital as a patient is a scary time for the patient. The personal connection is so important, but difficult to achieve with all of the PPE. What a simple, yet creative way to put patients at ease to feel a more personal connection with the healthcare team.

What is your place of employment doing about this? Please share with our community. Thank you!

Black Lives Matter protests are happening all across America and as people take to the streets to protest, medical workers are doing their part in supporting protesters.

After working tirelessly for long hours and risking their own lives on the front lines caring for coronavirus (COVID-19) patients, Nurses are leaving their shifts and going straight to protests to help those who've been injured.

Martha Dawson, DNP, RN, a professor and the president of the National Black Nurses Association, said Nurses and frontline healthcare workers of color were deeply saddened after the killing of George Floyd, an unarmed Black man who was killed in Minneapolis, Minnesota, at 46 after a white policeman pushed his knee into Floyd’s neck for more than eight minutes.

Dawson told Refinery29, “For Nurses of color working on the frontlines, it’s disheartening to still realize that you’re living in a country where you’re under-appreciated and judged, first, on the color of your skin, rather than the content of your character. And you have to recognize that the concern with the death in Minnesota is just now emerging as one stressor on top of the many stressors of the pandemic.” 

Nurses want their voices heard at rallies but they also want to help protesters who have been shot with rubber bullets, sprayed with tear gas, or have been otherwise physically injured. 

Not all protests have become violent. But when they have, healthcare workers have also found themselves in the line of fire while treating injured protesters.

According to an article from Shape.com, a Minneapolis Nurse said police stormed a medical tent and opened fire with rubber bullets while she was working to treat a man bleeding badly from a rubber bullet wound.

"I was trying to look at the wound and they were shooting at us." The wounded man tried to protect her, she said, but eventually, she decided to leave. "I told him I wouldn't leave him, but I did. I feel so bad. They were shooting. I was scared," she recounted through tears.

Nurses are using social media to share tips on how to stay safe from coronavirus while protesting and where to find free medical help for those injured during protests.

One Nurse tweeted, "I am a licensed Nurse with an organized group of frontline medics. We are all healthcare workers (doctors, nurses, EMTs) and we provide safe spaces of first aid care for anyone who might have minor injuries related to police protest. We prioritize care for Black, Indigenous, and People of Color (BIPOC) folks."

Another person tweeted health safety tips for protesting during a pandemic.

For the first time in history, the world will unite in celebrating the benefits that Nurses and Midwives bring to the health of the global population. The World Health Organization (WHO), has declared 2020 as The Year of the Nurse and the Midwife (YONM).

It is celebrated in honor of the 200^th anniversary of Florence Nightingale's birth. President of the International Council of Nurses (ICN), Annette Kennedy, said "The 20 million Nurses around the world will be thrilled to see their profession recognized in this way. Florence Nightingale used her lamp to illuminate the places where Nurses worked, and I hope the designation of 2020 as the International Year of the Nurse and Midwife will provide us with a new, 20-20 vision of what Nursing is in the modern era, and how Nurses can light the way to universal health coverage and healthcare for all.”

WHO is working with partners such as, the International Confederation of Midwives (ICM), International Council of Nurses (ICN), Nursing Now and the United Nations Population Fund (UNFPA). Their goal for this year-long global focus on Nurses and Midwives is to: 

• Celebrate the contributions of health workers, with particular focus on Nurses and Midwives, in improving health globally,  
• acknowledge, appreciate and address the challenging conditions Nurses and Midwives  face while providing care where it's needed most and
• advocate for increased investments in the Nursing and Midwifery workforce

Lord Nigel Crisp, co-Chair of the Nursing Now campaign said, “The WHO has provided a unique opportunity both for countries to demonstrate how much they appreciate their Nurses and Midwives and to showcase what more Nurses and Midwives can achieve if given the support to do so."

Check out the World Health Organization's video, Nurses and Midwives: Key To Universal Health Coverage

We at DiversityNursing.com are thrilled Nurses and Midwives are receiving recognition for their commitment to the profession and selfless dedication to their patients, families and students.

Nurses see firsthand how facilities are being used every day. They observe what furniture is being used or not used by visiting families and friends. They see how patients move about the hallways, patient rooms, stairs, elevators, cafeterias, bathrooms, etc. Nurses see the pros and cons of the infrastructure of the building(s) and should have a say in how they're built in order to provide the best care possible. 

"Input from Nurses and other healthcare professionals are mirroring the health professions' renewed focus on quality and safety in their designs. Nurses might not know how to read architectural drawings or use computer-assisted drafting tools, but they have a very important role to play in helping plan and design physical spaces that support the delivery of safe, effective patient care.", said Matt Freeman a spokesman for the Robert Wood Johnson Foundation.

According to the Robert Wood Johnson Foundation briefing, some design choices being used across the country as a result of input from Nurses include:

• Ventilation and filtration systems to improve air quality and remove allergens, pathogens and more;
• Ergonomically designed patient rooms, including patient lifts and handrails, as well as beds and Nursing stations designed to reduce patient falls and staff injuries;
• Decentralized unit layouts so as to increase the time Nurses spend at the bedside;
• Better lighting to ward off medical errors;
• More natural sunlight, in part because studies show that it helps blunt the perception of pain, improves the quality of sleep and leads to shorter hospital stays, while allowing Nurses to better assess skin tone;
• Noise reduction features, such as carpet, acoustical tiles, handheld pagers as a substitute for overhead systems, to improve sleep and reduce stress;
• Better way-finding systems, including maps, landmarks, signage, information kiosks, directories and more, to help patients and visitors while allowing staff to focus on their clinical duties instead of giving directions; and
• Access to nature, water features and works of art, all to reduce stress.

With a new work space, a new work flow should follow. The Nursing team at Stamford Health in Stamford, CT, helped design their new hospital. Ellen Komar, MPA, BSN, RN, NEA-BC, Vice President of Patient Care Services and Chief Nursing Officer said “Old, inefficient habits are not allowed to invade our new workspace. Given such a different layout, the way we work will have to change. A few members of our Nursing team are retooling every workflow process."

It takes time and resources, but this kind of collaboration between Nurses and architects provides the opportunity to give patients the best possible care.

Are you a Nurse who has been involved in the design of your new facility? Do you have some great design ideas you’d like to share? Please comment below, we would love to hear them!

As you know, Nursing is a demanding profession that requires a lot of dedication and commitment. The field has challenges that you must constantly work to overcome.

Professional Responsibility

You hold legal responsibility for all patients under your care. If a physician gives an incorrect
order, you won’t be absolved of the blame if you carry it out. This requires you to be fully aware of the risk of each order, prescription, and treatment you provide.

Workplace Safety

Nurses face a number of workplace safety issues. According to an AJC article, depending on the setting in which you work, Nurses can also be subject to substantially higher rates of workplace violence injuries than many other professions. They're more likely to experience incidents of hitting, kicking and beating in inpatient facilities such as hospitals, but these injuries often go unreported.

Short Staffing

Beckers Hospital Review discusses short-staffing in hospitals as a top concern for Nurses. The article says, "A 2017 survey conducted by AMN Healthcare showed 72 percent of CNOs acknowledged moderate, significant or severe nursing shortage at their healthcare organizations, and most believe the shortages would worsen over the next five years. Overall, the U.S. Bureau of Labor Statistics estimates more than 1 million registered nurses will be needed by 2022 due to occupational growth and replacement hiring. It’s worth noting, other research shows variation among the nation's major metropolitan areas, with some facing nursing shortages and others facing surpluses."

Changing Technology

Technology is always changing. The challenge is to stay ahead of it. CNO’s, nurse managers, and floor nurses must stay up to date with technology and adopt the systems that improve patient care. Nurses must be trained in the new technology, whether it is enhanced EMR/EHR, patient glucose monitors, patient scheduling systems, or software platforms that enhance patient/family/provider communication.

Long Working Hours

Nurses are often required to work long shifts. Many are working back-to-back or extended shifts, risking fatigue that could result in medical mistakes.

Healthcare is constantly changing. As you know, it’s your duty to navigate through the workload and responsibility the best you can. If you have some tips to share on how you handle these changes, please comment below.

Pediatric Nurse, Meghan Nesom is an inspiration and a true example of strength. She has received heart breaking news that won't stop her from continuing her passion of healing others. Meghan reminds all of us how amazing Nurses are and no matter what they are going through in their personal lives, they will always try their hardest to stay positive and moving forward. Staying positive is something Meghan has clearly passed on to her son and once you see his response to his mother's diagnosis, you'll completely agree.

Nesom is a wife and mother who has been working as a pediatric nurse. She’s helped heal children with cancer, and has also been there to comfort children in the moments they succumb to the disease.

“There is never a ‘woe is me,’ with kids,” she says, “They just are fighters. They’re wonderful.”

And the same could be said of this brave woman, who, in a cruel twist of fate, has also been diagnosed with cancer.

But rather than feeling sorry for herself, her response is one of utter selflessness: she describes the relief of knowing it’s she, and not her child, that’s been diagnosed.

She underwent surgery and radiation three years ago to kill the cancer; now, however, it has returned in the shape of clear cell sarcoma, for which there is no cure. That also means she’s recently been tasked with telling husband Philip and 4-year-old son Colin about the traumatic procedures she’s about to undergo.

So, Meghan told her son that she was going to have to have her leg cut off — and his response truly proves that some children have a wisdom far beyond their years.

“He told me that all of his friends are going to be jealous because his mommy’s going to have a robot leg,” she proudly recounts.

And, despite already beginning oral chemo, she still continues to work as a nurse and help others. Like the retired nurse who spends her days driving cancer patients to their chemo appointments, Meghan has been tireless in her quest to help others.

Her coworkers have been by her side through it all, even raising a whopping $10,000 to help cover medical costs.

To help this fantastic woman who has devoted her life to helping others, visit her GoFundMe page.

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