Executive Power During the COVID-19 Pandemic

Evaluating the Impact of Executive Orders Lifting Restrictions on Advanced Practice Registered Nurses During the COVID-19 Pandemic

Background

In the early stages of the COVID-19 pandemic, strains on the healthcare system forced many U.S. states to revisit long-standing statutory limitations on the care coordinated by advanced practice registered nurses (APRNs). This was done by issuing waivers via executive, legislative, or board of nursing orders.

Purpose

To identify the impact of temporary practice waivers on APRNs’ direct patient care during the COVID-19 pandemic.

Methods

This cross-sectional study utilized a two-phased approach. First, a confidential online survey was conducted of APRNs practicing across 27 U.S. states. Second, comprehensive APRN discipline data from 2019 to 2021 were retrieved from the National Council of State Boards of Nursing's Nursys database and reviewed. Univariable and multivariable binary logistic regression models were used to determine the significance of observed trends.

Results

A total of 16,699 APRNs responded to the survey for a response rate of 14.2%. APRNs practicing in private outpatient clinics, in rural areas, and in health provider shortage areas were more likely to report a positive effect of the practice waiver (all p < .05). Providers noted that the waivers allowed them more time with their current patients and expanded the geographic boundaries of their direct patient care to take on new patients. Furthermore, despite the changing profile of APRN care during the early stages of the pandemic, including a pronounced increase in telehealth usage, the current review found no evidence of an uptick in discipline cases brought against APRNs in 2021.

Conclusion

Full practice authority for APRNs benefits patients by promoting expanded access to care and increasing the resiliency of our healthcare system without compromising patient safety. It is time for states and organizations that employ APRNs to recognize that permanently removing barriers to APRN practice is essential to the health of our nation.

The COVID-19 – related problems encountered by nursing homes in Poland and the steps undertaken to prevent disease spread in the first phase of the epidemic

Nursing Homes (NHs) are institutions of social assistance run by local governments or non-government organizations. Their purpose is to provide individuals with basic services. On March 20, 2020, the Regulation of the Minister of Health issued the declaration of the COVID-19 epidemic in Poland. The introduction of legal regulations allowed the authorities to take actions to prevent infections at NHs. The aim of the study was to analyze the COVID-19 – related problems encountered by nursing homes in Poland and the steps undertaken to prevent disease spread in the first phase of the epidemic.

The survey was conducted with use of an original questionnaire e-mailed to 532 NHs throughout Poland in May 2020. Results were analysed by way of the IBM SPSS Statistics program.

A total of 89 completed questionnaires were received from: 40 NHs organized by local government (44.9%), 24 run by churches (27.0%), 13 established by non-governmental organizations (14.6%) and 12 operating privately (13.5%). Among them, 78 NHs had less than 100 employees (87.6%) and 11 had more than 100 employees (12.4%), while 68 had up to 100 inhabitants (76.4%) and 21 had more than 100 inhabitants (23.6%). All NHs had problems with recruiting and retaining enough nursing staff.

The most commonly used method of COVID-19 spread prevention at NHs in the first phase of the pandemic was establishing an increased sanitary regime, monitoring of temperature of residents and staff members and preparing isolation rooms. The greatest problem was personnel shortages.

Impact of COVID-19 pandemic on APRN practice: Results from a national survey

Background

The impact of the COVID-19 pandemic on Advanced Practice Registered Nurse (APRN) practice is not well known.

Purpose

This study aimed to describe state practice barriers and explore the effects of the COVID-19 pandemic on APRN practice.

Methods

A descriptive study design used a 20-item web-based survey open from June 1 through September 23, 2020.

Findings

A total of 7,467 APRNs responded from all 50 states, including nurse practitioners (n = 6,478, 86.8%), certified registered nurse anesthetists (n = 592, 7.9%), certified nurse-midwives (n = 278, 3.7%), and clinical nurse specialists (n = 242, 3.2%). A number of barriers to practice prior to the pandemic were identified. Most respondents (n = 6334, 84.8%) identified that practice barriers limited the ability of APRNs to provide care during the pandemic.

Discussion

Barriers to APRN practice continue to restrict aspects of patient care and patient access to care, even in states with Full Practice Authority (FPA), during the COVID-19 pandemic and with state executive orders waiving practice restrictions. The study findings can be used to advocate for policy changes to support APRN practice authority.