The Pandemic to Come

Lindsay Huse, MPH, DNP, RN, PHNA-BC

2/11/2021

So, you may or may not have noticed this, but we are in the middle of a pandemic.

If you are a nurse, your spidey senses might be tingling, telling you something ominous is on its way. The earthquake has hit, the aftershocks are still rattling, and while you seem to be making some headway digging folks out of the rubble, you suddenly are seeing the water along the shoreline retreating. You know that isn’t good. What was it you heard about water retreating?

I knew the proverbial water was just starting its retreat when I watched the season opener of The Resident. Don’t you love medical dramas? They are sometimes pretty corny, and someone is usually making out in a supply closet. Normally, they are a guilty pleasure for me. But this episode detailed the start of the COVID-19 outbreak and response. As a public health nurse who has been in response mode since last March, I suddenly found myself sitting on the couch with a rapid heartbeat, panting for breath, feeling the sensation of an elephant sitting on my chest. Yes, you heard me right- an episode of The Resident gave me a full-blown panic attack.

Triggered. Huh.

The next day, still a touch embarrassed by my response to what amounts to a nighttime soap opera, I started exploring why this might have happened. In the episode, people come into the hospital in respiratory distress. One by one, staff fall ill despite their efforts to protect themselves- and others- from the virus. Doctors and Nurses have to go through symptom screening each day as they arrive to work, and they carefully remove well-used N-95s from paper bags, hoping they still seal around their faces. People are pronated on ventilators, and some people don’t make it. There is terror and grief on many faces. I force myself to finish the episode, but I cry the whole way through.

It hits me that it simply hit too close to home. I’m shocked at the force with which I’ve responded to the episode, but a moment later I’m struck by another realization. I’M having this response; ME. I have a fairly well-insulated position with daily hard decisions and extremely long hours but rarely having to take on first-hand the hate, lashing-out, betrayal, and destroying of trust that my public health nurses in local offices have endured for almost a year now. How are my already-exhausted, tapped out public health nurses going to respond when they have the chance to slow down enough that everything that has happened actually hits them? How will they respond when something random brings on the anxiety of an entire pandemic in a single moment?

Oh my god. The water is retreating, and they are on the beach. And they, tired and burned out from trying to save people who are turning around and spitting in their faces for doing so, are going to be swallowed whole when all of this catches up to them.

We have to talk about what comes next, and we have to talk about it yesterday. In many places, public health professionals, nurses especially, have been betrayed and are now seen in completely different light by the public and the community partners they’ve always worked so hard to serve. We’ve all had to carry out work that served a greater good, but created a moral injury within us. We’ve had to isolate and quarantine the single mom with three kids, meaning no paycheck to buy food or heat or rent. We’ve had to try to tease out the best path forward for our communities in the face of conflicting and sometimes harmful federal recommendations, creating even more confusion and distrust. We’ve had to backpedal on some of our tactics as we’ve learned more about this virus, which those who aren’t experts see as, well, wishy-washy. And the result of all of this has been that everything we imagined to be true over 20 years of pandemic planning- assumptions like people pulling together to do what’s best for our communities, or partners with whom we’ve worked to build relationships being willing to help us out when the time came, or a political climate that supports the science of health- turned out to be false.

The result of all of this, is that the largest portion of our public health workforce is in danger. In some communities, public health nurses have been shunned by their churches, their schools, their neighbors. Going to the grocery store or the gas station feels like a risk. Someone they’ve known all of their lives may see them and say something hateful, and no one can really take it anymore. Nurses serving communities they’ve lived in their entire lives are considering not just leaving their communities- a difficult enough prospect given the value they bring- but they are considering leaving nursing. Not leaving public health nursing, leaving nursing.

I don’t have to tell most of you that this is bad news. Key findings from a recent Georgetown University study on the nursing workforce found that over a million nurses will retire in the coming 20 years, and nearly a quarter of nurses over the age of 55 are planning to leave the field or reduce their hours.1 And while it’s true that more people are applying to nursing school and many positions may be coming open, most of those newly minted nurses will not choose the poorly-paid and now abused ranks of public health. They didn’t before, and they won’t now unless something changes.

So what does this mean? Well, without a strong public health nursing workforce, every level of the socioecological spectrum will suffer. Given our track record of increasing the public’s immunity (read: health and survival) to a variety of infectious diseases, educating people on an entire range of health problems and healthy behaviors, decreasing infant and maternal mortality through interventions such as home visiting, and building bridges for disadvantaged clients to necessary and sometimes hard to find resources, the outcome will be a sicker public. And a sicker public does not function optimally. A sicker public uses extraordinary resources, both within and outside of the health care system.

We have to find ways to take care of our PHNs, right now, before the wave crashes. Mental health resources such as Employee Assistance Programs may be a start, but are not sufficient. Finding therapists is tough on a good day, and three visits won’t even scratch the surface. Employee Wellness programs are equally lacking to address the level of burnout, moral injury, and emotional distress nurses are facing. Nursing leaders need to strategize now how we can get our people off of the beach. Consider it a public health intervention.

1. Georgetown University Center on Education and the Workforce (2015). Nursing Supply and Demand through 2020. https://1gyhoq479ufd3yna29x7ubjn-wpengine.netdna-ssl.com/wp-content/uploads/Nursing-Supply-Final.pdf