Angelou Z. Salangsang BSN 4E READINGS WITH REACTION Article: The Need for Visible Nursing Leadership During COVID-19 2020 was welcomed as the Year of the Nurse and Midwife (World Health Organization [WHO], 2020), but it will long be remembered as the year of COVID-19. It has illustrated the best in nursing resourcefulness and has also been the year when many nurses and other key workers died, mainly due to a lack of personal protective equipment. The Year of the Nurse and Midwife seems an appropriate time to reflect on nursing leadership and plan for the future. Thus, in this editorial, we as a group of nursing leaders from across Sigma Chapters in the United Kingdom— Phi Mu (England), Upsilon Xi at Large (Wales), and Omega Xi (Scotland)—aim to draw on this emergent critical dialog about nursing leadership to offer our collective position for embracing future opportunities afforded by this unexpected global event. We constructively focus on three key aspects: (a) leadership as not visible; (b) leadership as not collaborative; and (c) leadership not advocating for personhood of citizens. We aim to take a future facing position and search for what can be done and what is possible in the future, moving out of the immediate crisis into recovery. Globally, 59% of healthcare professionals are nurses (WHO, 2020). Of these, there are leaders at every level—in practice, education, and research. The recent WHO (2020) report on the State of the World's Nursing 2020 calls for countries globally to take action to invest in their education and jobs, and primarily to strengthen nurse leadership, ensuring their role in influencing the development of health policy as well as decision making and contributing to the effective leadership and management of health and social care systems. We recognize that in a crisis on the scale of COVID-19, with incomplete and even conflicting evidence, speed is of the essence. We also recognize that safety remains a top priority, and that preferred decision-making models and processes across nursing have been sidelined for more directive and command-based models. We believe it is time to reflect on how nurse leaders need to reinstate our preferred person-centered decision-making models and processes and regain our visibility across the healthcare system. The inclusivity of such approaches allows for patient, carer, and community response and collaboration in care. Now is the time for nurse leaders to be increasingly visible and active participants with other key decision makers, to offer our creativity and, for example, our extensive experience of practice development and quality improvements that can enable transformation in the system, grounded in enhancing staff and patient experience. Given the enormity of the task of leading and managing the safety and well-being of the population during this pandemic, several liberties that really matter to persons in care settings and others significant to them were eroded and often arbitrarily removed, for example, family contact and choices at the end of life. The consequences for people's health and well-being as well as community cohesion have barely been explored, and it is time to recapture nursing's fundamental attention on person and person-centeredness before it is relegated or even lost. Indeed, we suggest there is an urgency to close the dissonance between the commitment of nurses with responsibilities for shared decision making and person-centeredness locally in practice, and the apparent silence of nursing leaders about the absence of citizen representation among the Scientific Advisory Group for Emergencies advising the government using scientific evidence. After all, evidence-based and evidence-informed practice includes data from studies, clinical experience, and patient preferences, and not a reliance on any one type of knowledge in isolation. Angelou Z. Salangsang BSN 4E These are extraordinary times, especially as it appears that should we experience further waves of COVID-19, we need to be prepared and draw on the investment in nursing leadership, a global focus for a number of years, and ensure that it is visible and effective at a strategic level. For example, leadership frameworks developed over the past 20 years have leaned heavily towards transformational, distributive, collaborative, and person-centered methodologies and are now widely advocated and used in organizations globally. However, in the context of COVID-19, we observed and experienced a master–servant model of leadership that failed to draw upon the collective intelligence, knowledge, wisdom, and intellectual capital of the wider nursing community. As nurse leaders, we have reflected on the use of the crisis management strategy of command and control, which at the outset we would continue to support in the interest of population safety. However, as the situation unfolds, we believe it is now time to reflect and learn from this and from others across the global community. Reflecting on health and care systems around the world and their response to COVID-19, there are good examples of a more inclusive approach. New Zealand, for example, has been dominated by these contemporary leadership values for an alternative approach and evidenced outcomes. Additionally, in Taiwan, building on their response to the SARS epidemic in 2003, nurse leaders worked together with government to protect public health and established nurse-led quarantine care call centers (Shwu-Feng, Ching-Chiu, Hsiu-Hung, & Chia-Chin, 2020). In contrast, we observed that in the United Kingdom, the visible geographical position of nurses was on the front line, with a minimum visible profiling of nurse leaders orchestrating, or at least contributing to, the strategic response to the pandemic. Given that one of our core responsibilities is advocating for persons as our primary partners, it is critical that we are leading the return to enabling shared decision making with the public and service user representatives. For example, the exclusion of families and others from hospitals and other care settings seems to have continued too long without review, especially when set alongside the fact that many organizations were able to bring in volunteers and train them and new support workers in 1 or 2 days. This would have been the chance to offer similar opportunities to families, as trusted partners in care. In conclusion, it is important now to identify how to make nursing leadership more visible, especially in how to drive the voices and decision making of nursing leaders as we move forward. We would advocate and support Sigma in setting up an international panel of nurse leaders to debate how we can best help to assist in the endeavors to offer a more collaborative and inclusive approach to decision making when we experience future waves of infection and future global challenges to nursing, healthcare delivery, and systems. Reference: The Need for Visible Nursing Leadership During COVID-19. Sigma. Retrieved October 26, 2023 from https://sigmapubs.onlinelibrary.wiley.com/doi/full/10.1111/jnu.12587 Angelou Z. Salangsang BSN 4E Reaction: Strong nursing leadership is necessary to direct and support the nursing workforce and guarantee the best possible patient care since nurses play a major role in healthcare systems, especially during a crisis in public health like a pandemic. Being prepared and drawing on the investment in nursing leadership is essential, not only during the COVID-19 pandemic but for the ongoing sustainability and effectiveness of healthcare systems. When addressing global difficulties in nursing, healthcare delivery, and healthcare systems and planning for future waves of infection, a collaborative and inclusive approach to decision-making is essential. Nurses possess a wealth of clinical expertise and knowledge that is invaluable during a healthcare crisis. Visible nursing leadership can share best practices and offer evidence-based advice with the larger healthcare community. Additionally, because nurses provide direct patient care, the nurse leaders are in a unique position to advocate for patients' needs as well as the security and wellbeing of healthcare professionals. This involves making certain that necessary personal protective equipment (PPE), sufficient staffing numbers, and secure working conditions are all available. Effective communication is crucial during a crisis. Nursing leaders can help coordinate efforts between different healthcare departments, disseminate essential information, and provide clarity and direction to nursing staff and the broader healthcare team. Visible nursing leadership is essential during the COVID-19 pandemic for guiding and supporting the nursing workforce, advocating for patients and healthcare workers, coordinating efforts, and ensuring high-quality patient care. During a public health emergency, their knowledge, advocacy, and communication skills are crucial for building a strong and efficient healthcare system. In addition to being a wise healthcare strategy, investing in nursing leadership and being ready to capitalize on this investment ensures that healthcare systems are resilient, adaptable, and able to effectively address present and future challenges, including pandemics, natural disasters, and other healthcare crises. With their special knowledge and first-hand experience, nursing leaders are essential to ensuring that the healthcare response is efficient and patient-centered. Angelou Z. Salangsang BSN 4E Article: An expanded institutional- and national-level blueprint to address nurse burnout and moral suffering amid the evolving pandemic The COVID-19 pandemic has exposed and amplified the longstanding occupational circumstances of nurses. In this article, the authors provide updates to their 2020 institutional recommendations and craft a national plan to tackle burnout and moral suffering. In 2020, members of our team developed an institutional-level blueprint to minimize nursing burnout and moral distress, published in this journal as “A Blueprint for Leadership During COVID-19: Minimizing Burnout and Moral Distress Among the Nursing Workforce.” To sustain the nursing workforce, it's imperative to decipher between “unavoidable occupational suffering (inherent to the [nurse's] role) and avoidable occupational suffering (systems failures that can be prevented).” Although resilience capacity building is key to addressing the unavoidable suffering of clinical practice, avoidable suffering must be prevented and resolved at the organizational level. Here, we provide an expanded blueprint, with updates to our previous institutional recommendations accompanied by a national plan to address nurses' burnout and moral suffering. The problems started long before COVID-19 The common misconception that nurses are burned out and leaving their jobs because of COVID-19 mischaracterizes the problems nurses face. More accurately, the pandemic has exposed and amplified the longstanding occupational circumstances of nurses. Scientific consensus suggests that understaffing, poor work environments, and the lack of robust ethical frameworks are the primary contributors to the development of burnout and moral suffering among nurses. Although moral suffering can contribute to the development of burnout, the two are distinct based on their differential causes and consequences. There's agreement that the poor working conditions leading to burnout and moral distress were prevalent long before the pandemic started. Inadequate state-level leadership from some of our elected leaders has compounded negative working conditions for nurses through misguided policy action and glaring inaction. For instance, despite the thousands of people hospitalized with COVID-19 in Florida at the time of this writing, Florida's governor has attempted to uphold a ban on vaccine and mask mandates, contrary to over a century of empirical evidence supporting these effective public health interventions. Similar choices of leaders across the country further jeopardize population health and place healthcare workers at great risk under the guise of protecting personal liberties. Policymaking that lacks a scientific base, or worse, intentionally contravenes scientific knowledge, intensifies patterns of verbal and physical violence toward nurses. Nurses who are victims of workplace violence don't have the same legal or policy-based protections that other service workers do, compounding nurses' feelings of betrayal by leaders and the public they're dedicated to serving. These mental health costs are resulting in rising levels of depression, anxiety, posttraumatic stress disorder, and suicide among nurses. Reference: An expanded institutional- and national-level blueprint to address nurse burnout and moral suffering amid the evolving pandemic . Nursing Management. Retrieved October 26, 2023 from https://journals.lww.com/nursingmanagement/Fulltext/2022/01000/An_expanded_institutional__ and_national_level.5.aspx Angelou Z. Salangsang BSN 4E Reaction: The nursing workforce raises concerns about burnout and moral distress, which can have a serious impact on nurses' well-being, patient care, and the healthcare system as a whole. The particular challenges and significant responsibilities that nurse leaders frequently shoulder might result in burnout and moral distress. The common misconception that nurses are leaving their jobs primarily due to COVID-19 oversimplifies a complex issue. Although the COVID-19 pandemic has undoubtedly put a lot of strain on nurses, it is important to realize that nurse burnout and attrition were caused by a variety of factors long before the COVID-19 pandemic. Nurses often work long hours in high-stress environments, leading to emotional exhaustion. It can be extremely draining emotionally to provide care, especially during emergencies like the COVID-19 pandemic. High nurse-to-patient ratios and persistent understaffing have long been problems in the healthcare industry. The hard nature of nursing's high stress and workload has always been present. When nurses are presented with moral choices that contradict their values and beliefs, moral distress results. For example, making decisions about resource allocation during a crisis may lead to moral distress. Nurses also face ethical dilemmas and moral distress when they cannot provide the level of care they believe patients need due to resource constraints. Nurses may feel morally distressed when they want to advocate for their patients but face obstacles from hospital policies, physicians, or administrators. The pandemic has increased the workload and intensified stress, but these factors were present beforehand. Nurses are essential to patient care, and their general well-being is directly related to both patient outcomes and the standard of care as a whole. Recognizing that nurse burnout and turnover are complicated problems that are not just a product of the COVID-19 pandemic is a crucial first step in creating measures that will help nursing professionals be supported and retained. It is important to realize that a variety of factors combine to affect nurses' decisions to leave their jobs or experience burnout. While the pandemic has brought these challenges to the forefront, addressing nurse burnout and attrition requires addressing the systemic issues within healthcare systems, including staffing levels, workload, resources, and ethical considerations.
