COVID-19 effects on practice: Perspectives of Tennessee APRNs.

BACKGROUND: In response to the COVID-19 pandemic, Tennessee's Governor issued executive orders temporarily suspending certain practice restrictions on advanced practice registered nurses (APRN), which expired after 2 months as the pandemic worsened. PURPOSE: This purpose of this qualitative study was to analyze APRN interview data to evaluate how prepandemic APRN practice barriers, executive orders, and the pandemic affected APRN practice in Tennessee. METHODS: Fifteen Tennessee APRNs who completed the National APRN Practice and Pandemic study also completed follow-up interviews via a HIPAA-compliant Zoom platform. Given the unprecedented circumstances associated with the COVID-19 pandemic, we conducted a qualitative descriptive study seeking descriptions and unique perspectives of Tennessee APRNs. Consistent with qualitative study design, we conducted an atheoretical study that featured interviews, purposeful sampling with maximum variation sampling, and content analysis. RESULTS: The major themes were practice changes, impact of executive orders, and ongoing care barriers. The data revealed that patients, APRNs, and other health care providers were strained in new and profound ways during the pandemic. An underlying theme was Tennessee APRNs' frustration with continued regulatory and other practice barriers despite their state's health and health care disparities and under resourced health care system. CONCLUSION: These findings indicate the need to improve care access and health outcomes, advocate for full practice authority for APRNs, support telehealth expansion, address transportation deficiencies, and respond to the pandemic-precipitated mental health crisis.

COVID-19 Pandemic Mental Health Challenges: Patients and Providers.

Interviews with 15 Tennessee Advanced Practice Registered Nurses early in the COVID-19 pandemic revealed a major theme of mental health challenges unrelated to the primary study purpose. Without direct prompts, 13 out of 15 interviewees mentioned mental health issues among patients and 14 of the 15 interviewees discussed provider mental health problems. A secondary analysis of interview transcripts revealed three themes associated with mental health challenges: general barriers to mental health care, patient-specific concerns, and provider issues. Responding to the new and worsening mental health and substance use disorders revealed by informants and cited in the literature is an urgent priority.