Supporting the Mental Health of Primary Care Nurses and Staff through the Pandemic and Beyond.

As a clinical nurse specialist, I provide leadership and strategy for our primary care program where I lead clinical initiatives and develop practice tools and guidelines across our clinics. My portfolio encompasses five clinics, one perinatal program, an opioid agonist therapy (OAT) clinic and an intensive case management team, and in the past year I supported several teams that focus on COVID-19 testing and isolation support. Our clinics specialize in serving people who experience significant economic and social marginalization and those who are not well served by traditional health services. Our nurses, in particular, juggle many roles: providing both outreach- and clinic-based care and supporting our injectable OAT program, youth clinic and our transgender specialty care program. Our work has become increasingly complex as our clients navigate survival with competing syndemics - the opioid crisis, COVID-19, a Shigella outbreak and an ongoing housing crisis - among the many significant structural factors that impact our clients' health.

Clinical Nurse Specialist Impact on COVID-19 Preparation at a Military Treatment Facility.

PURPOSE: The COVID-19 pandemic has significantly challenged healthcare organizations across the globe, forcing innovation, resourcefulness, and flexibility. The purpose of this article is to describe the impact of clinical nurse specialist practice on COVID-19 preparation at a military hospital. ENVIRONMENT OF CARE CHANGES: The pandemic required facilities to develop expansion plans to facilitate a potential surge of COVID-19 patients. Clinical nurse specialists collaborated to develop a plan to expand care capacity and streamline testing while designating specific critical care and medical-surgical areas for COVID-19 patients. STAFFING CONSIDERATIONS: To capitalize on the expanded bed capacity, clinical nurse specialists identified and trained outpatient nursing staff to serve as nurse extenders. DISCUSSION: Early in the pandemic, a lack of strong evidence-based interventions to mitigate transmission and treatment necessitated the development of innovative solutions. The clinical nurse specialist team established designated transport routes for COVID-19 patients, leveraged technology to improve methods of care, and cultivated a culture of innovation by providing on-the-spot meaningful recognition to staff. CONCLUSION: As leaders in healthcare, clinical nurse specialists are change agents that work to maintain high-quality, safe patient care even during a global pandemic.

Leveraging nurse practitioner capacities to achieve global health for all: COVID-19 and beyond.

AIM: To argue that nurse practitioners have been under-utilized generally in the current global health environment, creating barriers to achieving universal health coverage and the Sustainable Development Goals. BACKGROUND: Nurse practitioners are advanced practice nurses possessing expert knowledge and leadership skills that can be optimized to narrow disparities and ensure access to high-quality health care globally. Nurses worldwide have been challenged to meet global public health needs in the context of COVID-19 (SARS-CoV-2 virus), and there are early indications that nurse practitioners are being called upon to the full extent of their capabilities in the current pandemic. SOURCES OF EVIDENCE: PubMed; Google Scholar; the International Council of Nurses; World Health Organization; United Nations; and the experiences of the authors. DISCUSSION: Several international reports, nursing and health organizations have called for continued investment in and development of nursing to improve mechanisms that promote cost-effective and universally accessible care. Expanding nurse practitioner scopes of practice across nations will leverage their clinical capacities, policy and advocacy skills, and talents to lead at all levels. CONCLUSION: Ongoing empirical data and policy change is needed to enable the full scope and strategic utilization of nurse practitioners across healthcare systems and contexts. IMPLICATIONS FOR NURSING PRACTICE, AND NURSING AND HEALTH POLICY: Widespread education regarding nurse practitioner capacities for interdisciplinary partners, policymakers and the public is needed. Policies that safely expand their roles are critical. Role titles and remuneration reflective of their scope and service are required to lead, sustain and grow the workforce internationally.

A COVID-19 screening tool for oncology telephone triage.

PURPOSE: Symptoms associated with COVID-19 infection have made the assessment and triage of cancer patients extremely complicated. The purpose of this paper is to describe the development and implementation of a COVID-19 screening tool for oncology telephone triage. METHODS: An Ambulatory Oncology Clinical Nurse Educator and three faculty members worked on the development of an oncology specific triage tool based on the challenges that oncology nurses were having with the generic COVID triage tool. A thorough search of the published literature, as well as pertinent websites, verified that no screening tool for oncology patients was available. RESULTS: The screening tool met a number of essential criteria: (1) simple and easy to use, (2) included the most common signs and symptoms as knowledge of COVID-19 infection changed, (3) was congruent with the overall screening procedures of the medical center, (4) included questions about risk factors for and environmental exposures related to COVID-19, and (5) assessed patient's current cancer history and treatment status. Over a period of 3 weeks, the content and specific questions on the tool were modified based on information obtained from a variety of sources and feedback from the triage nurses. CONCLUSION: Within 1 month, the tool was developed and implemented in clinical practice. Oncology clinicians can modify this tool to triage patients as well as to screen patients in a variety of outpatient settings (e.g., chemotherapy infusion units, radiation therapy departments). The tool will require updates and modifications based on available resources and individual health care organizations' policies and procedures.