As the coronavirus pandemic plunges the United States and the U.S. healthcare system into crisis, it’s “all hands on deck” in patient care organizations nationwide. And among the clinical professionals who are at the center of addressing the crisis are the nation’s nurse practitioners, nurses with advanced and often specialized, training. The nationwide association that represents more than 100,000 nurse practitioners is the American Association of Nurse Practitioners. Last week, Sophia Thomas, DNP, FNP, PNP, FAANP, the AANP’s president, and a nurse practitioner who practices at the Daughters of Charity Health System in the Kenner area of New Orleans, spoke with Healthcare Innovation Editor-in-Chief Mark Hagland, regarding the current situation, and her and her fellow nurse practitioners’ perspectives on what’s happening and what needs to happen, in patient care organizations and beyond, to address the crisis. Below are excerpts from their interview.
What are your top concerns right now, as the president of your association?
I have a few concerns. Number one is to be sure that nurse practitioners and providers across the country have adequate supplies of personal protective equipment (PPE); we’re hearing about shortages of masks, gowns, gloves. I’ve heard from colleagues stories of PPE actually being stolen from their offices; I had some PPE stolen from my office last night. So that’s difficult. That’s my first concern.
My second is, nurse practitioners are educated, trained, and nationally certified to be able to provide care to patients across the spectrum. This is a time when we need for clinicians to be able to practice to the fullest extent of their licenses. We’re calling on governors in states that don’t allow NPs to practice with full practice authority, to practice at the tops of their licenses. That is, without regulatory restrictions or barriers to that. In 23 states and the District of Columbia, nurse practitioners have full practice authority. But in the other states, they require a collaborative practice agreement with a physician—we call it a permission slip. That if there are questions, they have to turn to a physician. In reality, NPs collaborate with all clinicians; it's an unnecessary barrier; it’s really outdated.
There remains a concern in certain circles that nurse practitioners might end up exceeding their scope of practice. Is that at all a legitimate concern?
Hospitals are being overwhelmed. And a lot of medical offices are quite slow right now; patients are choosing to stay at home, because they’re practicing social distancing, and rightly so. So we have situations in which nurse practitioners are available to practice in high-volume areas, but regulations are restricting them from doing so. So there’s really no need to have these regulatory restrictions. In 23 states and the District of Columbia, nurse practitioners are able to practice at the tops of their licenses. In Tennessee this week, the governor signed an emergency declaration to waive a lot of elements in their regulations. [On March 12, Gov. Bill Lee signed an executive order to address the COVID-19 crisis; among its provisions is one that gives the state’s health commission the power to allow licensed health professionals from others to practice medicine in Tennessee without having to pursue a state license.]
And Governor Bill Lee of Tennessee’s action spoke to this?
Yes, it waived some elements related to a collaborative practice agreement.
Is one of your concerns that of the possibility of nurses themselves becoming ill?
It’s a huge concern. That’s why we’re recommending social distancing. We want to stretch it out. If 100 people are sick, it’s better if they’re sick over a two-week period rather than a two-day period, because we don’t want the system to be flooded. And the shortage PPE adds even more risk. And with the PPE shortages, there’s also a chance that providers could become sick and not know it, and could actually become infected themselves. And people who are committed to healthcare; I certainly could speak for nurse practitioners, who are dedicated to providing high-quality care to patients, especially in crises; it’s something we do well.
What are you hearing from AANP members right now?
We’re already becoming flooded here in the New Orleans area as well. We had 92 cases on Sunday, and now have 490 cases [as of midday, Friday, March 20]. We’re seeing more and more complaints of COVID-19 cases. Some organizations are not able to test; some are running out of PPE. The shortage of PPE remains very high. Testing has become much easier now that Quest and LabCorp are rolling, the private labs. So we’re in a different situation now. But as the markets are becoming flooded with more and more patients, we’re looking at being swamped. And so we’re having to improvise. I’ve heard of one hospital in Washington state that’s making their own face masks with materials from Home Depot. And the CDC is saying, if you don’t have face masks, just use bandannas. And there certainly is no evidence that bandannas could be more effective. We’ve gone from N-95s to surgical masks and now bandannas. Though in my personal opinion, using that is better than using nothing at all.
What will everything look like a month from now?
I’m not an epidemiologist, but I don’t think we’ll be out of this in a month from now. There are two scenarios: people could take heed and practice social distancing, in which case we could be out of the woods, if people really adhered to it. Alternatively, if people didn’t adhere to it and restrictions weren’t enacted, the numbers could rise significantly. So really, people need to practice social distancing, and make bold moves. The governor of Louisiana closing schools and gyms last Friday was a big and important move.
Can you speak to the IT and staffing elements of this situation, particularly the need to try to optimize clinician staffing in patient care organizations?
It’s a day-to-day thing. More than ever, really having to be organized, to keep up, and certainly keeping up with the guidance from the CDC. Telehealth, with the waivers, will really help change how we deliver patient care. And the waiver eliminates the Medicare restrictions on telehealth that are geographically related to the originating sites. I think that’s a great move to help keep people at home. The more people we can keep at home, the better.
Is there anything you’d like to add?
I’m proud of my nurse practitioner colleagues who are stepping up to the plate, manning command centers, opening up coronavirus Kiosks, working to stay up to date on the CDC guidelines. I’ve seen many NPs showing leadership in their organizations. I couldn’t be more proud of my nurse practitioner professionals now.