Notes from the Dean's Desk


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Name: Marie Ann Marino, EdD, RN, FAAN
Position: Dean and Professor, Jefferson College of Nursing

Pandemic’s Stress on System Highlights Need for Expanded Scope of Nursing Practice

The collision of America’s physician shortage with an unprecedented pandemic highlights our need to expand the cadre of medical professionals legally empowered to prescribe medications, diagnose patients, and provide treatment.

Note that I said legally empowered to deal with the flood of COVID-19 patients on top of the usual cases of illness and injury. In many places, professionally qualified people have been available — thousands of nurse practitioners — but their state laws restricted their ability to meet patients’ needs to the full extent of their capabilities. 

Eight states temporarily rolled back limitations on Nurse Practitioners (NPs) during the pandemic, allowing them to work without the presence of a physician. But as a recent joint report from the National Academy of Medicine and Robert Wood Johnson Foundation, The Future of Nursing 2020-2030, points out, it’s time to make scope of practice permanent, in every state, to truly create a healthcare workforce that meets patient needs.

Already, 23 states and the District of Columbia grant full practice authority to NPs. If those eight states taking the “temporary” route during the pandemic join in, a solid majority of states will have risen to meet the need — and, we hope, will convince the rest of America to follow suit.

A recent Kaiser Family Foundation/Washington Post survey found that 60% of front-line healthcare worker respondents said the pandemic negatively impacted their own mental health. Almost a third of respondents needed mental health services or medication but didn't get them – with their reasons ranging from workload and inability to get time off to the cost of treatment or simply worrying about the embarrassment of it all. 

That’s not acceptable in a modern society where nurses handle so much of the front-line care for all of us, and where we need to expand the nursing workforce every year to meet growing demand.

The Future of Nursing 2020-2030 calls not only for a permanent broadening of NPs’ scope of practice nationwide, but also for nurses earning bachelor’s and doctoral degrees to be prepared not just for primary care settings (as many are now) but also for other fields where they are critically needed, including long-term care, behavioral health, and public and community health. They must be ready to deal with issues of health equity, racial disparities and social determinants of health, and make better use of technology, the report advises.

Also, as the report notes, we need to broaden the composition of our nursing program faculties – now mostly white and female – to better reflect that of students and patients. This will help lead us away from our history of discrimination and implicit bias in healthcare.

The COVID-19 pandemic already is forcing reassessment of how we prepare for and deal with healthcare crises. It’s also an opportunity to address shortcomings in the way we prepare and manage the healthcare workforce – particularly among the nurses at the heart of the system.

Maggie's Compassion Tour

I welcome you to take a break for some compassion by viewing highlights that captured our fabulous Jefferson Nurse teams interacting with Maggie on our Nurses Week 2021 Compassion Tour. Here is a link to a great video that you are free to share, and you can watch the video in its entirety below:

And if you haven’t already, we welcome you to follow Maggie on Instagram for a regular dose of Compassion.