1. Hassmiller, Susan B. PhD, RN, FAAN

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As the COVID-19 pandemic ravages the United States, every American has been dramatically affected. Our nurses work long hours, spending days-and in some cases, weeks-away from their families and at great risk to their own health. The pandemic has brought our collective failures to create health equity into stark relief: The poor, unhoused, and immigrant populations are at greater risk (Besser, 2020). With no end in sight to the greatest catastrophic health and economic disaster to hit the United States in over a century, the National Academy of Medicine elected to incorporate into the second future of nursing report our nation's pandemic response and the role of nurses in responding to the crisis. The report-originally slated for release this December-will now be released in late Spring of 2021. The overarching task remains the same: to chart a path for our profession to help our nation build a culture of health, reduce health disparities, and improve the health and well-being of the U.S. population in the 21st century.

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Much uncertainty remains in the months ahead, including whether and when a vaccine will be available and the time frame for when Americans can safely return to school, work, religious services, and recreational activities. Two things are abundantly clear, however: (a) Nurses and other frontline health workers will need significant emotional support to continue to serve patients and to prepare for the future of health care, and (b) the rampant inequities, fully exposed by this pandemic, must be addressed at their root. Professional development practitioners-who play a key role in the development and advancement of frontline staff, clinical education, and practice-are sorely needed to offer practical continuing education offerings that emotionally support nurses and help them to address their patients' unmet health needs.



Even before COVID-19 hit the United States, many frontline nurses were understaffed, overworked, and often burned out. Many worried about bullying and violence in the workplace. Outside work, many cared for their own children and supported elder family members. As caregivers, they often cared for everyone but themselves. A survey of 1,200 frontline nurses conducted by Robert Wood Johnson Foundation (RWJF) in 2019 revealed that 46% believe that they are already stretched too thin (RWJF, 2019). Another survey of 500 nurses conducted in 2018 by RWJF showed that. although nurses expressed interest in addressing their patients' unmet social needs, they do not necessarily have the time or the institutional buy-in to do so (RWJF, 2019).


The COVID-19 pandemic has exacerbated the daily stresses of frontline nurses. Too many are falling critically ill, and some have lost their lives (The Guardian and Kaiser Health News, 2020). Many are working without an adequate supply of personal protective equipment needed to keep them, their patients, and their families safe (Mason & Friese, 2020). Nurses are connecting grieving family members over FaceTime to say goodbye and staying with patients so they do not die alone. Many are self-isolating away from their families. In short, many are exhausted and overwhelmed. Our nation's nurses must have adequate protection and emotional support.



The COVID-19 pandemic has laid bare a devastating fact about U.S. health care: We spend more on health care than any other nation in the world but experience some of the worst health outcomes in the developed world. Health is greatly influenced by nonmedical factors that affect communities, such as access to jobs that pay a living wage, safe housing, reliable transportation, walkable neighborhoods, good schools, fresh food, and adequate green spaces. Where people live and work, their income, their education level, and other factors have as much, or more, influence on their physical, emotional, and spiritual well-being as their access to health care. The COVID-19 pandemic has revealed that the risk of exposure and the ability to protect oneself and one's family depends on income, access to health care, and immigration status, among other factors. Achieving health equity-giving everyone a fair and just opportunity for health-is key to our nation's health.


Nurses, who spend the most time with people and make them feel seen, understood, and capable as they cope with illness, are trusted and respected members of their communities. Many nurses already help individuals tackle nonmedical needs every day, from assisting with housing, to arranging ride shares so patients can get to their appointments, to advocating for their needs.



Successful professional development practitioners anticipate future trends and workforce needs and take into account the daily realities of frontline nurses in designing programs to address current needs. The key challenge for professional development practitioners this decade will be to tackle the compassion fatigue and burnout that many nurses feel and to prepare nurses to fully address the unmet social needs of patients and their families-an admittedly difficult task.


However, I am confident that professional development practitioners will rise to the challenge. Frontline nurses interviewed by RWJF expressed interest in receiving continuing education on the social determinants of health-related needs of individuals and more ongoing educational opportunities to ensure that they are well prepared to address "real-life" situations (RWJF, 2018). Professional development practitioners can set up continuing education programs with social workers, community health workers, and other community partners that emphasize team-based care and collaboration to underscore the importance of partnerships in addressing unmet social needs (Heath, 2019).


In addition, they can collaborate with hospital administrators to implement straightforward mechanisms for frontline nurses to address unmet social needs. They can work with providers to improve their ability to interface with housing, transit, and schools to address their patients' needs more broadly. Professional development practitioners can create or encourage experiences that aid frontline nurses in getting to know the communities they serve. They can ensure that frontline nurses have abundant community resources to which they can refer their patients with unmet social needs.


Furthermore, the professional development practitioner field has a strong track record of meeting past challenges. They improved safety and quality following the release of the then-named Institute of Medicine report To Err Is Human, and they advanced the recommendations from The Future of Nursing: Leading Change, Advancing Health in the areas of education and leadership. Nurses in professional development promoted lifelong learning, encouraged staff nurses to return to school to attain their baccalaureate degrees and higher, and built the evidence base for nurse residency programs and demonstrated the return on investment to their organizations. They identified nurses with nascent leadership capabilities and created learning opportunities to buttress their skills and offered leadership and mentorship programs.


Frontline nurses have expressed a desire to address their patients' unmet social needs-the most salient issue of this decade. But I have heard repeatedly as I speak to nurses across the country that they cannot give what they do not have. They have even less now as they serve on the frontlines of this pandemic. In order for frontline nurses to be able to address their patients' unmet social needs, professional development practitioners must improve frontline nurses' daily work environment. This is a top priority. By designing programs that meet nurses' emotional needs and address their community's unmet needs, professional development practitioners will serve as vital partners in the national effort to give everyone a fair and just opportunity for health and well-being.




Besser R. E. (2020, May 5). On coronarvirus, we know who will pay the price if we open up before we should. USA Today. [Context Link]


Heath S. (2019, December 4). Supporting nurses to address the social determinants of health. Patient Engagement HIT. [Context Link]


Mason D., & Friese C. (2020, March 19). Protecting health care workers against COVID-19-And being prepared for future pandemics. JAMA Forum. [Context Link]


Robert Wood Johnson Foundation. (2019). Unpublished audience research. "In Their Own Words: Nurse Insights on the Unmet Needs of Patients." Author. [Context Link]


The Guardian and Kaiser Health News. (2020, May). Lost on the frontline. [Context Link]