A critical time for nurses and all vulnerable populations.

When healthcare professionals and communities prepare for and respond to disasters and other mass casualty events, we generally think of them as having a distinct beginning, middle, and end. However, the COVID-19 pandemic—with all its uncertainties—has upended our nation, our normal. It’s taking a toll on frontline nurses, other healthcare workers, and first responders, many of whom have been expending massive amounts of their physical, mental, and emotional energy caring for patients and trying to meet other public health needs.

Although we don’t ordinarily think of ourselves in this way, frontline nurses have become a vulnerable population—whether it’s because they’re risking infection by working without adequate personal protective equipment (PPE), witnessing the ravages of the disease, experiencing ethical conflicts, or worrying about transmitting the virus to loved ones. Beyond the physical threat, studies have shown that nurses working under these sustained crisis-mode conditions are at higher risk for depression, anxiety, and post-traumatic stress disorder. To support nurses’ short- and long-term needs, the American Nurses Foundation, in partnership with the American Nurses Association (ANA) and three of our affiliated specialty nurses organizations, developed a comprehensive mental health and well-being initiative, which is available here. Its components include peer-to-peer conversations, a digital self-assessment tool, hotlines, and provider resources.

Additionally, some RNs report being fired or retaliated against in other ways for speaking out about the lack of PPE and related healthcare concerns. Nurses have a right and—as stated in the Code of Ethics for Nurses with Interpretive Statements—an obligation to speak out when we encounter practices that endanger patients, the public, and ourselves. Healthcare organizations that try to prevent us from doing so, especially during a pandemic when countless lives are on the line, is unconscionable. And it’s a slippery slope: If nurses are forced to compromise on their own infection control and prevention measures, what’s next?

That said, nurses should follow the chain of command when reporting unsafe practices. But if that chain is faulty, they must—and do—have the right to report issues in other ways, including by filing a complaint with the Occupational Safety and Health Administration (OSHA). Early on in the pandemic, ANA expressed concerns about retaliatory practices to the U.S. Department of Labor and OSHA, and we urge nurses facing retaliation to file an OSHA whistleblower complaint online or call the agency.

I also want to briefly address the health disparities of long-standing vulnerable populations that—at least momentarily—have come into sharper focus with the emergence of COVID-19. For example, data reported in Los Angeles County and in Chicago show that a disproportionate number of African Americans have been infected with or died from COVID-19. And in the Southwest, the Navajo Nation has been hit hard, with healthcare systems struggling to meet the population’s needs. We must encourage vulnerable populations to seek care, and we must determine how to safely get services to them, such as through churches. And nurses need to continue to advocate for increased funding and programs to end these life-threatening disparities. (Watch for an upcoming podcast on this issue here.)

As I write this, states and counties are making plans to “reopen” with various restrictions in place. No matter what comes next, we must stand up for our patients, communities, and ourselves. Everyone deserves to be safe and have their physical and mental health needs met, and nurses are uniquely positioned and qualified to make that happen when we make our voices heard.

– Ernest J. Grant, PhD, RN, FAAN, President, American Nurses Association