Nurses and frontline workers show resilience in an incredibly tough year

The theme for the 2021 campaign for International Nurses Day is Nurses: A Voice to Lead – A vision for future healthcare, highlighting how the profession will transform the next stage of healthcare. This past year has certainly shown their courage, resilience, innovative and heroic spirit – there is little doubt that, with the necessary support and investment, they can achieve their vision for the future and transform healthcare.

A few weeks into the outbreak of the pandemic, with more than one-third of countries worldwide had enacted lockdown measures to contain the spread of the virus, UICC member organisations were reporting difficulties in providing patient support, regular check-ups and screenings, treatments even. A rapid assessment by WHO in June 2020 confirmed the severe nature of disruptions to services for non-communicable diseases, including cancer, during the pandemic.

A major concern was the need to ensure the safety of cancer patients and a secure environment to run tests and treat them, finding ways to limit their visits to hospitals for medication or setting up separate cancer wards to reduce the risk of COVID-19 infection.

Nurses and doctors caring for cancer patients struggled to cope with disrupted supplies of medicines and reduced resources to manage patients, and were often redeployed to the coronavirus response. Yet they and other frontline health workers placed their physical and mental health at risk, facing shortages in protective equipment, an increase in violence and discrimination, many long hours in overrun hospitals and lack of sleep, as well as fear of catching and spreading the virus, according to the International Council of Nurses (ICN).

An estimated 1,6 million healthcare workers in 34 countries were infected with COVID-19 as of end 2020, and in some cases nurses were the biggest health worker group infected with the virus (up to 415 in Mexico). 2,710 nurses have reportedly died as of 31st January 2021 in 59 countries but sadly, the number of infections and deaths could be even higher than ICN figures indicate due to under-reporting.

In addition, nearly 80% of ICN’s national nurses associations who were surveyed reported mental health distress in nurses working on the COVID-19 response. Some 64% of nurses in the US felt overwhelmed and 67% were sleeping badly. The long-term effects in terms of post-traumatic stress have yet to be assessed but are feared to be significant. 

The situation remains dire, according to Dr Stella Bialous, Immediate Past President of the International Society of Nurses in Cancer Care (ISNCC), a UICC member organisation. She wonders about the long-term impact on cervical cancer screening, palliative care, availability of pain medication and other supportive care services so often provided by nurses. 

“There are some places where nurses continue to be appreciated, others not so much and, overall, there is ongoing struggle for fair wages and good working conditions. My other home country, Brazil, is an example of that, where a request by nurses for an increase in base salary was denied, while hundreds of nursing professionals have died from COVID-19."
–   Dr Stella Bialous, Associate Professor in Residence, Social and Behavioral Sciences, School of Nursing, University of California San Francisco and Past President of ISNCC

Shaping the future – A shortage of nurses

Many innovations that have emerged in terms of e-prescriptions, as well as telemedicine and the use of social media and webinar platforms for group meetings, counselling and other support programmes, will undoubtedly remain long after the pandemic has waned. Certainly, they will take on a new form, complementing rather than replacing in-person contact that is so often essential for people living with cancer.

Telehealth has not been an option in many low- and middle-income, however, and digital and other technological innovations cannot fill the systemic shortage of qualified nursing staff at the global level. Nurses (along with midwives) account for almost half of the global health workforce. The situation was alarming even before the pandemic, however, with a shortfall of nine million nurses and midwives estimated by 2030 according to WHO. 

More than a year into the pandemic, ICN now estimates that this shortfall has dramatically increased, estimating that the world will need an additional 13 million nurses by 2030.

“There is a clear toll that we are just now starting to understand - nurses that have been in the frontline are dealing with trauma and burn out. The impact this will have a few years down the road is unknown, including the impact this might have on the nursing shortage and related health care needs of the population and of cancer patients. How are we to meet the 2030 health goals with even fewer nurses?”
–    Dr Stella Bialous, Associate Professor in Residence, Social and Behavioral Sciences, School of Nursing, University of California San Francisco and Past President of ISNCC

In the words of Dr Bialous, the world could and should honor nurses by investing in understanding their situation and urgently relieving the burden that COVID-19 has placed on nurses and nursing care.