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Nursing: A critical profession in a perilous time

Published online by Cambridge University Press:  24 May 2021

P. D. Harms*
Affiliation:
University of Alabama
*
*Corresponding author. Email: pdharms@cba.ua.edu
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Abstract

Type
Commentaries
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the Society for Industrial and Organizational Psychology.

Long before anyone had even heard of COVID-19, the World Health Organization had declared 2020 to be the Year of the Nurse and Midwife, an opportunity for society to recognize the critical role that these professions play in health care and the personal risks that they must take in order to fulfill their missions. The timing of this recognition may seem ironic in retrospect, but in some ways the current health crisis has made the need to recognize the invaluable role of nurses in society all the more apparent. Yet, in spite of both the critical nature of their work and the sheer size of the healthcare industry (there are over 4 million registered nurses in the United States alone), industrial-organizational (I-O) psychology as a discipline tends to largely ignore the unique aspects of the nursing profession in our research. A quick survey of the past 5 years of four premier journals in our field (Journal of Applied Psychology, Personnel Psychology, The Leadership Quarterly, and Journal of Management) reveals only three papers that use nursing samples (Koopman etal., Reference Koopman, Johnson, Wang, Lanaj, Wang and Shi2019; Neubert etal., Reference Neubert, Hunter and Tolentino2016; Zhang etal., Reference Zhang, Li and Gong2020), but none of which where the issues addressed were necessarily centered on the issues facing the nursing profession itself.

To their credit, the focal article by Rudolph etal. (Reference Rudolph, Allan, Clark, Hertel, Hirschi, Kunze, Shockley, Shoss, Sonnentag and Zacher2021) does raise the issue of potential health threats faced by healthcare workers in the current crisis, but their coverage of the effects of the pandemic largely overlooks many of the unique challenges faced by the nursing profession and the related issues where I-O psychologists can contribute. Specifically, even before the COVID-19 crisis, it was widely acknowledged that the nursing profession was facing massive workforce shortages resulting from a dearth of individuals being trained as nurses, a rapidly aging workforce, and chronic problems with attracting and retaining nursing professionals in rural areas (Buerhaus etal., Reference Buerhaus, Skinner, Auerbach and Staiger2017; Oulton, Reference Oulton2006). Adding to the workforce shortage issue were ongoing problems with burnout and turnover that further threatened to thin the ranks of qualified nursing personnel (Aiken etal., Reference Aiken, Clarke, Sloane, Sochalski and Silber2002; Leitner & Maslach, Reference Leitner and Maslach2009; Poghosyan etal., Reference Poghosyan, Clarke, Finlayson and Aiken2010).

All of these problems have been made worse by the COVID-19 crisis (Jun etal., Reference Jun, Tucker and Melnyk2020). Healthcare professionals are not only at an extremely high risk for exposure to the disease; the stress and guilt associated with being a possible vector for the disease among those they are charged with caring for can further exacerbate feelings of burnout and depression and even lead to suicidal thoughts (Allen & Cug, Reference Allen and Cug2020; Greenberg & Gnanapragasam, Reference Greenberg and Gnanapragasam2020; Sheares, Reference Sheares2020). But beyond the health and safety issues among incumbent nursing professionals, consider too how the COVID-19 crisis may affect aspects of nursing in terms of issues frequently addressed by I-O psychologists but not covered in the target article, such as recruitment, training, job design, and workplace interventions.

Recruitment. For a profession that was already struggling to recruit enough qualified workers, how might the current pandemic have negatively shaped the perceptions of individuals who were potentially considering nursing for a career? And what can we do to make either change those perceptions or make individuals more willing to assume personal risk in order to help others?

Training. The current crisis has meant that nursing students are being thrown into their jobs possibly without fully completing their training and without the time to become fully familiarized with their jobs (Spurlock, Reference Spurlock2020). What the consequences of this sudden shift into a fraught environment in terms of worker well-being, turnover, and performance and safety? Relatedly, what are the consequences of making emergency changes in regulatory requirements for licensing (Bayne etal., Reference Bayne, Norris and Timmons2020) in order to make up for staffing shortfalls?

Job design. It is already understood that prolonged shifts can lead to decreases in work efficiency and increase the likelihood of medical errors (Melnyk etal., Reference Melnyk, Orsolini, Tan, Arslanian-Engoren, Melkus, Dunbar-Jacob, Hill Rice, Millan, Dunbar, Braun, Wilbur, Chyun, Gawlik and Lewis2018) and, similarly, that rotating shifts are associated with decreases in well-being (Books etal., Reference Books, Coody, Kauffman and Abraham2017). The critical understaffing of medical personnel paired with the dramatic increase in COVID-19-related illnesses requiring emergency treatment has meant that nurses are being asked to work longer hours without meaningful time off more now than ever. Are there more efficient ways of deploying healthcare workers in order to reduce fatigue and burnout? Can jobs be redesigned so that nurses are able to spend more of their time on critical, life-saving functions?

Workplace interventions. Given the unique challenges presented by the COVID-19 crisis, there is a real need to design, implement, and evaluate workplace interventions that are directed at improving well-being, resilience, and retention (e.g. Dawood & Gamston, Reference Dawood and Gamston2019; Sultana etal., Reference Sultana, Sharma, Hossain, Bhattacharya and Purohit2020). In particular, it would be worthwhile to figure out how much we can learn about whether and how past interventions of this nature (see Vanhove etal., Reference Vanhove, Herian, Perez, Harms and Lester2015 for a review) can be meaningfully applied to the nursing or healthcare context.

Despite the enormity and the ubiquity of the COVID-19 threat, we must recognize that not all industries and not all professions are disrupted in the same manner and to the same extent. The healthcare industry and the nursing profession in particular are the front line in this fight and are being tested unlike any other sector. Nurses are trained to face death and disease, but the COVID-19 pandemic is threatening to break both the system and the resolve of those we need the most. I-O psychology can rise to the challenge by marshalling our expertise in recruitment, training, and job design and applying it directly to the unique circumstances and conditions faced by nursing professionals in this pandemic. This is their year, and it is time for us to recognize them.

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