The Connell School of Nursing hosted their Maureen P. McCausland Pinnacle Lecture on Monday, Nov. 16. Each semester, the Connell School hosts lectures featuring a widely recognized nurse who speaks on an issue at the forefront of healthcare. The topic of this lecture was “COVID-19: Lessons Learned and a Call to Action” from keynote speaker Patricia Davidson Ph.D., M.Ed., RN, FAAN Dean, Johns Hopkins University School of Nursing.
A registered nurse since 1980, Davidson serves as Secretary General of the Secretariat of the World Health Organizations Collaborating Centers for Nursing and Midwifery and Counsel General of the International Council on Women’s Health Issues.
In her lecture Davidson outlined the role of social, political, and economic factors influencing healthcare. She also discussed the impact of the pandemic on ourselves, our organizations, and our world, as well as opportunities and challenges of future-proofing our healthcare system.
Davidson began by acknowledging that like most people, she believed that the spread of the virus was not going to be as severe as it has been. “This is a real call to action in universities such as ours where we do have a voice to really shape a different vision for the future,” said Davidson. “Although many of us feel moral outrage, it’s not a strategy and it’s not going to move us forward.”
Reflecting upon her early days of nursing, Davidson explained, “our interactions with the community were minimal and a lot of community health nursing at that time was focused more on mothers and babies. We’re now in a totally different society driven by forces such as globalization.”
The complexity of the current geopolitical environment plays an influential role in healthcare systems. Non-state political actors have fostered an environment of political distrust and a strong move toward nationalism and populism. Davidson recognized that there is a yearning for a world of 50 to 100 years ago that prevents individuals from accepting the future, particularly one shaped by cultural diversity and pluralism. Davidson emphasized that healthcare systems need to improve their aid to world refugees, specifically children at the US-Mexico border. “Healthcare and science have been highly politicized as we ignore that at our peril,” said Davidson.
Touching upon some of the challenges posed to healthcare systems, Davidson mentioned the effects of climate change and other challenges that go beyond biology. “Poverty, access to care, environmental exposure, and racism are major predictors of adverse outcomes,” said Davidson. “I think COVID-19 has shown us that these factors are not just present but pronounced.”
COVID-19 has also shown us some of the many societal issues that need to be addressed. Long-term effects of the pandemic are especially evident in the economy and in education. Davidson pointed out that people in the US are lining up for food banks and children’s educational preparedness is jeopardized. The pandemic has also drawn attention to health disparities in society.
Syndemics is another ongoing societal issue. This process occurs when two or more conditions interacting synergistically contribute to an excess burden of disease in a population. “We have people with HIV with COVID-19; we have people with cardiovascular disease and COVID-19,” said Davidson. “The vulnerability to many of these factors is due to the social conditions in which people are born, live, and die.”
Additionally, there are divisions within the nursing profession that have become more visible during the pandemic. “Four to six percent of the registered nursing workforce are Filipino nurses yet they comprise 30% of the deaths due to COVID-19,” said Davidson, who described reasons for this statistic as “complex and multifactorial.” For example, someone who desperately needs to send money home to their family is more likely to work extra shifts and therefore expose themselves to the virus more often.
One of the reasons why other areas of the world are doing better at handling the pandemic than the US is that other countries have better coordination. When explaining the concept of coordination, Davidson referred to the six building blocks of a robust health care system: leadership and governance; health care financing; medical products and technologies; information and research/indicators; service delivery; and health workforce. “COVID-19 has been a validation of these elements,” said Davidson.
“If someone said to me five years ago ‘you will have a mask for the week and you put it in a paper bag,' I would have thought they were crazy,” said Davidson. “I would think yes, in Thailand or a remote area that’s what I would be doing, but not in the richest country in the world where much of science has emerged and innovation has occurred.” Davidson stressed the importance of nurses seizing their power in order to prevent future vulnerability to onslaughts such as COVID-19.
“Aspects such as empathy, reliability, and advocacy are germane to our practice,” said Davidson. Especially during a time where some nurses are not receiving the adequate respect they deserve, “these are some of the important things we need to think about.”
Recently, Davidson has resisted pressure that would allow Johns Hopkins students out of school early to work during the third wave of the pandemic. “If it’s that bad, the faculty should go, but it’s this notion that there’s an element of martyrdom, and that we’re expendable, and we’re not that highly valued.” said Davidson, who preached that this rhetoric has to change.
Additionally, Davidson rejected the idea that COVID-19 calls for an overhaul of nursing curricula. She explained that most students understand infection control. The problem can be solved through improving the organization of health systems, specifically, supply chains. “I think it’s important that nurses are at the decision-making table,” said Davidson, adding that “it’s the system that has let people down.” In the US, privatized companies should have supplied masks, nursing gowns, and other equipment. “I don’t think we, as nurses, should take the rap for anything,” said Davidson, “I think we should be speaking up to be more entitled to resources we need.”
“Across your nursing career, there will be infectious disease challenges. I am very confident that your training as a registered nurse will prepare you to deal with these issues effectively. But if you’re working in systems where you’re not provided enough resources and equipment, that’s a very different challenge,” said Davidson.
Looking toward the future, Davidson believes the “new normal” will consist of expanded digital education, more adaptability and recalibration, a new idea of an international agenda, and partnership models. “We cannot go past the importance of sustainable development goals,” which include peace and justice, no poverty, gender equality, and clean water. Without them, “health seizes to prosper,” said Davidson.
“Nurses are essential to achieving the sustainable development goals, but often we are absent from decision-making tables,” said Davidson. She also urged lecture attendees to review the 2020 State of the World’s Nursing Report, which “provides an important data driven argument for investing in the education of nurses and leadership strategies.”
In her conclusion, Davidson gave an overview of some of the lessons she has learned from this pandemic. She believes that universities have to renew their social contract and demonstration of value proposition. She stressed the importance of tackling diversity, equity, and inclusion. “When we work with communities, we need to look at partnership and true reciprocity,” said Davidson, who holds that partnerships will be critical but the devil is in the detail. These partnerships include those between universities and those between government sectors.
“We need to think about our occupational health and safety models and where OSHA is in all of this conversation,” said Davidson while reflecting upon the number of nurse fatalities during the pandemic.
“I really think technology has the hope for addressing some disparities,” said Davidson. Nevertheless, she acknowledged that the increased use of technology in the nursing profession comes with several obstacles. One of the best things she heard during the pandemic was “don’t move problems to the cloud,” emphasizing the importance of preventing inefficient systems from being digitized.
Davidson ended the lecture by acknowledging the many parallels between John Barry’s The Great Influenza and the COVID-19 pandemic. “Nursing could give the victim of the disease the best possible chance to survive. Nursing could save lives,” wrote Barry.
Davidson also drew upon a profound quote from one of her current Ph.D. students, Nadia Andrade, who said, “An intensive care bed without a nurse is just another place of suffering.”
“We can talk about equipment; we can talk about monoclonal antibodies. All of those things are important and matter, but we know particularly in an illness such as COVID-19 that diligent nursing care is really important,” said Davidson.