Nursing Strategies for Optimizing Patient Care During the COVID-19 Pandemic

TON - October 2020, Vol 13, No 5

During the COVID-19 pandemic, oncology nurses have been the cornerstone of healthcare services, whether they are on the front lines offering compassionate care or in a leadership role developing and implementing new policies to promote better patient outcomes. As part of the Association for Value-Based Cancer Care’s COVID-19 Impact on Cancer Care and Road to Recovery webcast series, Lillie Shockney, RN, BSN, MAS, HON-ONN-CG, Professor of Surgery at Johns Hopkins University School of Medicine and Founder of the Academy of Oncology Nurse & Patient Navigators (AONN+), led a panel of experts who reviewed some of the valuable lessons that healthcare workers have learned over the past several months. They also discussed the ongoing challenges that nurses will continue to face as they strive to provide safe and effective care to patients with cancer.

Facing the Fallout from Delayed Screenings

The “pause” in screening for a type of cancer is likely to lead to significant excess mortality over the next several years, Andrea Dwyer, BS, Vice Chair of Colorado Cancer Coalition, and Co-Chair of the National Navigation Roundtable of the American Cancer Society, said during an August 25 session. She pointed to recent data from the National Cancer Institute, which projects almost 10,000 excess cancer deaths from just breast and colorectal cancer alone in the next 10 years, with a peak in the next 1 to 2 years.

“And that is a conservative estimate,” she said. “This trend isn’t anecdotal. We will see a backup of people who have not been screened, followed by a higher incidence in mortality. Nurse navigators need to be thinking about prioritization for cancer prevention and control. For example, we will have to prioritize those who are at increased risk because of signs and symptoms as well as family history.”

Ms Dwyer noted that healthcare professionals and the media have been helpful in sharing pragmatic discussions of cancer risk and the need for screening. “As we talk to our over 100 clinic systems throughout Colorado about ramping screening back up, we know that there is significant fear of COVID-19 and misinformation about what it means to visit a hospital and the risk of infection. Here is a key opportunity for nurse navigators and community healthcare workers to spread good information and educate patients on balancing the risks and benefits.”

The expansion of telehealth services offers the opportunity for in-home consultations with genetic and family counselors, Ms Dwyer explained to participants during the session. “We are also opening up capacity in other meaningful ways, such as doing more pre-consults to minimize the time that patients have to be in GI suites.”

Preparing for the Future

The COVID-19 pandemic has had a major impact on staffing, said Brenda Nevidjon, MSN, RN, FAAN, CEO of the Oncology Nursing Society (ONS). She pointed to results of a recent survey from the American Association of Nurse Practitioners, which showed that although 82% of nurse practitioners (NPs) indicated their practices are better prepared to deal with COVID-19 than they were at the beginning of the pandemic, only about 1 of every 3 NPs reported their practices are ready for a surge in COVID-19 cases, a surge in issues related to delayed or deferred care, and the upcoming flu season.

“We need to be prepared with plans like these for the future with good staffing plans should the next COVID situation happen,” said Ms Nevidjon. She noted, for example, that the ONS has just completed a survey (not yet released) on the status of personal protective equipment (PPE). “In short, it continues to be a problem. Regardless of what the news may tell us, people are still very limited in what PPE is accessible to them.”

Ms Nevidjon indicated that recovery and preparation for the next pandemic will involve several key issues, including the following:

  • Scope of practice. Will more NPs be given the authority for independent practice and prescriptive authority?
  • Sites of care. It will be very important to measure and document innovative new models of different sites of care that can be scaled up. If treatments move away from infusion centers and into the home, who will be the providers in the community?
  • Workforce issues. The pandemic has revealed which organizations are supporting their nurses with flexibility and which ones are not, and this will be a relevant issue regarding staff shortages.

Remote working is a model that is likely here to stay for nurse navigators, said Sharon Gentry, MSN, RN, HON-ONN-CG, AOCN, CBCN, Program Director of AONN+. “One of our local navigator groups here in North Carolina proved that they could be just as efficient working from home as in the office,” she explained. “With space at a premium, we can work smarter and still meet those patients’ needs. The navigators’ phone calls to patients were invaluable. They established trust and gave them the information they needed about what it would look like and feel like when they actually came into the clinic. And in many cases, the navigators were able to spend a little more time with the patients when doing counseling calls from home. We will have a good recovery, but we have to be proactive, listen to each other, and apply what we’ve learned to achieve better responses for our nurses and our patients in the future.”

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