From Florence Nightingale and Clara Barton to Mary Eliza Mahoney and Mabel Staupers, nursing practice has never lacked groundbreakers. Even today, nurses continue to shine as the real heroes on the Covid-19 frontlines. But, at what cost?

A recent publication by Johns Hopkins Center for Health Security highlights significant gaps in education, training, and resource allocation that have stretched nurses in ways that their forebears could have never imagined. The report also underscores several significant concerns previously revealed by the American Nursing Association, including PPE shortages (>50%), being short-staffed (66%), and lack of training in Covid-19 testing (50%). Both sources accentuate a critical vulnerability in the ability to conduct essential medical countermeasures in the near future, such as mass Covid-19 vaccination efforts.

A myriad of factors contribute to and drive nursing development and responsiveness to pandemics. The responsibility for ensuring adequate resource allocation, the ability to implement practices that align with quality metrics, and targeted education initiatives ultimately lie with federal agencies and academia. At the same time, steps can be taken to address some of these challenges before the next Covid-19 wave occurs on local levels.

Staffing shortages and the inability to meet surge capacity rise to the top of the list. The Covid-19 pandemic has required nurses to take on greater responsibilities for patient care without adequate training, organizational support, or surge capacity preparedness. While less-affected locales have furloughed nursing staff, others hard-hit by Covid-19 cases have experienced significant staffing deficits. Additionally, nurses are often considered expendable expenses rather than critical components of the care team. The pandemic has also exposed significant shortcomings in workforce development and training, especially around infection control measures (e.g., doffing and donning personal protective equipment). Accordingly, the lack of consistently adopted and adapted crisis standards of care across organizations has affected pandemic response efforts. Undoubtedly, many of the solutions lay with hospital and organizational crisis leaders and decision-makers, who might wish to consider the following:

• Conduct and include nurses in emergency preparedness drills and exercises outlined by Assistant Secretary for Preparedness and Response and Centers for Medicare and Medicaid Preparedness (CMS). 
• Develop an expert migration strategy that ensures nurses redeployed to cover other departments can provide adequate patient care. 
• Turn to hard-earned expertise versus trying to educate and train new talent; by pivoting nurses with relevant experience in the emergency department to the frontlines, their positions can be back-filled with other staff proximal to their positions. 
• Clinical apprenticeship and/or shadowing can address challenges underlying specialty migration and significant gaps in ongoing nursing continuing education and career development.
• Provide rapid Covid-19 testing to all healthcare professionals and initiate education around vaccine uptake, side effects, hospital policies, and receipt before an agent becomes available.
• This reinforces a commitment to workforce safety and provides an important framework to provide education and encourage vaccine uptake in patients and by the community.
• Finally, ensure clear, honest communication between leadership and staff targeted toward workforce safety, including risk, roles, and plans to minimize exposure. 
• Data shows that lack of access to timely information and communication can increase anxiety levels, consequently affecting presenteeism. 
• Regular, transparent communication also helps to reinforce nursing workforce roles as essential team members and not expendable resources that are conveniently cut when budgetary demands become too great.