With the pandemic still raging, getting a forest-level view of how Covid-19 has impacted healthcare and nursing is impossible. But after more than two years of living and working amid an unending public health emergency on a global scale, the American Journal of Nursing drew attention to a handful of takeaways.

The most surprising thing about their observations is that not all the changes are negative. Most are improvements to the profession, albeit heavily offset by the significant negative of burnout and a departure from the profession. Here are five ways the pandemic has left a deep impression on nursing, with the caveat that these changes did not occur universally.

1. Greater Collaboration and Innovation Are Now Frequently the Norm

They say that necessity is the mother of invention, but there’s no need to invent if you can innovate. If there’s anything nurses excel at, it’s making do with what they have on hand and finding ways to improve the efficiency of their jobs. And that’s precisely what happened when the pandemic put more significant stress on the healthcare system than it’s seen since at least the HIV epidemic of the 1980s.

Nurses stepped up, and just as importantly, administrators and physicians often listened and collaborated. Megan E. Brunson, MSN, RN, CNL, CCRN-CSC, immediate past president of the American Association of Critical-Care Nurses, told AJN that the pandemic led to an environment where ”the free flow of ideas is prized, whether they come from nurses, physicians, respiratory therapists, or others on the team.” That increase in collaboration came both within units and across units.

That openness to problem-solving and innovation may be why nurses who spent more time with Covid-19 patients reported greater job satisfaction in some areas early in the pandemic, according to an online survey by Johnson & Johnson, the American Organization for Nursing Leadership, and the American Nurses Association. Of the 4,000 Americans surveyed in August 2020, about 1,000 respondents were nurses, and 250 were nursing students.

”This study revealed that despite the incredible challenges posed by Covid-19, the crisis has resulted in some progress within the profession, accelerating changes in attitudes and expectations regarding nurses,” the researchers wrote.

Compared to nurses who spent less time with Covid-19 patients, nurses who spent more than half their time with Covid-19 patients reported greater satisfaction with opportunities for professional advancement, leading programs or initiatives, working on collaborative interprofessional teams, and influencing decisions about workplace organization. The caveat, of course, is that the survey occurred in August 2020. Nearly two years later, would the same questions yield the same results?

2. Burnout Reached Sky-High Levels and Contributed to an Exodus From Nursing

In deep contrast to number one above, burnout levels spilled over, according to multiple surveys. We’ve covered burnout extensively already, so we don’t need to belabor the point—many of our readers live it themselves. But it will be interesting to see what happens in the next few years with early retirements and nurses simply deciding to leave healthcare altogether.

3. Interest in the Nursing Profession Has Grown

Perhaps paradoxically, the same pandemic that pushed thousands of nurses beyond their limits has also inspired thousands of others to consider the profession. According to the American Association of Colleges of Nursing, an estimated 6% increase in applications to bachelor’s nursing programs occurred in 2020. Increased media coverage of nurses and nursing may be one reason for that increase. Still, it’s a modest increase overall, and it may not be enough to offset those leaving the profession, Diana Mason, Ph.D., RN, FAAN, senior policy service professor and co-director of the Center for Health Policy and Media Engagement at the George Washington University School of Nursing, told AJN. She anticipates a looming shortage that will “take a decade at least to reverse.”

4. Advanced Practice Registered Nurses (APRNs) Faced Fewer Barriers To Practice in Many States

Twenty-one states “temporarily suspended or waived some requirements for practice agreements between NPs and physicians,” according to AJN, citing the American Association of Nurse Practitioners. In January 2021, Massachusetts began allowing NPs to practice independently, the 23rd state. Similarly, in April 2020, guidance from the Department of Veterans Affairs allowed certified registered nurse anesthetists (CRNAs) to practice without a doctor supervising if they held a license in a state that allowed it. The March 2020 Covid Relief Action (CARES) also authorized NPs, PAs, and clinical nurse specialists to order and certify Medicare home health services without a physician’s involvement, as previously required.

5. The Major Expansion in Telehealth Brought More Nurses Into the Virtual Practice Setting

An August 2020 survey found that 75% of NPs and 77% of nurse-midwives used telehealth in the last year, according to the Medscape Nurse Career Satisfaction Report 2020. A hefty proportion of RNs, LPNs, and clinical nurse specialists also used telehealth, one of the primary reasons that people who needed essential outpatient non-Covid care could get it. What remains to be seen is whether the telehealth waivers that state and federal governments implemented during the pandemic would remain permanently.