Nurses’ Lived Experience, Part 2: Lessons From Nurses for Guiding Future Emergent Situations

The 2020–2030 Future of Nursing report1 focuses on the role of nurses in achieving equity of health and health care to improve individual and population health. One of the key areas identified in the report centered on strengthening nurses’ emergency preparedness and response. If trends continue, we can expect the need for nurses to serve our communities to grow as climate disasters, gun violence, terror threats, infectious disease outbreaks, and other public health events increase in frequency and scale, threatening population health and health equity. The current model of public health does not account for these trends, and most nurses are not sufficiently prepared for disaster and public health emergency response.1 The COVID-19 aftermath taught the world this lesson. Still, nurses continue to be an essential component in preparing for, responding to, and healing those affected by catastrophes.The Future of Nursing report supports and recommends that organizations capitalize on the inherent leadership strengths of nurses. Nursing as a profession demands strong leadership characteristics—courage, humility, caring, compassion, intelligence, empathy, awareness, and accountability. These qualities compose the daily work of any nurse and are considered vital nursing competencies in most health care organizations.1 Thus, possessing the ability to lead is an implicit expectation for nurses, but health care organizations must do more to support the development of these abilities to grow nurses as leaders at all levels.To meet the growing needs of our communities and effectively respond to threats to population health, nurses must be supported and prepared to lead with readiness, strength, conviction, and innovation. The intent of part 2 of this evidence synthesis is to harvest learnings from the voices of frontline nurses in part 1’s collection of 16 lived experience studies about the recent COVID-19 pandemic and thus continue our “action-sensitive understanding” to examine how learnings from the pandemic can be applied for the future.2 The following question informs this synthesis: In part 1, the CINAHL and PubMed databases were searched for original research published since March 2020 by using the key words nurses, COVID-19, pandemic, and lived experience. The practical solutions offered by nurses in these studies were extracted and synthesized from the Results and Implications sections of those publications.As described in part 1, 16 studies were retrieved.3–18 The key concepts of the practical solutions harvested from these studies are arranged in Figure 1 according to the components of the American Association of Critical-Care Nurses’ (AACN) healthy work environment (HWE) framework: authentic leadership, skilled communication, true collaboration, appropriate staffing, effective decision-making, and meaningful recognition.19Nurses provided many suggestions and solutions inherent in an HWE that could have lessened the impact of the pandemic on their personal and professional lives. By first listening to and honoring nurses’ stories of lived experience, leaders and organizations can reinforce their commitment to developing and, more importantly, sustaining HWEs. The section below offers a definition of each HWE component, followed by the specific recommendations offered by nurses in these studies.3–18 Some recommendations pertain to nurses in all roles; others focus on nurses in formal leadership positions.Fully embrace the imperative of a healthy work environment, authentically live it, and engage others in its achievement19Be as proficient in communication skills as you are in clinical skills19Be relentless in pursuing and fostering true collaboration19Be committed partners in making policy, directing and evaluating clinical care, and leading organizational operations19Staffing must ensure the effective match between patient needs and nurse competencies19Be recognized and recognize others for the value each brings to the work of the organization19These recommendations from the lived experience studies echo the findings of the large national AACN HWE survey of 9335 registered nurses conducted in 2021.20 Administered 20 months into the pandemic, findings revealed alarmingly (but perhaps not surprisingly) that the health of work environments had declined in all 6 components since the survey was last administered in 2018. Beacon units or those on the journey to implementing the HWE standards fared better. These findings demonstrate that when formal and informal nurse leaders embrace the concept of an HWE and tap their authentic leadership skills to engage others, this type of environment can grow and flourish.20The HWE framework provides a roadmap of interventions to transform the work culture so that nurses are healthy and well supported to provide high-quality, equitable care.1 Formal nurse leaders can accelerate needed changes in their unit and organization through collaboration with their team, cocreating practice environments that support innovation.21,22 Leaders must also elevate the performance of teams through substantial resource investment by guiding, supporting, and developing their nursing staff to work at their fullest potential. All nurses must embrace their roles as leaders as a critical part of the profession and as the next step in advancing and preparing health care for future disasters and emergencies.1