Nurses – the Heroes at the Frontline of Healthcare

When health crisis occurs, the nursing profession is always at the frontline working for citizens and patients. This has been part of the European history since the time of Florence Nightingale. In times of war and pandemics, when the population needs healing and support, the nurses are at the frontline day and night.

All of these are the reality in the present time too, in which the ongoing COVID19 pandemic is greatly impacting EU citizens life. Many EU countries have put their populations in lockdown for a few weeks already, with very few exceptions. The soundest are the nurses and the healthcare professionals, who still need to go to work, often unprotected and untrained on the COVID-19 disease. Locked citizens have expressed their appreciation to the frontline nursing workforce, by signing, by applauding, and even donating funds. Nurses’ holistic and altruistic approach to healthcare made respectful and even admirable to citizens.

In the current context, nurses are labelled as “heroes” by citizens and stakeholders precisely because of the conditions in which they are approaching their frontline nursing care. When citizens get infected by COVID-19 disease and need hospitalisation, all their human interaction for a period of time will be reduced and nurses are central to human dignity, ensuring a quick and efficient recovery. This is nursing care. However, in doing so, the lack of protective equipment and knowledge exposing frontline to get infected, and even to bring the disease back to their families when they go home, is a huge concern to nurses, as they are the ones touching the patients, washing the patients, providing the most complex care needed. For some patients who die from the disease, there are cases of nurses who have set videocalls with their relatives so they could say goodbye. There are cases of nurses sleeping at healthcare facilities, to make sure that they do not spread the disease to their families. For all of these, the population rightly identifies nurses as “heroes”.

But let’s be realistic!

The COVID-19 outbreak has proved the need of a holistic and integrated approach. The outbreak occurred in a context in which most EU healthcare systems were already under heavy pressure due to already existing challenges: the rise in life expectancy, the ageing population, the growing number of people living with co-morbidities and chronic diseases, etc. As a result, some already existing structural weaknesses have now deepened.

And nurses were still recovering from the aftermath of the economic crisis of 2008, which negatively influenced the nursing workforce. Covid19 has shown  that Europe’s healthcare systems need to be strengthened to be better prepared to future possible scenarios such as the current pandemic. Sufficient and safe workforce staffing levels are key for the right functioning of healthcare ecosystems. Healthcare systems were dramatically understaffed with highly qualified general care nurses (DIR55) and to alleviate the situation, several EU countries have introduced emergency measures such as hiring back retired healthcare professionals or introducing student nurses as assistants. Of course, these measures are not taken without a risk.

Due to their involvement, European nurses expect the EU and national leaders to be involved to the same extent, and to take concrete and immediate actions to support them, the “heroes” of the COVID-19 pandemic. EU institutions, governments and all health stakeholders should immediately take concrete actions:

Support the EU health workforce, in particular the nursing workforce, to respond to the challenges of Infectious Diseases of High Consequences (IDHC) without compromising its safety and wellbeing, through coordinating and building capacity in the nursing workforce, providing further access to vital education and training that includes opportunities for regular drills on donning and doffing PPE, and assuring the provision of adequate resources and support for a safe working environment.

The ongoing pandemic proved the European Commission that its structures were not prepared to protect the health workforce. At the national level, protection and testing devices were insufficient and, in some cases, not even available. This translated into avoidable risks for the nursing workforce, who had to approach the frontline unprotected and sometimes unprepared, often with deadly consequences.

Furthermore, co-creating and co-designing with frontline nurses fit-for-purpose political decision-making processes and policies for IDHC preparedness is a must. This is a challenge for the European Commission as their only counterparts are the Member States and sometimes academics who they ask for advice, but not frontline healthcare professionals. Healthcare professionals, in particular nurses, are often kept out of the decision-making equation, making political actions often unfit-for-purpose. This accounts for the lack of pragmatism in the decision taken by national governments in handling the COVID-19 crisis.

The new coronavirus outbreak proves that more EU support to the frontline is needed when emergencies emerge. EU citizens need EU policies that protect frontline staff from working overtime and of being continuously understaffed.

The nursing workforce will need to be better equipped to be able to handle the next pandemic. The COVID-19 outbreak is having an unforeseen impact across all EU countries, and it is affecting all layers of society.

In sum, EU institutions, national governments, and all health stakeholders, need to make sure that the nursing workforce is approaching the frontline with the right equipment, training, and staffing levels. And that should be done not only for them, but for the interest of EU citizens and patients too.

The European Commission continues being a stakeholder with whom the nursing profession engages in constant dialogue, but a new area of cooperation has arisen coordinating actions to tackle the health crisis with the EU Member States. Moreover, the EFN continues being engaged with all interested EU and health stakeholders to do what is best for the frontline nursing profession across the EU and Europe, and in doing so, maximising the health outcomes of patients affected by the COVID-19 disease.

Secretary General of the European Federation of Nurses Associations