COVID-19

Nursing Students and Educators Must Be Part of a National Public Health Surveillance Strategy

By KAREN JOHNSON PhD, RN

Shortly before our world was turned upside down by COVID-19, I visited Space Center Houston with my family. We marveled at the collective ambition and investment it took to move from space travel being an aspirational dream to setting foot on the moon. I thought about my favorite scene from the movie Apollo 13, when Gene Kranz overhears the NASA Director saying “This could be the worst disaster NASA has ever experienced,” and candidly replies, “With all due respect, sir, I believe this is going to be our finest hour.”

Just months later, our entire planet is on a mission to turn tragedy into triumph. Only this time, Americans have not led the way in proactively translating science into action for the benefit of humankind. Instead, we ignored scientists who warned about the inevitability of a pandemic and now lead the world in most confirmed cases (which, due to our testing debacles, underestimates actual cases). As a public health nurse, this is not a race I want to see us leading. Future outbreaks are all but certain while we wait for a vaccine. Every single one of us must start preparing now, for we will all have a role to play.

To be sure, it is imperative that we all stay the course with current physical distancing efforts to prevent spread, minimize death, and avoid the collapse of our healthcare system and its ability to care for patients with COVID-19 and other life-threatening conditions that do not pause just because of a pandemic. But social distancing cannot be the only public health tool used to bring the pandemic under control. 

Public health experts agree we need a coordinated national public health surveillance strategy that includes widespread testing in order to identify and isolate infected people early (this is crucial given how many contagious people are asymptomatic), contact tracing to figure out who has been exposed to infected individuals, and quarantining everyone who tests positive or has come in contact with an infected person. We must leverage technology to ensure testing provides fast and accurate results, and that we are able to safely and comprehensively track exposures. Without accurate, detailed, and timely data about the epidemiology of COVID-19, we cannot make scientifically sound decisions about how to ease social distancing or ethical decisions about how to equitably allocate scarce healthcare resources to communities of greatest need.

Our capacity to do widespread testing, contact tracing, and tracking must be ramped up as soon as humanly possible, definitely in two-to-three months. We face many challenges in launching these efforts on such a short timeline, with one important bottleneck being lack of person power. Due to years of funding cuts to public health, many local and state health departments simply don’t have the capacity to scale up these efforts on their own. In the absence of adequately staffed health departments, we will need all hands on deck to mount our response. The National Guard, laid-off workers, Peace Corps volunteers, and nursing and medical students have been proposed as ideas in the public dialogue.

We will likely need a combination of various groups of people, and I want to call on my colleagues in nursing education to mount a nationally coordinated effort among nursing programs, professional nursing organizations, and regulatory boards to prepare nursing students (alongside faculty) to step into these roles. For example, there are almost 1,000 baccalaureate nursing education programs nationwide with over 360,000 students enrolled, all of whom require coursework in public health nursing to graduate. As this pandemic has unfolded, baccalaureate students around the country have been pulled from clinical rotations in hospital settings for safety reasons and to preserve PPE for licensed providers. This leaves educators searching for creative ways to fulfill students’ clinical requirements so that they can graduate and progress into the workforce, such as more simulation. But even in states such as California that have temporarily relaxed regulations around what percentage of clinical hours can be in-hospital versus simulation exercises, we still must think creatively about how to safely provide opportunities for direct patient care in coming semesters where additional COVID-19 outbreaks may necessitate pulling students from hospital-based rotations once again.

Having nursing students participate in public health surveillance efforts is a win-win: it can help them safely acquire clinical hours while also meeting a crucial public health need. Because we will need to invest robustly in public health in our post-pandemic world, this can also introduce more nursing students to opportunities in public health, where nurses comprise the largest percentage of the public health workforce but have not been immune to staffing reductions due to budget cuts. We must begin now to anticipate the needs of our partners in local and state public health and prepare students and faculty for public health surveillance efforts so that we are ready to answer their immediate call to action in the coming weeks and months. We should look to Massachusetts, and their formation of the Academic Public Health Volunteer Corps, as an example for how nursing academic programs can form collaborations with public health departments, programs, and organizations to meet crucial surveillance needs moving forward.   

This pandemic has shown us the importance of keeping people healthy and out of the hospital. It is therefore crucial that we restore the public health workforce to a level that not only allows us to be better prepared for future pandemics, but to also address endemic threats to our nation’s health such as heart disease, cancer, diabetes, mental illness, accidents, maternal and infant mortality, domestic violence, and the social determinants of health that influence all health conditions and health inequities. Nurses must play a crucial role in our post-pandemic public health workforce. Leveraging students now to help with public health surveillance will force educators to reconsider the often siloed way that we teach baccalaureate students about public health, and the need to champion advanced public health nursing graduate programs to ensure we have nurse educators who specialize in public health. It will help students and educators alike understand the important connections between public health and healthcare, and the role of the nurse in both systems. It can also encourage us to consider how we create pathways for new graduates who want to work as public health nurses immediately, as I was able to do many years ago (but is still a rare opportunity). If we can temporarily modify permit requirements for graduate nurses to practice in hospitals during the pandemic, we can surely reconsider institutional, financial, and cultural barriers preventing qualified graduate nurses from entering into the public health workforce immediately or soon after graduation.

When future generations make a blockbuster movie about this pandemic, our hospital-based nurses working under unthinkable conditions will rightfully be depicted as heroes. Let’s also give them a triumphant story to tell about how nurses returned to their roots in public health and, driven by data, helped prevent thousands of hospitalizations, deaths, and the collapse of our healthcare system.   

Dr. Karen Johnson is a public health nurse and associate professor from the School of Nursing at the University of Texas at Austin and a Public Voices Fellow of the Op-Ed Project.   

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