Some positive changes amid the COVID-19 crisis

If COVID-19 is the war, then front-line healthcare workers are our hero soldiers. Sadly, the list of healthcare providers lost to COVID-19 worldwide grows longer and longer. How is it that the country that spends the most per person on healthcare ended up sending soldiers to the battlefield without proper protection (too few masks and caregivers resorting to garbage bags as gowns).

As mental health and public health nurses with over 50 years of combined experience, we are left with the sentiment that we cannot go back to the way things were. Yes, when we signed up to be nurses, we knew what we were getting into. We knew that we would miss family events, such as parties, baptisms and weddings. We were prepared to miss out on spending time with our families. We also knew that we would work long shifts, spending hours on our feet, sometimes without so much as a bathroom break or an opportunity to sit down and eat a meal.

We knew all of this and we did it anyway because caring for patients, families and communities is what we do. But what we couldn't possibly know is that the COVID-19 global pandemic would strike the U.S. in 2020 and that we could die from it as a result our work. U.S. healthcare will not and should not ever be the same.

Still, despite the tragic losses and seismic industry shifts, there have been some positive developments during this crisis that could shepherd major change. Among them:

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has been one of the most prominent and trusted scientific voices in this crisis. He's kept the country informed on the evidence-based public health efforts to prevent the spread of COVID-19 and handle the surge of people who are already sick. Fauci and all of our medical experts and researchers—true public servants— deserve support and respect. Healthcare workers and first responders risking their lives for the well-being of others is not unique. What is new today is that their work and dedication are being heralded as heroic amid this pandemic. As a result, healthcare providers and first responders are receiving support in the form of nightly neighborhood serenades in their communities, video messages from celebrities, as well as countless perks from corporations and local businesses—to name just a few gestures of public support.

Probably the biggest thank you would be in the form of student loan forgiveness for front-line healthcare providers. That's an objective of the movement calling for a Student Debt Forgiveness for Frontline Health Care Workers Act.

COVID-19 offers the public a small window into the daily lives of our healthcare providers and first responders.

Healthcare visits across the country have quickly shifted online or by phone to patients who do not require an in-person visit. The number of telehealth visits have rapidly increased due to the need to prevent unnecessary exposure to COVID-19. As a result, insurance companies have agreed to reimburse for these visits without regard to the location of the provider or patient (e.g., at home). This was virtually unheard of prior to COVID-19. Before the outbreak, one of the only ways for providers to be reimbursed for telehealth visits was from clinic to clinic—when the provider and the patient were situated in separate clinics.Telehealth visits have increased access to medical and mental healthcare, helped us prioritize and improve workflow and harnessed our triage skills.

Surely, after we have rapidly implemented protocols for these visits—processes that can take years to implement—these efforts must not be lost after COVID-19. Instead let's keep reimbursing for these visits, offering them from providers' homes and in patients' homes whenever possible. All temporary waivers and regulatory changes should be made permanent.

As the need for more healthcare providers has risen during this pandemic, the pressure to remove barriers to practice for advanced practice registered nurses has become even more apparent. APRNs have been fighting for the removal of these barriers—which vary from state to state—for years.Our scope of practice includes ordering tests, diagnosing, treating and prescribing medications for a variety of health concerns. We have a solid reputation of offering quality healthcare to patients, especially in under-resourced areas. APRNs are often the providers of choice for patients. Despite improving access and offering quality care, barriers to practice such as state requirements for supervisory (restrictive practice) or collaborative (reduced practice) relationships with physicians persist. Some states have already removed barriers to full practice authority and these states are called full-practice states. Other states that have removed some barriers to practice are considered reduced-practice states. Recently, Florida joined 28 other states in granting nurse practitioners full practice authority. California, currently a restricted practice state, is looking to join the ranks of states granting full practice authority.

Since APRNs do not train as long as physicians, many opponents of full-practice authority voice concerns about the safety of patients cared for by APRNs. The data suggests otherwise, because research indicates that APRNs can and do provide care comparable to that provided by other medical providers.

During these dark days of the COVID-19 pandemic it's crystal clear that APRNs are not competitors of physicians but instead partners in healthcare. Once this crisis has passed, we should continue to expand full-practice authority nationwide for the common goal of access to quality healthcare.