Nurses’ Response to COVID-19: A Portrait of Courage, Collaboration, and Co-creation

By Nelson Tuazon, DNP, DBA, RN, NEA-BC, CENP, CPPS, CPHQ, FNAP, FACHE
Vice President & Associate Chief Nursing Office
University Health System, San Antonio
President, South Central Texas Organization for Nursing Leadership (SCTONL)
 
On January 21, 2020, the first case of COVID19 in the U.S. was reported. Nursing and healthcare in the U.S. have experienced the dramatic, drastic, and devastating effects of the coronavirus pandemic since that day. As hospitals, government agencies, private businesses and corporations, and the public braced themselves for the disaster brought about by the pandemic, nurses acted quickly and swiftly to respond to this public emergency.

The COVID19 Crisis: Nursing Presence at the National Level

On February 27, 2020, the American Hospital Association (AHA) and the American Nurses Association (ANA) sent a joint letter to Speaker Nancy Pelosi and Senate Majority Leader Mitch McConnell with specific requests and recommendations to respond to the public health emergency presented by COVID19. The letter contained a request for Congress to provide initial supplemental emergency funding of $1 billion to prepare and respond to the coronavirus. On February 28, 2020, the American Academy of Nursing (AAN) joined several health organizations in sending a letter to members of Congress to express concern for the novel coronavirus (SARS-CoV-s) public health emergency. On March 18, 2020, several nursing organizations met with President Trump at the White House to discuss COVID19. These included the American Academy of Nursing (AAN), American Association of Nurse Anesthetists (AANA), American Association of Nurse Practitioners (AANP), American Association of Colleges of Nursing (AACN), American Association of Critical Care Nurses (AACN), American Nurses Association (ANA, 2020), Emergency Nurses Association (ENA), and the American Organization for Nursing Leadership (AONL).

Nursing Organizations and Associations: Advocacy for Nurses and the Public

A professional organization exists to advance and further the interests of its members and the public it purports to serve (Echevarria, 2018; Tuazon, 2019). Individually and collectively, nurses have demonstrated leadership and advocacy, especially in times of disasters and emergencies. Nurses who join professional organizations embrace the opportunity to be a part of a culture that promotes value leadership and to be engaged in health policy (Catallo et al., 2014; Cherry et al., 2019; Ross et al., 2014).   A fundamental reason for the involvement of the members of professional organizations at the local, regional, national, and global levels is to advocate for a cause (Jarrett, 2018; Mahlin, 2010).   The Code of Ethics for Nurses stipulates that professional organizations must articulate the values that nursing holds, uphold the integrity of the profession, and incorporate the principles of social justice into nursing and health policy. The ANA Nursing Scope and Standards of Practice highlight the need for the nurse to be of service to the profession and to be a part of the advancement of the evolution of nursing (Matthews, 2012).

It has been estimated that there are about 100 to 150 nursing organizations in the US. One report indicates that there may be over 200 associations with distinct goals and purposes (Jarrett, 2017; Tuazon, 2019). For this article, major nursing organizations, including four minority nursing associations, were randomly selected to examine their response to the COVID19. A quick review of their websites show some of the activities that are featured in this article.

Letter-Writing Campaigns: Calls for Action

The leaders of the various professional nursing organizations put the COVID19 at the forefront through letter-writing campaigns to regulators and politicians. The professional organizations cited in this article wrote position statements and white papers to advocate for additional PPEs, support funding for the World Health Organization (WHO), and increase the production of life-saving equipment such as ventilators. Other topics in these calls for action included staffing solutions, surge capacity management strategies, mental health programs, support for faculty and students, advocacy for foreign nursing graduates, and moral distress amongst nurses. 

On March 20, 2020, amidst the prohibitive barriers faced by the States in procuring personal protective equipment, nursing organizations including the AAN, AACN, American Association of Nurse Anesthetists (AANA), American College of Nurse-Midwives (ACNM), ANA, AONL, Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), National Association of Pediatric Nurse Practitioners (NAPNP), and Oncology Nursing Society (ONS) joined forces with other health care professionals to urge Vice President Pence, Speaker Pelosi, Leader McConnel, House Minority Leader McCarty, and Senate Minority Leader Schumer to ensure that healthcare facilities have access to PPE. 

On April 30, 2020, the AAN, representing 2,700 nursing executives, scientists, and educators, wrote a letter to the House and Senate leaders to address the Coronavirus. Through the synthesis of the work of its 24 Expert Panels, the letter focused on protecting the most vulnerable populations, supporting nurses and healthcare workers, and increasing access, scale, speed, and accuracy of testing. Each of the recommendations came with specific actions and requests for budgetary allocations. (AAN, 2020).

Focusing on Advocating for Resources

The AACN (2020b), in partnership with other organizations including the ANA, Association of peri-Operative Registered Nurses (AORN), and ENA, launched the Fight Against GOVID-19: A Call to Action for America with three mandates: (we) must have personal protective equipment, (we) must have life-saving equipment, medications, and supplies, and (we) must stop the spread. The ANA Enterprise, composed of the ANA, the American Nurses Foundation (ANF), and the American Nurses Credentialing Center (ANCC) committed resources to respond to the COVID19 pandemic and the national emergency that was declared. The AAN (2020) highlighted the resources from the Center for Disease Control and Prevention (CDC), the World Health Organization (WHO), the Centers for Medicare and Medicaid Services (CMS), and ANA in its website.

The Academy of Medical-Surgical Nurses (AMSN, 2020) developed a staffing toolkit that is available to its members and to the other professionals to assist nursing leaders in developing staffing plans during a pandemic. The ENA (2020) has published guidelines, protocols, and standards on surge capacity and surge staffing. In the absence of national standards regarding the floating of perinatal and mother/baby nurses to other areas, AWHONN (2020) provided guidance to nurses and providers by referring them to the recommendations for healthcare workers by the CDC.

The National Association of Hispanic Nurses (NAHN, 2020) debuted a new COVID-19 Public Service Announcement (PSA) campaign that featured members from across the country.  Presented in English and Spanish and rolled out through various platforms, the PSA aimed at educating the community on COVID-19 focusing on reducing risks and the spread of the virus.

Specialty Practice Resources

Nurse-Centric and Patient-Centric Resources. Several specialty associations posted resources to assist their members and the general nursing population with regards to specific clinical practice.  ENA (2020) has guidelines, protocols, and standards on topics that include PPE, supplies, and ventilators; ARDS, and prone positioning; self-care; and palliative and end-of-life care.  In addition to PPE and safety information, the Oncology Nursing Society (ONS, 2020) maintains a COVID-19 Information for Nurses that provides resources for patient care and support, professional practice, and advocacy efforts particularly for cancer patients. The ONS is fiercely advocating for cancer patients who may experience emotional vulnerability during the COVID-19 pandemic.

Clinical Resources. The AACN (2020b) showcases Top Clinical Resources that are focused on supporting nurses with timely and critical clinical resources. Free courses are offered on topics such as COVID-19 Pulmonary, ARDS, and ventilator resources. There are also blogs on clinical topics including cardio-vascular effects, mitigating post-traumatic stress disorder, and pronation therapy. The American Society of PeriAnesthesia Nurses (ASPAN, 2020) has developed a comprehensive COVID-10 Toolkit for the Perianesthesia Nurse. The toolkit has two major sections – strategies for caring for the nurse and strategies for caring for the COVID positive patient. The topics for the first section include self-care, donning and doffing, home recipes for sanitizers, and handmade face masks. The topics for the second section include pathophysiology of COVID-19, treatment, and nursing care based on different systems.  AWHONN (2020) highlights COVID-19 practice guidance that includes updated on pregnant healthcare personnel, post-birth education, PPE during the second stage on labor, and intimate partner violence, to name a few.

Academic and Teaching Resources. AACN (2020a) provided guidance to its members with regards to the impact of the corona virus on Commission on Collegiate Nursing Education (CCNE) – accredited entry-to-practice nurse residency programs on the CCNE-accredited baccalaureate and graduate nursing programs. The information emphasized the need to comply with the CCNE standards but allows for innovation, flexibility and changes in the delivery of the programs. The National League for Nursing (NLN, 2020) published a policy brief entitled, Evaluating Board of Nursing Discipline during the COvid-19 Pandemic. This policy brief offered key recommendations regarding the determination of waiving disciplinary action during the COVID-19 pandemic by the states and state boards of nursing.

Specific Programs and Benefits to Members

Personal Protective Equipment and Life-Saving Devices. AONL (2020) launched the 100 million mask challenge aimed at helping to protect the health care workers. This program was implemented based on the realization and recognition health care workers are the most valuable resource in treating and stopping the spread of the coronavirus. The 100 million mask challenge was an aggressive strategy to secure personal protective equipment (PPE) for the nurses as provide care to patients. AACN (2020b) focused its advocacy for its members by creating awareness on the need for personal protective equipment (PPE), ventilators, and other life-saving equipment. Specifically, the association called for the enactment of the full Defense Protection Act, urged businesses to donate excess PPE, and appealed to individuals to stay home and to practice social distancing. Information on masks was evident on the AMSN (2020) resource center, the National Association of Indian Nurses of America (NAINA, 2020) coronavirus update, and the Philippine Nurses Association of America (PNAA, 2020) resource center. The National Black Nurses Association, Inc. (NBNA) developed the Coronavirus: A Primer for Communities of Color and the National Association of Hispanic Nurses (NAHN) continues to urge greater intervention by the federal government to ensure the supply of PPE at the state and local levels.

Professional and Personal Development. The ONS (2020) offers information on COVID-19 Coronavirus and Cancer Care to its members through podcasts and webinars. It also shares links from the CDC, WHO, the US Food and Drug Administration (FDA), and from other professional organizations.  The members of AACN (2020b) are encouraged to share their expert knowledge and to express their bold voices through their website. The AACN website shares the links to nurses who may be interested in volunteer opportunities to care for COVID-19 patients in states that are in dire need of nurses.

Travel Advisory. NAINA (2020) has offered webinar series on the coronavirus aptly titled, COVID19: The Pandemic that Changed the World. In addition to the general information on the coronavirus, the SAINA website highlights information on US and India travel advisory and resources on substance abuse and mental health services. AACN (2020a) put out travel advisories related to study abroad programs, medical and nursing mission trips, and on-site immersion experiences. AACN urged the schools of nursing to follow the CDC and Department of State travel advisories to postpone or cancel international travel.

Teaching and Learning. NLN (2020) launched the Taking Aim webinar series to assist educators and students regarding nursing education issues amidst the COVID-19 pandemic. Topics include challenge associated with remote teaching, capstone experience and testing; managing civility and chaos in turbulent times; and strategies for online teaching and learning. AACN (2020a) developed the Coronavirus Resources for Nurse Educators to support the information needs of not only the school deans and faculty of the member nursing schools but also the students and other stakeholders.

Grassroots Efforts of Minority Organizations. The four ethnic minority nursing organizations – the NAHN, NBNA, PNAA, and NAINA – showcase many of the activities and programs of their chapters regarding COVID-19. The websites of these four organizations address the following topics during the COVID-19 pandemic: care for the elderly, access to care among immigrants, foreign educated nurses at the forefront, disparities and health equity, cultural proficiency, and community empowerment, among others. A special report on the Indian-American nurses working on frontlines highlights the contribution of NAINA and its members (Dutt, 2020). PNAA (2020) highlighted published reports regarding the increased incidence of COVID19 among Filipino-American healthcare workers, particularly nurses. The increase in the number of Filipino-Americans afflicted by COVID19 has been attributed to cultural norms, risk levels, vulnerability due to personal health and age, and high number of Filipino-Americans in the US healthcare workforce (Almendral, 2020; Diokno, 2020; Martin & Yeung, 2020; McFarling, 2020).

Financial Support to Members

The leaders of AMSN developed a program where donations were earmarked for the AMSN Emergency grant for members during the COVID19 crisis. AMSN offers emergency grants to eligible members through an application process for $500 per applicant for a total of $25K. The association also offers resources for donations to its members including scrubs, transportation, and rental cars discounts. In recognition of the financial hardships faced by its members, the association also extended grace periods for memberships (AMSN, 2020).

The ANA, through the ANF Coronavirus Response Fund for Nurses, allow the public to support and thank nurses through donations. Johnson & Johnson and the Tylenol brand provided the initial fund of $1.5 million to address the identified emerging needs of nurses.  The funds will provide direct financial assistance to eligible nurses, support the current and future mental health of nurses, and ensure access to the most up-to-date science-based information of self-protection, infection prevention, and care for those in need (ANA, 2020).

AACN (2020a) created the COVID19 Nursing Student Support Fund to provide assistance to students who were affected by the coronavirus. The funds are available to students to assist them financially in completing their degrees. Through the philanthropy of Darlene J. Curley, an honorary associate member of AACN, the Nursing Student Support Fund received an initial funding of $25,000 earmarked for 50 students at $500 each. The funds are available students who are enrolled in AACN-member schools.

The COVID19 Task Force of the PNAA and the PNAA Foundation launched the Heal Our Nurses Project aimed at addressing the critical, intermediate, and long-term needs of nurses. Based on the feedback from frontline members, the Task Force will implement strategies that will address the psychological trauma associated with the loss of lives and feelings of helplessness. A care package program that includes Mask our Nurses, Express (Y)our Compassion, and Lift Everyone’s Spirit was launched as part of the Heal Our Nurses Project. A donation campaign was initiated to support these programs (PNAA, 2020).  

The ENA (2020) launched its COVID-19 Emergency Relief Fund to support emergency nurses serving on the frontline. Aside from financial donations, ENA is advocating for donations of N95 masks and sanitizers to local hospitals, blood donation, dropping off meals and groceries, and offering assistance for dog walking, pet sitting, and tutoring with appropriate social distancing. NAINA launched the COVID-19 Relief Fund not only to provide PPEs and other lifesaving medical supplies to hospitals and clinics but also to deliver essential items to struggling families.  AWOHNN (2020) offers self-care resources that include screening tools, apps, and hotline information. These resources are aimed towards the psychological, emotional, and physical impacts of COVID-19 to nurses who are faced with the demands and stress of providing care to patients and their families.

Program Cancellations

The limitations in travel, increased demand for nurses at all levels at their places of work, and fear of exposure have all contributed to the cancellations of organizational programs, particularly with regard to conferences and meetings. Several nursing organizations cancelled their national, regional, and local chapter conferences in response to COVID19.

Conferences, Conventions, and Educational Summits. The widely attended and much-awaited National Teaching Institute offered by AACN (2020b) which was scheduled on May 4-7, 2020 was cancelled. ASPAN cancelled its 2020 annual conference.  PNAA cancelled its regional conference scheduled in Indianapolis scheduled in May and its national convention scheduled to be held in San Diego in July 2020.

Nominations and Elections. Spring and summer seasons are times for leadership turn-over.  Due to COVID-19 pandemic, AONL (2020) has postponed its nominations and is exploring its next steps in electing the national leaders for 2021. As of this writing, AACN (2020b) is exploring the next steps for the Representative Assembly to vote for the 2020-2021 national candidates.

Testing and Certifications. Organizations that offer certifications such as AMSN made accommodations for review course, testing sites, renewals, and recertification fees. Because of the global impact of COVID-19, AMSN decided to suspend all testing at all of the testing centers in the US and Canada until April 30, 2020. To assist those who are interested in taking the CMSRN examination, Medical-Surgical Nursing Certification Board is offering remote proctored examinations as a testing option. Testing resumed May 1, 2020 (AMSN, 2020).

The Show Must Go On

Amidst the challenges posed by the COVID-19, a number of professional organizations continue to operate key activities. Although this is not a complete list, the following examples demonstrate the commitment of nurses to serve their members, healthcare organizations, and the public while flattening the curve.

As fn this writing, NLN (2020) moved forward with its elections for Board of Governors, Nominations Committee, and Certification Commission and is preparing for its Education Summit in Orlando, Florida scheduled on September 23-25, 2020. AACN (2020b) implemented its call for nominations for the AACN and AACN Certification Corporation leadership positions. AWHONN (2020) moved forward with its call for the 2021 Board of Directors through the month of April. Its annual convention was moved to November 1-4, 2020 to be held in Las Vegas. PNAA (2020) moved forward with its election of the 2020-2022 officers. A live online presentation and debate of the president-elect candidates was held on May 2, 2020. As of this writing, the ENA (2020) is moving forward with it planned annual conference scheduled September 8-11, 2020 in Las Vegas. It also proceeded with the call for nominations for its national leaders, extending the deadline to May 13, 2020.  AORN (2020) is moving on with its acceptance of nominations for the 2021-2022 Board of Directors and Nominating Committee. NAINA is moving forward with its biennial conference on October 2-3, 2020 in Raleigh, North Carolina.

AORN, along with the American College of Surgeons (ACS), the American Society of Anesthesiologists (ASA), and the AHA, published a joint statement entitled, Roadmap for Resuming Elective Surgery after COVID-19 Pandemic. This road map provides guidance regarding the safe resumption of elective surgeries which may have been delayed or postponed by COVID-19. As the COVID-19 flattens, the roadmap focuses on readiness, prioritization, and scheduling of elective procedures (AORN, 2020).

Looking Ahead and Forward

Moving Beyond Collaboration toward Co-creation

The new reality of social distancing dominated the news and has affected the way patients are receiving care (Ayres, 2020; Brinkman, 2020; Tuazon, 2020). As we go back to the normal pre-COVID19 operations and witness the re-opening of hospitals, long-term facilities, schools, and other healthcare-related businesses, nurses at all levels will need to pause and reflect. To sustain the momentum of the innovations and value-based care practices amidst the COVID19 pandemic, this would be a great time to evolve from collaboration to co-creation (Israilov & Cho, 2017; Ortiz, 2020).  As we have witnessed, COVID19 paralyzed the economy and literally affected every individual. As an integral part of co-creation, the public has the chance to become makers and shapers of healthcare services rather than simply playing the roles of users and choosers (Janamian et al., 2016). Leaders must now address the uncertainties, vulnerabilities, and doubts on the viability of some hospitals resulting from the devastating effects of COVID19 (Muller, 2020; Rollins, 2020).  The future of the post-COVID19 pandemic is riddled with questions. Berwick (2020) poignantly pointed out that the post-COVID19 normal is best defined not by predictions, but by the choices that we will make. I submit that as we move forward, we will be asked to make three options: Adopt, adapt, or abandon.

Adopting What Works

Nurses at all levels have adopted additional technology in their clinical, teaching, and administrative practice including telehealth, televisits, virtual and remote teaching, and teleconference meetings (Ayers, 2020; McClunie-Trust, 2020). Schools and healthcare facilities have adopted creative and innovative approaches in delivering didactic and clinical education programs, orientation and on-boarding programs, and continuing education through online and virtual training. Academic and practice partnerships have forged closer collaboration in developing and implementing creative student learning activities.

Annual competencies on emerging infections, pandemics, and emergency preparedness have been reinforced. Professional organizations should adopt a similar strategy of AAN’s Expert Panels, especially on the Emerging Infectious Diseases to ensure constant readiness to prevent and combat the adverse effects of pandemics (AAN, 2020). Nursing organizations have provided guidance regarding surge capacity management and surge staffing strategies, especially in the emergency departments. Mental health programs have been identified as critical part of future initiatives to address the devastating effects of the COVID-19 pandemic.

Adapting to the New Normal

The talk about the new normal has dominated the conversation among many of the nursing organizations as they plan to return to their operations (Ayres, 2020; Berwick, 2020). The lessons learned from COVID-19 will certainly highlight the need to have emergency preparedness as part of organizational readiness (Coen et al., 2020).

Professional organizations should adapt to the new way of working together. Nursing leaders should capitalize on co-creation and move beyond collaboration (Israilov, & Cho, 2017; Ortiz, 2020). Joining forces in letter-writing campaigns, promoting public service announcements, and co-authoring joint position statements and white papers would further galvanize nursing efforts.  Before pandemics and emergencies re-occur, organized nursing groups should develop protocols in creating a just-in-time consortium of leaders. All presidents and chief executive officers, executive directors, or administrators of professional organizations should consider regularly scheduled meetings as part of pre-pandemic planning. 

Abandoning What Does Not Work

The lessons learned from the COVID-19 pandemic have shown that nursing organizations should abandon silos and the old ways of thinking. Nursing leaders should work with their colleagues in the healthcare manufacturing, technology, and pharmaceutical industry to prevent future deceptive and aggressive marketing of products and services and price gouging (Newman, 2020). Recruiting agencies should proceed with caution and consideration in marketing highly competitive pricing. The fierce competition for nurses could adversely affect hospitals that are already affected by the pandemic (Reuter, 2020).  Lastly, nursing organizations should avoid projecting an alarmist position. Nurse leaders should sound the alarm early but avoid creating panic. The words, tone, and body language should not provoke fear or incite undue distress. The COVID19 crisis should provide the impetus for hospitals to respond effectively to the changing nature, scope, and scale of pandemics (Coen et al., 2020). 

Words to Live By

The examples and exemplars cited in this article are a small representation of the various efforts and actions which were undertaken by professional nursing organizations. The quantity and quality of information and the innovative strategies provided through their websites are a fitting tribute to the work of nurses. Amidst the COVID-19, nurses have been hailed as heroes and 2020 is indeed the Year of the Nurse! I would like to borrow the words of NAHN (2020) to sum up the magnificent and exceptional response of professional nursing organizations during these times of chaos, uncertainty, and crisis: “Speaking out; fighting for nurses; and fighting for our communities.

 

Table 1. Professional Associations’ Response to COVID-19

Professional Associations Membership Coronavirus Resources
Academy of Medical-Surgical Nurses (AMSN) 12,000 members

Coronavirus (COVID-19).
https://www.amsn.org/covid19

American Academy of Nursing (AAN) 2,700 members Responding to COVID-19. https://www.aannet.org/news/coronavirus

American Association of Colleges of Nursing (AACN)

840 schools

Coronavirus resources for nurse educators. https://www.aacnnursing.org/News-Information/COVID-19

 American Association of Critical-Care Nurses (AACN) 100,000 members  Coronavirus (COVID-19) update. 
https://www.aacn.org/clinical-resources/
American Nurses Association (ANA) 172,107 members  COVID-19 resource center. 
https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/ana-response-to-coronavirus-disease-covid-19/
 American Organization for Nursing Leadership (AONL). 10,000 members  Resources on novel coronavirus (COVID-19). https://www.aonl.org/updates-and-resources-novel-coronavirus-covid-19
Association of peri-Operative Registered Nurses (AORN)  43,000 members  Essential COVID-19 clinical tools and resources. 
https://www.aorn.org/guidelines/aorn-support
 American Society of Peri-Anesthesia Nurses (ASPAN) 60,000 members  COVID-19 toolkit for the perianesthesia nurse. https://www.aspan.org/Home/COVID-19
Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) 24,000 members

Novel coronavirus (COVID-19) updates and information.
https://awhonn.org/novel-coronavirus-covid-19/

Emergency Nurses Association (ENA) 40,000 members  COVID-19 information.
https://www.ena.org/practice-resources/COVID-19
National Hispanic Nurses Association (NAHN) 47 local chapters

NANH COVID-19 resource center.
http://www.nahnnet.org/NAHN/Content/COVID-19_Resources_and_Updates.aspx

National Association of Indian Nurses of America 16 chapters ~2,000 members*

Coronavirus update.
http://nainausa.com/index.php/coronavirus-19/

National Black Nurses Association, Inc. (NBNA) Represents 200,000 members

NBNA: Coronavirus (COVID-19).
https://www.nbna.org/coronavirus%20(covid-19)%20statements

National League for Nursing (NLN) 40,000 members and 1,200 institutional members

Coronavirus resource center.
http://www.nln.org/coronavirus-resource-center

Oncology Nursing Society (ONS) 35,000 members

ONS information regarding the coronavirus (COVID-19).
https://www.ons.org/coronavirus?ref=HC&ref=HP

 Philippine Nurses Association of America (PNAA) 5,000 members COVID-19 updates.
https://www.mypnaa.org/COVID-19

*A. Therady, personal communication, May 7, 2020.

 

References

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American Academy of Nursing (AAN). (2020). Responding to COVID-19. https://www.aannet.org/news/coronavirus

American Association of Colleges of Nursing (AACN). (2020a). Coronavirus resources for nurse educators. https://www.aacnnursing.org/News-Information/COVID-19

American Association of Critical-Care Nurses (AACN). (2020b). Coronavirus (COVID-19) update. https://www.aacn.org/clinical-resources/

American Nurses Association (ANA). (2020). COVID-19 resource center. https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/

American Organization for Nursing Leadership (AONL). (2020). Resources on novel coronavirus (COVID-19). https://www.aonl.org/updates-and-resources-novel-coronavirus-covid-19

Association of peri-Operative Registered Nurses (AORN). Essential COVID-19 clinical tools and resources. https://www.aorn.org/guidelines/aorn-support

American Society of Peri-Anesthesia Nurses (ASPAN). (2020). COVID-19 toolkit for the perianethesia nurse. https://www.aspan.org/Home/COVID-19

Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). (2020). Novel coronavirus (COVID-19) updates and information. https://awhonn.org/novel-coronavirus-covid-19/

Ayres, C. (2020). Nursing and the new normal: Corona Virus Pandemic. Journal of Nursing Practice Applications and Reviews of Research, 10(1), 1. https://doi.org/10.13178/jnparr.2020.10.01.1001

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Dutt, D. (April 2020). Special report: Indian-American nurses on frontlines of Covid-19 patient care. News India Times. https://www.newsindiatimes.com/special-report-indian-american-nurses-on-frontlines-of-covid-19-patient-care/

Echevarria, I. M. (2018). Make connections by joining a professional nursing organization. Nursing, 48(12), 35–38. https://doi.org/10.1097/01.NURSE.0000547721.84857.cb

Emergency Nurses Association (ENA). (2020). COVID-19 information. https://www.ena.org/practice-resources/COVID-19

Israilov, S., & Cho, H. (2017). How co-creation helped address hierarchy, overwhelmed patients, and conflicts of interest in healthcare quality and safety. AMA Journal of Ethics, 19(11), 1139-1145. doi: 10.1001/journalofethics.2017.19.11.mhst1-1711.

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Muller, L. (2020). Deep concern for some hospitals’ viability after COVID-19. Corridor Business Journal, 16(41), 6.

National Association of Hispanic Nurses (NAHN). (2020). NANH COVID-19 resource center. http://www.nahnnet.org/NAHN/Content/COVID-19_Resources_and_Updates.aspx

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