The Time to Act is Now: Dr. Stephanie Ferguson on the Critical Role of Nurses During the COVID-19 Pandemic
Content Note: This article includes mention of suicide.
Dr. Stephanie Ferguson is a global health care consultant with over 35 years of experience in designing, executing, and evaluating public health strategic plans and programs. A visiting fellow at the Harvard T.H Chan School of Public Health, she previously joined us in the Leadership Studio in December 2019. Throughout her career, Dr. Ferguson has served as a technical advisor and consultant for the World Health Organization and the International Council of Nurses, as well as past president of the White House Fellows Foundation. She is currently the founder and CEO of Stephanie L. Ferguson & Associates, LLC.
As we adjusted to the social circumstances of the COVID-19 pandemic, on April 30, 2020, we welcomed Dr. Stephanie Ferguson to share her thoughts on the role of nurses during this crisis in a live-streamed conversation with Dr. Sara Bleich, Professor of Public Health Policy and Management at the Harvard T.H Chan School of Public Health and Carol K. Pforzheimer Professor at the Radcliffe Institute for Advanced Study. This was our first virtual session of the Voices in Leadership web series, with a special focus on what it takes to lead during this global pandemic.
Meaningful Measures to Deal with the COVID-19 Pandemic
When asked about the most important thing Congress can do to impact the pandemic, Dr. Ferguson stressed a focus on increased testing and re-opening of healthcare delivery systems to resume elective surgeries that had been postponed. She also raised concerns about the possibility of COVID-19 and the upcoming flu season occurring at the same time and called for vaccination of vulnerable populations in order to prevent deaths unrelated to COVID-19. She shared:
“First of all, we have to get testing right. We need to test. We need to track. We need to isolate the infected people with COVID-19, everybody in our nation. So that’s number one. And we need to open up our healthcare delivery systems. And when I say healthcare delivery system, I mean the public health infrastructure, all the community-based clinics, all of the acute care centers, all the ambulatory care centers.”
She was appalled that the United States is short on personal protective equipment that aids the safety of frontline workers, including nurses and other healthcare providers. Dr. Ferguson called for government intervention, stating: “If you have nurses who are getting infected and dying, then you don’t have a healthcare delivery system, and you don’t have a country anymore”.
Ending a Vicious Cycle
In the middle of a global pandemic, the last thing needed is the shutting down of health care delivery systems and not having enough resources to pay healthcare professionals and ensure their safety. Dr. Ferguson shared her thoughts on opening up the U.S healthcare delivery system with general nurses and advanced practice registered nurses at the frontline where they need to be, with appropriate gear to protect themselves while taking care of patients. She also talked about the furloughs and licensing challenges the nurses are currently facing. The furloughing of healthcare workers is not the right thing if the U.S. wants to turn around the current pandemic. Dr. Ferguson opined:
“Basically, the last people that you need to be laying off are your healthcare workers. So if anybody’s listening to me, find the money to pay the healthcare system so that they can bring their nurses back to work, get them out of furlough, and get them where they need to be. They are your frontline workers who can do public health, testing, tracing, contact tracing, isolating the people, going into the homes, going into the apartments, and wherever people live, in the backwoods of Virginia, in rural and urban settings. And really work with people to help them get well.”
She believes that nurses are innovative and creative and are equipped with the skills to set up and run nurse-led clinics. They can handle their typical responsibilities and still work on the frontlines, ensuring the testing, tracking, isolation, and treatment of patients diagnosed with COVID-19. It is very important to get them back to work and allow them to practice to the full scope of their licenses, nursing education, skills, and abilities.
A Pandemic Does Not Discriminate
Dr. Ferguson addressed her concerns about Black and Brown neighborhoods, which are more likely to be exposed to coronavirus due to the historical and current marginalization of their communities that creates circumstances such as residence in high population density areas, overrepresentation in lower-paying jobs that are deemed “essential”, and inability to stop working at those jobs because they need income to support their families:
“Now let’s keep it real. When you see who’s dying right now, you see a lot of Black people are dying, a lot of Latinx people are dying, a lot of Asian people. We could go down the list. And yes, of course, there are a lot of other majority of people who are dying, but I want to talk about Black and Brown populations.”
She called for the need to disseminate information about COVID-19 in multiple languages, not just English, to ensure that every person can access and comprehend written resources to help them understand the pandemic. Dr. Ferguson also stressed how a lack of command and control in a situation like this can eventually lead to chaos and conflict. This is where nurses can provide assistance. They know how to collaborate with communities to help spread the right information about COVID-19. They know how to set up clinics and make sure the clinics are safe. They are well-trained to reliably perform in tense situations to care for people living with infectious diseases and their comorbidities. She asserted:
“You know, people need to realize not everybody is looking at Fox News and CNN everyday. Black people are listening to different mediums, if you will, to learn about what’s going on in their communities. Same thing with Latinx populations… [But] everything is in English. How about you need to be speaking some Spanish, too.”
On the International Front
The readiness of a country to deal with this pandemic is dependent on increased testing and ensuring the safety of their health care professionals. It is important to watch and learn from countries that are able to handle pandemics appropriately and from countries who were not able to adequately deal with COVID-19. Dr. Ferguson urged:
“Figure out how to get your testing right. Figure out how to get your protective gear for your nurses. If the nurses get sick and die, there will be no healthcare system. That country will fall apart. So from a national security perspective, it would be game over. And so they need to understand, you got a little bit of time there to prepare. Just look and learn from some of the other countries that have not been able to deal with this situation in a good way.”
According to the international nursing report, the world is down 6 million nurses with over 23,000 dead due to the pandemic. This is due to a lack of investment supporting nurses and midwives. Dr. Ferguson believes that there are more nurses and healthcare workers who are falling sick due to the virus and called for expanding the nursing workforce and changing nursing education programs around the world to focus on public health and primary healthcare.
She also commended the great job done by the nurses working in the frontlines in South Korea, New Zealand, and countries in the continents of Africa and Europe. These nurses, who are working tirelessly to care for everyone’s loved ones, while putting their own lives at risk, provide insight into how to handle the pandemic.
Short-and-Long Term Planning
The first thing the U.S. needs to do is to be honest about its shortcomings. Investing in nurses, instilling appropriate regulatory systems in nursing that work with the accreditation of academic institutions, and reforming curricula to ensure nurses have the right licenses to protect people during a pandemic, are all things the U.S. needs to improve. The country’s leaders have to make it a priority to ensure nurses are well-equipped with all the resources needed to work on the frontlines.
Dr. Ferguson also highlighted mental wellbeing during the pandemic and called for better mental health services, with increased access to clinical psychologists and psychiatrists, since nurses have to care for their own mental health in addition to giving that care to the patients. She shared:
“They need the psychiatrist. They need to have interaction and talk to people. When you are down, when you are depressed, when you’re sad, when you’re ready to commit suicide, I don’t know too many people who are like, oh, I think I’ll look at a webinar. No. Now, I do think that you need those types of materials once you get people through the crisis.”
Dr. Ferguson also discussed the benefits of telemedicine and telehealth, as better and faster means to bring the right health services to people in need using technology. To ensure this, nurses need access to high-speed internet, something that is worth the investment. She stated:
“I’ve seen nurses live outside, live in tents. It’s unfortunate because they don’t have housing. And I think that we need to do the right thing so that they can be able to dial up to text somebody and say, I had a rough day. I had a really rough day. I feel like I went to the morgue more than I did to go check on my patients. That’s how many people died today. And when you have that type of thing happening in your life, you need to talk with somebody.”
Optimism During Difficult Times
Dr. Ferguson is clearly optimistic about the future when asked to give reasons for hope. To her, every nurse in the world is resilient and responsible and is leading the crisis by doing all the right things. Players in the health and policy systems must ensure they have everything they need so they can do their jobs.
Her deep care and compassion were evident while talking about the integrity of the nurses as she shared one of her favorite quotations: “So often, we do not know where our journey will take us. But in walking toward those in need, and the experience of doing for the sake of others, truths are revealed”. She also affirmed that:
“We’re in a perfect storm now, and I always like to say that, when you’re in a perfect storm there’s going to be a perfect new beginning. I am very optimistic that we will get through this. But we need to make sure that we do the right thing now, and invest in nursing, scale up our mechanisms for monitoring the health workforce, including our nursing workforce, to see who we are, where we are. So we can put the right nurse in the right place, at the right time, to be able to care for people who are both suffering from an infectious disorder and a non-communicable health disorder”
What the U.S. needs to do now is to look, listen, and learn. The pandemic is evolving and everyone needs to be able to adapt accordingly. Great leaders are always thinking and doing assessments for meaningful decision-making. They have good insight and judgment and are effective communicators, because that is the very essence of true leadership. Dr. Ferguson left the Voices in Leadership session on a positive note, advising the audience to be humble, embrace the adventure, and to keep walking.
Story written by Harika Dasari MBBS, a second-year MPH- Epidemiology student at the Harvard T.H Chan School of Public Health. She is a medical professional trained in India and is currently involved in basic science research on Chimeric Antigen Receptors on Regulatory T cells at CHU Sainte Justine affiliated with the University of Montreal. Her interests are focused on women’s health and gynecological bleeding disorders.
Story edited by Sherine Andreine Powerful, MPH, a Doctor of Public Health student at the Harvard T.H. Chan School of Public Health. A Diasporic Jamaican, she received her Bachelor’s degree in Latin American and International Studies from Yale University and holds a Master of Public Health degree in Population and Family Health, with a concentration in Global Health, from the Columbia University Mailman School of Public Health. Her interests, centered around the English-speaking Caribbean, include feminist global health and development leadership; gender and sexual health, equity, and justice; and pleasure, healing, and liberation.