Good morning, and thank you so much for coming to this session. Really appreciate it. My name is Megalyn Anderson. I am a faculty member at the University of Pittsburgh School of Nursing and a nurse practitioner at the UPMC Critical Care Medicine. Today I'm going to be talking to you about women in critical care nursing, specifically the contributions to the practice of critical care nursing made by and for women in 2021. I have no conflicts of interest or any other disclosures to report for this activity. I have three main objectives for this short talk. First to review the impact of 2021 on women in critical care nursing. I want to let everybody know who's listening that I will be discussing burnout and suicide briefly at the beginning of the talk if you would rather avoid that part of the discussion. The second one is to discuss key contributions during the last year to women nurses' ability to provide excellent critical care and review women nurses' contributions to and impact on the practice of critical care nursing in 2021. Many of you listening today, though certainly not all of you, know that when a nurse or soon-to-be nurse graduates from school, they are presented with Nightingale's Lamp. And for the nurses before us and the nurses who will come after us, it represents a wish and a promise that we continue our devotion to our practice, we bring kindness and care wherever we are serving, and also that we are courageous. And if there's a better word to describe nurses and all of our healthcare colleagues during 2021 than courageous, I haven't found it yet. There's nobody in the room who's escaped the headlines over the past year. For many of us, it seemed clear that for once the headlines were tame compared to the reality of our day-to-day jobs. Nurses who had been working at the bedside for years and years, seemingly indomitable, were retiring left and right. The first great waves of nurses leaving for travel assignments started and everyone else was exhausted. What became very clear with a little investigation is that the pandemic took a much greater toll on nurses than anyone expected or realized early on. A survey by the American Association of Critical Care Nurses found that 66% of the 6,000 nurses surveyed considered leaving their jobs because of the pandemic, and many were afraid of putting their families' health at risk. 92% of those surveyed believed that the pandemic would shorten nurses' careers, and 76% felt that unvaccinated patients undermined nurses' physical and mental well-being. In a May 2021 study published in eClinical Medicine, 61% of the 21,000 U.S. healthcare workers surveyed had significant fears of exposing themselves or their families to COVID-19. Half of those workers suffered from burnout, and 38% said they were dealing with anxiety or depression. Nurses have always been a vulnerable group for burnout, anxiety, and depression, and our fears that the pandemic would dramatically increase these vulnerabilities were realized during 2020 and 2021. Looking specifically at various professionals who work in critical care medicine, this 2021 nurse co-authored study compared burnout levels from 2017 to burnout levels during the early part of the pandemic in 2019 and 2020. Results from all of the adult ICUs in the system were given the Maslach Burnout Inventory as well as the Areas of Work-Life Survey. And out of the 572 respondents in 2017 and the 710 respondents in 2020, it became clear that one, burnout was very common in all of the multi-professional team members, and two and three, nurses had the highest prevalence of burnout and also the highest increase from the pre-pandemic baseline. And four, female clinicians were significantly more impacted by burnout than male clinicians. A similar pattern revealed itself in this 2021 article published in Intensive and Critical Care Nursing about the effects of the COVID-19 pandemic on the mental health of Canadian critical care nurses. They found that ICU nurses demonstrated symptoms of PTSD, depression, anxiety, and stress, and that these were specifically related to rapidly changing policies, overwhelming and unclear communication, personal and colleague safety issues, and balancing the commitments of work and at home. For any professions that primarily deal with taking care of other people, impacts on mental health can be significant despite various mitigation efforts over the years. This was especially true for female nurses included in this study from 2021 that looked at cohort data from 2007 to 2018. The authors found that nurses' risk of suicide was increased from the general population while physicians' risk was not. Particularly, they found that female nurses were at especially high risk. The study did not discuss possible drivers of these outcomes. They do note that given the year of publication that the effect of the COVID-19 pandemic may have exacerbated this risk, but there is no data to substantiate this yet. According to the American Nurses Association, 21% of nurses and nursing students have experienced physical assault and over 50% of them have experienced verbal assault. Additionally, workplace violence is underreported, particularly assaults that do not result in injury. Workplace violence is associated with nurse absenteeism, job dissatisfaction, intent to leave jobs, as well as post-traumatic stress disorder. All types of workplace violence in this 2021 study from the Journal of Research in Nursing were positively correlated with emotional exhaustion and negatively correlated with patient safety. There's also a negative correlation between emotional exhaustion and patient safety. I was so honored to be asked to deliver this review of 2021 for women nurses in critical care because I knew personally that despite the burnout and the mental health challenges and the pandemic and all of the other challenges that make nursing, especially nursing in the ICU, very difficult, that the nurses I knew had been rising to the challenge the entire time. I suspected, though, that much of their work over 2021 was going to go unnoticed. Using two different databases, I looked for publications by women nurses in critical care from all of 2021. These searches were certainly limited by my ability to accurately filter for all nurse authors, but despite which database I used, I found the same thing. Women nurses were not publishing as much in 2021 as they had the year prior, and especially not as much as they had in 2019. In every search I did, the number of publications by women nurses was down by 60 to 70 percent in 2021. I cannot tell you for sure why this is true, but I suspect the nurses across the United States and probably the world were just too busy taking care of patients. Taking care of patients to such an extent that other career ambitions and projects were put on hold. This was probably exacerbated by emotional exhaustion, fear for themselves and their families, and just the sheer amount of work that had to be done in the hospital as well as at home to navigate the last two years. While keeping their colleagues and their families safe, of course. But diving deeper into the literature that was produced by women nurses in critical care and published in 2021 was truly a testament to the courage of nurses everywhere and the commitment to addressing the problems that we face in healthcare and beyond together. From the 2021 literature by women nurses in critical care medicine, I'll now talk about those who have the courage to focus on mental health. In this study, a team of critical care nurse researchers from Boston Children's Hospital and Harvard Medical School reported on three nurse-led research studies that were a result of a call to action to support intensive and progressive care nurses who are experiencing moral and ethical challenges. An interdisciplinary work group implemented a nurse education and support team coach role that was designed to provide peer-to-peer support for nurses in a just-in-time approach. The training coaches provided coverage five days per week in four different intensive care units and one progressive care unit, and staff satisfaction and feasibility were assessed at six months and 1.5 years after implementation. After both evaluation periods, more than 80% of those surveyed indicated that they were satisfied with their interactions and that they would seek consultation again. The American Association of Critical Care Nurses Healthy Work Environment is focused on key standards that are associated with the healthiest ICU work environments, including skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership. In this 2021 study conducted at Duke University Hospital, a team of nurse leaders and researchers who are concerned about nurse turnover and tenure implemented the AACN Healthy Work Environment Framework and focused on interventions addressing each of the main standards. Nurse cohorts involved in the study were predominantly female and had been working in the ICU for an average of five years. They were able to achieve significant improvements in nearly all of the standards, stabilize the registered nurse turnover, and increase tenure by 79 days over a two-year period. The challenges of 2021 have also inspired not only nurses, but those who support nurses to make significant changes. In April of 2021, the U.S. House of Representatives passed H.R. 1195, the Workplace Violence Prevention for Healthcare and Social Service Workers Act. In parallel to this, 39 out of 50 states either established or increased penalties for assault of nurses, and in January of 2022, the new and revised workplace violence prevention requirements from the Joint Commission went into effect for all accredited and critical access hospitals. In response to calls for change, specifically about violence against healthcare workers, the U.S. House of Representatives passed H.R. 1195 on April 16th of last year. This is the Workplace Violence Prevention for Healthcare and Social Service Workers Act. In parallel to this move, 39 out of 50 states either established or increased penalties for assault of nurses, and on January 1st of this year, the new and revised workplace violence prevention requirements from the Joint Commission went into effect for all accredited and critical access hospitals. The women in critical care nursing who continue to strive for excellence during 2021 at the bedside and in research, despite the many challenges of the year, cannot go unrecognized. I don't have time to tell you about all the fabulous work, but I will highlight a few excellent publications in the next few slides. In a study that is a true child of the global coronavirus pandemic, a case report of a critical care transport of a non-intubated patient who was prone for treatment of severe hypoxemic respiratory failure was published in Pre-Hospital Emergency Care Journal. The study was co-authored by critical care nurse Heidi Noland. They were able to transport him without incident to the receiving hospital with an oxygen saturation greater than 95% and stable blood pressures. This is the first known critical care transport of a prone patient who was not intubated. During the coronavirus pandemic crisis in the Carolinas hospital system, a team of clinical nurse specialists who normally worked in varying capacities and areas found quickly that the unique training and skillset of the clinical nurse specialist was an ideal fit for a rapidly changing resource challenged environment. Working together to leverage their skills in the spheres of impact of patient and client nursing and nursing practice and organization and system, they responded to arising issues and arising needs quickly and efficiently. From intervening at the administrative level to quickly roll out IV pump updates to developing a dedicated nursing runner position to ease unit workflow, to collaborating with hospital leaders to establish compassionate family communication pathways, they used their advanced clinical knowledge and their logistical and systems training to provide ongoing just-in-time quality improvement at multiple levels in the hospital. The authors point out quite rightly that though this is their daily practice, even before the pandemic, the unique needs of the hospital, the nurses, and the patients during this crisis highlighted the adaptability and leadership, as well as the unique skillset of the clinical nurse specialist. Failure to rescue continues to be one of the most important problems that we face in critical care medicine. Many nurse researchers are working on system solutions to decrease the risk to patients and increase the response times of providers. This team of nurse researchers implemented the use of an early warning score to identify patients at risk for clinical deterioration. This pilot program was initiated on a 27-bed general medical unit. They used the modified early warning score for clinical deterioration, which uses ranges of blood pressure, heart rate, respiratory rate, temperature, and responsiveness to score a patient's risk. Along with the scoring system, they developed a graded response system for escalating scores, and they implemented evening and night rounding by resident nurses and respiratory therapists. The mortality of their patients decreased on this unit by 27%, the rate of multiple rapid response team activations on a single patient decreased by 15%, and nurses and residents were satisfied with communication about the patients and their awareness of early vital sign changes. Our experience with the pandemic has certainly changed the playing field in regards to telehealth, and in particular, telecritical care. For the military, telecritical care has the potential to concurrently support field and facility operations and increase capacity during mass casualty events. First author Christina Uranimakis and her research team piloted simultaneous telecritical care support during three field exercises. In the first two, an ICU and a remote field exercise were simultaneously monitored by a physician and a nurse. In the third, a telecritical care nurse simultaneously monitored the ICU while providing reachback support to field hospital nurses who were training in a simulation scenario. They found in all three exercises that concurrent telemonitoring was feasible and enhanced the quality and the safety of ICU bedside care while increasing capacity. Notably, this allowed novice bedside or field caregivers increased procedural capability and scope of care with telecritical care support. Some additional notable studies, but by no means all, published in 2021 by nurse authors and collaborators included research about manual versus automatic prone positioning, elements of the critical care work environment associated with burnout, practice strategies for clinical nurse specialists in taking care of children with medical complexity, models for disaster nursing during the COVID-19 pandemic, verifying arrhythmias using all available EKG leads, and nurse patient communication in the intensive care unit. Last but certainly not least, 2021 was about nurses who had the courage to persist. In 2021, nurses gowned up, masked up, showed up. They supported each other and all the members of the multi-professional critical care team. They pushed their research forward. They found new solutions to old problems. They managed to teach a growing number of nursing students. And locally and nationally, both, they built community and collaboration. There's always a next step in the process. Women nurses in critical care, in fact, all nurses in critical care, need options and pathways that honor nurses' expertise in not only caring for patients, but clinical research, quality improvement, and teaching. This may look like involving nurses and ongoing research, but it could also look like reexamining institutional processes that create barriers for established nurse researchers. Beyond that, nurses like to get paid well, of course, but also, and probably mostly, they want the resources to be able to do their job safely and well. Anything that can be done to promote ownership of the profession and patient outcomes and leverage the input from nurse innovators is critically important. Nurses run the hospital, and they run the ICUs. They have solutions for many of the problems we are tackling every day in critical care, and they need the space and support to put those solutions into action. But don't ask me. Ask your friendly neighborhood nurse what they need. They will definitely be able to tell you.

women in critical care nursing

pandemic challenges

burnout

mental health issues

workplace violence