Dec 22, 2020

Nursing Organizations Among Leaders Urging Caution in Crisis Care

Four leading nursing organizations are among 10 major health care groups appealing to governors and state health care leaders to agree to crisis standards of care based on individual assessment, not categories including age and disability, when it comes to allocating treatment as the country’s hospitals reach capacity with COVID-19 patients.

The letter recognizes concerns shared by the Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP, and the Robert Wood Johnson Foundation, as well as other organizations, including AARP, that without effective and protective standards, the rationing of care can disproportionately hit those with less income and power.

In a letter posted on the website of the National Academy of Medicine, the nursing organizations, including the American Nurses Association, American Association of Colleges of Nursing, National Council of State Boards of Nursing, and National League for Nursing, make clear their commitment to protecting the most vulnerable.

“We have reached a point in the crisis at which critical decisions must be made in order to do the most good possible for the largest number of people with limited resources. These decisions effectively signal a shift from conventional to crisis standards of care,” the letter said. “This means making unprecedented and agonizing decisions about how resources are used, stretching many resources well beyond conventional limits.”

The health care leaders signing the letter urge that allocation of resources be based on assessment of individuals, not based on categories such as disability, age, “judgments as to long-term life expectancy” or “evaluations of the relative worth of life.”

“Health departments, along with health care coalitions, should be coordinating care across jurisdictions, and hospitals should be working closely with their clinicians to not only adjust processes and procedures to maximize capacity, but also implement processes to make fair and ethical decisions if these adjustments fail and there is not enough of an essential resource.”

Not all states have crisis standards of care, which are emergency plans the National Institutes of Health defines as “a substantial change in usual healthcare operations and the level of care it is possible to deliver, which is made necessary by a pervasive (e.g., pandemic influenza) or catastrophic (e.g., earthquake, hurricane) disaster.”

Read the letter

Susan C. Reinhard is senior vice president and director, AARP Public Policy Institute and chief strategist for the Center to Champion Nursing in America and Family Caregiving Initiatives