Advanced practice nurses, Covid protocols, and patient autonomy in healthcare

Interview with APRN

Abstract

This paper discusses an introduction with an APRN at a health care organization under the Mercy Health umbrella. It begins by identifying the mission, vision and values of the organization and extrapolating its goals from them. It then describes the interviewee approached for this project. It lists the ten interview questions used to guide the interview, which was conducted over Zoom and lasted approximately 30 minutes. The interview showed the primary concern of the advanced practice nurse stemmed from her experience in dealing with Covid protocols. She discussed how many nurses, including herself, felt these protocols went against what they learned and were expected to show regarding patient autonomy and human dignity. She felt discouraged at the way her organization’s leaders were handling the response to Covid. She lamented that the professional climate had become so toxic that many professionals were considering quitting, which would only further hurt the field. In her view, the leaders in the industry were fanning the flames of division rather than uniting everyone under a human approach to care in accordance with the organization’s core values and vision. By the end of the interview, she discussed that the industry was changing in big ways and it concerned her, as she was thinking of exploring closer relationships with natural health practitioners in the future. This interview has revealed deep fissures in the practice of health care and should be viewed as a warning of what might be in store for the field.

Keywords: health care interview, advanced practice, covid

Responses and Analysis

The interviewee stated that her professional expectations as an APRN with Mercy were to be able to have the autonomy and support required to provide primary care to families in a Christ-centered manner. Her reason for working with Mercy was that it was a Christian-oriented organization that promoted Christian values. At the same time she recognized that as a professional nurse, she has to be inclusive and respectful of all people, as not every patient who comes for care is going to have the same Christian outlook. For that reason, she stated that as a professional, she sees an appreciation of diversity as one of the most important professional outlooks that needs to be cultivated among nurses. She lamented that diversity appreciation is often muted among young nurses she meets, many of whom are being boxed in by current regulations and protocols, which have created tension and division among workers. When pressed for an example, she brought up current vaccine mandates among health workers; some see them as good and some see them as a violation of human rights; there is no respect for diversity of opinion, but only constant clashing and a spirit of division that has been fostered. It undermines trust and communication. She was not prepared for that when she entered the field as an APRN and she said she sees it as a step backward for the nursing field. As Arslan, Yener and Schermer (2020) have pointed out, it is important for nurses to develop strong communication and trusting relationships so as to avoid alienation in the workplace. Unfortunately, alienation is happening because the climate in the nursing field has become very toxic.

This led into the next question of Mercy’s health policy. The interviewee stated that the policy is sound and has been sound for many years—but the organization is hamstrung by federal guidelines, and viewpoints are being pushed that not all agree with; some feel they conflict with their responsibility as a nurse. She pointed to current mask mandates and Covid approaches as an example. She noted that at the outset of 2020, when nurses where being told to report coronavirus numbers many were flabbergasted because in their experience coronavirus was commonplace and then all of a sudden it was being treated like a deadly, dangerous disease. She remarked that at the outset, even in the face of all the media coverage, almost all nurses were exasperated by the way messaging was being done in public by the media. Then in April of 2020, everything suddenly went to an extreme no one could have predicted and even Mercy’s health policy reflected this extreme decision-making. She said she herself questioned it, as did others, but for fear of losing their employment almost everyone kept quiet and went along with the new policies being implemented from higher up in the administration.

When the interview switched gears to touch upon health reimbursements, the interviewee stated that she had no problem with them and was happy to see alternative health payment plans being implemented. She then noted that the historical role of the professional nurse has changed so much just in the past 50 years. She observed that in the past, nurses were meant to assist physicians, but that as more and more physicians moved into specialized medicine, a gap opened in primary care and nurses began receiving training so that they could fill that gap. This aligns with what O’Brien (2003) has stated about the historical role of the advanced practice nurse. Moreover, the interviewee stated that she was happy nurses have greater autonomy in many ways, and she pointed to the IOM (2010) and its important recommendations for the future of nursing, particularly the need for advanced practice nurses to be able to practice to full scope of their training. She noted that in the past Mercy had been very good about helping nurses pursue additional education and training so as to become advanced practice nurses.

As for ethical frameworks, the interviewee stated that Christian ethics were primarily employed at Mercy and this was good since she, as a Christian, aligned personally with that ethical framework. However, she also noted that as a professional nurse, it is her responsibility to discover the views and health beliefs of patients so as not to violate them as well. She lamented that the leadership response to Covid at Mercy was such that it seemed to trample on the health and personhood beliefs of many patients and practitioners. She felt that people were putting both profits and politics ahead of people. She noted that she tried to respect human dignity as best she could in such a situation but that it was becoming harder and harder to do because the system itself was stepping away from treating people with respect and appreciation for their autonomy. She feared what was happening in the health care industry. She also noted that she would like to see more EBP in place—and she stressed the phrase “actual EBP”—in response to Covid. She stated that everything she had seen up till now was based on fear mongering and nothing more. She said that the major challenge in health care in the coming years would be restoring the people’s trust in the institution of health care. She said more and more people were viewing health care as corrupt, as commoditized, and as in the pocket of Big Pharma; she said she felt this way just from conversations she had with people every day. This led to the final question of interprofessional collaboration: she said that ultimately she would like to collaborate with holistic doctors, homeopathic doctors, and natural medicine practitioners. She said her perspective on health and healing was changing dramatically the more she looked into the work of doctors like Tom Cowan and Stefan Lanka. She said she would like to see inerprofessional collaboration in that direction, but she doubted very much that Mercy would support such a direction.

Conclusion

Based on the interview, it appears that much has changed in the health care field since 2020, and it has affected the interviewee especially dramatically. Her view of nursing is now more in line with the holistic approach, and she discussed the person-centered theory of care briefly and argued that this approach was being lost in the face of Covid regulations. Her main concern was that her health care organization was becoming too far removed from the vision, values and mission that had defined it in years past.