key: cord-0923213-ol43qvu9 authors: Kyranou, Maria title: Setting minimum standards of practice in times of crisis date: 2021-05-17 journal: J Nurs Manag DOI: 10.1111/jonm.13374 sha: 0d312dcd10920eb71658fcaa50c1eb4a95bf0f67 doc_id: 923213 cord_uid: ol43qvu9 The Covid‐19 global pandemic is certainly taking a toll on all countries of the world. Health care systems are seriously challenged and shortages both in staff and equipment are evident even in high‐income countries. Nonetheless, one cannot avoid wondering: were these problems new or did they just exacerbate because of the terrible pandemic? Were there ways to have avoided the trauma faced by nurses (International Council of Nurses, ICN, 2021) after the overexposure to the health care crisis?Such a grim realization has specific implications for nursing. Naturally, one cannot change the world. Similarly, nurses cannot affect all aspects of health care systems that need serious reform. But nurses can affect nursing‐sensitive outcomes. Most importantly, nursing‐sensitive outcomes can be used to establish criteria for safe nursing practice. Health care institutions must enable health care professionals to function within the scope of their professional ethical codes. After all, systems operate thanks to the professionals comprising them. Similarly, professionals need to be facilitated by systems to function with integrity. This article is protected by copyright. All rights reserved The Covid-19 global pandemic is certainly taking a toll on all countries of the world. Health care systems are seriously challenged and shortages both in staff and equipment are evident even in high-income countries. Nonetheless, one cannot avoid wondering: were these problems new or did they just exacerbate because of the terrible pandemic? Were there ways to have avoided the trauma faced by nurses (International Council of Nurses, ICN, 2021) (EFN, 2015) . Even worse, the same report confirms that "nurses are still missing from discussions relating to policy both at the EU and Member State level". Such a grim realization has specific implications for nursing. Naturally, one cannot change the world. Similarly, nurses cannot affect all aspects of health care systems that need serious reform. But nurses can affect nursing-sensitive outcomes. Nursing-sensitive outcomes are indicators of nurses' contribution to the changes of patients' health status, experience with the health care system and cost of care (Joint Commission International, 2014). They are distinct and specific to nursing and differ from medical indicators of care quality. According to research studies that took place in the last 20 years, the most frequently investigated nursing-sensitive indicators are nursing ratios, mortality and nosocomial infections followed by pressure ulcer, patient falls, length of stay, patient satisfaction, central line infection and pulmonary embolism (Oner et al., 2020; Myers et al., 2018; Audet et al., 2018) . For example, nurse staffing and the nurse-patient ratio affect the quality of nurse communication which in turn affects patients' functional independence at the time of hospital discharge (McGillis et al., 2003) . This article is protected by copyright. All rights reserved Other than their contribution to the systemization and improvement of clinical care, nursing-sensitive outcomes bear the potential to benefit nursing in multiple ways. To start with, funding can be sought according to specific research goals geared towards the improvement of the quality of care nurses can affect. Research agendas can be constructed based on this approach and the findings of research studies could target the quick uptake by clinical nurses. Finally, education can be guided accordingly to prepare professionals with a focus on nursing quality and nursing-sensitive outcomes. Undoubtedly, the above approach should take place in the context of multidisciplinary teams which work together to maximize patient outcomes. Most importantly, nursing-sensitive outcomes can be used to establish criteria for safe nursing practice. Health care institutions must enable health care professionals to function within the scope of their professional ethical codes. When specific organizational standards, such as low staffing and/or poor supplies, are not met then professionals cannot be held accountable for missed care. However, each professional is personally responsible for the care he/she provides. Therefore, as Tonnessen et al. (2020) propose, a minimum set of standards need to be guaranteed by health care institutions to allow nurses to provide safe and competent care. After all, systems operate thanks to the professionals comprising them. Similarly, professionals need to be facilitated by systems to function with integrity. What are the criteria for setting minimum standards for nursing care? Indisputably, health and health care are considered a human right (WHO, 2017). Thus, aspects of nursing care that are thought of as humane need to be safeguarded in any work setting. Patients' fundamental needs, such as nutrition and hydration, comfort care as well as psychological and spiritual concerns need to be addressed in all occasions assuming we are practicing in a safe and organized environment (International Council of Nurses, 2012) . It would be noteworthy if the revisions of the Code of Ethics for Nurses, currently taking place (ICN, press release: 21 October 2020) could take into account the above concerns and provided a way to specify what constitutes minimum standards of nursing practice. This article is protected by copyright. All rights reserved Nurses have traditionally been in the frontline of every pandemia around the world and need be, will operate again having their patients' best interest as a priority even at the expense of their own health. When the crisis is over, nurses need to participate equally in decision-making processes for the training and coordination of acute responses in future similar situations. Furthermore, instead of waiting from others to acknowledge the contribution of nurses in the care of individuals, a set of minimum standards for safe nursing care need to be established to prove when nurses are functioning within the scope of their professional moral codes or when they are being outstretched to save as many lives as possible. In these latter situations, health care authorities and systems need to take responsibility for their level of preparedness that allow or hinder health care professionals to practice for the welfare of patients. Associations between nurse education and experience and the risk of mortality and adverse events in acute care hospitals: A systematic review of observational studies exodus-experienced-nurses-compounding-current-shortages International Council of Nurses, press release. International Council of Nurses launches Consultation to revise Code of Ethics for Nurses Joint Commission International Accreditation Standards for hospitals Lessons learned from Ebola and Covid-19 We are not prepared unless we are all prepared" EU Health Professionals' Perceptions of Preparedness for Ebola and Infectious Diseases of High Consequence Identifying nurse-sensitive indicators for stand-alone high acuity areas: A systematic review Nurse Staffing Models as Predictors of Patient Outcomes Nursing-sensitive indicators for nursing care: A systematic review Safe and competent nursing care: An argument for a minimum standard? Nurs Ethics