By Guest Blogger, Marci Farquhar-Snow, M.S., CCRN CMC A.C.N.P-BC AACC
We definitely need to start getting back to “semi-normal” or whatever the “new normal” is. But many of us are feeling the uncertainty of what constitutes the notion of a safe return to work in more close proximity. This has led to many requests by patients for letters allowing them work restrictions, telehealth options or even to delay physical therapy sessions or gym memberships.
Information on risk factors for more severe illness resulting from infection with SARS-COVID19 continues to evolve with progression of the pandemic and reporting from affected regions. The Centers of Disease Control and Prevention (CDC) defines those at higher risk as:
- People 65 years and older
- People who live in a nursing home or long-term care facility
- People of all ages with underlying medical conditions, particularly if not well controlled, including:
- chronic lung disease or moderate to severe asthma
- serious heart conditions
- immunocompromised (including cancer treatment, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, prolonged use of corticosteroids and use of immune weakening medications or smoking)
- severe obesity (body mass index [BMI] >40)
- chronic kidney disease undergoing dialysis
- liver disease
The New England Journal of Medicine (Larochelle, 2020) reported return to workforce recommendations based on the criteria of the occupational risk, including proximity and known positive COVID19 contacts, to the risk of death due to age and comorbidities.
Here is a summary of the suggestions:
Low risk or general population
- Population: Younger age without high-risk condition. Patients who work from home or workplace practices strict physical distancing. All ages with close proximity (< 6 feet) exposure to people with uncertain coronavirus exposure
- Recommendation: Instruct the patient to wear a mask outside the home, practice recommended hand hygiene and use PPE as directed.
- Population: Young, middle age or older age with high-risk condition who have had contact with people with uncertain coronavirus status or known to have coronavirus
- Recommendations: Discuss individual risks and opportunities to mitigate exposure and to consider stopping work.
- Population: Older age or middle age with high-risk condition with contact to people known to have coronavirus exposure
- Recommendation: Counsel patient on high risk of continuing to work and to consider stopping work.
Using the considerations above, the NP/PA can individualize the risk assessment. Here are some guidelines that may be used when drafting a letter to fit the particular clinical or occupational circumstances.
Format a letter that balances safety and the employer/provider/patient triad. This also provides an opportunity for NPs and PAs to advocate for public health and protection—ensuring that all elements of this triad can carefully make the journey back to some semblance of normalcy.
For months, we have fought for PPE and safety for healthcare workers—now is time for NPs and PAs to be proactive for safe practices and PPE for all workers and to prepare the community for what many expect will be a difficult fall/winter.
Recommendations for how to talk to patients, colleagues, and more professional development topics are discussed during our year-long program, ThriveAP. Clinical and professional development lectures are hosted every week via webinar for the 12 months in the program. For more information, please contact firstname.lastname@example.org.
Marci Farquhar-Snow, M.S., CCRN CMC A.C.N.P-BC AACC. has been a nurse for over 30 years. She is board certified, licensed in the states of Arizona and California as an Acute Care Nurse Practitioner. Over the years, Marci has worked in multiple aspects of cardiovascular care in the inpatient and outpatient settings including critical care, clinical education, program development, and research. Previously, Marci practiced at the Mayo Clinic as a Cardiovascular Nurse Practitioner in outpatient interventional cardiology clinic. She developed and is the Past Program Director for the Cardiology Nurse Practitioner Fellowship at Mayo Clinic that is accredited by ANCC at a PTAP program. Marci has presented at local, national, and international conferences on a variety of cardiovascular clinical topics and education related topics, and is a frequent speaker for ThriveAP. She is actively involved in many committees of the American College of Cardiology and is the national chair of the Cardiovascular Team State Liaisons.