Just as the horrors of World War I were winding down, millions of people were stricken by an influenza epidemic that displaced war as the tragic focus of everyday life. The disease was known as the Spanish influenza and was pandemic in scope. Since the epidemic defied the capabilities of prevailing medicine, good nursing care was the best predictor of outcome. Nurses came to the rescue by working long, hard and tirelessly. One important outcome of the epidemic was a general recognition of the visiting nurse service and all nursing as a valuable and essential community service.

Aim This multisite study describes the lived experience of registered nurses (RNs) caring for coronavirus (COVID‐19) patients during the pandemic in rural America. Design A qualitative phenomenological design was used. Methods From January to June 2021, using the purposeful sampling method, 19 frontline nurses were interviewed regarding their experience caring for seriously ill COVID‐19 patients in three Upper Midwest tertiary care hospitals. Three doctoral prepared nurses transcribed and analyzed verbatim interviews with data interpreted separately and conjointly. Approved qualitative methods specific to transcendental phenomenology were used. Results This phenomenological study identified four themes describing the lived experience: (1) feeling of being overwhelmed, (2) feeling of role frustration related to chaos in the care environment, (3) feeling of abandonment by leaders, families, and communities, and (4) progressing from perseverance to resilience. Implications for Practice Significant implications include ensuring frontline RNs are in communication with leaders, and are involved in tactical planning. Leaders can provide a stabilizing presence, build resilience, confidence, and security. Recommendations for additional research are provided. Conclusion Nurses in intensive care and COVID‐19 designated medical units had experiences similar to high population United States and international cities. Their shared experience included high volumes of critically ill patients in hospitals frenzied by rapid change, uncertainty, and capacity strain. Differences in the experience of rural nurses included close social connection to patients, families, and community members. This rural connectedness had both positive and negative effects.

Just as people living in the early 1900s experienced the horrors of World War I followed by the Spanish influenza epidemic, those of us surviving the coronavirus disease 2019 pandemic will have our lives forever changed. Both pandemics defied the capabilities of prevailing healthcare and public health. Since there was no known cure in either pandemic, much depended on nurses to fight the battle against the viruses.History has shown pandemics are occurring more frequently and are unpredictable in timing and severity. Therefore, we need to place focus on the valuable lessons from the century's two pandemics to prepare for future global disease outbreaks. Lessons that will benefit nursing are the importance of continual preparation and planning, care coordination across communities and healthcare systems, and ensuring nurses have the necessary resources and training to perform their roles in an effective and safe manner.comparing pandemics, COVID-19 pandemic, pandemic lessons, Spanish flu Editor of a nursing publication offered the following comments:As we close our pages, …influenza is rampant in the United States and according to the statements given out …, it has now reached practically every state. Never within the recollection of people living today has there been an epidemic so wide-influenza is rampant in thespread or so disastrous in its results. It has reached people in their own homes not only in the cities and towns, but it has even spread into the rural areas.

Otoscopy is an important skill for primary care physicians and otologists. Until now, training has been by repeated exposure to patients with ear disease. Structured instruction in how to assess an ear has not previously been reported. Not-diseased ears and those with varying types of chronic (suppurative) otitis media were chosen to be photographed as this is an important condition to be able to diagnose and in which pneumatic otoscopy has no role. Two sets of 30 slides of equal difficulty were shown to 10 trainees, one before and one after structured teaching. The overall error rate fell from 44 to 21% (P < 0.001). Most importantly, the error rate in assessing ear activity fell from 35 to 17% (P < 0.05). In conclusion, a structured approach to otoscopy has been shown to improve the diagnostic ability of trainess tested with photographs of ears with chronic otitis media. Such a teaching approach is likely to be equally beneficial to other otological conditions and to live otoscopy.

Myocardial infarction (MI) continues to be a significant health care issue because of its prevalence. As treatment options improve the survival rate, an increasing number of individuals have to learn how to adjust to this major life event and prevent recurrence. Recovery can be difficult. Many patients experience emotional distress, fear of dying, and family turmoil, fail to return to work when physiologically capable of doing so, are unable to return to their previous levels of sexual activity, and are not capable of making the necessary diet and exercise changes. Acute management strategies continue to be aimed at limiting the infarct size, whereas holistic approaches to the patient and family adjustment must target seeking prompt treatment when symptoms present, psychologic adjustment, stress reduction, and patient and family education for self-care and risk reduction. As hospital length of stay for acute MI decreases, health care professionals must provide an interdisciplinary, collaborative approach to ensure that the at-risk MI patient is provided all of the information and support needed to lead a satisfying, productive, healthy life. An excellent way for nurses to not only address this challenge, but to lead the effort, would be to develop a network of care for the at-risk MI patient.

Professional practice programs are designed to attract, retain, and reward nurses. This three-part series will describe Vanderbilt's performance-based career advancement system, the Vanderbilt Professional Nursing Practice Program (VPNPP). Part 1 outlines the overall program's foundation, philosophical background, and basic structure. The VPNPP is built upon Benner's work, distinguishing among four levels of practice: novice, competent, proficient, and expert. Work by many in the organization identified the expected behaviors for nurses at each level, which were then used to develop clear process evaluation criteria. Part 2 will examine the performance measurement and evaluation system created to support the program. The process of advancing within the program will be described in part 3.

In this exploratory study, a random sample of nurses from nine nursing specialties was surveyed to identify which Current Procedural Terminology (CPT) coded procedures they perform and how frequently they perform them. CPT codes are used universally to file claims for physician payment. The sample included 74 school nurses, 67 enterostomal nurses, 53 family nurse practitioners, 43 critical care nurses, 43 oncology nurses, 40 rehabilitation nurses, 39 orthopaedic nurses, 34 nephrology nurses and 25 nurse-midwives. Specific questionnaires were developed for each specialty with codes identified by expert panels. The number of CPT codes ranged from 233 for family nurse practitioners to 58 for school nurses. The mean number of coded services performed by individual respondents ranged from 79 (FNP) to 18 (school nurses); individual respondents performed 0-162 codes. Supervision by physicians was very infrequent. Charges to Medicare in 1988 for the coded services included in the survey were $22,793,427.34 (aggregate allowable charges). The study provides some documentation of the degree to which nurses perform the same services and procedures for which physicians are being paid. If policy makers are serious about reaching innovative solutions to the problems of quality, access and cost, everything must be "on the table," including the contributions of nurses.

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