Nursing Shortage and the Impact of COVID-19

Nurses have repeatedly demonstrated that they are the backbone of the healthcare system. Without nurses, the hospital will not be able to provide 24/7 care. The COVID 19 pandemic has created significant stress in many institutions throughout the world for nursing personnel. Nurses on the front lines manage these critically ill patients.  The nurses face a substantial risk to their health and safety.

Nevertheless, despite the dangers and risks, many nurses continue to serve those in need. The question becomes, as the COVID crisis continues, will the existing nursing workforce be able to continue to manage these acutely ill individuals? Burnout and stress, while well documented within nursing has been exacerbated with the COVID 19 patients. As the pandemic begins to subside in some parts of the world, will the nursing workforce simply regroup and prepare for the next onslaught of the pandemic? Alternatively, will many simply move to other types of nursing positions where they face less risk to their health?

In 2019, hospitals across the nation participated in the ANSI National Healthcare Retention and RN Staffing Survey. Respondents to the survey had indicated a turnover rate reduction goal of 3.3%. While there was a slight decrease in the turnover rate, it still stands at 17.8%. Now with the impact of COVID 19, it is anticipated the retention rate, particularly for new graduates, will markedly decrease. The certified nursing assistants who are critical to supporting patient care has a turnover rate of 26.5%. The rate will most likely also increase.

The World Health Organization estimates there is a need for at least six million nurses worldwide. The question becomes how this workforce can be educated and then deployed appropriately to provide the needed services to patients. The current COVID crisis has focused on nursing care primarily on managing and assisting these individuals. However, as patients with chronic health conditions develop acute exacerbations plus the need for surgical interventions and hospitalizations, grow nurses will also be needed to care for these individuals.

According to the Employment Projections 2016-2026  of the Bureau of Labor Statistics, Registered Nursing (RN) is ranked among the top occupations in terms of employment growth through 2026. It is expected that the RN workforce will grow from 2,9 million in 2016 to 34 million in 2026, an increase of 438,100, or 15%. The Bureau is also forecasting the need for an additional 203,700 new RNs to fill newly created vacancies and replace retired nurses each year through 2026. One might question if the forecasting is accurate.

Current models of forecasting nursing workforce needs are inconsistent, and given the nature of forecasting often is unreliable. COVID 19 was not anticipated when forecasting models were developed. The forecasting models did not anticipate that many nurses will retire because of their experience in working with patients infected with COVID 19. It is anticipated that baby boomers if they have not already retired, will do so. Generation X and millenniums most likely will stay in the workforce. However, it may depend on their experience managing COVID 19 patients. Given the high death rate from nurses infected by the patients because the lack of personal protective equipment may impact nurse’s willingness to practice in acute care settings.

Nursing schools, at least in the United States, are not able to expand clinical sites in part because of the educational model used. The educational model, with some modifications, is utilized worldwide. There are limitations to the acute care practice model used by educational institutions.  How are they going to be able to educate enough nurses to meet the need for six million more nurses using an outdated model? A model-based primarily on practicing in hospital settings.

New and innovative community-based curriculums combined, including the use of human simulation models, are urgently needed. Competency-based education that integrates a comprehensive educational experience designed to educate nurses for the 21^st century must be created and implemented. No longer can we rely on a predefined mandated clinical hours educational model. These curriculum standards rely heavily on state boards of nursing regulations regarding the number of clinical hours. Boards are prescriptive, often including the type of learning experiences students are expected to achieve. Most of these models are developed primarily from the job analysis of nurses working in an acute care environment. As the number of beds in hospitals decreases, patients hospitalized will be more acute. The nursing educational models need to be adjusted. Future nursing will be primarily community-based, caring for individuals in a wide variety of settings, and addressing many health disparity issues. Perhaps lessons learned from state boards of nursing, allowing other models of learning besides a defined number of clinical hours because of the COVID crisis will result in evidence-based changes. Given the foreseeable need for nurses, particularly in low- and middle-income countries, the need for change is urgent.

Using social media to impact health policy

Engaging in health policy—easier said than done, right? But amid this pandemic, the need for nurses to influence public health policy has never been more urgent. The reports of staff caring for coronavirus patients without adequate personal protection equipment (PPE) is, at its very core, frightening beyond measure. We see and hear their cries for help, but are they being heard? I'm left wondering, could government leaders continue to ignore the calls for change if all nurses and healthcare providers, along with their family and friends, advocated together? It can be done—and has been done—simply utilizing something most of us have direct, easy, and free access to social media. We have a real opportunity, right here and now, for nurses from a grassroots perspective to engage the public and stakeholders in a conversation about health policy needs.

Few people would fail to recognize the incredible social activism created by #MeToo, which uncovered shared stories of sexual harassment. Closer to our healthcare home, however, the viral 2014 #IceBucketChallenge aimed to raise essential funding for the Amyotrophic Lateral Sclerosis (ALS) Foundation. It is likely the most recognizable example of healthcare hashtag activism, where participants dumped a bucket of ice water over their heads in a communal effort to raise awareness about ALS.  When researchers were unable to secure the US $1 million they needed for an innovative project from the US government, the hashtag was their "Plan B." Today, it is credited with engaging over 17 million people, who uploaded over 10 billion videos. These videos were then viewed by over 440 million people internationally, with donations exceeding US $220 million. An extraordinary outcome that monumentally dwarfed their original ask of US $1 million. And that success is directly attributable to their well-heard voice via social media. Those researchers credit new gene discoveries, new stem-cell models, and a better understanding of proteins involved in the fatal disease to the viral social media campaign. Could a similar strategy be useful to advocate for PPE and other resources nurses need to stay safe?

With social media, nurses can bypass the bureaucracies of hierarchy and put into the public forum what they stand for, their values, and their message as it pertains to their renewed capacity as a health experts. As we build an audience, armed with authority as an expert and the trust that comes with being nurses, we are well-positioned to be influencers.

It is not without its risks, though. Anecdotal stories are the enemy of evidence-based practice. Privacy and confidentiality risks exist. Conflict may occur when non-verbal communication is misunderstood. Oversharing is possible. All of these give rise to the potential for unprofessional conduct.

But none of these risks are unmanageable for the professional nurse who maintains devout commitment and cognizance to their licensing body's regulations and ANA Code of Ethics as well as principles of evidence-based practice. And I'd argue, this is nowhere near as risky as caring for patients without the proper protective gear.

All that said, here are some guidelines I can offer:

1.      Make sure the intent of your message is clear and consistent.

2.      State who you are and where you are from. (Do not give your employer's name unless you have permission to do so.)

3.      Include a brief synopsis of your qualifications as a nurse expert.

4.      Explain what you wish to discuss an issue, such as PPE.

5.      Let others know why they should support or not support your issue.

Situational knowledge of the nursing experience should not be underestimated, so offering your targeted audience a patient example is what nurses can uniquely provide. Obviously, being aware of the importance of de-identifying for HIPAA compliance is essential, yet this expert advice can be enormously persuasive.

Ged Kearney, who once led clinical nursing education in a large Australian health service, successfully made the transition from nurse to a politician. Now an Australian Member of Parliament, she reflects, "I look back on my career, and I have always been an advocate; as a nurse, I advocated for patients, in the union for our membership and the health system" (Dragon, 2019). Kearny exemplifies the internal struggle nurses have where the dilemma of the health system has directly impacted how a nurse can deliver care yet have a limited opportunity to participate in the public debate. That lack of participation belies an ethical duty of concern that the nursing voice has in scrutinizing reform, regulatory changes, care coordination, and health information technology that directly impacts our ability to deliver safe and optimal patient outcomes. As Kearney said, "You have to speak up. Sometimes it is challenging, sometimes it is tough. As a nurse, I would walk into a room of physicians and health administrators, and I would think my voice was not that important. Now I look back and know that was not true. As a nurse, you develop an excellent ability to assess a situation, and I do that now. I think nurses are excellent listeners, and they can see the hidden messages" (Dragon, 2019, p. 33).

Source: Published in Sigma Theta Tau, Reflections. 2020

Addressing Healthcare Cost - Prescription Medications

In the United States, the cost of prescription drugs is one of the highest in the world. Several factors are contributing to the high cost of medications. Part of the issue is the restricted importing of medications from Canada, Europe, and other countries in which many of the drugs are manufactured. In Switzerland and other European countries, the respective agencies responsible for prescription drugs negotiates directly with the manufacturer. The negotiation centers around the cost-benefit analysis of the medication and if it should be in its formulary. The Ministry of Health spends a considerable amount of time researching which new drugs should be included in their agreement. In the United States, the Food and Drug Administration does not regulate other than the safety approvals of the introduction of medications into the healthcare system. The pharmaceutical agencies can charge whatever fees they decide. In many cases, individuals end up paying significant copayments to have access to the medications.

In part, the US pharmaceutical industry has lobbied Congress extensively to prohibit any significant changes in implementation laws. Also, the Medicare Modernization Act does not allow Congress to negotiate prices of medication. Unlike the Veterans Administration and the Department of Defense can negotiate directly with the pharmaceutical companies regarding the costs of their products. Besides, these agencies have a defined formulary which restricts the medications available to enrollees. These reports can be modified based on clinical need.

The significant profit margins particularly from Medicare beneficiaries by the pharmaceutical companies combined with their aggressive lobbying campaign will continue. There is no foreseeable end to their price gouging.  Taxpayers are continuing to pay higher prices then one should.

A related challenge is the ability of pharmaceutical companies to market directly to consumers. Other than the disclosure required by the FDA the direct marketing is thought to have a significant impact on many consumers' decisions. Of course, the drugs marketed are typically newer and have a higher price. There is a discussion that the US should ban direct to consumer prescription drug marketing.

Elijah E. Cummings Lower Drug Costs Now Acpassed in House in the fall of 2019 could save more than $345 billion in federal spending over the next seven years. Per the Congressional Budget Office, the out of pockets costs could be reduced by $158 billion over the decade. Specifically, this bill requires the Health and Human Services Sectary to negotiate rates directly with drug makers on as many as 250 prescription drugs that Medicare spends the most on. The Republican-controlled Senate has blocked movement on the bill. In the meantime, taxpayers and consumers continue to pay unreasonable prices for prescriptions.

In an article appearing in the New York Times, The American Way of Paying for Drugs Isn't Working a new poll from the Kaiser Family Foundation, reveals at least 85 percent of Americans — including a majority of both Democrats and Republicans — want the government to negotiate directly with drug makers and for the results of those negotiations to apply to private insurance as well as to Medicare. Seventy-two percent want drug makers who refuse to participate in such negotiations to face financial penalties, as they would under the proposed bill.

Support for the same ideas shrank when respondents were told that research and development would be imperiled because of these changes. The reluctance is not surprising, given the fear-mongering by the pharmaceutical industry and its supporters in Congress. However, Americans are increasingly desperate for affordable medicines. Given the system they have now, change may soon become the far less frightening option.

Addressing Healthcare Costs - Health Professional Salaries

Addressing Healthcare Costs - Health Professional Salaries

The primary contributors to higher costs are administrative costs, healthcare professional labor, and pharmaceutical.  Administrative costs in the USA average 8% with some reported to be over 15% compared to other countries 1% to 3%. Medicare while many opponents of government managed care administrative costs are around 2% (Medicare is More Efficient Than Private Insurance). Physician and nurses salaries are also higher in the USA than in most other countries.  Primary care physician average $218,173 while in other high-income countries salaries are $86,607 to $154,126.  The USA medical education system is more costly and more prolonged than those in other countries. Regarding pharmaceuticals in different counties, the average cost ranges between $466 to $939 while in the USA is $1,443. The first in this series will be addressed administrative costs, followed by health professional salaries, and pharmaceutical expenses.

Health Professional Salaries

Compensation of healthcare professionals particularly Physician Compensation Worldwide is highest in the world. Some factors have contributed to this continuing escalation in compensation paid particularly since the implementation of Medicare and Medicaid in the mid-1960s. Before that time physicians were primarily paid on the fee-for-service basis paid by limited insurance coverage or whatever the patients were able to afford. With a more structured program offered through the Medicare and Medicaid program continued growth in the private insurance market the compensation paid to physicians continued to escalate.

The fee-for-service model that was the primary modality had built-in conflicts of interest. Without any significant oversight by the payer meaning Medicare or private insurance companies physicians were free to charge pretty much whatever the market would bear. For the most part, they were not even questioned about the procedures that they were recommending. The escalation in costs of care eventually created movements within the Centers for Medicare and Medicaid to begin restricting how compensation was paid to physicians. As noted in an earlier posting, there have been significant changes in terms of how physician within healthcare organizations are compensated through the Medicare and Medicaid program. While these have the potential of making substantial changes in terms of the amount of revenue spent on care provisions there are still some factors contributing to physician compensation.

One of the significant factors that from my perspective is the curriculum required for physicians in the United States. Our model is a postbaccalaureate degree, and most cases require at least a four-year educational experience followed by four years of medical school, then another one year of internship, and then followed by a 3 to the 5-year residency program. For some specialties, the additional two years or more of fellowship is required. Read more about medical education in the USA The Road to Becoming a Doctor. Thus we are demanding an extensive amount of education for these medical school graduates with limited improvements in outcomes based on a lesser complex model of medical education found in developed countries.

The cost of this model is extremely high, and students often have to borrow substantial funds to pay for this lengthy and questionable valuable educational model. It’s almost as if medical education relies primarily on an apprentice model with interspersed educational requirements. Addressing this curriculum requirement is necessary if we're going to be able to help drive down some of the cost of educating new physicians.

Most developed, as well as middle-income countries, have a well-established model for physician education. The student enters into medical school following high school and then at the end of the six years can choose to go on for postgraduate education. The degree at the end of this program is a bachelor of science in medicine. Then with further education and specialties training depending on the option, chosen a doctorate of medicine degree is awarded. The curriculum is more focused on the necessary knowledge need to provide competency care thus fostering a shorter curriculum. Since the Flexner Report was completed in the early 1900s, there has been a little review of what a medical school curriculum should contain. An article in the German Medical Science journal published in 2017 provides A comparison of medical education in Germany and the United States: from applying to medical school to the beginnings of residency.

It seems that the developed and middle-income country models that are graduating physicians for less cost and achieving better patient outcomes are something that needs to be seriously considered. In my opinion, the change will only come when state legislature who fund these programs begin to demand changes in the curriculum. Also, the state legislature is also going to have to’s provide additional funds to the schools to decrease the cost to students.

At the moment there is a restriction on the number of medical school students. This is created by having fewer medical schools, limiting the number of applicants that they will take, followed by a residency slot system that is fostering the creation of specialists. The curriculum reform by primarily shortening the educational programs, providing additional financial support to the establishment of new medical schools using both state and federal resources, should produce an opportunity to increase the number of positions for medical students.

The residency requirement is another area that needs to be evaluated. Currently, Medicare pays for these residency slots at an estimated cost of $150,000. The 1997 Balance Budget Act capped the number of slots. The vast majority of these positions are for a specialist. Many of which we do not need. The most urgent need is for primary care physicians. If Medicare would stop funding the high number of specialty positions and concentrate on primary care, this would be a significant contribution to not only decreasing the cost of education, and as well as compensation paid to specialist physicians. Primary care doctors typically made substantially less than a specialist. Using specialist to provide primary care services not associated with their advanced training is a misuse of their education and expertise. Determining the number of specialists by category would be part of a policy decision that needs to be made annually using a model similar to that found in the European countries.

The use of foreign medical graduates needs to be expanded. America needs foreign medical graduates. Currently, there are significant barriers in place for many of these well-educated physicians to enter practice in the United States. Reviewing the competencies of these programs could be one way of helping to assess skills. In the state of Missouri, they have created an exciting program in which some of these foreign medical graduates who currently are not able to meet all of the specific requirements for licensure are allowed to practice under the supervision of a physician. Many middle-income countries have an export model of educating physicians and using these competent graduates particularly in our underserved areas will also help with the cost of care.

Advanced practice registered nurses as well as physician assistants and other healthcare professionals have demonstrated their ability and competency to provide a significant percentage of primary care needs. In fact, some studies have shown that these providers can care for up to 80% of patients seen in primary care settings. Nurse Practitioners can fill the void in primary care. Because of the cartel approach to limiting the number of providers driven primarily by the medical associations as a restriction of trade to force a limited supply of physicians has impacted the practice of these providers. Eliminating these restrictions so that they can provide a full scope of practice services primarily for advanced practice registered nurses can also serve as another high-quality lower-cost provider to meet the needs of many individuals who are currently not receiving adequate services.

Often cited as a limitation on why there is a restriction on the number of providers and the requirements for lengthy residencies and in some cases fellowship has been related to our legal system. While some states have enacted restrictions on malpractice claims the practice of such is minimal. If there could be a consideration in the legal system to also include standards of care from our Europeans colleagues some of the malpractice concerns could become less prevalent. Given we work in an international environment and the European outcomes of care are substantially higher than the US, it seems logical that we should also review and potentially at that some of their standards of care particularly in regards to our legal system.

Changing the compensation of physicians is currently underway. The Centers for Medicare Medicaid have begun limiting compensation paid to providers. Also, policymakers are also starting to realize that merely providing unlimited funds for federal insurance programs without addressing outcomes and other related activities is not a good idea. Ultimately, it’s my opinion that a decrease in revenue from the federal government insurance programs will force changes in physician and other healthcare professional compensations.

Change is difficult. Mainly when working in an environment in which physicians are well respected and provide a valuable service. At some point, we can no longer afford the $100 billion additional cost of providing compensation to these individuals. This is especially true when outcomes are not on par with what we find achieved by our European colleagues for much lesser compensation. There will always be arguments about our population mixed being such that we cannot compare apples and oranges and at the same time nowhere else in the world do we find such high salaries paid to so many physicians.

In summary, there needs to changes in the curriculum. Placing a priority on primary care residency slots.  We need to increase the number of medical schools. There should be innovative programs to engage the use of foreign medical graduates. The need for all 50 states plus territories needs to enact legislation to allow advanced practice registered nurses to practice under full scope authority.  And adopting some of the European standards of care is going to help address the cartel focus on the restriction of physicians as the only provider of healthcare services. Change is necessary and visionary leaders supported by policymakers can assist with addressing excessive compensation. For additional thoughts on this topic view the 2017 article by Dean Barker in Politico The problem of doctors’ salaries

Addressing Healthcare Costs -Adminstrative Costs

The primary contributors to higher costs are administrative costs, healthcare professional labor, and pharmaceutical.  Administrative costs in the USA average 8% with some reported to be over 15% compared to other countries 1% to 3%. Medicare while many opponents of government managed care administrative costs are around 2% (Medicare is More Efficient Than Private Insurance). Physician and nurses salaries are also higher in the USA than in most other countries.  Primary care physician average $218,173 while in other high-income countries salaries are $86,607 to $154,126.  The USA medical education system is more costly and more prolonged than those in other countries. Regarding pharmaceuticals in different counties, the average cost ranges between $466 to $939 while in the USA is $1,443. The first in this series will be addressed administrative costs, followed by health professional salaries, and pharmaceutical expenses.

Administrative Costs

Our current private health insurance system as shared has a substantially higher expense to administer the programs compared to Medicare.  Addressing these costs assuming there will continue to be a private insurance option is critical.  Some of the differences between Medicare and the private sector is they spend significant amounts of time reviewing the population that they are serving. They carefully examine claims, double check against eligibility requirements, often seek other medical opinions/alternatives for treatment and so forth. All of these activities drive up costs. Historically Medicare is not involved to this extent in their reviews of claims.

Another issue is that the private insurance industry typically has a provider network in which they carefully monitor their activities and negotiate their reimbursements rates. This is unlike Medicare which has a flat payment schedule for all providers. Thus, again raising administrative costs.

Marketing costs for the private and insurance companies are incredibly high in comparison to Medicare which has little or no marketing costs. It is it more costly to market to an individual than a group. Private insurance companies market to both. Thus attempting to enroll consumers into their health care plans is an expensive adventure.

While the costs of administering the Medicare program is substantially less with healthcare for all program, there will undoubtedly be an increase in the expenses. Primarily the cost increase will be driven by the significant growth in the number of individuals enrolled in the plan. However, experts estimate the cost will not significantly exceed the expected 3% associated with administrative costs.

Another difference between the Medicare program and private sector is also the salaries of executives. With so many different private insurance companies the cost of merely just having sufficient administrative support as well as higher executive salaries is also significant. In the most likely scenario where a private and combination Medicare and/or expansion of the Affordable Care Act will be the most viable option, the private sector will have to adjust their costs given the reimbursement limitations that will be imposed on administrative overhead. The cap will force efficiency and perhaps encourage fewer review processes. These actions may mean some restrictions on treatments and specific pharmaceutical that are outside of a negotiated rate.  For more information check out 2017 article in PolitiFact Comparing administrative costs for private insurance and Medicare.

Healthcare Coverage for All

The critical issue with comprehensive health insurance for all at least from my perspective is the eventual goal.  Based on my experience and knowledge of the literature a Medicare For All model that allows a buy-in for those who need health care while keeping the current private health insurance options in place seems most viable.  With this model, the current successful Medicare model would be a phased-in by first reducing the age for eligibility to 50. The proposal is similar to a new proposal Medicare X. Lowering the entitlement should also offset some of the high-cost insurance programs for those not currently eligible for health subsidies. The percentage of the population between 50 and 65 have more health needs thus forcing the private insurance market to raise the premiums to cover their financial risks.  One of the Affordable Care Act “Achilles heel” particularly for individuals living in rural areas is the lack of any financial support for premiums for those not eligible for subsidies.  In addition to lowering the Medicare eligibility to 50, another viable option is to create a reinsurance pool.  The pool would cover a portion of the claims insurers face which means the overall premiums can be decreased because there are lower claims for the insurers.  The program Minnesota Health Insurance Program has worked well in Minnesota and in Alaska who has a similar plan.  While participation in having insurance with coverage currently required with Medicare such would be mandatory. Individuals could purchase private insurance plans if so desired.  There would be a tax penalty for those who do not have any insurance.  The health tax would provide a fund for health care providers to supplement bad debts.

The Medicaid expansion options would continue as would the Children Health Insurance Program.  The patient would still choose his/her provider as now done with Medicare.  The 20% co-payment would remain so a requirement for secondary privately funded insurance would be needed.  The Center for Medicare and Medicaid would have authority to negotiate pharmaceutical costs.  Current provisions such as Prospective Payment System, Medicare Hosptial Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Prospective Payment System, Valued Based Programs,  and Alternatives to Nursing Homes would be strengthened.  While participation would be mandatory individuals could purchase private insurance plans if so desired.  There would be a tax penalty for those who do not have any insurance.  The health tax would provide a fund for health care providers to supplement bad debts.

The outlook for any of these changes except the Minnesota option which is state funded is slim as long as there is a Republican control Senate and White House.  Thus, the 2020 elections will largely determine how the reality of healthcare for all will be manifested.  

Opportunities for Volunteering

Guest Posting by Joy Edwards, RN.

Thanks to Dr. Robert’s recommendation I created a list of opportunities for us as nurses if we wanted to help impoverished countries as clinical professionals.

Here is a list of organizations along with the requirements.

    1. Doctors without borders

https://www.doctorswithoutborders.ca/job-profile/nurses

This is a quick overview of requirements

Doctors Without Borders favors at least 2 years of active commitment, during which time fieldworkers complete 2 to 4 field assignments. A minimum of two years of professional work experience is required. Language skills are a strong asset. The ability to speak French, Spanish, Russian, Arabic or an African language, as well as English, relevant travel or work experience in a developing country or remote parts of Canada.

What I like is Doctors without borders provides coverage for your health, licensure all things needed to travel abroad in terms of immunizations, malpractice insurance and they provide a monthly stipend as well.

2. Nursing volunteer blog has some opportunities listed as well.

https://www.volunteerhq.org/blog/how-to-volunteer-abroad-as-a-nurse/

Overview of requirements

IVHQ runs volunteer programs year-round, and you can choose to volunteer abroad for durations ranging from 2 weeks to 24 weeks, and this one requires you to pay program fees starting as low as $180 for 1 week.

3. Samaritan’s Purse International Mission

https://www.samaritanspurse.org/

A 501(c)(3) Christian organization offers a variety of missions ranging from healthcare, clean water initiative, feeding projects, construction projects, and sanitation. Nurses are required to submit an online application and letters of recommendation from current and former colleagues.

While this organization is rooted in the Christian faith, it has a strong reputation in the volunteer community. It welcomes individuals of all religious affiliations. Trip locations vary but have included Iraq, Vietnam, Kenya, and Tanzania. Costs also vary based on the length, ranging 2 to 4 weeks, of the trip but can range from $500-$2500.

4. MEDICO

https://www.medico.org/

A non-denominational humanitarian organization focuses entirely on the needs of Central America. Trips typically last 7-10 days and are comprised of medical and non-medical volunteers.

These trips tend to be more rustic in accommodations such as back-packer tents and cots. Living conditions are important to consider when determining which mission organization is best suited for you. Trips are typical $1500.

5.  Project HOPE

https://www.projecthope.org/

Project HOPE currently has medical projects focusing on infectious disease, chronic disease, health policy, disasters and health crisis, and maternal/neonatal/child health.

Current needs are for Spanish speaking nurses to assist in Puerto Rico, but other openings are available in China, Haiti, Kosovo, and the Dominican Republic. Costs are based strictly on the length of time and location. Volunteer opportunities are sparse for nurses and often fill up very quickly.

This short list is only a small sampling of organizations that conduct medical missions to help serve those in need. Missions range in length of time and price, but there are ones that could potentially fit everyone’s needs.

What I have found is many require out of pocket expense upfront to help. The only one on this list that provides a stipend from what I’ve seen is doctors without borders, and the stipend is 2790 a month which I believe is across the board for all medical professionals.

References

https://nurse.org/articles/get-involved-with-nursing-medical-mission-trips/ accessed February 8,2019