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Unforeseen Crisis and Emergency Standards in Nursing Care during the COVID-19 Pandemic in the United States: A Legal Nurse Consultant's Perspective

Updated: Feb 16


The COVID-19 pandemic has placed unprecedented strains on healthcare systems worldwide, requiring rapid adaptations in nursing care delivery. The response to the pandemic has been multifaceted in the United States, involving policy changes, resource allocation challenges, and significant disruptions to standard nursing practices. As a legal nurse consultant, it is imperative to analyze and document the deviations from the standard of nursing care during this critical period, spanning from the issuance of executive orders by the president to the latest available data.


Since the declaration of a national emergency in March 2020, various executive orders have been issued at the federal, state, and local levels to mitigate the spread of COVID-19. These orders have impacted nursing practice by expanding telehealth services, altering licensure requirements to facilitate interstate practice, and allocating resources such as personal protective equipment (PPE). However, inconsistencies and delays in implementing these directives have led to challenges in maintaining the standard of care.


One of the most significant deviations from the standard of nursing care during the pandemic has been the shortage of essential resources, including PPE, ventilators, and critical care beds. This scarcity has forced nurses to ration supplies, compromising their safety and that of their patients. Additionally, staffing shortages, exacerbated by illness, burnout, and redeployment, have stretched nursing teams thin, impacting patient care and nurse-patient ratios.


To accommodate the surge in COVID-19 cases, healthcare institutions have implemented alternative care delivery models, such as converting non-traditional spaces into temporary treatment areas and deploying mobile healthcare units. While these measures were necessary to expand capacity, they have introduced logistical challenges and raised concerns about the adequacy of monitoring and infection control protocols.


The pandemic has presented nurses with complex ethical dilemmas, including triaging scarce resources, balancing patient care priorities, and navigating conflicting directives from policymakers. The rapid evolution of clinical guidelines and treatment protocols has further compounded these challenges, requiring nurses to adapt quickly while maintaining ethical integrity and patient advocacy.


Marginalized communities, including racial and ethnic minorities, the elderly, and individuals with underlying health conditions, have borne a disproportionate burden of COVID-19 morbidity and mortality. Disparities in access to healthcare, socioeconomic factors, and systemic inequities have exacerbated their vulnerability, highlighting the need for targeted interventions and culturally competent nursing care.


The pandemic has prompted legal and regulatory changes affecting nursing practice, including liability protections, scope-of-practice expansions, and emergency licensure provisions. While these measures aimed to facilitate an effective response, they have also raised concerns about accountability, standardization of care, and patient safety.

The COVID-19 pandemic has tested the resilience and adaptability of nursing professionals across the United States. While deviations from the standard of nursing care were inevitable amidst unprecedented challenges, it is essential to assess these deviations critically, identify systemic weaknesses, and implement corrective measures to enhance preparedness for future crises. As a legal nurse consultant, advocating for evidence-based practices, ethical principles, and patient-centered care remains paramount in navigating the complexities of healthcare delivery during and beyond the pandemic.


Brandy Seyller, RN, BSN, is a Legal Nurse Consultant and Nurse Expert Witness with 20 years of experience specializing in surgical critical care nursing. For more information about her expertise and services, visit



- American Nurses Association. (2020). COVID-19: Ethics, Law, and Health Policy Resources.

- Centers for Disease Control and Prevention. (2022). COVID-19 Data Tracker.

- Institute of Medicine. (2020). Crisis Standards of Care: Ten Years of Successes and Challenges – Proceedings of a Workshop.

- The White House. (2020). Executive Orders on Ensuring Essential Medicines, Medical Countermeasures, and Critical Inputs Are Made in the United States.


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