In hospitals around the world, doctors, nurses, and other healthcare workers are fighting to combat the spread of the novel coronavirus, a highly contagious and little known virus that has infected over 1.5 million US citizens and has killed nearly 87,000 people at the time of this post.
Nursing staff are on the frontlines and are affected in all settings: within the community, primary and social care, redeployment, clinical placement, hospital wards, and more. Nurses are bravely responding to this crisis without question of their duty.
Historically, professional nurses have brought compassion, ethical and competent care while meeting the medical needs of the communities they serve. However, they are now finding themselves in uncharted territory in response to the enormity of the coronavirus pandemic.
COVID-19 has required an unprecedented, fast-paced response from the nursing community. This response has been challenged by exposure to a highly contagious virus, shortages of personal protective equipment (PPE), work overload, and increased moral stress when required to make high-stake decisions on patient care.
The Risk Of Burnout
Nurses play an integral role in promoting health, preventing illness, and ensuring the well-being of their patients throughout their healthcare journey. They are no strangers to stress and tragedy in this profession. However, the coronavirus has upped the ante on anxiety, increased levels of stress, and exhaustion.
High and increasing rates of burnout amongst healthcare providers have been well-documented. The World Health Organization (WHO) recognizes burnout as an “occupational phenomenon,” citing 63% of hospital nurses reporting burnout before the COVID-19 crisis. The risks for clinician burnout seems particularly high now, with a growing concern for long-term emotional and mental consequences beyond the pandemic.
Providing care to others during the COVID-19 pandemic can lead to fear, depression, feelings of isolation, and ongoing emotional trauma. Nurses providing care to critical patients are putting themselves at risk with multiple exposures, at times without appropriate PPE. Nurses have the same pandemic-related stressors as the general public, but with additional challenges, as they leave their homes each day to care for gravely ill patients. Nurses’ greatest worries include:
- the fear and uncertainty of a heightened risk of infection
- worry that they may carry COVID-19 home and infect loved ones
- a dwindling or already inadequate supply of PPE needed to minimize the risk of infection
- increasing demands to work longer hours as their colleagues become sick or are quarantined
- ever-changing recommendations from local leadership, medical and public health experts, and political leaders
- the inability to provide the level of care they are used to
- having to make distressing and difficult ethical decisions about which patients get lifesaving care and which do not
The hard data has been slow in coming, but we know that the mental health impacts of this pandemic are here now. For some, it will remain long after the threat of infection has been reduced. Researchers examined the mental health outcomes of 1,257 healthcare workers attending to patients with COVID-19 in 34 hospitals in China, the epicenter of the virus. The study showed that a large portion of them report experiencing symptoms of depression (50%), anxiety (45%), insomnia (34%), and psychological distress (75.1%).
Be Aware and Monitor Your Mental Health
Provision 5 of the American Nursing Association (ANA) Code of Ethics for Nurses states, “The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence and continue personal and professional growth.”
A nurse’s code of ethics and values become compromised when they are overworked and exhausted, when they are asked to work unprotected, when they fear for their own health and safety, and when they cannot practice their trade the way they were trained to. Nurses are natural problem solvers, demonstrating incredible resilience in caring for their patients on a normal day. However, today, they are being tried and tested in ways they have never experienced, and need to recognize that it is normal to feel vulnerable, and that is ok to ask for help when they are feeling excess stress or psychological distress.
Experiencing or witnessing traumatic events and multiple deaths will impact individuals differently. It is important during the pandemic, and on any given day, to recognize the signs of emotional stress and where to look for support.
Some of the warning signs of excessive stress are:
- Difficulty problem solving and making decisions
- Disorientation, confusion or memory issues
- Misinterpretation of situations and comments
- Anger, hostility or frustration
- Difficulty maintaining emotional balance
- Headaches, tremors, rapid heart rate, palpitations
- Trouble sleeping, nightmares, flashbacks
- Conflict with others, reduced ability to support peers or endangerment to others
Managing Stress to Avoid Burnout
Recognizing the signs and addressing them, is more important now than ever before. Taking care of yourself will ensure the best care for your patients. Some tips for self-care, recommended by the Center for Disease Control (CDC) are below:
- Remind yourself that everyone is in an unusual situation with limited resources.
- Increase your sense of control by keeping a consistent routine daily. When possible, get adequate sleep, eat healthy meals, and take breaks during shifts to stretch, rest and check in with supportive colleagues, friends, and family.
- When away from work, get outdoors for fresh air while staying active or relaxing and spending time with family.
- Engage in mindfulness techniques such as breathing exercises and meditation.
- Communicate with co-workers, supervisors, and other nurses about job stress. Talk openly about how the pandemic is affecting your work. Identify factors that cause stress and look for solutions
- Recognize that you are performing a crucial role in fighting this pandemic and that you are doing the best you can with the available resources.
There is no one-size-fits-all approach to coping with mental health. If symptoms affect your ability to provide care to your patients or family, or if you are feeling overwhelmed by sadness, anxiety, depression, or hopelessness, seek help from a trained mental health professional.
If you or someone you know needs help in finding mental health or substance abuse support in your area, go to SAMHSA, call the Disaster Distress Hotline (1-800-985-5990), or text TalkWithUs to 66746.
The Future and the Need for Governance: COVID-19 has not only exposed racial, ethnic, and socioeconomic disparities, but it has revealed a health care system that is ill-equipped to care for its citizens and is failing to protect its health care workers.
Healthcare organizations will need to illustrate a higher level of commitment to support all frontline workers to ensure best practices can be followed in the future. The assurance of adequate levels of PPE to do their jobs safely; eliminating redundant administrative duties; avoiding excessive hours worked; hazard pay and providing anonymous mental health advocacy are just the beginning of a system in need of a tremendous overhaul to protect our valuable healthcare workers.