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COVID-19 and the health of nursing

Brown, Allana Marie DNP, PMHNP-BC

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doi: 10.1097/01.NURSE.0000743120.85893.b7
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NURSES HAVE OFTEN not been fully equipped to meet care demands amid fluctuating rates of COVID-19, the acute respiratory disease caused by the SARS-CoV-2 virus. Basic materials such as personal protective equipment (PPE) among other vital resources were in short supply in hospitals and long-term-care facilities across the country during the first several months of the pandemic. The initial shortage has improved, but there are still not enough N95 masks and other PPE for nurses and other healthcare professionals.1 Although this is an issue of shared concern for all essential healthcare workers, nurses are particularly challenged as the largest group of frontline workers in healthcare. According to the National Council of States Boards of Nursing, there are approximately 4.2 million RNs in the US.2 Nurses are contending with repeated exposure to COVID-19, possible minimal protection, ethical dilemmas, bureaucratic issues, work-life imbalance, and varying degrees of psychological trauma linked to the COVID-19 pandemic.3,4

With this estimation in mind, we have seen many nurses come out of retirement to help combat COVID-19. Nurses have a long-standing history of rising to the occasion and the COVID-19 pandemic has proven to be no exception when it comes to nurses carrying out their commitment to the profession and patient care. However, acts of heroism in these present times should not be mistaken for the notion that nurses are invulnerable to COVID-19 itself and the health risks associated with it.

Data from the CDC show that approximately 1,400 US healthcare personnel have died from the COVID-19 pandemic. However, the CDC notes that its data is limited, suggesting that this figure is undercounted.5 A tally by Kaiser Health News and The Guardian estimates that the number of US healthcare workers who have died from the pandemic is over 3,500 as of March 2021.6 In addition, every day nurses and other healthcare workers are grappling with all types of stress surrounding the pandemic. The emotional toll is concerning—depression, anxiety, and insomnia have all been reported at a higher rate during this pandemic than in past pandemics.7-9 As similar findings emerge, so will the need to secure the health and well-being of nurses and other frontline workers.

The call for support and relief efforts have been made clear by nurses given a platform to speak out on the impact of COVID-19. Speaking at the Nightingale 2020 virtual conference in October 2020, International Council of Nurses Chief Executive Officer Howard Catton decried the lack of standardized and systematic data collection to track COVID-19-related nurse mortality.10

“Florence demonstrated during the Crimean War how the collection and analysis of data can improve our understanding of risks to health, improve clinical practices and save lives...If she were alive today, world leaders would have her voice ringing in their ears saying they must protect our nurses,” Catton said. “There is a chasm between the warm words and accolades and the action that needs to be taken.”10

Dr. Ernest Grant, president of the American Nurses Association, recently emphasized the need for nurse involvement in policy and advocacy to support the nursing profession. Speaking in January 2021 during an appearance on Nurse News, a weekly livestream hosted by Nurse.org, Dr. Grant discussed ANA's work with Congress regarding the severe lack of PPE at the onset of the pandemic and the ongoing efforts aimed at addressing COVID-19 issues most relevant to nurses' health. While this political relationship led to the development of ANA's COVID-19 response fund, as well as wellness and educational resources for nurses, there is still plenty of work to be done. In the interview, Dr. Grant urged nurses to consider joining a professional organization so their voices may help to impact policy change and decisions that affect nurses every day.11

Nurses are in crisis. The need for tangible support in a fragmented healthcare delivery system is dire. Nurses must continue to speak out on issues that threaten the health and vitality of the profession. Although attempts to reverse the conditions of our healthcare climate sometimes seem futile, safe patient care and quality assurance depend on nurses who feel heard and well supported when it comes to initiating efforts for change.

Nurses are also especially vulnerable to psychological distress characterized by depression, anxiety, insomnia, and suicidal ideations during the pandemic.12-14 Mental health associations such as the American Psychological Association and the American Psychiatric Nurses Association have made various resources freely available to strengthen mental health promotion and wellbeing.15,16 They can be found through the following links:

Other interventions, including the deployment of mental health expertise, access to therapeutic services at the workplace, and the establishment of peer advocacy and support systems, should be implemented with a sense of urgency. In doing so, we can minimize the long-term psychological burden, mitigate the impact of stress, and build a more resilient healthcare workforce in the face of COVID-19.

For anyone requiring immediate crisis intervention or assistance finding a local mental health provider, the following resources are available:

  • Mental Health America: 1-866-400-6428 for referrals, 1-800-273-8255 for crisis
  • National Alliance on Mental Illness HelpLine: 1-800-950-6264
  • National Suicide Prevention Helpline: 1-800-273-8255.

REFERENCES

1. Iati M. More experts now recommend medical masks. Good ones are hard to find. The Washington Post. 2021. www.washingtonpost.com/health/2021/02/02/medical-mask-shortage.
2. National Council of State Boards of Nursing. Active RN licenses. 2021. www.ncsbn.org/6161.htm.
3. National Nurses United. Press release: NNU executive director Bonnie Castillo to testify before congress on protecting nurses during the pandemic and the dire need for optimal PPE. 2020. www.nationalnursesunited.org/press/nnu-executive-director-bonnie-castillo-testify-congress-protecting-nurses-during-pandemic-and.
4. US Bureau of Labor Statistics. Occupational outlook handbook: registered nurses. 2020. www.bls.gov/ooh/healthcare/registered-nurses.htm.
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6. The Guardian, Kaiser Health News. Lost on the frontline. 2021. www.theguardian.com/us-news/ng-interactive/2020/aug/11/lost-on-the-frontline-covid-19-coronavirus-us-healthcare-workers-deaths-database.
7. Ali SS. Why some nurses have quit during the coronavirus pandemic. NBC News. 2020. www.nbcnews.com/news/us-news/why-some-nurses-have-quit-during-coronavirus-pandemic-n1201796.
8. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020;24(1):200.
    9. WebMD. U.S. nurses already facing severe stress over coronavirus. 2020. www.webmd.com/lung/news/20200323/us-nurses-already-facing-severe-stress-over-coronavirus#1.
    10. International Council of Nurses. ICN confirms 1,500 nurses have died from COVID-19 in 44 countries and estimates that healthcare worker COVID-19 fatalities worldwide could be more than 20,000. News release. 2020. www.icn.ch/news/icn-confirms-1500-nurses-have-died-covid-19-44-countries-and-estimates-healthcare-worker-covid.
    11. Nurse News Now. ANA president encourages nurses to get into politics and advocacy. 2021. www.nurse.org/articles/american-nurses-association-politics-advocacy.
    12. Du J, Dong L, Wang T, et al. Psychological symptoms among frontline healthcare workers during COVID-19 outbreak in Wuhan. Gen Hosp Psychiatry. 2020;67:144–145.
    13. Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3):e203976.
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      15. American Psychological Association. COVID-19 information and resources. 2020. www.apa.org/topics/covid-19.
      16. American Psychiatric Nurses Association. COVID-19: tips & resources for psychiatric-mental health nurses. 2020. www.apna.org/i4a/pages/index.cfm?pageid=6686.
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