By Allana Marie Brown, DNP, PMHNP-BC
Nurses are currently in crisis. The need for tangible support in a fragmented healthcare delivery system is dire. In some settings, nurses are still less than fully equipped to meet care demands amid fluctuating rates of COVID-19 within the US. Although this has become an issue of shared concern among other essential healthcare workers, nurses are particularly challenged as the largest frontline entity within the healthcare industry. Nurses continue to contend with repeated exposure to infection and death, minimal protection, ethical dilemmas, bureaucratic issues, work-life imbalance, and varying degrees of trauma linked to the COVID-19 pandemic.1,2
Many nurses have come out of retirement to help combat COVID-19, continuing the profession's proud history of rising to the occasion as necessary. 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 times ought not to be mistaken for the notion that nurses are invulnerable to COVID-19 itself and its associated health risks. Every day, nurses and other healthcare workers are grappling with all types of stress surrounding the pandemic. The emotional toll includes an increase in conditions such as depression, anxiety, and insomnia, and these are being reported at a rate greater than that of other pandemics.3-5 Studies from China investigating healthcare worker exposure to COVID-19 have shown that nurses are especially vulnerable to psychological distress characterized by depression, anxiety, insomnia, and suicidal ideations.6-8 As similar findings emerge so will the need to secure the health and well-being of nurses and other frontline workers.
Mental health associations such as the American Psychological Association and the American Psychiatric Nurses Association have made various resources freely available to promote mental health and wellness during this time.9,10 Other interventions and resources include the deployment of mental health expertise and access to therapeutic services at the workplace.
The call for support and relief efforts have been made clear by nurses given a platform to speak out on the impact COVID-19. President Dr. Ernest Grant and Chief Nursing Officer Dr. Debbie Hatmaker of the American Nurses Association have made public appearances on major news networks to discuss current practice issues and advocate for better working conditions for frontline nurses rendering care to patients stricken by the novel virus.11,12 A critical care nurse from Arizona gained the nation's attention with her noteworthy demonstration against residents of the state who refuse to follow and adhere to COVID-19 health precautions.13
Nurses must continue to use their voices to raise awareness about concerns that affect the health and vitality of the profession, regardless of how futile these attempts sometimes seem to be in reversing the conditions of our healthcare climate. Safe care and quality assurance depend on nurses who feel heard and well-supported to lead efforts for change. Peer advocacy and support systems should be readily available and called upon with a sense of urgency. In doing so, we can help deter the long-term effects of psychological burdens, mitigate the impact of stress, and build a more resilient healthcare workforce in the face of COVID-19 and future healthcare challenges.
1. NBC News. Why some nurses have quit during the coronavirus pandemic. 2020. https://www.nbcnews.com/news/us-news/why-some-nurses-have-quit-during-coronavirus-pandemic-n1201796.
2. WebMD. U.S. nurses already facing severe stress over coronavirus. 2020. https://www.webmd.com/lung/news/20200323/us-nurses-already-facing-severe-stress-over-coronavirus#1.
3. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun. 2020; 88:901-907.
4. Stelnicki AM, Carleton RN, Reichert C. Nurses' mental health and well-being: COVID-19 impacts. Can J Nurs Res. 2020; 52(3):237-239.
5. Wong AH, Pacella-Labarbara ML, Ray JM, Ranney ML, Chang BP. Healing the healer: protecting emergency health care workers' mental health during COVID-19. Ann Emerg Med. 2020; 76(4):379-384.
6. 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.
7. 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.
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. American Psychological Association. COVID-19 information and resources. 2020. https://www.apa.org/topics/covid-19.
10. American Psychiatric Nurses Association. COVID-19: Tips & resources for psychiatric-mental health nurses. 2020. https://www.apna.org/i4a/pages/index.cfm?pageid=6686.
11. American Nurses Association. COVID-19 interview with Debbie Hatmaker on CNN. 2020. https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/covid-19-interview-with-debbie-hatmaker-on-cnn.
12. Fox News. American nurses association launches relief fund amid coronavirus crisis. 2020. https://video.foxnews.com/v/6146381051001.
13. ABC News. Why this ICU nurse stood up to people protesting stay-at-home orders. 2020. https://abcnews.go.com/Health/icu-nurse-stood-people-protesting-stay-home-orders/story?id=70554778.
Allana Marie Brown is a psychiatric NP at St. Vincent's Hospital Westchester in White Plains, NY.