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By Jessica Rainbow, Assistant Professor of Nursing, University of Arizona; Chloé Littzen,
Assistant Professor of Nursing, University of Portland; and Claire Bethel,
Adjunct Instructor of Nursing, University of Arizona. Originally published at The Conversation.
Nurses stepped up to the challenge of caring for patients during the pandemic, and over 1,150 of us have died from COVID-19 in the U.S. As cases and deaths surge, nurses continue working in a broken system with minimal support and resources to care for critically sick patients, many of whom will still die.
We are nurses and nurse scientists who study nurse well-being during the COVID-19 pandemic. One of our studies, which asks health care workers to share voicemails about their experience providing care during the COVID-19 pandemic, is ongoing. What we have found across our studies is that nurses are struggling, and without help from both the public and health care systems they may they leave nursing altogether.
To help you understand their experiences, here are the five key takeaways from our studies on what nursing has been like during the COVID-19 pandemic.
1. Calling nurses ‘heroes’ is a harmful narrative
Nurses demonstrated that they will do almost anything for their patients, even risking their own lives. As of the end of December 2020, more than 1.6 million health care workers worldwide had been infected by COVID-19, and nurses make up the largest affected group in many countries.
For this, nurses have been hailed as heroes. But this can be a dangerous label with negative consequences. With this hero narrative, expectations of what nurses should do become unrealistic, such as working with inadequate resources, staffing and safety precautions. Consequently, it becomes normalized for nurses to work longer hours or extra shifts without consideration for how this may affect them personally.
This ultimately could result in nurses’ leaving the profession because of burnout. A survey conducted by the American Association of Critical-Care Nurses of over 6,000 ICU nurses found that 66% of respondents were considering leaving nursing as a result of their care experiences during the pandemic. Similarly, we found that 67% of nurses under 30 are considering leaving their organizations within the next two years.
The nurses in our studies put the needs of their patients and society above their own. This is how one young nurse described their experience caring for COVID-19 patients without any safety guidance: “There was a palpable tenseness being there … nobody knew what was going on or what was expected. There was no real protocol yet. If a patient was admitted and you had to take care of one, you kind of felt like you were being thrown to the wolves as an experiment.”
2. Nurses lack adequate resources or support
Nurses have cared for patients despite working in hazardous work environments. While some health care organizations have offered increased pay to travel nurses, or contracted temp nurses to address staffing shortages, that offer hasn’t been extended to their full-time staff. Many organizations instead require overtime and don’t provide adequate resources, such as personal protective equipment or support personnel, for safe patient care. This has left many nurses feeling unappreciated, undervalued and unsafe.
As one nurse from our study explained: “Lack of resources, lack of staffing, lack of getting all our concerns addressed, things like that. Those are very draining, especially when we’re supposed to provide patient care and do a good job. … All the drama from work and things like that, those don’t help. If anything, it just makes the environment more toxic and unbearable, definitely, and at one point, it will start affecting … your mental health and your physical health, even your spiritual health.”
3. Nurses lost trust in health care organizations
Nurses said they struggled with rapidly changing policies and procedures. Even when they were given information about these changes, many health care organizations weren’t transparent about the reasons behind them and expected nurses to just roll with the punches.
Even worse, some health care organizations gaslit nurses for being concerned for their own safety. One young inpatient nurse, for example, described frustrations with lack of communication from management: “They just weren’t telling us much of anything. We have three managers and seven clinical coordinators on our unit. There were definitely enough people to be sending emails and to be giving updates, but they were so unsure as well that they just kind of opted for radio silence, which was really frustrating and made the whole situation more challenging. When they were giving us information, a lot of it was, you guys are overreacting. You don’t need to wear N95s all the time.”
The safety sacrifices nurses have made for their organizations and patients has led to severe mental health consequences. In one study of 472 nurses in California, 79.7% reported anxiety and 19% met the clinical criteria for major depression.
Another nurse in our study had a similar experience: “Our policies were changing so rapidly that oftentimes anesthesia would have a different understanding [of the policy], the doctors and residents would have a different understanding, and nursing would have gotten a different email always within like a half-hour. It was extremely frustrating. It was very, very stressful.”
4. Nurses experience morally traumatic events
Nurses have been exposed to a substantial amount of moral injury, which occurs when they witness, perpetuate or fail to prevent something that contradicts their beliefs and expectations.
Not only have nurses seen a high volume of deaths every day, but they have also been placed in morally difficult situations due to resource shortages, such as oxygen supplies, ECMO machines that support heart and lung function, and hospital beds and staff. Even more routine aspects of care, such as basic hygiene, were neglected, further contributing to nurse moral distress.
One nurse in our study described their experience of moral distress in making life support decisions for patients: “We were told very early on … if this person needs a ventilator, they are not going to get it. So, in a way, we were determining code status without really consulting the patient, which to me is very problematic and unethical.”
5. Nurses are frustrated by the public’s not taking the pandemic seriously
Masks and vaccines are proven to help prevent the spread of COVID-19. Yet some Americans still refuse to mask, and, as of Nov. 1, 2021, only 67% of the population has received at least one dose of the vaccine.
According to the CDC, 92% of COVID-19 cases and hospitalizations, and 91% of COVID-19-related deaths, were among individuals who were not fully vaccinated between April and July 2021. Conversely, only 8% of COVID-19 cases and 9% of deaths were among fully vaccinated individuals.
Nurses care for patients regardless of vaccination status. Unfortunately, what the public may not realize is that their decision to decline vaccination or masking has serious consequences not only for nurses, but also their friends and community members. When hospital systems are overwhelmed with unvaccinated COVID-19 patients, there may be limited staff or resources to help those who need care for other medical emergencies. This is a frustrating experience for nurses who find themselves unable both to care for every patient in need and to protect people from contracting COVID-19.
A nurse in one of our studies recalled having to chase after an unvaccinated pregnant person with COVID-19 who attempted to leave the ICU against medical advice, despite the risk that she might infect other people: “This was so early [in the pandemic], we didn’t know how far [the virus] would travel. So I’m, like, is she going infect the staff in the lobby? Are there people down there? You know, she’s just going to go home and give this to her newborn. And … her husband looked at me and said, you know, basically Western medicine isn’t real and this isn’t real and I’m, like, OK, this is real. And I’m, like, you’re going to give it to your newborn and your five kids.”
How you can help nurses
As the pandemic continues to overwhelm hospitals and communities across the U.S., its effects on nurses need to be carefully considered. Exhausted and demoralized nurses are already quitting or retiring at alarming rates.
Only time will tell what long-term effects the COVID-19 pandemic will have on the nursing profession. But the public and health care organizations can step up to help nurses now by increasing access to mental health support and providing adequate resources, safe working conditions and organizational transparency during times of immense change. And everyone can help by protecting themselves from COVID-19 through masking and vaccination.
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The constant use of the word “hero” in U.S. life has turned the word into an empty glass. Why anyone wants to use it even still is beyond me. (See also “passion.”)
But I do not want to shortchange nurses. There are some major class and gender issues here: Nursing has been an under-paid “pink collar” calling. The doctors (mainly men) were in charge. Yet the nurses have been providing the day-to-day care–and this was even before the pandemic. U.S.-style health insurance, the rigid/artificial divisions among specialist doctors, and the profit model have only made nurses’ jobs even worse. The description of how information was often split among specialty groups and management with e-mail arriving in real time to make it all into something incomprehensible is a symptom.
I am reminded how suddenly everyone is wondering why no one wants to work in restaurants: Like nursing, which is care for the sick, hurting, and dying–an essential task–feeding people in restaurants is kinduv essential. Yet we hear stories of abuse by the clientele and by the owners.
There’s even more at stake in nursing–yet the same indifference to those who do the work and to real human need is on full display.
> But I do not want to shortchange nurses.
I recently re-read Hugo’s Ninety-Three. There is a great line that I copied down and sent to all the nurses I know:
‘The doctor prescribes but it is the nurse who saves’
To the bean counters Nurses are fungible.
I mean really, how much training does it take to empty a bedpan?
If RN’s aren’t willing or able to step up and maintain profit margins,give CNA’s a few hours of OJT and have them take over.
And if they run thin,bring over people from housekeeping and give them a $2 per hour raise.
Problem solved.
You’re welcome.
Years ago a friend was hospitalized for a “footballectomy”, (removal of ovarian cyst), where, to save money, it was decided to phase out the housekeeping dept. All of those workers were cross-trained as phlebotomists. When a visibly nervous young woman came in to draw blood on the morning of the surgery she asked my friend if she minded if she prayed first. The wise response, “I’ll pray with you.”
After two sticks an experienced phlebotomist was sent.
Not much has changed really.
I work in Spiritual Care in a major high-tech hospital. I have felt lucky to be per-diem over the course of the whole pandemic because, even though I have no benefits, I have the luxury to set my own schedule, and to work as much or as little as I want. I think that has proven very valuable to me, as I get my sources of rejuvenation from unstructured time.
Just literally yesterday, I had a couple of anecdotes with nurses that made me question how long I can keep doing this job.
Firstly, there was an end-of-life situation, and I called in to find out when the family was arriving (we currently have limits of 3 family members at bedside for end of life), and I felt that the RN was snippy with me on the phone call. No big deal, they have a heavy load, but it made more sense to me when I arrived and met the RN. She worked that day in a heart ICU, was assigned to at least 2 patients: 1 Covid patient, and also had this non-Covid end of life case with 6 more more family members (some who had traveled from out of state) who were juggling being in the room but also meeting the visitation rules. I think the normal ratio is 1:1. The RN was very nice when I met her in person, and she asked me to be in charge of the call light if the patient looked agitated and needed more medication. I’m not trained to know what agitation looks like, but luckily one of the patient’s children is a former ICU RN and knew what the signs were. So, the RN was utilizing the chaplain as a second set of RN eyes during that day. Part of my job is to assist the RN staff, so I took it on willingly, but I felt bad about the heavy load that young RN, probably a traveler, was carrying that day.
2nd anecdote: on another ICU floor, there was a patient who was heavily disabled (not able to use his arms to reach his call light or any objects on his table). I had a brief encounter with him, and then was sitting out in the hallway when he started yelling, “Hello?!” about 7 or 8 times. I’ve worked at other hospitals, ones that served patients of lower socioeconomic status, where it was normal to see patients calling out “Help” from their room, but not here typically. I was personally feeling upset emotions about it, there was no one to help, only Environmental Services staff who were just ignoring it. That part of the ICU hallway was devoid of nurses. Even I had the urge to ignore him, sadly, but I looked at some nursing medical notes in the chart and saw “continues to be anxious and needs emotional support.” I went in and asked him what he needed, and he had lost his Gatoraid bottle, which I couldn’t find. I called to his nurse’s pager, and it went right to the default function of going to the front desk. As I said, I am used to that in other hospital environments, but this is a hospital that caters to more highly functioning patients (as a general rule, he obviously broke that rule), and it felt like some of the norms of the hospital ethic of caring are breaking down.
After posting that, now I am getting ads for Gatoraid. lol.
In Buffalo, 2500 hospital workers, including 1900 nurses, went on strike against Mercy Health. Wages, of course, were an issue, but staffing levels were an equally important issue. The strike was settled after one month in late October. Management imported scabs during the strike. The agreement ending the strike includes mandatory staffing level ratios of nurses and support staff to patients:
https://www.wkbw.com/news/local-news/catholic-health-cwa-reach-tentative-agreement-to-end-mercy-hospital-strike
A friend from Buffalo that closely follows labor unions said he believes this is the first hospital union contract that includes minimum staffing levels.
Definition of “Hero”:
A term used by political figures, white collar workers and members of the press to recognize courageous blue collar workers who can’t be given pay raises because that would contribute to inflation.
See: “Stakhanovite”, “9/11 New York firemen with non-functioning radios”, and “US ARMY 11B and O1-2 pay scales “. Farm workers sprayed with pesticide don’t qualify for either the term hero or a pay raise.
I had an experience of going to an urgent care unit here in an urban area in Massachusetts this week. After a two hour wait past the time our appointment was for, we did finally see the Nurse Practitioner. He was the only one there in a center that needs two. This is what he espoused to me:
#1. That everyone can’t find nursing staff, because of the pandemic everyone is burnt out or leaving the profession.
#2. That the hospitals are running at half staff for nurses, because see #1.
#3. The short staffing us causing burnout for all the staff. From reception up.
The failure of our system to deal with this pandemic, as well as the ability of the system to throw all s$#@ downhill to the people who have to shoulder the day to day work while the bosses WFH, should bury our for profit health care system. But the clamour for change is not heard.
Anecdotal data here.
My wife is semi-retired RN. The local hospitals were all calling – they had treated her like crap. She never called back. Sister is an RN who finally took a LOA for stress. I don’t think she will be going back.
Hospitals and healthcare insurance are making record profits so I doubt anything will change about how employees are treated or paid.
Lesson learned, when the news calls you heros, you are underpaid, overworked, and $crewed. Get another job.
That we have to scour comment threads of a VERY few blogs to read day-to-day reality and escape PR releases, propaganda and obfuscatory pleonasm posing as journalism, is just as scary as pictures of nurses, staff and a retired brain surgeon, here in NYC taping garbage bags and take-out food clear plastic into impromptu PPE, as Cuomo, Trump, de Blasio, ALL media and public health officials just told everyone to “just go on about your lives, like normal.” That they’ve repeated the process three times, sacrificing little kids now, without millions on the streets; shows that our “Hey, it’s not my problem!” attitude isn’t just a NYC mindset?