COVID-19 Is Affecting Critical Care Nurses. What Nurse Leaders Need to Know

The president of the American Association of Critical-Care Nurses shares what nurse leaders can do to support nurses during the pandemic.

"Unstoppable." That's the American Association of Critical-Care Nurses' 2019–2020 theme and, given the way nurses have had to battle against COVID-19, it seems that no better word has been chosen to describe nursing. While many Americans are sheltering in place due to stay-at-home orders, nurses and other healthcare professionals are heading to work each day to care for patients with and without COVID-19.

"[Nurses] are rising up and charging [toward] the problem. It just validates to me how much I'm really honored to be part of this profession," says Megan Brunson, RN, MSN, CCRN-CSC, CNL, AACN president and night shift supervisor for the cardiovascular ICU at Medical City Dallas.

During the COVID-19 crisis, Brunson has had both an up-close and personal as well as eagle-eye view of what critical care nurses are experiencing during this time.

"I work at the bedside, I work 12-hour shifts, and am president of a national organization, so I really feel I have a unique perspective," she says.

During a recent interview, Brunson shared her insights on what it's like being a critical care nurse during the coronavirus pandemic. She also shares how nurse leaders can support nurses as COVID-19 continues to ramp up during the coming weeks.

The following is a lightly edited transcript of that conversation.

HealthLeaders: Can you paint a picture of what you're seeing across the country as critical care nurses deal with the pandemic?

Megan Brunson: As a bedside ICU nurse, when you add personal protective equipment, your whole routine changes. It's hot. It's hard to talk. Your glasses fog up when you have a mask on. You're motioning to others outside the room in a kind of horrible game of charades [to get] what you need. You have to cluster your care. You worry about every step you take and everything you touch inside and outside the room, and you wash your hands till they're raw.

On a national level, nurses are bravely rushing into this crisis without question of their duty. Nurses across the country are feeling it in different ways. There are nurses who don't have PPE or have severely limited PPE, and there are nurses right now that are not able to work because their hospital censuses are dropping significantly due to the cancellation of routine surgery. There are nurses that are in the preparation stage, and nurses coming out of retirement or working more than part-time. They're being introduced to critical care all over again.

The projections [of when the pandemic in the U.S. is] supposed to start hitting its peak are changing. I think that it is difficult for nurses to have this ball that's constantly rolling down that hill.

HL: Are nurses across the country seeing shortages of ventilators and PPE?

Brunson: There's no bigger way for me to say yes. Yes, yes, yes, yes. Many hospitals in the United States are at their own level of contingency planning, which is recommended by the CDC. We have to call on others in this time, like those that are not necessarily in healthcare, whether it be the community or industry partners. For example, there are a lot of research labs that don't do human experiments and have N95 masks. That's another place where we can come together as a community to see how we can mitigate these shortages.

It's completely unacceptable to not have the PPE at all levels of where you provide healthcare. Every time we have a shortage, it's nurses who are at risk. It's so, so important that from the government level down to our states and communities that nurses have PPE.

HL: What are some ways that communities can support nurses?

Brunson: There are things already being done that just bring warmth to my heart. In our local area, people are tying white ribbons around trees. You see the clapping at eight o'clock [for healthcare workers] across the country.

But the other way, that's more important than all that, is to just stay at home. Nurses are begging, in fact, imploring, the public to stay home to slow the spread of the disease because it's just making the risks posed to nurses and healthcare providers even greater. We're willing to go to work, but [the public should] please stay home.

HL: What are some of your biggest concerns for nurses over the next couple of months?

Brunson: We really need to have the discussion about making sure nurses are not going to be put in a place where [they can get sick] because of frequent exposure to the COVID-19. It's not like they're taking care of one patient and one exposure, it's multiple exposures. [We can't risk them] getting gravely ill each day without having proper protection. The other concern is not having the ventilators. We can't put nurses and providers in a place where they have to make a decision on care. Moral distress is already evident in the pandemic and it will be ramped up to another level if nurses and healthcare providers have to make decisions [about which patients receive care or not].

Nurses also have their own worries at home—loss of jobs for their spouses, perhaps kids with no childcare. They want to be taking care of patients, but they have the effects of this pandemic on them equally at home.

HL: What are your long-term concerns for nurses?

Brunson: Moral distress and burnout. The Critical Care Societies Collaborative (of which AACN is a part) has placed a priority on [addressing] burnout. This pandemic is going to elevate it even more. We have to recognize that nurses are experiencing not only more stress but also ethical dilemmas. We have nurses who are managing ethical concerns during a disaster in a crisis situation. We're confronted with our standards being altered. It's not just one time. It's constantly going back to work with those challenges. So, I do worry about the long-term effects of burnout and moral distress and the ethical challenges.

HL: How do you recommend nurse leaders support nursing staff members at this time?

Brunson: As leaders, it's important that we're in there masked up and gowned up with them and walking through their daily life. It's important that we acknowledge their ethical and moral conflicts, [and] that we take time to talk about it and make sure that they're aware of what resources are available, whether it be resources within your organization like [the Employee Assistance Program] or counseling.

We need to encourage staff to speak up when they're seeing things that are distressing them now, whether it be care situations or ethical concerns, and [to escalate those issues]. When you do that, you're asking nurses to be courageous, to speak up, and sometimes that's not easy. So being available as a leader to really encourage them to have that courage is important. Then finally, acknowledge what they're doing and their contributions. 

HL: What are some positive things that could come out of this situation?

Brunson: I am just in love with the innovation now that I'm seeing. It makes me smile. As nurse leaders, we really need to support innovation by empowering others to implement solutions and discover those who are doing out-of-the-box thinking.

Sharing ideas is important because if there ever was a time to cast competition aside between hospitals, it's now.

Also, as a leader, it's important to leverage [staff] expertise and bring forward nurses who are those shining lights that have the potential to be leaders. Ask, 'How can they lead in a small way?' and give them license to do that.

HL: What's been the most difficult experience that you've ever had as a nurse? And how does it compare to the pandemic?

Brunson: By far, nothing compares to this. Every breathing minute I think about COVID-19 and the teams at risk. It's a marathon, not a sprint. The AACN community knows my story, but I was kicked out of nursing school my senior year. That is a very long story, but I had someone tell me I couldn't be a nurse.  Although that part of my life is behind me, some aspects of this [are the same]. Nurses are being told that they can't be the nurses they want to be, in so many ways. Maybe not verbally, but with lack of PPE, they're not able to be the nurses that they want to be. For me, that reminds me of that feeling I had when I was told that I couldn't be a nurse.

They want to feel protected and supported. The hard part about wanting to be a nurse is that you walk into a patient's room every day and you want to provide excellent care with every interaction. When there's a barrier to that, it's crushing to your practice.