While the pandemic has put extreme strain on the nursing profession, nurse leaders share best practices for addressing the mental health and emotional trauma their staff face.
As the United States tackles the next big wave of COVID-19 infections, frontline nurses who have already been stretched to their limits during the pandemic must endure continued challenges that pose serious risks to their emotional and mental health.
Nursing burnout, compassion fatigue, and moral distress have been perpetual issues in nursing for at least the past decade. But nurse leaders like Tari Dilks, RN, DNP, APRN, PMHNP-BC, FAANP, president of the American Psychiatric Nurses Association and professor at McNeese State University in Lake Charles, Louisiana, are concerned that the scale, intensity, and pervasiveness of the COVID-19 pandemic will intensify these issues.
In addition to workplace stress, nurses are dealing with pandemic-induced stressors at home, including school closures, spousal job losses, and the fear of COVID-19 infecting their families, Dilks points out. Thus, nurses' well-being and mental health can no longer be overlooked.
"It's going to be incumbent upon their employers to make sure that mental health needs are being met," she says. "If we can figure out those things that help nurses be resilient … we're going to be in a much better place emotionally."
Peer support is one of many strategies that Penn Medicine Princeton Health in Plainsboro, New Jersey, has implemented to care for nurses' mental health, says Sheila Kempf, PhD, RN, NEA-BC, the organization's chief nursing officer.
For example, staff were trained to recognize the signs of being at high risk for emotional distress, such as verbalizing specific thoughts or emotions, and when peers should be referred to the Employee Assistance Program (EAP). The hospital also contracted a trauma clinical psychologist to talk with staff and run support groups with the EAP and the Ministries department.
"In the very beginning, when no one really knew what the [COVID-19] treatments were, it was overwhelming. But you didn't have time to stop and think about it," Kempf says about the nurses' experience. "By about June, it all started to sink in: what they went through, what they witnessed."
During the spring surge in COVID-19 cases, the 231-bed hospital had over 30 patients on ventilators with a census of around 80 COVID-19 patients a day. Typically, the hospital operates a 12-bed ICU.
To offer additional support during the crisis, the hospital's nurse advisory council formed a wellness committee. The group put together "code lavender" kits to promote self-care among the entire hospital staff. The kits included stress balls, chocolates, tea bags, cards with motivational sayings, and lavender essential oil. The team assembled about 3,000 kits and distributed them to all hospital employees.
"They went department by department and gave them out, which I thought was phenomenal," Kempf says.
The organization also began holding "clap outs," where staff gathered to clap and cheer for patients with COVID-19 who had been on a ventilator and were being discharged. In addition, for all COVID-19 patients being discharged, they played the song "Here Comes the Sun" over the loudspeaker. The intent was to celebrate patients' recovery and to show staff that their hard work was paying off, Kempf says. She estimates that song has been played about 500 times.
Yet, despite these recent efforts, Kempf says healthcare leaders should view nurses' mental health and well-being as a long-term issue.
"Even now, I'll say something to a staff nurse, and they'll start crying. It still happens," she says. "[Nurses] witnessed private conversations between husband and wife, sons and daughters, where they were saying goodbye [to loved ones]. I think that's where the crux of the emotional distress and PTSD is coming from because they witnessed things they should not." In addition, the staff was worried about bringing the coronavirus home to their own families. One of the local hotels provided free rooms to staff who either had to quarantine or could not go home due to a high-risk family member.
“It's going to be incumbent upon their employers to make sure that mental health needs are being met.”
Tari Dilks, RN, DNP, APRN, PMHNP-BC, FAANP, president, American Psychiatric Nurses Association; professor, McNeese State University
Leverage peer support and employee assistance programs to assist colleagues who may be in emotional distress.
Celebrate victories to show staff that their efforts have had a positive effect.