How are nurse leaders responding to pandemic turmoil?

When she reflects on what the world has been through over the past two years, Dr Rose Sherman(opens in new tab/window) describes the collective experience as “a major disaster.” The turmoil people are feeling stems largely from the pandemic.

From Rose’s perspective, which includes working with just about every major health system in the US over the past year, some of the most testing moments have come since the arrival of the COVID-19 vaccine. As she describes it, the health services were able to weather the storm that 2020 brought, with less turnover of staff than one might expect. However, that changed in Spring 2021, Rose said:

It became clear that a fairly large number of people were not going to take the vaccine. And then the Delta variant hit, and the patients were younger, and they were sicker. There was this whole additional layer of what I call ‘moral distress,’ as nurses were called liars or accused by family members of inventing a COVID diagnosis to make money.

That kind of response from patients isn’t just distressing for nurses — it can prompt them to completely reassess their choices, in what Rose refers to as a “life quake”:

I think healthcare providers feel so angry about what’s going on with disinformation, and they feel distressed because they know they should be compassionate. I’ve heard stories of healthcare providers walking out of wards because they don’t want to get in a fight with a patient’s family.

This kind of thing has never really happened before.

The issue also extends into the home lives of healthcare providers. Rose pointed out that nurses can find themselves targeted by their own families if their relatives see the pandemic as a hoax, or vaccines as a conspiracy.

What can healthcare providers do to improve the situation?

Coupled with the ongoing stress caused by the workload pressures of the pandemic, the reports of emotional distress paint a bleak picture. But the situation is not hopeless. Part of Rose’s work involves helping healthcare leaders establish support for their workers in order to address these challenges. She explained some of the ways in which healthcare leaders are supporting their staff:

We’re about to publish an article in Nurse Leader about one team that does ‘Just in time’ interventions. This involves putting together a quick crisis response where leaders send personnel to a unit where they know there are issues — they may be short staffed or may have had a challenging interaction with a patient — and help the staff take some time to recenter.

Part of it is about letting staff know it’s OK to stop, that it’s OK to go into a quiet room and decompress. Having people around to steer you to that, and to emphasize that it’s important, is valuable.

Other health systems have psychologists within the unit, available up to five days a week, to talk to staff and bring help to them. That means there’s no pressure on staff to ask for help, and no stigma attached to needing help. It’s assumed that everyone needs psychological support and psychological safety in order to thrive. Rose also pointed to the New York hospital system, which borrows a concept from the US military to ensure that staff can rely on their peers:

When the US military had high dropout from bootcamps, they started this system called Battle Buddies. They found that if people are paired up in a buddy system where they can talk to each other about their experiences, then they’re more likely to be engaged. 

Rose pointed to the survey management consultancy Gallup conducted in 2018(opens in new tab/window) on the difference having friends in the workplace can make to employee engagement:

Even a ‘forced’ friendship is better than none, and it helps prevent people from becoming disconnected, like they don’t know anyone in the workplace. That’s important when social distancing makes it hard for friendships to develop organically.

The strain the pandemic has put on the relationship elements of work is something that comes up again and again in Rose’s consulting process. She mentioned that many health systems are looking at this issue and examining how to help teams rebuild when the necessities of social distancing have broken them apart. Indeed, the more emotional elements of work overall are increasingly being recognized as important.

There’s a hospital I work with in Connecticut that started a program around mental health, which I think is very important. Every nurse gets a 30-minute appointment with a psychologist, and you have to opt out.

That ‘opt-out’ element not only increases participation; it helps destigmatize the need for emotional support and the need to look after your mental health. The default assumption is that this is something that everyone will require, and you can choose not to use the service if that’s your preference. “I see that hospital as an example of best practice,” Rose said. “What they’re doing really seems to be working.”

Other social factors are impacting nurse attrition

However, not every challenge a caregiver faces stems from the pandemic or from misinformation. There are also systemic issues, long in gestation, that are causing problems for the nurse community, and these too must be addressed. Rose explained:

Addressing the challenges the nursing workforce is facing is not just about fixing the working environment. There are a lot of social determinants that might prompt someone to leave the nursing workforce.

For example, Rose points to student loans or the price of housing as reasons someone might reconsider their role as a nurse. “Take childcare as another example,” she said. “Back when the baby boomers had kids, health systems offered childcare for their workers, but they don’t now. These nurses may be working 12-hour shifts, and they may not have family members available to take care of their kids. These are the kinds of things that affect your decisions about where to work.”

These are the kinds of issues Rose discusses with healthcare leaders in her consultations, and overall, she notes a real urge to create meaningful change for the nursing community:

Just this past week, I had I leader from Dartmouth-Hitchcock clinic(opens in new tab/window) at one of workshops, and he said that if you want to make a difference for staff and keep them on board, you look at the social determinants of work. Whether … they can afford housing, childcare, student loan repayments — it makes a big difference in the way people look at their work.

I think that’s exactly right, and I think healthcare leaders are keen to make that change for their staff.