How are nurse leaders responding to pandemic turmoil?
16. Februar 2022
Von Ian Evans
Amid the havoc wreaked by COVID-19, there are actions healthcare leaders can take to support their staff, says nurse leader Dr Rose Sherman.
When she reflects on what the world has been through over the past two years, Dr Rose Sherman Wird in neuem Tab/Fenster geöffnet describes the collective experience as âa major disaster.â The turmoil people are feeling stems largely from the pandemic.
âItâs just a shitshow here, Rose âŠâ
For many, the effects have been especially pronounced. Rose, who is Editor-in-Chief of the Elsevier journal Nurse Leader, which is affiliated with the American Organization for Nursing Leadership Wird in neuem Tab/Fenster geöffnet, also works as a consultant for frontline healthcare leaders, who have borne the brunt of the impact of the pandemic. The kind of feedback she receives is a bit blunter.
One of my blog readers emailed me and said âItâs just a shitshow here, Rose. Weâre holding the whole thing together with rubber bands and paper clips. We donât have enough staff. Weâre just moving from day to day, and politicians donât want to admit this is happening.â
Those challenges have come about because of systemic problems that have been accelerated by the pandemic. But as dire as the situation can be, there are actions healthcare providers can take to make things better for their staff.
From Roseâs 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 âmoral distress,â as nurses were called liars or accused by family members of inventing a COVID diagnosis to make money.
That kind of response from patients isnât just distressing for nurses â it can prompt them to completely reassess their choices, in what Rose refers to as a âlife quakeâ:
I think healthcare providers feel so angry about whatâs going on with disinformation, and they feel distressed because they know they should be compassionate. Iâve heard stories of healthcare providers walking out of wards because they donât want to get in a fight with a patientâs 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 Roseâs 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:
Weâre about to publish an article in Nurse Leader about one team that does âJust in timeâ interventions. This involves putting together a quick crisis response where leaders send personnel to a unit where they know there are issues â they may be short staffed or may have had a challenging interaction with a patient â and help the staff take some time to recenter.
Part of it is about letting staff know itâs OK to stop, that itâs OK to go into a quiet room and decompress. Having people around to steer you to that, and to emphasize that itâs 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 thereâs no pressure on staff to ask for help, and no stigma attached to needing help. Itâs 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 theyâre more likely to be engaged.Â
Rose pointed to the survey management consultancy Gallup conducted in 2018 Wird in neuem Tab/Fenster geöffnet on the difference having friends in the workplace can make to employee engagement:
Even a âforcedâ friendship is better than none, and it helps prevent people from becoming disconnected, like they donât know anyone in the workplace. Thatâs 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 Roseâs 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.
Thereâs 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 âopt-outâ 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 thatâs your preference. âI see that hospital as an example of best practice,â Rose said. âWhat theyâre doing really seems to be working.â
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. âTake childcare as another example,â she said. âBack when the baby boomers had kids, health systems offered childcare for their workers, but they donât 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.â
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 Wird in neuem Tab/Fenster geöffnet 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 â it makes a big difference in the way people look at their work.
I think thatâs exactly right, and I think healthcare leaders are keen to make that change for their staff.