How Has Covid Affected Nursing?

Brenda F. Johnson, MSN

Nurses have a larger portion of burnout than other professions which can lead to patient care issues. Some of the prominent contributing factors for nurse burnout are: lack of supplies necessary to do their job, psychological effects of taking care of a larger number of critically ill patients, fear of infection, and basically, just being overwhelmed (Jose, Dhandapani, & Cyriac, 2020). Covid 19 has stretched our countries’ resources in ways that have caused many people psychological distress, especially for nurses. Burnout is described by Jose, Dhandapani, and Cyriac in their article as, “ a prolonged response to chronic emotional interpersonal stressors on the job” defined by emotional exhaustion, cynicism and not being effective on a personal level (Jose et al, 2020).

Just last week I was in the ICU to assist with a procedure on a Covid patient. When I walked into the ICU room, my jaw dropped. The attending nurse saw my face and asked me if I had seen one before (COVID patient). I just shook my head and continued to try and absorb what I was seeing. She could tell how shocking it was for me. I can usually make sense of things I have seen as a nurse, but this time I couldn’t. All this time, I had heard a lot of stories and definitions of the treatments for COVID patients. However, seeing it in person took it to a whole other level. This particular patient was a young, white unvaccinated male who was prone and ventilated. He had skin breakdown on all extremities and was on ECMO. There were more IVs than I had ever seen in one place along with a tube feeding.

I asked the nurse to explain the ECMO (extracorporeal membrane oxygenation) machine to me and she explained that it was a method of oxygenating the patient's blood. It is similar to a bypass machine that is used in open-heart surgery, allowing the patient’s heart and lungs to rest. This particular patient had been in the hospital for many weeks and at this point, the prognosis is poor. I’m sure that many of you reading this have experienced COVID up close along with the tragedy that can follow. That day, the nurse taking care of this young man was my hero, as are all of you out there.

While I was setting up all of the equipment, I asked the nurse a few questions, such as, “did she feel supported by the management.” I also told her that I knew several ICU nurses had left the hospital to do travel nursing, and did she know the reason why. She told me that she felt very supported by her immediate management, for which I was very glad to hear. She also told me that the nurses who had left to travel had done so basically for the money. A couple had left to do Hospice nursing as well. So the information that this nurse gave me was not what I expected to hear, especially after reading some of the research on how Covid has influenced nurses’ job satisfaction.

It is important for our leaders to understand how this pandemic has changed the job description for many nurses. In doing so, they can develop ways in which to support nurses (Thompson et al, 2021). By offering employee assistance programs, counseling, and other ways to help deal with the stress will decrease fatigue, below-average job performance, and higher patient errors (Thompson et al, 2021).

I reached out to our Chief Nursing Executive, with a few questions regarding what she had seen as a trend among the nurses this past couple of years. Also, what her thoughts were on what the nurses are going through on an emotional and mental level.

“I think that nurses are dealing with moral distress, burnout, fatigue from losing more patients than they ever have and working long hours and extra hours. I am glad you asked about this as I just talked on our leadership council last week about this and the plans that we have to roll out. ...High level: serenity room, badge access to utilize roof garden, process groups with Valley therapists for key areas - 4E, MICU and RT, a comprehensive list of all benefits such as NurseCAre, EAP, etc., Chaplin increasing rounds and holding monthly sessions”

Research has shown that the Covid pandemic has greatly affected the nursing profession. Hailey Mensik in her article, “Pandemic Keeps Exacerbating Burnout Among Nurses, Including Travelers”, tells us that not only has the nursing burnout not been addressed adequately, but many nurses are considering different work environments or continuing their education in order to open different career opportunities (2021). Hospitals are using sign-on bonuses to attract nurses, as well as using travel nurses to fill in the gaps (Mensik, 2021).

We as nurses know that burnout is common in the medical field due to the demands of the job. The effects on nurses who take care of Covid patients are much higher due to the higher rate of death among the patients (Gadiva, 2021). The usual contributing factors that affect job performance and job satisfaction are workloads, conditions, and workplace violence. The factors that are not often thought of are things like an EHR that is not streamlined (Gadiva, 2021). This can lead to errors that affect patient care and outcomes. The lack of PPE is something that also greatly influences how a nurse perceives their job. Not being able to protect themselves properly makes them question their career choice and live in fear of contracting the virus.

There are multiple sides to how the pandemic has changed our healthcare system, and jobs in healthcare. Some of the changes have been for the better, and others have put a strain on everyone involved. From financial concerns to physical and emotional exhaustion, we have been through a trying time. As a result, many nurses have retired early, some went into a different line of work, and others are leaving for more lucrative jobs. How a nurse feels supported by their facility can greatly influence job perception and satisfaction level.

We all have had very different personal experiences during the COVID pandemic. Share some of those experiences so that we can be supportive of each other and stand together at this turning point in healthcare.
References

Gadiva, M. (2021). EHRs, Covid-19, and Understaffing: Spotlighting Contributing Factors to Nurse Burnout. The American Journal of Managed Care.

Jose, S., Dhandapani, M., & Cyriac, M. (2020). Burnout and Resilience among Frontline Nurses during Covid-19 Pandemic: A Cross Sectional Study in the Emergency Department of a Tertiary Care Center, North India. Indian Journal of Critical Care Medicine, 24(11), 1081-1088.

Mensik, H. (2021). Pandemic keeps Exacerbating Burnout Among Nurses, including Travelers. Healthcaredive.

Thompson - Munn, L., Liu, T., Swick, M., Rose, R., Broyhill, B., New, L., Gibbs, M. (2021). Well-Being and Resilience Among Health Care Workers During the Covid-19 Pandemic: A Cross-Sectional Study.  American Journal of Nursing, 121(8), 24-34.