Nurses Did Not Sign Up for This

Can peer support fill in the gaps to keep nurses in the field of nursing?

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Nurses Did Not Sign Up for This

Nurses did not “sign up for this.” Yet, here we are.

And so, the current challenge to tackle is: how does the field of nursing survive a pandemic?  And how does healthcare keep its nurses in the careers they dreamed of, long before March 2020 happened?

With the deadliest pandemic in the history of the United States1, nurses have had to reinvent themselves, reinvigorate their love for healthcare and find ways to recharge like never before.  

Nurses are being bombarded daily not only with their own anxiety and stressors, but with instructions and pressure to practice self-care.  Codes for therapy services are being handed out like candy.  Beloved brands and stores are providing “front-line hero” discounts.  But what is actually working, what is just a band-aid?  And what can nurses do to help ease the emotional turmoil of taking care of the human race during these trying times?

One solution that is both evidence-based, and rooted in what nurses often already do, is peer support.  

So just what is peer support? Peer support encompasses what many nurses already naturally do…airing our frustrations in the break room during lunchtime, asking advice from the seasoned charge nurse and giggling together over an experience that no one but another nurse could possibly understand.  

The difference is that peer support takes on a more organized and structured approach than the organic ways nurses often help each other.  This strategy can help to heal the psychological wounds, anxiety and moral dilemmas that many of us are experiencing daily during this pandemic. Examples include support groups, mentoring, one-on-one sessions, and online forums.  

Recent studies have investigated the role and effectiveness of peer support with encouraging results.  One looked at the well-established peer support programs at two medical centers, and the lessons learned from those experiences. “One-on-one or group peer support can effectively offset the increased stress and other challenging experiences of nurses during the COVID-19 pandemic and other challenging events”2.

In a practical sense, managers and human resources departments can keep an eye out for staff that has certain characteristics and behaviors, such as:

  • High emotional intelligence
  • Natural helpers on their team
  • Are great at maintaining trust and respect within their peer group
  • Have been in a clinical role for at least 18 months
  • Are highly effective at communicating
  • Show an empathic presence
  • Viewed as non-judgemental by their peers3

Once these natural tendencies are identified, these staff members can be recruited to help support distressed colleagues in a more formal way4. These teammates can then be trained and deployed to serve as individual peer supporters, run group meetings, or round on varying units. High-risk areas, in relation to covid, should receive more attention and assistance.  

Another study5 evaluated formal peer support groups that were offered at a designated covid-only hospital.  Groups were led by psychiatrists and psychiatry residents and were attended virtually by hospital staff, including nurses. In comparison to the previous study, this group used trained mental health providers to help staff members through these difficult times.  The group members were assisted through group processes like feeling ventilation, peer support, the moral challenges of taking care of covid patients, and the trauma associated with it. Those with more extensive struggles, or those who needed more time. were given additional interventions such as individual sessions. 

The researchers did not use formal methods to calibrate improvement in mood or coping, as the participants were practicing nurses and not research subjects.  However, their determination was that it was a useful tool to offer in support of emotional and mental health issues surrounding covid.

If you aren’t in a place where your facility can institute a formal peer support program right at the moment, remember that peer support can happen organically, anywhere and at any time.  If you notice that a coworker seems like they are struggling, they are acting differently at work, or they tell you that they are having a hard time, evaluate your comfort level by providing some informal peer support. 

The American Association of Nurse Anesthesiology has some great tips on how to get started providing peer support to others6.

  1. Make sure that you are in a healthy place to provide support for someone else.  Set boundaries and check in with yourself consistently.
  2. Express care, concern, and express appreciation for anything the person shares
  3. Reflect back on their experience and summarize for them
  4. Validate their feelings and express how it can be normal
  5. Explore with them what coping mechanisms have worked in the past
  6. Ask about current support systems
  7. Share reliable resources, such as an Employee Assistance Program
  8. Listen more than you talk
  9. If you feel like suicide or self-harm is a risk, ask directly if they are thinking about suicide and take appropriate action if the answer is “yes”

Nursing today brings about struggles unlike our profession has ever seen.  According to Becker’s Hospital Review, 66% of nurses are currently considering leaving the profession7.  These are staggering statistics.  Often the fight against this exodus feels hopeless, but we all must do our part to try and keep ourselves mentally healthy.  Peer support not only offers one way to help our colleagues but also provides one way we can fight back against Covid-19 and its effects on nursing.  Consider that a win-win.

References

1COVID-19 Is Officially the Worst Pandemic in US History, Surpassing the Death Toll From the 1918 Spanish Flu

2,3,4At the Heart of the Pandemic: Nursing Peer Support

5Support groups and individual mental health care via video conferencing for frontline clinicians during the COVID-19 pandemic

6American Association of Nurse Anesthesiology. (2020). Peer Support - Giving and Receiving

766% of nurses say pandemic has made them consider leaving profession

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NurseintheMtns

About NurseintheMtns

As a second-career nurse on a community medical-surgical unit, I believe in the power of this field to heal others. I hope as nurses we emerge from this pandemic with more ability to stand up for ourselves and our profession than ever before.

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I signed up for this.

I am an ER nurse.  This is an emergency.

 

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Specializes in Family and Psychiatric Nurse Practitioner.

No. Just no. 

This is an administrative answer to a deeper problem. In a sense, blame nurses for systemic issues. 

A lot of front line nurses have struggled with stressors from the pandemic, but most were struggling before from moral distress due to systemic issues that minimize the value of nurses and treat nurses like the disposable panties we hand out to the indigent. 

Will having peer support address the kinds of issues like not getting PPE for nurses? Or telling nurses to work with COVID patients wearing scarves? Or calling the Board on nurses who tried to speak out and accusing them of patient abandonment? Nurses were feeling pressure from uncaring and unsympathetic administrators AND for their respective boards who sided with administrators (all of whom were working safely from home). And even prior to the pandemic, nurses regularly face bullying from bootlickers and older nurses who seem to enjoy running off younger nurses. 

It's not the job that runs off nurses, nor the stress. Not even seeing large numbers of patients dying. It's the fact that nurses are still treated like bumwipers by hospital administrators, nurse leaders, and a lot of physicians. It's the fact that the CDC and nursing organizations signed off on making sure physicians had proper PPE but nurses had to work with scarves and low quality surgical masks, if anything. Some nurses were told they couldn't wear ANY masks. And when you spoke up, you were told that you needed to leave nursing! That you weren't committed to the job. That you were too "scared" to work in the profession. And that in a nutshell is why I stopped giving the ANA my money for membership...because where the heck where they when all this was going on? Working from home, not saying a darned thing. But this kind of bullying was commonplace even before the pandemic. Speak out, and get told you need to leave the profession. That you aren't cut out for it. Go against the grain, even if you're 100% right, and you'll get bullied right out of your job and maybe the profession. 

In a for-profit health care system, nurses are still treated like housekeeping. And sorry not sorry what I have seen from these peer groups has just been more bullying. Peers who didn't like what another nurse said would go to administration and report back, frequently getting that person fired. Or peer to peer bullying to try to shut down the other nurse's (usually legitimate) complaints. 

In a broken system that devalues nurses and their lives, what's the point of a peer system if not to stomp down the tallest poppies? Or the most vocal?

If we're really serious about stemming the loss in nursing we'd demand the systemic changes needed to make nursing a better profession to be in.  A lot of nurses got run off when they were told they had to work in unsafe conditions during the pandemic, the exact same reason PRIOR to the pandemic why many nurses left the profession. If you could make more money in a profession that valued your safety, wouldn't you leave? If your employer was telling you to unnecessarily risk your life or leave? How stupid to demand nurses work without ANY PPE in many cases early on in the pandemic! And that's not even talking about the issue of nurse safety and the regular occurrence of hospitals looking the other way when nurses are assaulted on the job by patients, family, even sometimes other staff! That was bullying plain and simple, by nurses too ignorant to understand the complexity and seriousness of not coming up with some sort of solution for the need for some sort of protection. Nurses died in this pandemic from not having PPE. But at least the administration was safe, amiright?!

Stop putting on Band-Aids and handing out "solutions" coming straight from administrators. As long as nurses face safety issues and moral distress that are the direct result of systemic problems, we'll continue to hemorrhage nurses from the profession.

You say that having a "peer" system in place is evidence-based and proven to stem the tide of nurses leaving. I'll push back on that and then some. Is it EBP, or manipulated data? Because we've had peer systems in place for over thirty years now and yet nurses are still leaving. 

Hospitals and administrators, government  agencies, and a lot of nursing organizations don't want to hear this, but it's moral distress that's the problem. And while a lot of those in power want to claim it's moral distress related to day-to-day issues that arise in nursing, let's be honest...it's moral distress issues that result directly from hospitals and a system that values profit over people. And that kind of moral distress can only be resolved by those in power, not other nurse "peers." We have to start getting honest and serious if we want to really solve the problem, and unfortunately, the problem requires a major structural overhaul of nursing and our health care system.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I agree with the above post. I guess I am sick of being held responsible for our own moral distress.  (being called "burnt out", etc). By definition, it's not our fault. It's like blaming the victim of a domestic abuse situation. It's abuse!

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Specializes in Critical Care.

I agree the massive exodus of nurses is not because of covid, but because of the greed, disrespect and unsafe working conditions hospitals and healthcare systems are forcing nurses to work in.  In fact many places decided to take advantage of nurses by forcing them to take more patients, deny time off and increase mandatory overtime, either working 16 hour shifts or demanding they pick up extra shifts.  Some systems even demanded they float to other hospitals even though they are not float staff! 

https://www.njtvonline.org/programs/amanpour-and-company/hospitals-crisis-why-nurses-are-burned-out-and-quitting-zxyf/

This video is of two nurses, an ICU nurse who quit due to unsafe working conditions and a travel nurse making bank, but not planning to work as a nurse long term due to bad working conditions.

Hospitals could fix this if they really wanted to by raising pay, hiring more nurses and support staff, but choose to do the opposite.  Many have continued to make a profit throughout covid due to bailouts by the government.  Of course, now they get their state's to give them free money to hire travelers and even call on the national guard to bail them out.   The way things are I don't think they have any plans on fixing working conditions and are simply content with the status quo of rotating new grads and relying on the govt to bail them out.  I'm sure the CEO's and C-suite are still getting their extravagant bonuses, while some places are denying raises to their own nurses and staff, let alone hazard pay throughout this pandemic.  Shame on them!

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Specializes in Critical Care.

The treatment of nurses during this pandemic echoes what happened to Amber Joy Vinson and Nina Pham who contracted Ebola when their hospital Texas Health Presbyterian left them to Google how to protect themselves and were forced to use flimsy gowns and tape to try to cover themselves.  Then they had the nerve to videotape Nina in the hospital as a cheap PR stunt.  I heard Nina filed a lawsuit against them and did receive a settlement.  I wonder how they are both doing now.  I would be surprised if either of them were still working in healthcare though.

It reminds me of the way many of us were left without adequate protection not only from our hospitals, but even the CDC and OSHA who both chose to turn a blind eye to our health and safety.  Even when nurses and doctors spoke out we were dismissed and in some cases fired for daring to speak up! 

Instead OSHA and the CDC ignored our very lives in order to give legal cover to the corporate healthcare systems.  Thousands of healthcare workers lost their lives due to inadequate PPE.  Disgraceful!

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Specializes in Family and Psychiatric Nurse Practitioner.
10 hours ago, brandy1017 said:

The treatment of nurses during this pandemic echoes what happened to Amber Joy Vinson and Nina Pham who contracted Ebola when their hospital Texas Texas Health Presbyterian left them to Google how to protect themselves...

 ...even the CDC and OSHA who both chose to turn a blind eye to our health...

Amen! And amen to SmilingBluEyes. Once again, we get blamed for the results of working in a broken system. 

It's going to take a long time for a lot of us to trust the systems in place, whether hospitals, hospital administration, the CDC, or really any governmental agency. There was plenty of time since Ebola to have systems in place to make sure nurses were adequately protected. The will simply wasn't there. It has always been cheaper for administrators to buy insufficient amounts of PPE. Admit it...and I was just talking to my mother, also a nurse, about this...how many times BEFORE COVID did your unit either run out of PPE or you'd have to steal from another unit? Our lives are expendable, and then they want to blame us when we realize this and move on to greener pastures. We "burned out." Uh, no. We found someone who'd actually respect us. It's like blaming the victim for being beaten, but then criticizing them when they leave their abuser. 

All I'll say it this... If anyone wants to know at least partly why we're bleeding nurses... Watch one of the documentaries about COVID. In particular the one where the BBC went to a hospital where the nurses were wearing Glad trash bags. Literally using trash bags like they did in Third World countries in Africa during Ebola. Even then, usually it was only in individual homes and outback areas where they had to resort to trash bags. The interviewer was flabbergasted. As in, they had never seen nurses have to resort to trash bags for PPE. And that's on the hospitals, the CDC, and the state and federal governments. Remember when the governor in Maryland had to buy PPE from overseas and then have the state police race to keep the federal government from confiscating the shipment? 

This is insanity!

But it's even more insane for fellow nurses to promote administrative self-serving business newspeak that does not address the actual problem. Stop blaming nurses for systemic moral distress. We don't need "peer groups" with Nurse Narc-y Narc tattling on other nurses. We just need someone in power to take safety seriously and to pay nurses what they are worth! 

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@hherrn @BuckeyeNP @SmilingBluEyes @brandy1017

These are all great points and I do not disagree with almost anything that anyone has said here. To be fair, I am not in administration, nor have I ever been.  I am a floor nurse who has taken care of covid patients often, and even immediately upon returning from parental leave while we knew almost nothing about this virus.  

The intention of this article is not to blame nurses, and I don't believe it says that anywhere in this. The point of this article is that as nurses, we are hurtling down a hill with no brakes, and we already had the wobbles before this pandemic even started.  Peer support at least gives us a helmet, or a seat belt, or whatever...and might help us fix the profession that most of us loved or dreamed of at ONE point.  And in case anyone missed it...what is happening in these comments IS peer support.  So it does work and is never meant to be a band aid, but one tool where we can fight with and for each other.  And that is exactly the point.  There is so much that needs to change with our profession.  Have all of you quiet your jobs?  No?  Me either...at least not yet.  I have a family to feed and a house to keep.  So let's keep supporting each other and work together to take back the profession in many of the ways you all have mentioned above.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
2 hours ago, NurseintheMtns said:

@hherrn @BuckeyeNP @SmilingBluEyes @brandy1017

These are all great points and I do not disagree with almost anything that anyone has said here. To be fair, I am not in administration, nor have I ever been.  I am a floor nurse who has taken care of covid patients often, and even immediately upon returning from parental leave while we knew almost nothing about this virus.  

The intention of this article is not to blame nurses, and I don't believe it says that anywhere in this. The point of this article is that as nurses, we are hurtling down a hill with no brakes, and we already had the wobbles before this pandemic even started.  Peer support at least gives us a helmet, or a seat belt, or whatever...and might help us fix the profession that most of us loved or dreamed of at ONE point.  And in case anyone missed it...what is happening in these comments IS peer support.  So it does work and is never meant to be a band aid, but one tool where we can fight with and for each other.  And that is exactly the point.  There is so much that needs to change with our profession.  Have all of you quiet your jobs?  No?  Me either...at least not yet.  I have a family to feed and a house to keep.  So let's keep supporting each other and work together to take back the profession in many of the ways you all have mentioned above.

Your article did not blame us and I am so sorry if I was unclear. I agree with your words. I blame administration/management/tone deaf others (entitled patients/family, et al) who offer simplistic reasons why we are "burnt out" and it tends to blame us, not the systems that make us so unhappy. I hope I am a bit  more clear.

Thank you.

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Specializes in Peds ED.
On 12/2/2021 at 11:05 AM, BuckeyeNP said:

No. Just no. 

This is an administrative answer to a deeper problem. In a sense, blame nurses for systemic issues. 

A lot of front line nurses have struggled with stressors from the pandemic, but most were struggling before from moral distress due to systemic issues that minimize the value of nurses and treat nurses like the disposable panties we hand out to the indigent. 

Will having peer support address the kinds of issues like not getting PPE for nurses? Or telling nurses to work with COVID patients wearing scarves? Or calling the Board on nurses who tried to speak out and accusing them of patient abandonment? Nurses were feeling pressure from uncaring and unsympathetic administrators AND for their respective boards who sided with administrators (all of whom were working safely from home). And even prior to the pandemic, nurses regularly face bullying from bootlickers and older nurses who seem to enjoy running off younger nurses. 

It's not the job that runs off nurses, nor the stress. Not even seeing large numbers of patients dying. It's the fact that nurses are still treated like bumwipers by hospital administrators, nurse leaders, and a lot of physicians. It's the fact that the CDC and nursing organizations signed off on making sure physicians had proper PPE but nurses had to work with scarves and low quality surgical masks, if anything. Some nurses were told they couldn't wear ANY masks. And when you spoke up, you were told that you needed to leave nursing! That you weren't committed to the job. That you were too "scared" to work in the profession. And that in a nutshell is why I stopped giving the ANA my money for membership...because where the heck where they when all this was going on? Working from home, not saying a darned thing. But this kind of bullying was commonplace even before the pandemic. Speak out, and get told you need to leave the profession. That you aren't cut out for it. Go against the grain, even if you're 100% right, and you'll get bullied right out of your job and maybe the profession. 

In a for-profit health care system, nurses are still treated like housekeeping. And sorry not sorry what I have seen from these peer groups has just been more bullying. Peers who didn't like what another nurse said would go to administration and report back, frequently getting that person fired. Or peer to peer bullying to try to shut down the other nurse's (usually legitimate) complaints. 

In a broken system that devalues nurses and their lives, what's the point of a peer system if not to stomp down the tallest poppies? Or the most vocal?

If we're really serious about stemming the loss in nursing we'd demand the systemic changes needed to make nursing a better profession to be in.  A lot of nurses got run off when they were told they had to work in unsafe conditions during the pandemic, the exact same reason PRIOR to the pandemic why many nurses left the profession. If you could make more money in a profession that valued your safety, wouldn't you leave? If your employer was telling you to unnecessarily risk your life or leave? How stupid to demand nurses work without ANY PPE in many cases early on in the pandemic! And that's not even talking about the issue of nurse safety and the regular occurrence of hospitals looking the other way when nurses are assaulted on the job by patients, family, even sometimes other staff! That was bullying plain and simple, by nurses too ignorant to understand the complexity and seriousness of not coming up with some sort of solution for the need for some sort of protection. Nurses died in this pandemic from not having PPE. But at least the administration was safe, amiright?!

Stop putting on Band-Aids and handing out "solutions" coming straight from administrators. As long as nurses face safety issues and moral distress that are the direct result of systemic problems, we'll continue to hemorrhage nurses from the profession.

You say that having a "peer" system in place is evidence-based and proven to stem the tide of nurses leaving. I'll push back on that and then some. Is it EBP, or manipulated data? Because we've had peer systems in place for over thirty years now and yet nurses are still leaving. 

Hospitals and administrators, government  agencies, and a lot of nursing organizations don't want to hear this, but it's moral distress that's the problem. And while a lot of those in power want to claim it's moral distress related to day-to-day issues that arise in nursing, let's be honest...it's moral distress issues that result directly from hospitals and a system that values profit over people. And that kind of moral distress can only be resolved by those in power, not other nurse "peers." We have to start getting honest and serious if we want to really solve the problem, and unfortunately, the problem requires a major structural overhaul of nursing and our health care system.

Yes. ? down to calling this a bandaid to a systemic issue. These studies were also all conducted in 2020. We’ve since had another full year of the same or worsening conditions.

The support and friendships I have at work are definitely beneficial to me but that benefit has waned significantly as the pandemic has dragged in. What has helped my coping ability was dropping my FTE from 1.0 to 0.75. I am still working close to 1.0 with mandatory overtime requirements to stay- I have had frequent weeks where I am mandated every shift I work and it’s becoming more frequent for staff to refuse mandation. My hospital has over 400 vacant RN postings and my hospital and others in the region were recently featured in the NYTimes for our staffing crises. 

How is the identified compassionate nurse supposed to cope with the additional responsibilities of being a peer counselor? How are psychiatrists and psych residents supposed to find time for peer groups when our EDs are already boarding a high load of psych holds waiting for placement for over a week? How are we supposed to resist making 4 times as much in travel assignments to stay in our communities? 

Our ED wait times are 4-6 times what they typically are during our busiest months. We’ve stopped elective surgeries and have reduced available beds in the hospital which means the ED is 50-75% full of boarders. 

This is not a personal resiliency problem and coping mechanisms and peer support groups are yet another shifting of responsibility for a societal issue to already tapped out individuals. I’m a huge believer in the benefits of therapy but self care is increasingly going to look like reducing hours and leaving the profession.
 

 

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Specializes in Peds ED.
On 12/3/2021 at 3:26 PM, NurseintheMtns said:

@hherrn @BuckeyeNP @SmilingBluEyes @brandy1017

These are all great points and I do not disagree with almost anything that anyone has said here. To be fair, I am not in administration, nor have I ever been.  I am a floor nurse who has taken care of covid patients often, and even immediately upon returning from parental leave while we knew almost nothing about this virus.  

The intention of this article is not to blame nurses, and I don't believe it says that anywhere in this. The point of this article is that as nurses, we are hurtling down a hill with no brakes, and we already had the wobbles before this pandemic even started.  Peer support at least gives us a helmet, or a seat belt, or whatever...and might help us fix the profession that most of us loved or dreamed of at ONE point.  And in case anyone missed it...what is happening in these comments IS peer support.  So it does work and is never meant to be a band aid, but one tool where we can fight with and for each other.  And that is exactly the point.  There is so much that needs to change with our profession.  Have all of you quiet your jobs?  No?  Me either...at least not yet.  I have a family to feed and a house to keep.  So let's keep supporting each other and work together to take back the profession in many of the ways you all have mentioned above.

Rather than peer groups we should be organizing. Unionizing where we’re not unionized and making the unions more active where we are. Working together as a group is how we change systems. 

The language of self care and coping mechanisms is implicitly individualizing. You didn’t say “individual nurses are to blame” but you highlighted the importance of self care and coping which is just as much a shift of responsibility. This isn’t your fault- self care and coping mechanisms have been heavily sold to us by entities that benefit from individualizing societal problems rather than making systemic changes. We don’t need help coping we need to band together to demand systemic changes.

Peer support is a helmet/seatbelt that we’re responsible for designing, manufacturing, distributing for free while trying to keep the car hurtling down the hill under control.
 

 

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I'm sorry this is happening to y'all. I am witnessing hospital infrastructure collapse and the government is not taking it serious at all. 

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