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Nurses have been “forever altered” by what they have seen and experienced during the coronavirus pandemic, the authors of a new study have warned.
The research involved in-depth interviews with 27 nurses in the UK about the impact of the pandemic on their mental health and wellbeing, and found that many were considering quitting the profession.
“I think there’s an attitude in the NHS that you have to be strong and not show weakness”
Sarah, interviewee
Of the participants, 19 were redeployed during the first wave of the pandemic either to an intensive care unit (ICU) or other Covid-19 “hotspot” area.
The majority of those who were redeployed felt unprepared due to a lack of training to take on their new roles.
The researchers said nurses found it difficult to raise concerns because these “seemed to fall on deaf ears or marked them out as a troublemaker”.
The high numbers of patient deaths were described as “traumatizing” for the nurses who were not used to working in environments where death was common.
One nurse, Laura, who was redeployed to ICU, said: “Three of my patients died [in one night]and one of them was younger than my mum and only eight years older than me, it was just horrible.
“And you go back the next day and you’re just like, ‘What fresh hell am I in for now?'”
The findings, published in International Journal of Nursing Studiesare part of the ongoing Impact of Covid on Nurses (ICON) longitudinal study by the University of Surrey.
The researchers said many nurses reported that intense workplace pressures meant they could not deliver their normal high standards of care, which caused them “moral distress”.
Staff shortages also added “extra pressures”, with one nurse in ICU having four intubated patients to care for on her own where the standards say she should have only had one.
The study participants also reported “challenges and frustrations” in relation to obtaining personal protective equipment (PPE).
The community nurses interviewed expressed “upset” that acute services appeared to be prioritized for resources such as PPE.
One community nurse, Sue, said: “What little PPE they had all it all went to the acute trust, not us.”
The majority of the nurses in the study reported experiencing “short-term physical symptoms of stress” such as sleep problems, higher rates of alcohol consumption and eating more unhealthily.
There was also evidence of compassion fatigue, burnout and post-traumatic stress disorder among the participants, said the reseachers.
Some nurses went into “survival mode” or “autopilot” to make it through this period.
“We have a duty as a society to take care of frontline staff who experienced such extreme psychological and emotional distress during this pandemic”
Jill Maben
All participants said they sometimes felt unable to talk about their experiences with partners, families or friends because they did not want to worry or trouble them.
Mental health nurse Alison said: “I didn’t tell them for about the first six weeks I was working on a Covid-19 ward, which is terrible, but I chose not to… I thought it would make them feel much more anxious. ”
The support interventions implemented by employers, such as ‘wobbles rooms’ or counseling sessions, were “mostly unused due to barriers such as time constraints” and the desire from some nurses to forget about the trauma of work while not on duty, according to the study.
The researchers found that “stigma” may also have been a factor in some not accessing counseling during the first wave of the pandemic.
Sarah, who was redeployed to the ICU, said: “[Counselling is] just like almost a sign of weakness I feel.
“I think there’s an attitude in the NHS that you have to be strong and not show weakness and not many people show that much emotion.”
The study saw 27 nurses interviewed after the first wave of Covid-19 in July 2020, and 25 of them were then interviewed again at the beginning of the second wave in December 2020.
Only two nurses at the first interviews had accessed counseling support. By the second interviews, “many more” had sought counseling although this was “predominantly” through sources outside of their workplaces.
In contrast, the peer support nurses were able to give to and receive from colleagues was described by most as “the main positive aspect of the pandemic” and created a sense of “camaraderie”.
The researchers concluded: “Nurses reported being deeply affected by what they have seen and experienced and being forever altered.
“It is clear that for these nurses, the impact of Covid-19 is felt at a deeply personal level and may persist.”
They said there was an “urgent need to tackle stigma to create a psychologically safe working environment” for nurses and called for the development of a national Covid-19 nursing workforce recovery strategy.
Jill Maben
Professor Jill Maben, professor of health services research and nursing at the University of Surrey, and one of the study authors, said: “We have a duty as a society to take care of frontline staff who experienced such extreme psychological and emotional distress during this pandemic.
“To prevent a mass exodus of our nursing and midwifery workforce, it is important that they are offered the care and support that they need.”
Her calls to action match those of Nursing Times’ ongoing Covid-19: Are You OK? campaign, which is raising awareness of the mental health needs of nurses before, during and after the pandemic.
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