The safety and mental health needs of nurses working during the coronavirus pandemic must be placed as a top priority to avoid a post-crisis exodus of traumatised staff, researchers have warned.
The Covid-19 crisis is piling additional and unprecedented pressure on a nursing workforce who were already under considerable strain due staff shortages among other issues.
Leading professors from the University of Surrey and University of Southampton have today released new evidence-based guidance on supporting nurses’ psychological wellbeing during the crisis and after.
In it, they noted how in previous infectious disease epidemics, nurses reported the highest levels of occupational stress compared to other professional groups.
They said they feared that, without action to protect staff involved in the coronavirus pandemic, a “generation of burnt out nurses” could be left in its wake.
Failure to provide adequate protection could also drive nurses out of the profession when the crisis was dealt with, further exacerbating workforce shortage, they added.
It comes after Nursing Times launched a new campaign – Covid-19: Are You Ok? – to highlight the mental health needs of nurses working during the pandemic, and to lobby for immediate and long-lasting support for them.
The new guidance, published in the Journal of Clinical Nursing, identified a number of additional “stressors” facing nurses on the frontline of Covid-19 that could threaten their wellbeing.
These included unprecedented patient numbers and acuity, issues around access to personal protective equipment (PPE), concerns about personal and family health, and ethical and moral conflict.
The guidance stated that nurses must make sure to prioritise their own wellbeing and safety, including by paying attention to the basics of food, drink, rest and sleep.
Beyond this, peer support was highlighted in the guidance as being crucial, which noted how akin to the armed forces, healthcare work was “team driven”.
Among a profession “wired to look after others”, staff may need to be nudged by colleagues about the importance of thinking about their own needs too, said the document.
The guidance recommended a “buddying up” system to help new or temporary team members feel safe, valued and welcome as quickly as possible.
Teams should also dedicate time to communicate and check-in on each other’s wellbeing, such as through mid- or post-shift cluster meetings.
Meanwhile, the guidance called for a review of staff break areas across workplaces to ensure they were available and suitably welcoming and comforting.
Strong and supportive leadership would also be crucial, said the document, noting that there was “much” leaders and managers could do to support nurses in their teams and organisations.
Clear regular and honest communication was “key”, as well as visibility and ensuring the safety needs of their staff were being met, it stated.
At the same time, senior nurses must seek support for themselves to ensure they had the capacity to help others and “are able to role model good self-care”.
At a higher level, organisations and government must also fulfil their duty to protect nurses both emotionally and physically.
The guidance highlighted concerns from nurses and unions over problems around staff Covid-19 testing and PPE that has been raised consistently throughout the crisis.
It warned that failure to protect nurses who were putting their lives on the frontline to help others could result in resignations once the crisis over.
“A failure to protect nursing staff adequately is causing anger and frustration, making nurses feel unsafe at work, while they are risking their own health and fearful of transmission to their families,” stated the guidance.
“Unless nurses feel well-supported by their organisations and governments, that anger may linger after the crisis potentially causing some to leave the profession.”
Crucially, the guidance stressed the importance of understanding the psychological needs of nurses “following the height of the pandemic”.
Staff should be offered the opportunity to attend therapies and reflective groups, meanwhile funding should be set aside to treat those who may suffer post-traumatic stress disorder (PTSD).
“Post pandemic, or in the tail of the acute phase, staff may be ‘running on empty’ some may have unresolved grief, if staff colleagues have died or family members (and there has been no time to grieve), and some may have burnout or possibly retrospective guilt,” it said.
However, the timing of the more intensive “de-briefing” must be carefully considered, as undertaking it too early could “disrupt an individual’s normal coping mechanism” to the pandemic, warned the guidance.
While resilience would naturally play a part in nurses’ response to the crisis, the focus should be on team and organisational resilience, rather than expecting individuals to take whatever was thrown their way, it added.
Ultimately, the pandemic was a chance to push the wellbeing of nurses higher up the agenda beyond Covid-19 and “fully recognise the inherent stresses and emotional strain that nurses bear on behalf of society”.
“While Covid-19 places particularly high stress on nursing, there is very little in the guidance presented here that was not relevant to staff wellbeing ‘pre-Covid’ and when the pandemic is over, we look forward to the guidelines being used to establish better support for nurses and nursing into the future,” concluded the guidance.
Co-author of the guidance, Jill Maben, professor of health services research and nursing at the University of Surrey, said: “Nurses are on the frontline of care delivery, experiencing intense emotional, social and ethical difficulties as they rise to the challenge of caring for patients in such unprecedented times.
“If we are to avoid a generation of burnt out nurses, their physiological, psychological and safety needs must be prioritised.”
Having researched nurse psychological and mental health for more than two decades, Professor Maben described the Covid-19 pandemic as “the most critical time in my career for nurses’ wellbeing worldwide”.
“Our evidence informed guidance highlights the vital role of peer and team support and the role of leaders and managers in ensuring nursing staff have the support they need; making themselves visible and listening to concerns of their staff, letting them know that their opinion matters,” she added.
“This is vitally important across all health and social care settings. If nursing staff are not supported during this time, there is the danger that once this is all over they will leave the profession, which will put enormous strain on an already over stretched health service”.
Meanwhile, guidance co-author Jackie Bridges, professor of older people’s care at the University of Southampton, said: “When we’re caught up in trying to manage a crisis like Covid-19, it can be easy to be distracted from the price that is paid by nurses providing patient care.
“By making sure staff wellbeing is a priority and putting active measures in place to support nursing staff, employers in all relevant health and social care settings can reduce staff stress and distress and help ward off the development of longer-term mental health problems. Our guidance sets out practical, evidence-based ways to do this.”
The authors said the guidance was based on the best available evidence, underpinned by theory, expert opinion, and models used in the military, as well as experiences from other countries and other infectious disease outbreaks.
by Gemma Mitchell
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