A nursing perspective

The experiences of nurses working with respiratory patients during the pandemic.

This has been a very hard year for everyone, I, together with colleagues wanted to highlight the experiences of nurses working on the frontline with respiratory patients during the pandemic.   As part of our Academic Respiratory Researchers Alliance (ARRA) (this link will take you away from our website) and with colleagues from Glasgow Caledonian University we have surveyed nurses to document their experiences during the first pandemic wave last May.     A recent mental health survey of nurses during the pandemic [1] found that over 80% experienced increased levels of stress and another nursing survey showed nurses describing their mental health as bad or very bad during the pandemic [2].

The public’s perception has changed over the last 15 months or so with highs and lows of handclapping in appreciation for healthcare workers but also disbelief that COVID exists for some.   I think it is important to highlight what the experiences have been like from a nurse’s perspective.

We have shown that around 20% of those surveyed (n=255) experienced moderate to severe anxiety (20.9%) or moderate to severe depression (17.2%), this was more prevalent in younger nurses with less nursing experience [3]. 11.4% were unable to support or had difficulty supporting their household in terms of providing food, heat and emotional support.  A lot of healthcare staff changed jobs, took on extra hours and in some cases moved out of the family home to protect loved ones.  Concerns raised included worrying about their family – “My children are consistently worried and unsure with what I do in my job role.” As well as the issues around the provision and quality of personal protective equipment (PE) – “My worries are not being protected enough because of inadequate PPE.” 

Participants also highlighted concerns about each other:

 “I think the long hours and the extensive use of PPE is exhausting, not only are we nursing these people but fundamentally becoming their family, often the last people to see them alive, we know that many won’t survive despite best efforts. The odds are against us and I worry that in many it will lead to some form of post-traumatic stress disorder PTSD”

For those that changed job or came back from retirement or non-clinical roles there were feelings of inadequacy and a lack of time to get up to speed with the changes in care.  Or for those switching to delivering care in a new way over the phone, or video calling a feeling of just having to get on with things without adequate training or support.  Our survey over winter which we are analysing just now, highlights concerns on whether care is delivered as effectively as before the pandemic, and negative and positive experiences from patients which range from verbal abuse and threats to gratitude from family members unable to see loved ones.

As we return to normal it is important that we don’t forget the sacrifices that nurses and all healthcare staff have made, the long term mental health effects of this will be huge. We need to support younger nurses to stay in nursing, a large proportion of the workforce is near retirement age, ironically those who may have been more resilient during the worst of the pandemic.  Other studies, including our winter survey show, that around 25% nurses have considered leaving nursing – that would be catastrophic [4].    Tailored mental health support is needed for all staff and should be particularly aimed at those at higher risk of experiencing mental health issues.  A multi-pronged approach is needed to support staff at an individual, team, departmental and organisation level to ensure all staff feel supported and resilience and well-being is enhanced for the future.

References

1           Ford S. Exclusive: Nursing Times survey reveals negative impact of Covid-19 on nurse mental health | Nursing Times. Nurs. Times. 2020.https://www.nursingtimes.net/news/mental-health/exclusive-survey-reveals-negative-impact-of-covid-19-on-nurse-mental-health-29-04-2020/ (this link will take you away from our website) (accessed 14 Jan 2021).

2           Exclusive: Nursing Times survey reveals negative impact of Covid-19 on nurse mental health | Nursing Times. https://www.nursingtimes.net/news/mental-health/exclusive-survey-reveals-negative-impact-of-covid-19-on-nurse-mental-health-29-04-2020 (this link will take you away from our website)/ (accessed 1 Jul 2020).

3           Roberts NJ, McAloney-Kocaman K, Lippiett K, et al. Levels of resilience, anxiety and depression and in nurses working in respiratory clinical areas during the COVID pandemic. Respir Med 2020;176:106219. doi:10.1016/j.rmed.2020.106219

4           BTS. Future of lung disease care at risk due to workforce shortages and backlog from COVID-19 |. Br. Thorac. Soc. 2021.https://www.brit-thoracic.org.uk/about-us/news/2021/future-of-lung-disease-care-at-risk-due-to-workforce-shortages-and-backlog-from-covid-19/ (this link will take you away from our website) (accessed 14 Jun 2021).

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