Several urgent issues only seem to make the situation worse. Nurses in all practice areas are concerned by shortages of protective personal equipment (PPE), especially since resources are so limited. Ethical dilemmas occur when healthcare teams must triage care based on survivability. Public opinions on and adherence to social distancing, mask wearing, and quarantining spark fear and stress in many.
Compared to other medical disciplines, nurses spend more time with patients providing face-to-face care. As such, nurses are more exposed to the suffering of others, and they are at higher risk for disease transmission. It is the duty of nursing leadership to advocate for clinical nurses by helping develop and implement institutional policy recommendations which may be used in this and future healthcare crises.
Common concerns among nurses
Because of Covid-19, the nursing practice environment has quickly changed from the status quo. Nurses report a variety of concerns, including:
- Longer working hours and greater patient loads
- Fear of infection, including bringing the virus home to loved ones
- Forced isolation to prevent the spread of Covid-19 to others
- Threats to livelihood as some nursing positions are furloughed or even eliminated
- Risk of redeployment to unfamiliar practice areas
- A steep learning curve in relation to technology related to telehealth
- The unknown aspects of disease transmission and pathophysiology which prevents the dissemination of clear, transparent information
As a result, more nurses than ever are experiencing burnout and moral distress. The World Health Organization defines burnout as feelings of exhaustion or energy depletion which reduces professional efficacy and results in increased mental distance from one’s job duties.
Additionally, many nurses struggle to balance their own health and the health of their families with that of their patients. This is especially true because of the lack of PPE, and some may feel as if they cannot voice their concerns because of the risk of retaliation. Other nurses are disturbed by the shift away from a patient-centered ethical framework to one which instead prioritizes triage and resource allocation to those who are most likely to benefit.
These concerns, coupled with feelings of exhaustion, may lead to moral distress, which may be defined as knowing the right thing to do but not being able to act toward it. Moral distress may be a significant factor in burnout and may even threaten the stability of the nursing workforce.
Recommendations for nurse leaders
While the National Academy of Medicine has already recommended strategies to support providers’ health and well-being, the same cannot be said for nurses. However, the authors of an article in Nursing Management have taken these strategies and adapted them to better support the entire nursing workforce. Their recommendations include:
- Create a Covid-19 task force with a strong nursing presence – Including nurses on Covid-19 task forces ensures that other members are aware of the unique challenges nurses face. Then, the task force can develop methods to better support front-line clinicians and address concerns such as PPE rationing and disinfection protocols.
- Become more accessible – Nurse leadership should round regularly on all units to meet with nurses caring for Covid-19 patients. This helps nurse leaders better understand barriers and facilitators to best practices, as well as building trust and engagement within the organization.
- Redeploy clinical staff where appropriate – Thanks to the pandemic, many elective surgical procedures have been postponed or cancelled. It may be possible to redeploy RNs from areas such as the operating room to Covid-19 units to help nurses there. Redeployed nurses may provide basic care, cover shift breaks, dispense medication, and take vital signs. This strategy may help relieve and refresh overburdened RNs.
- Make communication transparent – Infection control personnel should be in frequent, direct contact with nursing staff regarding PPE, virus transmission, and best practices for mitigating risk. Communicating directly with nurses helps promote transparency and can alleviate fear.
- Strategically advocate for well-being – Many nurses experience anxiety, fear, and grief while caring for Covid-19 patients. As such, healthcare organizations should make mental health services readily available to all staff. Additionally, ethics consultants and open forums may help nurses work through ethical challenges to lessen the burden associated with difficult decisions.
The Covid-19 pandemic shows no signs of stopping soon. Nurse leaders must take steps to help promote the health and well-being of clinical nurses in all practice areas, but especially for those taking care of Covid-19 patients. Doing so can help reduce feelings of burnout and moral distress, which promotes better patient care from a more engaged workforce.
Lippincott Solutions note: for the latest coverage on Covid-19 by the Lippincott Nursing team, please visit nursingcenter.com/coronavirus.