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COVID-19 AND NURSES’ MENTAL HEALTH

COVID-19 and Nurses’ Mental Health: Recognizing the Damage and Searching for Solutions

Skylar C. Russell

Florida State University, ENC 2135, Project 1 Investigative Field Essay

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In 2020 the world was forever changed by COVID-19. This global pandemic came along

with significant challenges for everyone, especially those in healthcare professions. It has been

argued that perhaps the most negatively impacted were nurses working in the COVID-19

intensive care units. These brave people had to face the worst of what the virus had to offer on a

daily basis. They not only had to quickly learn to cope with huge changes to their workplace and

procedure but also a mass influx of suffering they were surrounded by. Not to mention changes

to their personal lives, and a much higher strain on both the physical and emotional demands of

their work. The purpose of this paper is to explore the impact that the pandemic had on nurses

working closely with COVID-19 patients and their mental health, including the recognition of

damage and the search for solutions. This essay will examine the current discourse about this

problem and provide insight into how hospitals may better prepare and care for their nurses and

other staff.

In regard to the global community, the COVID-19 pandemic has had a wide range of

impacts that left practically no one unmarred. According to the World Health Organization

(WHO) (2022), as of May 4, 2022, there were nearly 512 million COVID-19 cases and

approximately 6.2 million deaths worldwide, with approximately 341 thousand new cases

reported daily. In April 2020, there were 1.72 million confirmed COVID-19 infections and

104,889 deaths worldwide (Covid-19: Supporting Nurses' Psychological and mental health,

2020). These staggering statistics are evidence of how quickly COVID-19 grew to become a very

prominent issue at the forefront of the world's attention. Not only has the pandemic undeniably

caused massive upheaval and suffering in the personal lives of many people globally, but it has

also impacted the world in more widely recognizable ways, like public health standards, and
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huge impacts on the global economy. It's fair to say that the pandemic robbed many of any

stability they may have found comfort in. Because of COVID-19 many lost their jobs and fell

into financial instability. People were forced to stay home for months which brought about

copious mental health crises. In addition to its impact on the larger scale community, COVID-19

also specifically had a disproportionate impact on marginalized communities such as essential

workers, people of color, and those living in poverty. This broader context and perspective of the

pandemic is critical to consider when narrowing the lens down to a specific group, such as

nurses. It also provides valuable insight into the systems that need to change to work towards

building a healthier future where the consequences of the pandemic are less likely to be repeated.

Nurses were already a high-risk group when it comes to mental health and well-being.

Even years before the pandemic took hold of their profession the suicide rate among nurses was

23% higher than the national average (ONS, 2017). This tragic statistic should sound like a call

to action to any reasonable person. Nurses' jobs are one of the most strenuous and taxing in the

world, it is clear to see how serious the mental health crisis is within the profession. However,

despite the indisputably distressing facts, nurses report that when raising concerns about their

mental well-being to employers, they often feel ignored (Mitchell, 2019). When taking into

account the gravity of the situation already, one can imagine how adding the pandemic to the mix

truly caused a crisis for nurses. In addition to their already intense and stressful jobs, nurses now

had to deal with even less staff, more patients, new regulations, and a huge lack of information

on what it was they were dealing with. The COVID-19 pandemic hit hospitals hard, causing

shortages in many invaluable tools like PPE (Personal Protective Equipment) which was

necessary for healthcare workers to interact with patients without risking exposure and infection.

Nurses and other hospital staff were forced to go weeks, even sometimes months, without seeing
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their families or even leaving the hospital for extended periods of time. In these ways, a job that

already was known as time and life-consuming truly became people's lives. Nurses were

constantly fed tragedy, coming face to face with the worst of the pandemic, the virus overtook

their jobs, their families, their time, and their perspectives. Considering this, it is beyond feasible

that many nurses fell into mental and physical disarray. A first-hand account from Sydni Lane, a

nurse working in the United States throughout the coronavirus pandemic, showcases just how

broken-down nurses became. Lane shared her experience through her social media account,

posting, "I broke down and cried today. I cried of exhaustion, of defeat. Because after 4 years of

being an ER nurse, I suddenly feel like I know nothing" (Fick, 2020). Lane's statement, along

with other heart-wrenching first-hand accounts from nurses working through the coronavirus

truly leave very little question as to whether or not nurses' mental health was being impacted.

Many investigations conducted throughout the pandemic also serve to demonstrate that there

were multiple factors contributing to nurses' poor health. One source lists excessive work hours,

depletion of Personal Protective Equipment, over-enthusiastic media, lack of specific drugs, and

the infection rate among medical staff as some of the factors that left nurses feeling insufficiently

supported, leading to adverse mental and physical health consequences (Lai et al., 2020;

Spoorthy et al., 2020). Studies on healthcare workers during the pandemic shows that nurses

have some of the highest prevalence of anxiety and depressive symptoms out of those working in

medical professions. In a pool of just 223 nurses, the prevalence of anxiety and depressive

symptoms were 40.8% and 26.4% respectively (Xiong et al., 2020). Data from these studies also

exposes a concerning pattern, that all healthcare workers have a high risk of poor mental health.

One of these studies utilized questionnaires on a pool of 1,257 healthcare workers to test for

multiple forms of mental strain. The results were that 50.4% of the healthcare workers suffered
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from depression, 44.6% from anxiety, 34.0% from insomnia, and 71.5% from distress (Spoorthy

et al., 2020). These numbers represent the depleted mental health of people working in medical

professions across the board. While it does showcase that the issue exists, the perhaps even more

disturbing data shows the incidences where bad mental health became physically dangerous for

these medical professionals. Among 994 healthcare workers, 36.9% had subthreshold mental

health disturbances, 34.4% had mild disturbances, 22.4% had moderate disturbances, and 6.2%

had severe disturbances (Kang et al., 2020). While it is upsetting that this group has such obvious

trouble with mental health it is unfortunately not surprising. Nursing is well-known to be one of

the most taxing professions in the world. Nurses are at the bedsides of patients constantly, 24

hours a day, seven days a week, and have the highest levels of occupational stress and resulting

distress compared with other groups during similar outbreaks (Cheong & Lee, 2004; Maunder et

al., 2006; Nickell et al., 2004). Their profession is by far one of the most understaffed,

overworked, and stressful. There is, however, some hope. Nurses have begun to band together

and support each other in place of the lack of that support from their employers. One UK ICU

nurse named Shirley Watts, went on BBC News to call out the crisis and lend comforting words

to other nurses. Watts summed up her experience, relating to those of other nurses as well,

stating, "We're on our knees here, and it's really difficult and we're all trying the best we can…

we feel like we could be doing more, and I know we can't… we're putting ourselves in danger to

try to save other people's loved ones, it feels like a losing battle but it's not, we've all got hope

and we're all trying to do what we can" (Covid-19: supporting nurses' psychological and mental

health). This showcases one way that nurses are coping with the crisis at hand.

But what about their employers? In order for positive change to take place, workplaces

and employers need to make changes and stand up for their staff. In response to the pandemic
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and its widespread impact on people in the nursing profession, hospitals have implemented a

variety of systems and options for nurses to take part in to improve their health both mentally

and physically. Hospitals have begun to realize how critical mental health care is for nurses,

especially those who were working in COVID ICUs at peak pandemic and may still be

experiencing residual trauma. One nationwide qualitative study explored various coping

mechanisms employed by nurses such as distraction techniques and increasing social support, in

order to better manage their mental health, specifically in regard to the pandemic (Nurses' mental

health and coping strategies throughout COVID-19 outbreak: A nationwide qualitative).

One example of an effective solution is group-based acceptance and commitment therapy

(ACT). This method was tested on nurses during the COVID-19 pandemic and was found to be

effective in helping those reliving trauma (Nurse' mental health and coping strategies throughout

COVID-19 outbreak: A nationwide qualitative study). On the other side of the range of possible

solutions, studies have shown that regular physical activity and exercise have a multitude of

positive effects on symptoms of anxiety and depression. Proving it is somewhat successful as a

method of prevention and treatment (Maroufi, 2021). Considering the data supporting the need

for change, there is a global understanding of the fact that there is an obvious need for mental

health support for nurses. However, while many agree that it is necessary, there are still differing

viewpoints on the best way for hospitals and employers to provide it. One popular viewpoint is

that it is more helpful to wait for nurses to seek help on their own terms, while the opposing view

argues that the better answer is to provide required in-office care (Nurses' mental health and

COVID-19 pandemic: Is there any approach?). In addition to these tested solutions, more simple

and obvious things have been shown to contribute to an overall healthier workforce. Examples

include effective communication from leadership and more ready access to tools necessary for
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nurses' safety and work. These things are shown to improve the standing of nurses' mental health,

moral distress, and longer-term mental health (Hospital nurses' moral distress and mental health

during COVID-19). Overall, the quality of care provided by nurses and their performance in their

daily tasks and life as a whole are greatly impacted by their mental health. Therefore, it would be

in employers' best interest to explore the options when it comes to improving mental health care

and do all they can to support their nurses.

In conclusion, the coronavirus pandemic had a huge impact on the mental health of the

global community as a whole. However, certain groups, such as nurses, were impacted more

noticeably in both their professional and their personal lives. So, how can we recognize and

address the mental health challenges facing nurses during the COVID-19 pandemic? The

COVID-19 pandemic not only brought about more issues and stress for nurses and healthcare

professionals but also shed light on the already existing flaws within their employment systems,

such as a gross lack of support from employers. Nurses were forced to deal with being

understaffed, overworked, exposed to massive tragedy and fear, and expected to be on their feet

24/7, in what was already a high-stress environment. These things considered, in addition to the

lack of proper equipment, tools, and knowledge, and the implementation of foreign procedures

and new systems, it is not surprising that the already present mental health issues in the

profession became increasingly concerning. So, clearly, the issue at hand is multifaceted and

complicated, but there are solutions. Tested solutions include ACT, also known as Acceptance

and commitment therapy, physical activity, and optional or required in-office mental health

resources. Overall, supporting nurses is crucial to their performance in the workplace, which in

many cases determines the life or death of patients. The COVID-19 pandemic made it very
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difficult for nurses to work and live their everyday lives, increasing stress and depression and

causing lasting trauma. Therefore, employers may want to be more supportive of nurses and look

into solutions for mental health issues in order to move towards a brighter and more healthy

future.