Nurse Burnout: The Next COVID-19 Crisis?

Sept. 15, 2020

UArizona Wildcat Nurses Seek Ways to Mitigate Nurse Burnout During COVID-19 Pandemic

Even before the COVID-19 pandemic started its devastating roll across the country, the health care work environment was experiencing challenges – especially for nurses. According to University of Arizona College of Nursing Assistant Professor Jessica Rainbow, PhD, RN, and UArizona Nursing PhD candidate Chloe Littzen, MSN, RN, AE-C, PhD Candidate, the pandemic has only intensified a problem that many people outside the healthcare industry aren’t even aware of: nurse burnout.

Prior to the pandemic, nurses who experienced burnout were leaving the workforce at an exponential rate. Coinciding with this, nurses were placed at a higher risk for the negative consequences of suicide and poor mental and physical health issues. This exodus has put added pressure on the already existing nurse shortage, which in turn has already negatively impacted quality of patient care. A lack of enough nurses in the workforce has forced nurses to work more shifts and longer hours, further placing them at risk for experiencing burnout and suboptimal well-being.

Jessica Rainbow, PhD, RN, Chloe Littzen, MSN, RN, AE-C, PhD Candidate

Adding fuel to this fire, the COVID-19 pandemic has exacerbated these issues. “Before the COVID-19 pandemic, the suffering of nurses from suboptimal well-being and burnout was normalized in healthcare,” adds Littzen. “According to Arundhati Roy, COVID-19 is a portal, and we have the choice to decide what we leave behind. Now is the time we acknowledge that the normalization of suffering in nurses is unacceptable, and together we need to create work environments that enable all nurses to thrive in the new post-pandemic world.”

Dr. Rainbow and Littzen are both conducting IRB-approved research studies that will describe the experiences of our frontline nurses prior to, and during, the COVID-19 pandemic. Dr. Rainbow’s study is utilizing a voicemail box to collect recordings of the experiences of nurses and others working in healthcare during the pandemic. Anyone working in a healthcare setting in the United States during the pandemic is eligible to call the study voicemail box (1 833 624 0707) and leave a message detailing their experiences. Dr. Rainbow describes the inspiration for her study as, “Listening to nurses and other providers  talk about working during COVID-19 made me interested in capturing recordings of these experiences to figure out how we can intervene to improve the healthcare work environment and also to catalogue this time in our history.” Participants can access the consent form with study information online or contact Dr. Rainbow for more information.

"Now is the time we acknowledge that the normalization of suffering in nurses is unacceptable, and together we need to create work environments that enable all nurses to thrive in the new post-pandemic world," ~ Chloe Littzen, MSN, RN, AE-C, PhD Candidate

Littzen is doing this in her dissertation study titled, “Young Adult Nurse Work-Related Well-Being, Contemporary Practice Worldview, Resilience, and Co-Worker Support,” where she inquired about the role of COVID-19 in nurses work-related well-being. 

Littzen and Dr. Rainbow both plan to use their study findings to guide future interventions that will improve the healthcare work environment and nurse well-being. Dr. Rainbow says. “My goals in creating this study were to understand the different experiences of different healthcare providers and those working in healthcare settings during the pandemic. This will help us improve readiness for future pandemics and build interventions to improve the healthcare work environment.”  In the meantime, they reached out to nurses and other health care workers with a series of questions designed to garner their feelings about such subjects as how leadership can help nurses during this time, as well as how the public can improve the situation. “I kept getting asked by my non-healthcare friends how they can support nurses and other providers during the pandemic and what nurses are doing to cope during this difficult time, so I thought it was important to ask nurses and share that information,” Dr. Rainbow said. Littzen and Dr. Rainbow asked nurses on social media what they would like the public and healthcare leaders to know as well as how nurses are coping with the increased stress of working during a pandemic. Here is how nurses responded:

Following is a breakdown of the results that were garnered from the informal Twitter survey, as well as contact information for nurses seeking more information and support.

  • The pandemic is on the verge of breaking the nursing workforce, and to a larger extent, healthcare at large.

    The COVID-19 pandemic has strapped healthcare organizations for resources, both tangibly and financial. Nurses feel the squeeze of this lack of resources, and they are doing their best to make sure patients do not suffer. But this can only last for so long, and nurses will ultimately reach a breaking point. They will either leave their jobs once hiring freezes end or they can travel, or leave nursing altogether. Prior to COVID, the turnover rate among nurses was 15.9% in the United States.

For a snapshot of breaking point, Dr. Rainbow and Littzen asked in their informal Twitter survey, “Have you thought about leaving your job, or nursing completely during the pandemic?” Of the 44 participants, 39% selected “leaving my job” 18% selected “leaving nursing,” with only 43% selecting “neither.” Only time can tell if and when this comes to fruition, but 57% of respondents are demonstrating this breaking point.

  • What can nursing leadership do to support their nurses during the pandemic?

    Nurses know that leadership is maxed out, but they do not feel as if leadership is being honest with them. 

    Expressing concerns about nursing leadership, one participant stated:

    They need to be honest... If there is a shortage of PPE, be honest about it, don't try to make us believe using the same N95 for days is "safe"... needless to say, trust has plummeted (sic).”

    In the Twitter survey, nurses also expressed concern about the post-traumatic effects from the pandemic that are on the horizon for them.

    One nurse stated:

    A greater recognition of the effects that bearing witness to such extensive death and loss will have on providers in the coming days... I see so much PTSD in the near future.

    While data is lacking on the occurrence of post-traumatic stress related to the pandemic, leadership needs to proactively prepare for the potential of post-traumatic stress for their frontline nurses.

    One nurse described this experience to nursing leadership, and offered some suggestions to help frontline nurses:

    The worry from working directly with Covid patients can be overwhelming sometimes. Worry about taking it home to family. Worrying about family who lost jobs or gotten sick. Wondering how long these altered work environments will keep up. I think what so many people want right now is to feel safe and valued and heard in some way. We don’t want to be in the dark about decisions that will impact us. I think team of social workers and chaplains should be employed to support staff around the hospital on every shift.”

  • How can the public help support nurses during the pandemic?

    Nurses want the public to understand that they are doing everything they can to help their patients and families. But they are tired, and their bandwidth is maxed out.

    In describing her experience being a frontline nurse, one participant stated:

    We’re tired. Frustrated and over begging people to do the right thing. We’re doing the best we can, one second we’re heroes, the next villains for asking people to wear a mask. But we continue to fight. Because mask or no mask we will care for those in their sickest hour

    Nurses want the public to remember that nurses are human too. They have children, and some have multiple jobs. Nurses need the public to be more understanding of who they are as humans, and grant them flexibility, grace, and forgiveness when things don’t go as planned.

  • What have nurses been doing to help their well-being and burnout during the pandemic?

    Nurses have been trying out a variety of creative self-care strategies to help enhance their well-being and prevent burnout during the pandemic. Many of these strategies are mind-body focused activities such as meditation, yoga, and journaling. One resource that many nurses have recommended is the Calm app. Dr. Judith Gordon, UArizona Nursing Associate Dean, Research, has also developed an app, “See Me Serene,” an app that uses Guided Imagery to address the negative health effects of social isolation by reducing stress and anxiety.

    One nurse described:

    I started Calm several weeks ago, and it has been a significant quality of life enhancer. I do guided meditation at least 1xa day...

Nurses have also been reconnecting with nature by going for walks or hikes outside and gardening. Others have prioritized sleep including naps, hydrating, eating healthy balanced meals, and making sure they make time for creative hobbies such as cooking or baking. Some nurses know they haven’t been doing the best job managing their well-being and burnout, but they are actively practicing grace towards themselves during this difficult time. 

Dr. Rainbow and Littzen hope to expand on the understanding of the impact of COVID-19 on nurses from their two ongoing studies. The participation of more nurses in this research will help improve readiness for  future pandemics and build interventions to improve the healthcare work environment.