Health care providers around the world are in uncharted territory in response to the coronavirus pandemic. It’s undoubtedly a time of great stress and uncertainty for all clinicians.
We continue last week’s discussion on how nurses in particular are rising to the challenge of fighting the COVID-19 pandemic. Here are more insights from Dr. Cynda Rushton, a professor at the Johns Hopkins School of Nursing and Berman Institute of Bioethics and an international leader in nursing ethics.
Is risk of burnout among nurses especially high right now?
Even before this crisis hit, burnout levels among clinicians were escalating at alarming rates. Nurses and physicians were already working in situations that contributed to their burnout. This pandemic has stressed an already-stressed health care system, stretching it beyond its capacity to adapt to the magnitude of change.
I know clinicians show up in a crisis. They will do what is needed. What’s most concerning now are the long-term consequences. It’s not only post-traumatic stress; some people feel they’re acting against their own consciences in certain actions during the crisis. The fallout of that is significant moral distress or moral injury, which accumulates over time. We can’t wait to take measures to manage that distress. We must begin now.
How can we manage it?
I’ve written about the concept of moral resilience for health care workers. Some strategies include using tools for ethical analysis to determine the best course of action. We need to build our neural pathways for self-awareness and self-regulation through practices like mindfulness. This helps our nervous system regain balance, so we don’t become stuck in fight, flight or freeze, and we can see the situation clearly and respond rather than react. It also involves self-stewardship — prioritizing what nourishes our bodies, minds and sprit, and engaging resources that have supported us through ethical challenges before.
Nurses also really benefit from finding outlets to share and explore their challenges. I was very concerned about nurses saying they felt isolated and didn’t have safe spaces to share their experiences. So, I reached out to colleagues to help create the Frontline Nurses Wikiwisdom Forum, a moderated, crowd-sourced forum where nurses can safely share their experiences during COVID-19. This space will be available 24/7 until the crisis ends because we strongly believe that feeling part of a community, even a virtual one, can help.
So far, it’s a range of nurses who are outraged at the lack of guidance at national levels and lack of personal protective equipment; and those who are worried about risks to their own families. There are also incredible posts about the importance of community and solidarity so nurses can find inspiration in one another’s courage. Here’s one post (used with permission):
“The nightmare is real — and it has come home. … As a fourteen-year veteran of the emergency department I stand poised with my colleagues at the pier — reining in a river with a Dixie cup — and I have never been more proud to call myself a nurse.” – Stacy N.
At the end of this crisis, we’ll identify key participants and summarize themes to create a report for the American Journal of Nursing. We want to provide recommendations from frontline nurses to inform health care systems’ future responses to crises, so we are never unprepared in the way we have been with COVID-19.
What is giving you hope right now for nursing?
I think this pandemic only highlights and elevates the central role nurses serve in health care. We’re seeing the many ways nurses can contribute, adapt and take the lead.
I recently listened to some of our graduates from the Johns Hopkins School of Nursing talk about how they’re adjusting to “the new normal.” It’s really inspiring to hear them talk about their growth and the stretching they’re doing. In that, there’s hope.