In recent years, the issue of burnout and mental health amongst clinicians has become a hot topic within the healthcare industry. Prior to the COVID-19 crisis, burnout among nurses was at an all-time high, with some studies estimating that up to 63 percent of nurses exhibit symptoms such as job-induced stress, anxiety, and depression.
The pandemic has only exacerbated this issue, as frontline nurses find themselves delivering care for a high volume of acutely ill patients, often in situations with limited crisis response training or supplies of personal protective equipment (PPE). Many have been asked to ration care or have watched their colleagues fall sick. A recent peer-reviewed study of frontline healthcare workers in China found that a large proportion reported feelings of depression, anxiety, insomnia, and psychological distress.
As part of its overall mission to better support nurses -- the backbone of our healthcare system -- Trusted Health set out to understand the impacts of the COVID-19 crisis on nurses in the U.S. Through survey responses from 1,425 nurses, a picture emerges of a population who remain committed to their profession despite feeling under-supported by their facilities and by the larger industry in which they work, and whose mental health and well-being has declined as a result of the pandemic.
One thousand four-hundred and twenty five nurses from all 50 states and the District of Columbia responded to the survey, which was sent by email in mid-April 2020. Sixty-five percent reported that they were providing direct care to patients with COVID-19 in their current role.
The majority of nurses are concerned about contracting COVID-19 in the course of doing their jobs. Eighty-one percent of respondents reported being at least “slightly concerned,” and two-thirds were either “concerned” or “very concerned.”
Nurses’ mental health and well-being has declined significantly since COVID-19 began. On a scale of 1-10, nurses rated their current mental health and well-being an average of 5.4, compared to an average of 7.6 prior to the COVID-19 crisis, representing a decline of nearly 30 percent.
Nurses don’t feel that their health and well-being are being prioritized or supported. On a scale of 1-10, nurses rated their current facility an average of 4.8 in terms of the support it has provided related to their mental health and well-being. The rating with the highest percentage of responses was 1.
Nurses also report feeling unsupported at a systemic level. When asked how they think that the healthcare industry prioritizes and supports nurses’ mental health and well-being, nearly 95% said they felt that it was either not a priority or that it was a priority, but that there were inadequate measures in place to support it.
Despite these findings, most nurses remain committed to the profession. The vast majority of respondents (79%) said that the COVID-19 crisis has not impacted their career plans, and they remain as, or even more, committed to nursing than they were previously.
Fifty-two percent of nurses say their feelings about being a nurse haven’t changed, while 33 percent said they were more proud to be a nurse than they were before the crisis.
Wellness programs must be accompanied by structural changes in order to be effective. According to the American Hospital Association, nearly 90 percent of hospitals have some kind of employee wellness program, but overall participation remains low. While these programs are an important element of promoting a culture of mental health and well-being, they are insufficient without larger structural changes that get at the heart of the issue. One such change -- and perhaps the most important -- is an effective staffing system. No amount of gym discounts or healthy snacks can compensate if nurses are working excessively long hours, have unsustainable patient assignments, or aren’t able to take a break during the day. In general, the industry needs to focus more on larger systemic changes, rather than passing the burden on to nurses to manage their mental health and well-being at an individual level.
Nurses need specialized support programs tailored to their needs. Providing patient care comes with a unique set of stressors that requires more than a one-size-fits-all approach. While Employee Assistance Programs provide basic counseling that is sufficient for some needs, nurses who are working in high-stress units like the ICU or ED -- certainly those on the frontlines of a pandemic -- often require more comprehensive support. We should be offering nurses an ecosystem of options that includes access to crisis support, cognitive-behavioral skills building, and mindfulness techniques. Trusted and The Ohio State University’s College of Nursing recently launched a program in this vein. It offers nurses working on the frontlines of the COVID-19 crisis access to wellness support and evidence-based strategies from nursing faculty and advanced practice nursing (APN) students who have an innate understanding of the challenges that come from being a clinician. Our hope is that this “nurses-for-nurses” approach to providing mental and emotional support will be a model for other similar programs in the future.
We need to change the way that we educate nurses. The nursing profession suffers from a massive academic-practice gap. Newly licensed RNs often find that their schooling hasn’t prepared them for the structural realities of being a nurse, and one-third ultimately leave their first post within two years. One of the ways that undergraduate and graduate programs can address this issue is by integrating skills building around wellness and stress management into the curriculum. Nurses would then enter the profession with a solid foundation that could then be expanded and refined through access to tailored content around mental health and well-being offered via their mandatory Continuing Education Units (CEUs).
The COVID-19 crisis has highlighted not only how indispensable nurses are, but also the ways in which the health care system is failing them. At this moment, when the eyes of the world are on our healthcare workers, we have a choice to make about the legacy of this pandemic. We can add what will no doubt be the long-lasting effects of the crisis to the issues of burnout and mental health that were already afflicting our nursing workforce, or we can use this as a catalyst to come together to find sustainable solutions to support them. At Trusted, we certainly hope it’s the latter. Through our partnership with The Ohio State University -- our recently launched Mental Health and Well-being Resource Center -- and by partnering with organizations who share our nurses-first mission, we are committed to doing everything we can to support the individuals who consistently risk their own well-being to protect ours.
Trusted is where modern nurses go to build their careers. Nurses are the backbone of our healthcare system and yet their options for finding new roles are cumbersome and outdated. Trusted is on a mission to change this by matching the nurses on our platform with a range of flexible jobs that meet their preferences and career goals. With support from a dedicated Nurse Advocate and unmatched insight into compensation and contract details, Trusted makes it easy for nurses to navigate the job search process and manage their careers with confidence.
Trusted supports hiring in all 50 states and has connected the nurses on its platform with thousands of opportunities. Based in San Francisco, CA, Trusted has raised $25 million in funding from Craft Ventures, Felicis Ventures, and Founder Collective, as well as healthcare innovators like Texas Medical Center and Healthbox. For more information, visit www.trustedhealth.com.