by Dr Jane Wray, Associate Editor Evidence-Based Nursing
As the COVID-19 pandemic has continued we have become increasingly concerned about the impact on students and colleagues’ mental health and wellbeing. Research carried out without of the UK indicates that those caring directly for COVID-19 patients are at greatest risk of increased distress – reporting more depression, anxiety, insomnia (Wu et al. 2020), and this psychological burden appears to especially impact nurses (Lai et al. 2020). Even before the pandemic started, levels of stress and burnout were already of concern in nursing impacting job satisfaction, workforce turnover and care quality (WHO 2020). In 2019, The Health Foundation (Buchan et al. 2019) reported nursing vacancies at 44,000, and called for urgent action to increase numbers in training, reduce attrition and tackle retention.
During this period of crisis, we cannot afford to lose any more nurses from the workforce and the need for workplace support to maintain mental health and wellbeing has never been more important. For nursing students who are about to complete their programmes of study in the next few months they will experience ‘a transition unlike any other’ as they move from student to NQN. They will be qualifying during a period of unprecedented challenge and uncertainty, managing unexpected workforce demands whilst starting a new life and career as a registered nurse. For many this transition will be more sudden and less planned than they anticipated. The transition from student to NQN has always been described as a period of turbulence, in the 1970s, Kramer (1978) talked about ‘culture shock’ and Duchscher (2009) ‘transition shock’ in the 1980’s. It seems surprising that despite decades of research advocating the importance of providing support during the transition period, we are still discussing how best to ease the transition for NQNs. Life as a NQN can place considerable demands upon you and your personal resources, and although this is a time of excitement with access to many learning opportunities and experiences, NQN will still be vulnerable during this period. The stressors and challenges that they face during transition are likely to be magnified during the time of COVID-19. Despite the current situation and maybe even because of it, we still need to invest in supporting NQNs. This is a unique time for NQNs and it is encouraging to see that the need for additional guidance and support to specifically “alleviate transition shock” has been recognised (HEE 2020).
It is always important to look after your mental health and wellbeing and in times of increased stress even more so. Newly qualified nurses are a group that have already been identified as needing specific support in the workplace and that is without of the additional psychological impact of COVID-19. It is essential to identify those who may need additional support – and importantly reach out and offer it. COVID-19 may have derailed the original plans made for ‘The International Year of the Nurse and Midwife 2020’ it has however put a spotlight on the skills, knowledge and expertise of nurses and the importance of safe and supportive working environments. Providing nurses with access to appropriate psychological support and wellbeing services will not only help minimise burnout and help retain staff, it will ensure that nurses feel valued and better able to continue delivering high quality compassionate care.
Jane Wray is Senior Lecturer in Nursing and Director of Research, in the Faculty of Health Sciences at the University of Hull. She leads the STaR project (Supporting Transition and Retention of newly qualified nurses) https://starnursehull.com/ which is funded by the Burdett Trust for Nursing.
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Duchscher J.E.B (2008) Transition shock: the initial stage of role adaptation for newly gradated registered nurses. Journal of Advanced Nursing, 65, 1103-1113
Health Education England (2020) Accelerated preceptorship Covid-19. Available at https://www.hee.nhs.uk/our-work/capitalnurse/back-clinical-practice-covid-19/accelerated-preceptorship-covid-19).
World Health Organisation (WHO) (2020) State of the Worlds Nursing. Available at https://www.who.int/publications-detail/nursing-report-2020
Kramer, M. (1974). Reality shock: Why nurses leave nursing. St. Louis, MO: Mosby.
Lui J, Ma S, Wang Y et al. (2020) Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Network Open;3 (3): e203976. doi:10.1001/jamanetworkopen.2020.3976
Peter E. Wu, Rima Styra and Wayne L. Gold (2020) Mitigating the psychological effects of COVID-19 on health care workers, CMAJ April 27, 2020 192 (17) E459-E460; DOI: https://doi.org/10.1503/cmaj.200519