By Dr Jane Wray, Associate Editor, Evidence Based Nursing, Senior Lecturer in Nursing and Director of Research. @livinginhope

Throughout the COVID-19 pandemic, nurses have been in the frontline of care delivery and they have been lauded (and applauded) for their hard work, expertise, commitment and professionalism. However, as the public ‘clapped for carers’ and celebrated the ‘heroes of healthcare’¹, the impact of caring during a public health crisis on the health and wellbeing of front line practitioners was also evident.  As far back as April 2020, the International Council of Nurses (ICN) were already concerned about the mental health and wellbeing impacts on the workforce including high stress levels, anxiety and depression, post-traumatic stress disorder, illness and burnout. As the pandemic evolved, evidence continued to emerge which showed that additional demands such as workload, equipment shortages, deaths of patients and colleagues, fear of exposure all added to the pressure².  Even prior to the pandemic, nurses were considered ‘at risk’ of long term mental health issues with suicide rates higher than the national average (for those in other professions or the general working population) and low contact with mental health support services reported^3,4,.

As the pandemic continues to unfold and the demand on healthcare increases, work related mental health issues in the workforce will inevitably also increase. Nurses need to  be provided with “Adequate opportunities to recover from the job mentally as well as physically…to ensure health and optimum job performance” ⁴.  Given the scale of the challenge in the coming months, waiting for the nursing workforce to become stressed, unwell and burnout and then attempting to instigate a solution appears a risky strategy for employers and for nurses themselves.

We have seen a number of really positive initiatives emerge to support healthcare workers, qualified nurses and students during this period of time both in the UK and internationally, ^5,6,7,8.  This is to be welcomed. However, for a profession that is committed to putting patients first, taking some ‘time out’  and ‘time off’ when may not be so straightforward. Increasing numbers of acutely ill patients, staffing issues and equipment shortages all add to the pressure on nurses to continue working.  Nor it is easy to speak up and openly about the need for help and support when that pressure becomes too much. There is significant stigma faced by those who have mental health problems in society, and a particular stigma attached to those in nursing who choose to disclose⁹. Speaking up and asking for help may not be easy, individual nurses may be perceived as ‘not resilient’ or ‘failing to cope’ and this may be further compounded by the narrative surrounding ‘heroes of healthcare’¹.

Employers have a responsibility for the health and wellbeing of their staff, and this must be more than directing nurses to the resources or services that they have neither the time nor the energy to access.  Organisations that facilitate disclosure, early access to services and provide time and space for staff to use them will ultimately benefit from that investment in their workforce.

On Wednesday 14^th October 2020 at 8pm (UK time) EBN @EBNursingBMJ will host a Twitter chat that provides the opportunity to discuss issues surrounding the mental health and wellbeing of nurses during the pandemic.

1. How is your organisation supporting you /your colleagues’ mental wellbeing during this time?
2. What type of support have you found the most useful? And what support would you like to see provided?
3. What responsibilities do employers have for staff mental health and wellbeing?
4. What responsibilities do individual staff members have for their own mental health and wellbeing?
5. What strategies can you put into place to support your own mental health and wellbeing?

Join us on Wednesday using hashtag #EBNJC

References

1. Cox CL ‘Healthcare Heroes’: problems with media focus on heroism from healthcare workers during the COVID-19 pandemic Journal of Medical Ethics 2020;46:510-513.
2. West M, Bailey S, and Williams E (2020) The Courage of Compassion: Supporting nurses and midwives to deliver high-quality care. The Kings Fund https://www.kingsfund.org.uk/sites/default/files/2020-09/The%20courage%20of%20compassion%20full%20report_0.pdf
3. Davies N (2020) The Suicide crisis in nursing. Independent Nurse https://www.independentnurse.co.uk/professional-article/the-suicide-crisis-in-nursing/223994/
4. Kinman G, Teoh, K and Harriss, A (2020). The Mental Health and Wellbeing of Nurses and Midwives in the United Kingdom. https://www.som.org.uk/The_Mental_Health_and_Wellbeing_of_Nurses_and_Midwives

5. MIND How to look after your mental health as a nurse https://www.mind.org.uk/workplace/coronavirus-and-work/being-a-nurse-during-coronavirus/

1. Canadian Federated Nurses Unions. Supporting your mental health during COVID-19. Accessed September 30, 2020 https://nursesunions.ca/supporting-your-mental-health-during-covid-19/
2. American Nurses Association. Well Being Initiative. Accessed September 30, 2020 https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/the-well-being-initiative/
3. RCN Covid-19 and your mental wellbeing https://www.rcn.org.uk/get-help/member-support-services/counselling-service/covid-19-and-your-mental-wellbeing
4. Farmer P (2019) https://www.rcn.org.uk/magazines/activate/2019/oct/mental-health-and-the-workplace