COVID and the Erosion of Nursing Rituals

Roberta Heale, Deputy Editor for Social Media, EBN. @RobertaHeale. @EBNursingBMJ

Throughout my career, I’ve practiced in a variety of hospital units as a registered nurse and then in several community health organizations as a nurse practitioner.  Each new workplace has had its own unique culture, which was reflected in its rituals and traditions.  These rituals were not about patient care.  Rather, they informed every aspect of working with others in that specific place and knowing ‘the way things are done’ such as the identification of leaders, level of acceptance and support for newcomers, and how people were recognized or celebrated. For example, report to incoming staff was conducted differently on each unit, in some places completed in-person and in others, audiotaped. In one unit the incoming staff would come in early and have coffee with the outgoing shift. On some units, nurses worked together across all the assignments to lighten the loads.

Not all rituals were positive. I was often reassigned from ICU to another unit when things were quiet and the tradition on some floors was to give the reassigned nurse the heaviest patient assignment. In another workplace, as a newcomer, I happily said hello and introduced myself to a staff physician who proceeded to completely ignore me. Seasoned nursing staff warned me not to approach the medical staff.  Rituals defined the hierarchies of specific environments, both within and beyond the nursing staff.

The definition of culture is the ideas, customs and social behaviour of a particular people (1). and rituals within a culture are the social actions of a group of people who share some sets of common expectations (2).  Rituals are symbolic actions that can be expressed through communication, or action. Rituals help to form our identity as nurses and a sense of cohesiveness among a staffing group (2).

Dissecting the concept of ritual in nursing practice is far beyond the scope of this blog.  However, I am guessing that each of you has a good understanding of what it means and can give examples of the rituals that define your group of colleagues and the environment where you work. Becoming embedded within the culture of the workplace offers a sense of belonging and comfort in knowing what to expect from your coworkers.  Sometimes the aspects of a culture and rituals have been supportive and other times detrimental to the overall workplace vibe.

Quite suddenly everything changed. COVID 19 has put enormous stress on nursing across the globe. There is a loss of many of the rituals that previously defined their workplace culture.  Everything has been altered.  Of course, this is the same for all people, but in nursing there is an enhanced workload with screening and PPE, the feeling of helplessness in caring for those with a deadly illness where there are few, if no, effective treatments and there is the fear of contracting COVID-19 themselves.  Nurses can no longer cling to the comfort of the rituals within their particular environment. There seems to be an overall loss and mourning for the old times.

EBN covered many aspects of mental health concerns during COVID, including the mental health of nurses.  Beyond the efforts to help individuals cope with the impact the pandemic, perhaps as a group of nurses working together, there should be conscious consideration for making new rituals, ones that fortify and sustain those who are on the frontline taking risks for all of us.

I think it’s also important not to forget the lessons we’ve learned in the pandemic. Change is inevitable. COVID will end.  A vaccine is on the horizon.  Will we simply go back to the old rituals, or will we pay closer attention to our workplace culture and rituals and whether they are set up to bolster or undermine one another?

  1. Merriam-Webster. (2020). Dictionary. https://www.merriam-webster.com/dictionary/culture
  2. Holland, C. (1993). An ethnographic study of nursing culture as an exploration for determining the existence of a system of ritual. Journal of Advanced Nursing, 18, 1461-1470.

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