"As supporters of medical professionals, here at Scrub Pro Uniforms, we want to raise awareness and recognition of the key issues continuing to affect healthcare workers during COVID-19."

What now?

Nurses and other essential healthcare workers are accustomed to emergencies and stress to a certain degree. The adrenaline rush of working quickly on a patient is part of the job at times.  When Covid-19 hit in early 2020, the healthcare community banded together and faced it head-on. Undoubtedly, many showed extreme bravery in adverse conditions, and the world recognized front-line workers as heroes. 

Months later, October is here, and the pandemic has wavered but is still very active. Some areas of the country show increased cases that raise fears of a more considerable resurgence this fall. Long-term adversity, stress, and tragedy are now the name of the game for our healthcare workers. Frontline workers continue to face many COVID-19-related issues and working conditions. 

Mental Health:

A September 2020 article from Physician’s Weekly reviewed the current research on the mental health of medical employees during the pandemic.  Some of the issues recognized among healthcare employees as increasing during the pandemic are anxiety, depression, sleep problems,and distress.  Those workers with a more extensive social support system have better outcomes overall. Other surveys have preliminary findings that those healthcare workers who had mental health issues before the pandemic experienced worsening symptoms and altered coping mechanisms. Many states and healthcare organizations have offered mental health services such as enhanced employee assistance programs (EAPs) and resilience training.  All information is unknown at this stage, and further research will reveal the full impact.

Staff Shortages & Long Hours:

Healthcare organizations have experienced increased patient volumes in hospitals already understaffed before the pandemic.  Many hospitals relied on travel nurses or nursing agencies to fill staff needs before the pandemic, but these resources have been diminished due to fear and scarcity.  Some hospitals reallocated staff to areas that they were unfamiliar with to alleviate shortages, which caused another set of stress.  Nurses were expected to orient new staff without the time to do so, and floating staff were not given the resources to be successful.  Another common strategy was to staff with nursing students who were close to graduation to fill unmet needs. 

Existing nursing staff feel more pressure than usual to work overtime, remain on-call, and extend 12-hour shifts to as many as 18 hours.  Extreme amounts of hours are worked out of commitment to patients and dedication to the team of coworkers – but this can lead to burnout and compromised health. Healthcare workers often have very giving personalities, making work/life balance hard under normal circumstances.  The pandemic has only exacerbated that tendency. Essential worker status becomes a heavy burden, and scheduled vacations have been postponed indefinitely.

Risk of Infection:

Repeated exposure to contagious COVID-19 patients is stressful and risky to healthcare workers of all kinds – including food service, security, and environmental services workers.  PPE donning and doffing procedures must be strictly followed, and all precautions must be observed.  The combination of high workload, PPE shortages and reuse, long hours, and fatigue make mistakes inevitable.  According to data from the World Health Organization reported in the Washington Post, healthcare workers comprise about 2-3% of the global population but an average of 14% of COVID-19 cases.  This shows a much higher risk of contracting the disease, which workers know well as they see their coworkers sicken. Reports of physicians, nurses, and others succumbing to the disease or enduring weeks on a ventilator spread among colleagues.  Each cough or sniffle becomes suspect and stressful.

Perhaps even worse than the fear of personal sickness, workers fear spreading the disease to their families – spouses, children, and elderly parents and grandparents.  Extreme measures are taken to disinfect before heading home; some even stay in separate living spaces away from families to diminish the risk.  Others avoid visiting parents and other higher-risk relatives, further shrinking their support systems. The feeling of isolation intensifies the other stresses of the job. 

Feelings of Helplessness & Frustration:

Nurses, physicians, therapists, and others are natural “fix-it” people. They have dedicated their lives to learning about the human body and how to heal it. This disease has many unknown factors, very little treatment, and a feeling of hopelessness.

Patients are isolated from their families, and nurses feel helpless to reassure them. The necessity of maintaining a calm exterior, a smile, or a reassuring touch to patients while feeling anything but hopeful places emotional strain on staff.  The pressure to spend as much time as possible and fill the family role for patients is genuine.  It makes it hard to leave the shift and decompress once home.  The worry does not go away. Many workers also deal with the stresses of childcare and virtual schooling, elder care, and isolation. 

Staff Morale:

Any high-pressure job that relies on teamwork is affected by morale.  It is hard for administrators and managers to boost morale with no end in sight and no prospects of staffing relief.  A team can work through adversity and a common goal when a defined end-point can be determined.  Here, it is hard to know the goal – and time to do the usual social activities is limited.  Lunch breaks?  Birthday cakes?  Those things are afterthoughts, and many nurses have found the tone of their workplace much more somber and tense. 

Continued PPE Shortages & Rationing:

Much was done in the early days of the pandemic to boost supplies of PPE to hospitals, which helped.  As the pandemic wears on longer than anticipated, and virtually every area of the country uses masks for the general population, worries about the supply chain increase.  Hospitals frequently change policies about how long PPE can be used, what types of PPE are used, and when they should be disposed of. Workers are confused and still feel the need to ration PPE – adding to a feeling of instability and worry. Many hospitals struggle financially, which trickles down to inventory decisions and supply chains. 

When to Find Help:

We at Scrub Pro prioritize supporting frontline heroes with excellent service, low prices, and high quality. If you are facing some of the above severe issues and feel like you need to reach out for help, please read the resources below and obtain the support you need. Self-care is severe and necessary for maintaining your health during this time. 

The American Nurses Association provides some wonderful resources for assessing your own level of stress and mental health. Please visit their site to access a wide range of resources not just for nurses but all healthcare workers.

According to the ANA, these are the Common Symptoms of Excessive Stress:

• Physical Symptoms: rapid heart rate, muscle tension, headaches, GI distress, difficulty breathing, high startle response, nausea, nightmares or flashbacks, chronic exhaustion.
• Sleep Disturbance: nightmares, trouble falling asleep or staying asleep. Emotional Responses: anger, fear, frustration, irritability, anxiety, sadness, guilt, difficulty maintaining emotional balance.
• Difficulty Thinking Clearly: Disorientation or confusion, difficulty problem-solving or making decisions, difficulty concentrating or remembering instructions.
• Problematic or Risky Behaviors: Unnecessary risk-taking, increased use of alcohol or drugs to numb.
• Social Impacts: blaming others, conflicts with coworkers or family members, withdrawal and isolation, becoming clingy or needy.

For many, these feelings will subside with time as we begin to recover. The important thing is to develop coping mechanisms and find the support you need to address this stress. This support will look different for each person.

Resources:

• National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
• SAMHSA Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746

Crisis Text Line: Text HOME to 741741

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Tammy McKinney, a seasoned Registered Nurse, distinguished healthcare writer, and founder of HelpfulHospiceNurse.com, is committed to using her medical knowledge to educate, inform, and entertain healthcare workers and their patients. To connect with Tammy directly, check her out on LinkedIn.