The Impact of COVID-19 on The Mental Health of Nurses

In the wake of the COVID-19 pandemic, nurses emerged as unrecognized heroes, tirelessly working on the frontlines to combat the virus. However, behind the scenes, the toll on their mental health has been immense. The fear of infection, poor-quality PPE, frequent exposure to death, being overworked, and the risk of spreading the virus to their families proved to be detrimental to the health of nurses. How can we combat the effects of the pandemic on nurses and be better prepared for future health crises?

As COVID-19 spread rampantly throughout the globe, the United States witnessed a wave of mandates to control the spread of COVID-19. The mandates varied from stay-at-home orders to work closures. Despite these efforts, the losses have been vast, with 1.1 million COVID-19-related deaths in the country. The decline in public psychological health has been equally severe, with a spike in adverse conditions from 8.1% pre-pandemic to 25.5% during the crisis (Kobayashi et al., 2022).

Nurses, making up 59% of the healthcare workforce, faced never-before-seen challenges during the pandemic. First and foremost, the stress and fear caused by COVID-19 for nurses created symptoms of anxiety, depression, and PTSD. The fear of accidentally infecting others and being infected by COVID-19 was a cause of anxiety for nurses during the pandemic. The personal protective equipment (PPE) was reported to be "substandard" and caused "physical discomfort" (Rebecca H. et al., 2020). A nurse reported having to "doff early due to PPE tearing." This poses a risk for the nurse of contracting COVID-19. It also risks spreading COVID-19 to the other patients a nurse must see throughout the day. Additionally, nurses had anxiety about spreading the disease to their families. Some nurses spend their time at home in isolation from their families to decrease the risk of spreading COVID-19. Sadly, a nurse reported that both her parents had comorbidities, which meant that the parents contracted COVID-19 along with another disease and died (Rebecca H. et al., 2020). The lack of time with family also resulted in higher anxiety and depression levels in nurses (Demir M., 2023). Nurses have also reported that the "odd hours" of work caused many physical issues to occur. Some nurses reported fainting, vomiting, excessive sweating, nausea, dehydration, and weight loss. The daily exposure to deaths was a factor in the development of PTSD in nurses during the pandemic. 36.2% of nurses were shown to have PTSD symptoms, like unwanted memories, in a study (Bana Issa W., 2021). Some nurses in many other countries, like India and Italy, saw an increase in nursing suicide rates due to psychological pressure (Montemurro N., 2020). Additionally, many nurses left the field due to traumatic events that happened during the pandemic. My cousin, a pulmonary nurse, left the healthcare field to organize and manage databases. The number of deaths she had to witness and the amount of hours she was working burned her out of her career.

Subsequently, the mental health issues the nurses developed affected their performance and lives outside of work. A study discovered a relationship between work-life balance and the psychological well-being of nurses. The researchers used a scale that measured different aspects of work-life balance, like neglecting life and taking time for yourself. The sub-scale that scored the highest for the nurses was neglecting life; however, before the pandemic, the sub-scale of taking time to yourself scored the highest (Yayla, A. et al., 2021). During the pandemic, nurses had a heavy workload due to the influx of COVID-19 patients, which caused them to spend more time at work than at home. Another study conducted researched the relationship between quality of work life and work performance in nurses. It was found that the effect of quality of work life on work performance was significant (Diana, 2020). In the study, it was shown that due to the increase in patients during the pandemic, nurses spent up to three months sleeping in hospitals. This decreased the quality of work life and left many of the nurses exhausted. The exhaustion leads to a decrease in job performance.

Following, nurses used coping strategies to save their mental health; however, nurses need social support and new procedures to fully recover their mental health after the pandemic. It has been found that nurses used avoidant and positive reappraisal techniques to help cope with the pandemic (Salopek-Ziha et al., 2020). Some nurses tried to avoid others to ensure that the virus wouldn’t spread and to keep working. Other nurses reinterpreted the situation as positive to help cope with the deaths and negative situations they faced every day. It was also found that nurses over 40 sought social support, whereas nurses under 40 avoided stress.

To facilitate recovery, nurses need support services within hospitals and enhanced social support in private settings. Improving working environments, communication channels, and therapy offerings would be immensely beneficial to the mental health of nurses. However, barriers such as the fear of negative consequences and the stigma associated with seeking psychiatric help must be addressed to ensure nurses receive the care they need.

How can we personally help nurses and other healthcare personnel deal with their mental health? One of the best ways to help those dealing with mental health challenges is by listening and making sure they know you are there to support them. We may not all be counselors or therapists, but showing care and love can go a long way for those battling mental health issues.

As the healthcare industry charts its course forward, it is imperative to prioritize mental health support for nurses. Recognizing the unique challenges, they face and implementing measures to address burnout and shortages in the healthcare workforce will be critical for building a resilient and sustainable healthcare system.

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Brenda Thomas is a current junior from Texas, with a desire to be a nurse practitioner in her future. In her free time, she enjoys volunteering in the community and practicing the drumset.

References

Sources:

• Kobayashi, H., Saenz-Escarcega, R., Fulk, A., & Agusto, F. B. (2022). Understanding mental health trends during COVID-19 pandemic in the United States using network analysis. https://doi.org/10.1101/2022.10.10.22280933

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• Rebecca, H., Srinithya, R., J., S., Kamlesh, C., Deepika, K., & D. K., S. (2020).Explore the Psychological Experiences of Nurses Worked in Covid 19 Care Areas in Tertiary Care Hospital at the National Capital. Baba Farid University Nursing Journal, 18(1), 5-11.

• Demir, M., Sayilan, A. A., & Sayilan, S. (2023). Agreement between nurses’ anxiety and depression levels and their compliance with isolation measures during the covid 19 pandemic: An online cross-sectional study. Bangladesh Journal of Medical Science, 22(1), 115–120. https://doi.org/10.3329/bjms.v22i1.61860 

• Bani Issa, W., Al Nusair, H., AlTamimi, A., Rababa, M., Saqan, R., Hijazi, H., Al‐Marzouqi, A., Abdul Rahman, H., & Naing, L. (2021). Posttraumatic stress disorders and influencing factors during the COVID‐19 pandemic: A cross‐sectional study of frontline nurses. International Nursing Review, 69(3), 285–293. https://doi.org/10.1111/inr.12734

• Yayla, A., & Eskici İlgin, V. (2021). The relationship of nurses’ psychological well‐being with their Coronaphobia and work–life balance during the Covid‐19 pandemic: A cross‐sectional study. Journal of Clinical Nursing, 30(21–22), 3153–3162. https://doi.org/10.1111/jocn.15783

• Diana, Eliyana, A., Mukhtadi, & Emur, A. P. (2020). Quality of Work Life and Nurse Performance: The Mediation of Job Satisfaction in Pandemic Era. Systematic Reviews in Pharmacy, 11(11), 1739-1745.

• Montemurro, N. (2020). The emotional impact of COVID-19: from medical staff to common people. Brain, Behavior, and Immunity. https://doi.org/10.1016/j.bbi.2020.03.032

• Salopek-Ziha, D., Hlavati, M., Gvozdanovic, Z., Gasic, M., Placento, H., Jakic, H., Klapan, D., & Simic, H. (2020). DIFFERENCES IN DISTRESS AND COPING WITH THE COVID-19 STRESSOR IN NURSES AND PHYSICIANS. Psychiatria Danubina, 32(2), 287–293. https://doi.org/10.24869/psyd.2020.287

• Halms, Theresa, et al. “What Do Healthcare Workers Need? A Qualitative Study on Support Strategies to Protect Mental Health of Healthcare Workers during the SARS-COV-2 Pandemic.” BMC Psychiatry, vol. 23, no. 1, 2023, https://doi.org/10.1186/s12888-023-04686-z.