Purpose: The purpose of this study was to describe the COVID-19 pandemic impact on front-line registered nurses (RNs) in one large health care system in the United States (US) prior to effective treatments or vaccines for the virus.
Significance and background: The COVID-19 pandemic created the greatest US health care disaster since the 1918 pandemic. The virus spread rapidly, infection rates increased quickly, and US hospitals filled to overflowing. Many patients died, as did some front-line staff caring for them. Front-line RNs quickly became overwhelmed, both physically and psychologically. Research from other countries showed that RNs caring for COVID-19 patients had difficulty coping. Concerns have been raised about the psychological health of front-line RNs in the US who cared for COVID-19 patients during this unprecedented health care disaster.
Methods: The theory of shattered assumptions guided design and implementation of this study. The study objectives were to: • Assess the impact of the COVID-19 pandemic on registered nurses (RNs) using the impact of event scale – revised (IES-R). • Describe RNs opinions about what else hospitals could have done during the pandemic. • Describe RNs personal experiences during the pandemic.
All health system hospitals agreed to participate in this study. An email was sent to all RNs at those facilities containing information about the study, plus a link to the electronic survey. Data were collected from August 3, 2020, through September 4, 2020. Each hospital has designated RNs who encouraged their peers to participate throughout the data collection period. Results from the IES-R and multiple-choice demographic questions were analyzed using descriptive statistics. Written responses for objectives two and three were analyzed using content analysis.
Results: A convenience sample of 1,319 RNs participated in this study (18% of the health care system RNs). The mean IES-R score for the sample was 23.5, indicating some symptoms of post-traumatic stress disorder. Regression analysis showed that nurses younger than 40 had higher IES-R scores than nurses who were 40 or older. When asked what else the health care system could have done, communication issues and staffing concerns emerged as the major themes. Five themes emerged when subjects were asked about their personal experiences during the COVID-19 pandemic: work environment, subjects’ physical responses, subjects’ psychological responses, family changes/stress, and public misinformation. Many RN subjects stated that they were considering retiring to leaving the nursing profession.
Conclusions/implications: RNs continued work full time and even overtime knowing their lives were at risk, resulting in a significant psychological toll on both the RNs and their families. More RNs under 40 provided direct care to COVID-19 patients. Due to their higher IES-R scores, younger nurses may need psychological counseling. There are many lessons to be learned from the COVID-19 pandemic. Better communication with front-line RNs and increased staffing levels will improve the next pandemic response. A new national response plan that includes front-line RN staff, is evidence-based, and incorporates lessons learned from the COVID-19 pandemic should be developed. A more cohesive plan would improve overall communication and coordination between local, state, and national governments.
Evidence-based references 1. Caillet, A., Coste, C., Sanchez, R. & Allaouchiche, B. (2020). Psychological impact of COVID-19 on ICU caregivers. Anesthesia, Critical Care and Pain Medicine. https://doi.org/10.1016/j.accpm.2020.08.006 2. Hong, S., Ai, M., Xu, X., Wang, W., Chen, J., Zhang, Q., Wang, L. & Kuang, L. (2021). Immediate psychological impact on nurses working at 42 government-designated hospitals during COVID-19 outbreak in China: A crosssectional study. Nursing Outlook, 69, 6-12. 3. Jun, J., Tucker, S. & Melnyk, B. (2020). Clinician mental health and well-being during global healthcare crises: Evidence learned from prior epidemics for COVID-19 pandemic. Worldviews on Evidence-Based Nursing, 4. http://doi.10.1111/wvn.12439 4. Lai, J., Wang, Y., Cai, Z., Hu, J., Wei, N., Du, H., Chen, T., Li, R., Tan. H., Kang, L., 5. Yao, L., Huang, M., Wang, H, Wang, G., Liu, Z. & Hu, S. (2020). Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. Journal of the American Medical Association. https://10.1001/jamanetworkopen.2020.3976 6. Sun, N., Wei, L., Shi, S., Jaio, D., Song, R., Na, L., Wang, H., Wang, C., Wang, Z., You, Y., Liu, S. & Wang, Y. (2020). A qualitative study on the psychological experience of caregivers of COVID-19 patients. American Journal of Infection Control. https://doi.org/10.1016/j.ajic.2020.03.018. 7. Zhang, Y., Wei, L., Li, H., Pan, Y., Wang, J., Li., Q., Wu, Q. & Wei, H. (2020). The psychological change process of frontline nurses caring for patients with COVID-19 during its outbreak. Issues in Mental Health Nursing. https://doi.org/10.1080/01612840.2020.1752865
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Thank you for addressing this subject that affected our nursing community so deeply! Listening and reading made me emotional because I was there too and felt what you described in my community, nurse colleagues, and family. Thank you