For many people, the social restrictions experienced during lockdown will have long-lasting effects. These include stress, depression, insomnia, fear, anger, frustration, boredom and stigma associated with quarantine. But during the pandemic, NHS staff had to face all these things and deal with working on the frontline. As a result, many health workers will grapple with a lasting impact on their mental health and well-being.
Nurses working in respiratory care have played a particularly important role treating and managing COVID-19 patients, and they were also extensively involved in co-ordinaring services, screening, vaccination, emergency and intensive care.
Based on an online survey of 255 nurses working in clinical areas during the pandemic, our initial study in November 2020 revealed that just over a fifth (21%) experienced moderate to severe symptoms of anxiety, while similar proportions experienced depression (17%). One nurse reported feeling “exhausted and emotionally drained when getting home and unable to switch off”.
The survey used a resilience scale to assess how nurses were managing during the pandemic. Resilience can be described as someone’s ability to bounce back in difficult circumstances, and can indicate their ability to cope in crisis situations. Our analysis showed that younger nurses with less experience had higher levels of anxiety and depression, and lower levels of resilience.
Previous studies looking at the experiences of staff during other pandemics such as the Middle East respiratory syndrome (Mers) outbreak have highlighted staff concerns about becoming infected and taking it home to their families, and experiencing burnout. More recently, other research showed that 64% of frontline workers felt anxious at the start of the pandemic, while 35% needed support but did not feel able to ask for it.
Nurses’ fears and concerns
Our latest paper has analysed some of the comments participants included in their survey responses in our initial study. These focused on the concerns highlighted by nurses and the provision of informal and formal mental health support during the first wave of the pandemic.
We found that nurses were worried about passing the virus to family and loved ones, or contracting the virus themselves. Higher rates of infection were found in nurses working in respiratory care compared to other health staff and settings. Many participants also reported fears about the impact of the pandemic on their mental health.
I’m worried that I – along with many nurses – will burn out and our mental health will be affected. The deaths that we’re seeing have increased massively compared to what we are used to.
The nurses in our study also expressed concern about exhaustion and developing long-term stress, as well as the inadequacy of personal protective equipment (PPE):
I think the long hours and the extensive use of PPE is exhausting. Not only are we nursing these people but fundamentally we are becoming their family – often the last people to see them alive … I worry that in many it will lead to some form of PTSD.
Many nurses had their roles changed, taking on more hours, more responsibility and working in very different settings. The World Health Organization (WHO) has recognised that the nature of this work is often intense and stress-inducing, producing an inevitable psychological impact on nurses and healthcare workers.
Participants described how mental health and wellbeing services were made available, but were mostly telephone or web-based. A small number (2.7%) reported that they were unsure how to access services or were unaware of them.
In terms of additional management support, less than a third of participants reported flexible working patterns, emotional support, or clear leadership from their management team; a few reported receiving little or no support. A small number of respondents who worked different shift patterns or who were redeployed reported receiving less support.
But some set up their own networks and groups, using social media to communicate with colleagues to talk and have catch ups, and in some cases act as buddies for colleagues.
A new normal
After several waves of the pandemic, we are now beginning to rebuild and visualise what our “new normal” might become. We need to consider how we can better support nurses and healthcare workers in the future. The gaps we identified in mental health support for healthcare workers have illustrated the iniquities in provision of support services between organisations and, in some cases, between different staff groups.
It has also highlighted the way respiratory care nurses stepped up and supported their colleagues. But support needs to be flexible and tailored to individual needs without overburdening staff. The pandemic has worsened workforce shortages and many clinical staff are considering leaving the NHS. We need to develop a caring, resilient nursing staff who understand and value their own mental and physical health – a move that may encourage them to remain in the NHS.
Even if the impact and burden of COVID reduces in our hospitals and routine healthcare returnd to pre-pandemic levels, in the long term, staff will remain vulnerable to mental health conditions such as PTSD and burn-out. Since the launch of the Nursing Times’ COVID-19: Are You OK? campaign near the start of the pandemic, other organisations have signed up to protect and support nurses’ wellbeing.
But NHS organisations need to be ready to support staff in the longer term to keep our NHS running at an individual, team and departmental level. Like all of us, nurses must try to maintain healthy lifestyles and address mental health needs through family and friendships, social networks and relationships in and outside of work.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.