The coronavirus 2019 (COVID-19) pandemic has made a profound negative impact on healthcare nationally and world-wide. Insufficient personal

protective equipment (PPE), staffing shortages, increased patient loads, and emotional trauma are four major stressors that medical personal often face

each shift due to the pandemic. The fight against COVID-19 has often been referred to as a war. Medical professionals are being asked to engage in

combat without adequate protection or resources (Culbertson, 2020). Nurses follow a code of ethics and have a duty to provide care and advocate for

their patients, even when faced with the elevated risk of a global pandemic. Healthcare worker (HCW) well-being and safety have, at times, appeared to

not be a priority with many organizations.

Before the COVID-19 pandemic, employee well-being was an area many healthcare facilities were addressing. The theory was improving

employee well-being would increase employee engagement. The increase in employee engagement would translate to improved patient outcomes

(Jacobs et al., 2018). Employee well-being was added to the Triple Aim, which became the Quadruple Aim (Bromme & Marshall, 2020). As COVID-

19 taxed the healthcare system in the United States, employee well-being among medical professionals plummeted. More than 50% of nurses surveyed

stated they felt stress related to the COVID-19 pandemic (Shechter et al., 2020). Approximately half of those who responded to the survey experienced

depression symptoms, and 33% felt anxiety. The death by suicide has increased exponentially in front-line healthcare workers since the beginning

of the COVID-19 pandemic.

Hospitals can support employee well-being during times of crisis. Implementing mental health services, screening HCW for COVID-19 stress and

related anxiety, peer-support groups, and broad-based support for HCW’s immediate family can help deflect the negative consequences of the pandemic

(Miotto et al., 2020). The Northern Shenandoah Valley’s regional hospital uses a multifaceted approach to address employee well-being during the

COVID-19 crisis within their hospital system. The physical and psychological well-being of employees has continued to be a key consideration during

this time of unprecedented pressure. The hospital provides all employees with four free psychological counseling sessions. Part-time, per diem, and

agency nurses at the facility also qualify for the free counseling sessions. No nurse is forced to work on the COVID-19 unit. Nurses volunteer to work

shifts on the COVID-19 unit and receive additional financial incentives for these shifts. The hospital had signs printed that state “A Hero Lives Here”

and had community members erect these signs in the front yards of front-line HCWs. Weekly debriefings are held on each unit, and all employees who

work in that area are encouraged to attend. Leadership rounds with staff almost daily to promote professional well-being. It is more difficult for

healthcare facilities to work towards the Quadruple Aim during this crisis, but it is imperative that they do. If hospitals do not strive for HCW well-

being and take an active role in promoting physical and psychological welfare, they may find themselves with no one left to care for patients (Miotto et

al., 2020).

 

References

Broome, M., & Marshall, E. S. (2020). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY:

Springer.

Culbertson, R. (2020). Attaining the Quadruple Aim of Worker Well-Being in the COVID-19 Crisis: Competing Ethical Priorities. Journal of

        Healthcare Finance, 46(4), 77-84. http://www.healthfinancejournal.com/index.php/johcf/article/view/223/225

Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018). Engaging Employees in Well-Being: Moving From the Triple Aim to the Quadruple

Aim. Nursing Administration Quarterly, 42, 231-245. https://doi.org/10.1097/NAQ.0000000000000303

Miotto, K., Sanford, J., Brymer, M. J., Bursch, B., & Pynoos, R. S. (2020). Implementing an emotional support and mental health response plan for

healthcare workers during the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S165-S167.

http://dx.doi.org/10.1037/tra0000918

Shechter, A., Diaz, F., Moise, N., Anstey, D. E., Ye, S., Agarwal, S., Birk, J. L., Brodie, D., Cannone, D. E., Chang, B., Claassen, J., Cornelius, T.,

Derby, L., Dong, M., Givens, R. C., Hochman, B., Homma, S., Kronish, I. M., Lee, S., Manzano, W., … Abdalla, M. (2020). Psychological

distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. General Hospital

        Psychiatry, 66, 1–8. https://doi.org/10.1016/j.genhosppsych.2020.06.007

 

Discussion: Review of Current Healthcare Issues

If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?

By Day 3 of Week 1

By Day 6 of Week 1

response 1

Thank you for your post. I am glad you spoke about the mental strain this pandemic has placed on healthcare workers. I know I have personally suffered from mental stress that has affected many of my relationships since the start of the COVID 19 outbreak.  It was documented that nurses have a higher rate of suicide than the average population. In general, 7 per 100,000 women commit suicide, but female nurse suicide rates are 10 per 100,000. The general population male suicide rates are 27 per 100,000 and male nurse suicide rates are 33 per 100,000 (Carr, 2020).  Nurses are being placed in high-stress situations with no real end in sight. It is important for hospitals to offer mental health services for their employees. My facility is offering employee assistance programs (EAP) for all staff and family members for free.  They are been sending emails, texts, and rounding on units to offer up information on how to access these services. Many EAP programs offer more than just stress and grief counseling services. Some offer health promotion, retirement, legal. and wellness programs (SAMHSA, 2020).

Carr, J. (2020). National Study Confirms Nurses at Higher Risk of Suicide than General Population. Retrieved December 04, 2020, from https://health.ucsd.edu/news/releases/Pages/2020-02-03-national-study-confirms-nurses-at-higher-risk-of-suicide.aspx

Substance Abuse and Mental Health Services Administration. (SAMHSA). Provide Support. (2020). Retrieved December 05, 2020, from https://www.samhsa.gov/workplace/toolkit/provide-support

 

 

response 3

Great post.  mental health is important health care providers now more than ever need to take care of themselves both physically and mentally during this pandemic. We need to be careful that we do not get infected with the virus by taking care of patients infected with the virus.  And we need to have a place that we may go to be able to talk with someone about how we are feeling during this crisis.  Ruiz & Gibson (2020) believe that Front line health care workers are similar to combat veterans in the respect that they are separated from their loved ones for an extended period of time and likely struggle with feelings of helplessness and self-blame for outcomes out of their control.  Galbraith et al (2020) believe that effective leadership and managerial support for health care workers and their families by creating workplace interventions that reduce mental health stigma and promote sharing and support for colleagues.

 

References

Galbraith, N., Boyda, D., McFeeters, D., & Hassan, T. (2020). The mental health of doctors during the COVID-19 pandemic. BJPsych bulletin, 1-4.

Ruiz, M. A., & Gibson, C. A. M. (2020). Emotional impact of the COVID-19 pandemic on US health care workers: A gathering storm. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S153.

 

response 3

Your post is so relevant. Many of us are writing about the nursing shortage or nursing burnout. The two seem to go hand-in-hand. If work is not stressful enough, let us add the additional stressor of a global pandemic! Not only do we worry about the welfare of our patients, but we are also concerned about our own health and the health of our family members. Nurses may feel isolated or even live in hotels provided by the hospital to reduce the risk of spreading the virus. Health care providers face clinical and ethical issues that arise while balancing the value of a medical decision with resource utilization (Broome & Marshall, 2020). No one should have to decide which patient gets a ventilator.

In a study of 320 registered nurses in southern California, 80.1% endorsed a high level of stress related to COVID-19 (Kim et al., 2020). Levels of depression and anxiety were also elevated. The care of COVID-19 patients and the nature of quarantine directly correlated with higher stress levels (Kim et al., 2020). Factors that positively influenced nurses’ well-being during the pandemic were high resilience, spirituality, and family functioning (Kim et al., 2020). The researchers continue by discussing these predictive factors of mental health. Resiliency is a common theme, and a factor we can control. We also determine our own levels of spirituality (I personally find my faith to be the foundation upon which good coping skills are built). Family support is somewhat different. Having satisfactory family support and affection during difficult times has a broad positive impact across multiple dimensions of psychological well-being, including stress, anxiety and depression (Kim et al., 2020). I hope each of us has a supportive group of people to help them cope during these unusually challenging times, but it is not entirely within our control to determine how others behave.  This study suggests to me that we need to be actively seeking to improve resiliency and spirituality.

You may find it interesting!

References.

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer.

Kim, S., Quiban, C., Sloan, C., & Montejano, A. (2020). Predictors of poor mental health among nurses during COVID-19 pandemic, Nurs Open, 1-8.  https://doi.org/10.1002/nop2.697

 

another sample

An issue that has been prevalent during the entirety of my nursing career is nurse burnout. Many of us are writing about this topic (or one related to it, such as staffing shortages). In the 15 years that I have been a registered nurse, the wellbeing of the bedside nurse appears to be unimproved. Staffing shortages, higher demands placed on nurses to “do more with less,” lack of work-life balance, and the COVID-19 pandemic are sources of stress that can lead to burnout. Nurse burnout is a widespread phenomenon characterized by a reduction in nurses' energy that manifests in emotional exhaustion, lack of motivation, and feelings of frustration and may lead to reductions in work efficacy (Mudallal et al., 2017). Recognizing the importance of employee wellbeing and its effect on patient outcomes, the Triple Aim became the Quadruple Aim in 2008 (Jacobs et al., 2018). The speaker in the Laureate video acknowledges the challenging nature of nursing and suggests that employees utilize wellness programs offered by many organizations, such as smoking cessation programs (Laureate Video, 2018).

At my place of employment, most bedside nurses are overly stressed on a daily basis. Lack of relief (working at such a frenetic pace) has resulted in numerous resignations. The COVID-19 pandemic has increased anxiety levels for many of us. Nurse leaders are instrumental in fostering a resilient workforce (Broome & Marshall, 2021).  They have an obligation to model and enable evidence-based strategies that promote a happy and healthy workforce (Broome & Marshall, 2021). Attaining joy in one’s work is challenging in today’s workplace for many reasons. Ultimately, I believe it will be through the education of our future nurse leaders that we may best create a work environment in which nurses do not experience burnout.

 

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018). Engaging employees in well-being: Moving from the triple aim to the quadruple aim. Nursing Administration Quarterly, 42, 231-245. https://doi.org/10.1097/NAQ.0000000000000303

Laureate Education (Producer). (2015). Leading in Healthcare Organizations of the Future [Video file]. Baltimore, MD: Author.

Mudallal, R. H., Othman, W. M., & Al Hassan, N. F. (2017). Nurses' burnout: The influence of leader empowering behaviors, work conditions, and demographic traits. Inquiry : a journal of medical care organization, provision and financing, 54, 46958017724944. https://doi.org/10.1177/0046958017724944

 

response

Thank you for sharing such an insightful post. I found an interesting study on nurse burnout. The Geuens et al., (2020) study described nurse

burnout as the loss of ability to cope with stressors, evolving over a period of time. Nurse burnout holds three specific characteristics; emotional

exhaustion, depersonalization, and feelings of  incompetence. The use of core self-evaluations can help determine which specific stressors effect that

particular nurse ( Barać et al., 2018). What factors may cause stress for one nurse may not bother another. By identifying the areas that cause a nurse

increased amounts of distress, solutions can be developed to help the nurse develop coping skills for that particular trigger.

Neither of the hospital systems I've worked for have employed any form of self-evaluations for their nurses. This is something I could see

helping identify problems before the worker gets so burned out they quit. Nurse turnover is problem internationally. It isn't a just an issue in the

United States. The nursing turnover rate has grown exponentially since the pandemic struck. If hospitals aren't able to find a way to directly address

burnout, the nursing shortage we are seeing now is only going to continue to grow.

 

References

 

Barać, I., Prlić, N., Plužarić, J., Farčić, N., Kovačević, S. (2018). The mediating role of nurses’ professional commitment in the relationship between

core self-evaluation and job satisfaction. International Journal of Occupational Medicine and Environmental Health, 31(5), 649-658.

https://doi.org/10.13075/ijomeh.1896.01256

 

Geuens N, Verheyen H, Vlerick P, Van Bogaert P, Franck E (2020) Exploring the influence of core-self evaluations, situational factors, and coping on

nurse burnout: A cross-sectional survey study. Plos One, 15(4): e0230883. https://doi.org/10.1371/journal.pone.0230883