The Looming Mental Health Crisis in Nursing

In recent months, the nation has watched in awe as tens of thousands of nurses have raised their hands to go to the frontlines of the COVID-19 pandemic, putting themselves at great risk in order to help overwhelmed hospitals. Even now as the rate of cases starts to slow and the country looks to get back to some semblance of normality, the effects of the pandemic continue to linger for clinicians who have had to ration care, watch their colleagues fall sick and care for severely ill patients. 

As a former ER nurse who spent nearly a decade working in Level-1 trauma centers, I have witnessed this first hand. The memories of traumatic patients from my time at the bedside still linger even years later. And as a nurse executive, sending nurses to the front line brought stress, anxiety, and sometimes even tears. The gravity of this situation really hit home, as it did with many of my colleagues who share my growing sense of alarm at what will likely be the long-term negative impact on the mental health of our nursing workforce. 

New data shows the toll COVID-19 has taken on nurses’ mental health 

In an effort to better understand how the pandemic has impacted nurses, my company, Trusted Health, recently conducted a survey of 1,425 nurses across all 50 states, two-thirds of whom were providing direct care to COVID-19 patients. What we found was startling. 

The nurses in our study reported a 30% decrease in their mental health since the pandemic hit, rating their current facility an average of 4.8 (on a scale of 1 to 10) in terms of the support it provided related to their mental health and well-being. When asked how they think that the healthcare industry prioritizes and supports nurses’ mental health and well-being as a whole, nearly 95 percent said they felt that it was either not a priority, or if it was a priority, that there were inadequate measures in place to support it.

How the industry needs to change 

What makes these results particularly noteworthy is that awareness of the issue of burnout and its adverse effects on patient outcomes has been widespread within the healthcare industry, and there have been a series of efforts -- some very high profile -- to address it. And yet, our data shows that nurses largely see this as lip service. 

So where is the disconnect? I believe it stems from the fact that the solutions have largely been at the surface level and have put the onus on nurses themselves to manage their own mental health and well-being. In order to address this issue and prevent an onslaught of COVID-19-related mental health issues, we need to focus on meaningful changes, in particular: 

1. Close the academic-practice gap. We need to rethink the way that we educate nurses. Newly licensed RNs often find that their schooling hasn’t prepared them for the structural realities of being a nurse, such that one-third ultimately leave their first post within two years. We need to integrate skill-building around wellness and stress management into the curriculum for undergraduate and graduate programs. From there, Continuing Education Units (CEUs) can build on that foundation, offering additional relevant content around mental health and well-being.
2. Accompany wellness programs with large-scale structural changes. Nearly 90 percent of hospitals have some kind of employee wellness program, but overall participation remains low. I believe this is in large part because they fail to address the root of the problem via meaningful system-wide changes. One such change – and perhaps the most important – is an effective staffing system. No amount of gym discounts or healthy snacks can compensate if nurses are working excessively long hours, have unsustainable patient assignments, or aren’t able to take a break during the day. Additionally, evidence suggests the industry-standard 12 hour shift also leads to burnout and patient safety issues.
3. Institute support programs tailored to nurses’ specific needs. While the type of basic counseling that is generally provided through an Employee Assistance Programs is sufficient for some needs, nurses who are working in high-stress units like the ICU or ED often require more comprehensive support. Nurses need an ecosystem of options that includes access to crisis support, cognitive-behavioral skills building, and mindfulness techniques. As one example, Trusted Health and The Ohio State University’s College of Nursing recently launched a program in this vein – staffed by nurses, for nurses. Similar programs for physicians have also recently sprung up in response to the pandemic. This peer-to-peer relationship has been shown to be effective in getting people to open up and catalyze healing in other high stress jobs like the military, law enforcement and fire fighting.

Parting thoughts

A growing chorus of voices from the frontline have begun to speak out about the effect of COVID-19 on clinician mental health. Last week, Dr. Tsion Firew, an emergency medicine doctor based in New York, wrote a harrowing op-ed in which she underlined the struggle she and her colleagues now face:

“Medical professionals are indeed heroes, but we are also human. Many of us are suffering beyond anything we are able to articulate and the weight of this moment is heavy upon our shoulders. Heed our call. The front line of this pandemic needs mental health resources and emotional support to process the destruction we cannot prevent, we cannot fix.”

COVID-19’s legacy for healthcare is still being written. I for one hope that those of us who work in the industry will use this moment, when the eyes of the world are upon us, to come together to find meaningful solutions to help the millions of selfless healthcare professionals who have risked their lives to save ours. 

About Dan Weberg: 

Dr. Dan Weberg is an expert in nursing, healthcare innovation and human-centered patient design with extensive clinical experience in emergency departments, acute in-patient hospital settings and academia. He currently serves as the Head of Clinical Innovation for Trusted Health, the staffing platform for the healthcare industry, where he helps drive product strategy and works to change the conversation around innovation in the healthcare workforce.

Prior to joining Trusted, Dan spent seven years at Kaiser Permanente, where he held executive roles in nursing innovation, research, and technology strategy across eight regions, 38 hospitals, and 60,000 nurses. He was also part of the founding faculty for the new Kaiser Permanente School of Medicine.

Dan is on the faculty at The Ohio State University College of Nursing and multiple innovation fellowship programs. He previously taught on nursing innovation and leadership at Arizona State University. He is on the editorial board for Nursing Administration Quarterly and has authored two dozen peer-reviewed articles and two textbooks, including Evidence Based Innovation Leadership for Health Professions and Leadership in Nursing Practice.

Dan earned his Bachelors in Nursing, and was in the first cohort to graduate from the Masters in Healthcare Innovation program at ASU, as well as the first-ever graduate of the PhD in Healthcare Innovation Leadership program at ASU. His clinical background is in Emergency and Trauma nursing at Level 1 trauma centers in California and Arizona.