How COVID-19 is affecting cancer nurses’ mental health, and what to do about it

As we come out of lockdown, we need to focus on our well-being, soothe each other and lobby nursing organisations to develop accessible support

One year ago, an internal email was sent to staff in cancer care in our hospital in Southampton warning of the risk of psychological distress created by the pandemic. Today, after many months of work and life shaped by COVID-19, nurses’ brains are flooded with cortisol.

We’re tired of being short-staffed; tired of social isolation; tired of wearing personal protective equipment (PPE); and tired of sticking swabs up our noses. Gone is the adrenaline and the frantic TikTok dances with nurses adorned in PPE. We’re so fed up with Zoom and Teams that we don’t even have the energy to FaceTime granny.

Working as a nurse in oncology is high-risk at the best of times – burnout and compassion fatigue are common. Add a pandemic on top and it’s an unhappy mix.

‘As nurses, as well as absorbing our patients’ distress, we’ve been concerned for our own safety and that of family and friends’

As cancer care nurses our usual working practices were turned upside down overnight. The initial fear that all patients with cancer– irrespective of disease type and treatment – were at serious risk of COVID-19 meant we had to radically change how we treated or followed up treatment.

Catapulted into a world of remote consultations without proper training or equipment

In many cases, chemotherapy delivery was moved out of usual locations. This led to staff being uprooted from familiar environments and teams to work in often unsuitable spaces, including corridors. Our normal outpatient departments emptied and consultations became remote.

While there has been a national drive to increase remote consultations and improve telemedicine, COVID-19 has catapulted us into that world, often without proper training or equipment. Having to assess patients remotely without the benefit of non-verbal cues has been a challenge. The use of silence is almost impossible by phone as people immediately think they have been cut off.

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Both of us were redeployed – one to family liaison in the general intensive care unit and the other to chemotherapy day units. The lack of human contact was extremely hard for us, as it was for the patients’ next of kin, too. Clinical nurse specialists were redeployed to help on the wards or work remotely and field calls from patients distressed by delays or changes to treatment or access to clinical trials.

Nurses reported that patients were not calling in about potentially serious side effects because they were afraid to attend the hospital. Those inpatients who did come in, and in the first wave numbers were considerably reduced, were not allowed visitors.

Concern for our own safety and the welfare of family and friends

Our terminally ill patients sobbed because they had been robbed of their precious last few months or weeks and had been unable to fulfil their bucket lists. One patient spoke about how sad he was that he wasn’t going to get the send-off he had hoped for.

Not being able to support our patients in the way we would like, allow them access to their loved ones, or witnessing them being given bad news without the comforting hand of their partner or best friend, has been heartbreaking and, for some staff, has led to moral distress.

• RELATED: Moral distress in nursing practice

Moral distress occurs when we know something to be right, but are unable to do it due to institutional constraints. As nurses, as well as absorbing our patients’ distress, we’ve been concerned for our own safety and that of family and friends.

‘Nurses and nursing are the central narrative of the past year – and the voice of the future’

We’ve been socially isolated and at times ostracised for our profession – regarded as a risk to others. We’ve not seen our parents, have lost loved ones and, like everyone else, have struggled with homeschooling and financial loss. Some staff have had to retire after 40 years’ service by simply walking away or waving goodbye on a screen.

Storytelling can communicate, explain, soothe and make sense of difficult times

Shielding staff may have experienced guilt and loss through being at home rather than work, but when asked to return, they have had to adjust to an alien environment of PPE, new teams and unfamiliar workspaces. Some have reported sitting outside the hospital shaking with nerves about their return to work. We all need to check in with these colleagues.

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As we come out of this latest lockdown, we need to give real consideration to how we treat ourselves. We need to recognise distress in colleagues and lobby nursing organisations to develop accessible well-being events to support staff and help them manage their feelings.

After this difficult unprecedented time, it’s important not to lose the narrative of the past year. Storytelling can communicate, explain, soothe and make sense of difficult times, so we must continue to talk, tell our stories and soothe each other. Nurses and nursing are the central narrative of the past year – and the voice of the future.

View our well-being resource centre

Elaine Tomlins is nurse consultant in chemotherapy at the Royal Marsden NHS Foundation Trust, London, and was a consultant nurse at University Hospital Southampton NHS Foundation Trust

Alison Farmer, @towertalk, is psycho-oncology clinical nurse specialist at the University Hospital Southampton