Analysis

COVID-19: how nurse managers are dealing with the psychological toll of the pandemic

Senior nurses have stepped up to the challenges, but trusts need to support them

Senior nurses have stepped up to the challenges, but trusts need to support them

  • A survey of 4,000 UK nurses and midwives found one in four reporting severe depression, anxiety or stress
  • Nurse managers face a particular set of challenges, with concerns involving staffing and staff safety
  • Continual intense pressure can have serious implications for nurse leaders and trusts must support them

Picture: Alamy

Although the number of COVID-19 cases are declining for now at least the psychological impact of the pandemic on nurses will be felt for months, perhaps years to come.

A survey of 4,000 UK nurses and midwives carried out in late April and early May found

Senior nurses have stepped up to the challenges, but trusts need to support them

  • A survey of 4,000 UK nurses and midwives found one in four reporting severe depression, anxiety or stress
  • Nurse managers face a particular set of challenges, with concerns involving staffing and staff safety
  • Continual intense pressure can have serious implications for nurse leaders and trusts must support them

Senior nurse communicating via a laptop. Picture: iStock

Picture: Alamy

Although the number of COVID-19 cases are declining – for now at least – the psychological impact of the pandemic on nurses will be felt for months, perhaps years to come.

A survey of 4,000 UK nurses and midwives carried out in late April and early May found one in four were reporting severe or extremely severe depression, anxiety or stress. However, few respondents said they had accessed services to support their health and psychological well-being.

The survey is part of the Impact of COVID-19 on the Nursing and Midwifery workforce (ICON) study. Led by the RCN Research Society, surveys are being undertaken at three time-points: before the COVID-19 peak, during the peak, and in the recovery period following COVID-19.

But while the ICON surveys give an insight into the effects of COVID-19 on the nursing profession as a whole, less is known about the impact on nurse managers: those responsible for the safety and well-being of their teams, who have been faced with making difficult decisions in a rapidly changing environment and who have been looked on to lead by example.

View our COVID-19 resource centre

Managers responding to COVID-19 workforce challenges

RCN chair of nursing research Daniel Kelly
Daniel Kelly

RCN chair of nursing research Daniel Kelly says managers will have been faced with their own particular challenges during the pandemic.

'When it comes to COVID-19 we can surmise that they have been managing critical situations – having to redeploy people who may not want to be redeployed, having to deliver with workforce crises, quickly having to deal with people, having to bring in student nurses,' he says.

'These people have been faced with a wide range of workforce challenges.'

Here, senior nurses reflect on how they responded to the challenge, and we look at how employers can support their senior nursing staff.

‘It was dangerous. It was frightening’

For one nurse manager working in intensive care, her experience of the pandemic has made her question her future.

The nurse, who has asked to remain anonymous, was working in a major teaching hospital’s intensive care unit (ICU) at the start of the pandemic.

She says additional staff without experience in ICU were drafted in. She says an ICU nurse could be looking after up to five patients assisted by other staff who did not have the specialist skills needed to work in the environment.

'It was dangerous. It was frightening,' she reveals.

'I have only recently calmed down enough to talk about it. You can’t keep an eye on people and you don’t know what is going on.

'It had been a long time since I had that Sunday night feeling of not wanting to go to work the next day. But I had that every night.'

Although her trust provided psychological support, she says some colleagues were reluctant to access it.

'It felt like too little too late,' she adds.

 

Adapting to new pressures and ways of working

Caroline Alexander

Caroline Alexander is group chief nursing officer at London’s Barts Health NHS Trust, the largest NHS trust in England.

She describes the past few months as the most challenging of her professional life, which has taken every skill and relationship she has to navigate.

In the early weeks of the pandemic the trust – which runs five hospitals and has more than 16,000 staff – drew up a peak operating plan, including significantly increasing the number of mechanically ventilated beds across the trust. Barts also oversaw the operation of NHS Nightingale London, a temporary critical care hospital which was created in just nine days at the ExCeL centre.

Ms Alexander says one of her aims was to create an environment where staff could deliver the best possible care while having to adapt daily to new pressures and different ways of working.

For her, being able to reflect with others and a weekly coaching session have helped in the past few months.

How employers can support their managers

Picture shows woman relaxing with eyes closed. Nurse managers need time to look after their own well-being too. Picture: iStock

Picture: iStock

Jummy Okoya is assistant programme lead for the MSc course in human resources management at the University of East London and a fellow of the Chartered Management Institute. She says that continual intense pressure can have serious implications for nurse leaders and trusts need to support them.

She says that resources such as videos and examples of how other people have tackled similar problems, which nurse managers can be directed towards are also important. Peer support – either internal or external – can also help them share experiences, frustrations and concerns, and best practice.

Dr Okoya also advises nurse managers to be proactive about their own well-being.

'If they don’t care for themselves, they won’t be able to care for their patients and their staff,’ she says.

She suggests the following advice:

  • Try meditation A few minutes meditation first thing in the morning and another five minutes during the working day. Meditation app Headspace is offering all clinical and non-clinical NHS staff free access to its resources. The NHS website also offers tips on breathing exercises to help relieve stress
  • Address your sleep environment Keep your bedroom dark and cool. Avoid heavy meals, caffeine and alcohol close to bedtime, and do not be tempted to check your phone or tablet when in bed
  • Reflecting on the positive Remember what has gone well
  • Go outside Make a point of getting some fresh air, even if just a ten-minute walk

 

Supporting staff and staying visible

NHS Lothian executive director for nursing, midwifery and allied health professionals Alex McMahon
Alex McMahon

Staff sickness inevitably took its toll on nurse managers. Maria Pitt, a senior nurse in the medicine division at Whipps Cross Hospital in London, had to contend with staff either off sick or self-isolating.

'It was important to ensure that everywhere was safe,' she says.

'I knew my patients were being looked after to the best of the ability of my nurses but it was whether the nurses were being supported.'

Staying visible was a crucial part of maintaining staff morale for many nurse leaders.

'People look to you for leadership and guidance,' says NHS Lothian executive director for nursing, midwifery and allied health professionals Alex McMahon.

Ways employers can reduce stress in the workplace

  • Implement a stress policy which includes guidance on how to manage stress in the workplace and the process for assessing the causes of workplace stress
  • Provide staff support such as counselling, mentoring, coaching, training or supervision
  • Carry out a risk assessment and implement additional policies that are linked to common causes of stress, such as work-life balance/shift patterns. Simply put, anything significant that might be contributing to workplace stress needs to be considered
  • Offer stress management training
  • Offer staff opportunities to improve their own health such as healthy eating options in canteens
  • Ensure staff are able to take work breaks and are not regularly working beyond their scheduled hours
  • Improve current consultation and communication mechanisms, particularly around organisational change or changes to shift patterns

Source: RCN (2015) Stress and You: a Guide For Nursing Staff

 

A chaotic and frustrating atmosphere

In the early weeks of the COVID-19 pandemic, nurse leaders had to contend with rapidly changing guidelines, particularly around the use of personal protective equipment

Picture: PA

In the early weeks of the pandemic, nurse leaders had to contend with rapidly changing guidelines, particularly around the use of personal protective equipment (PPE).

'From my perspective it felt chaotic…the staff were saying there were patients who were suspected of being COVID-19 positive and this put them at greater risk but the guidance at the time did not support that [the use of higher standard PPE],' one nurse manager told Nursing Management.

One senior nurse says they were told of a new staff testing target that had to be met by the following evening.

'I found this kind of thing frustrating,' the nurse says. ‘I can’t say no, I have to say yes, but the way I balance that is important – I have to ensure staff are not stressed out.’

Support from friends, family and colleagues

So how do nurse managers cope with the stress? The support of family and friends is important – and often what they want is downtime when they do not talk about COVID-19.

Whipps Cross Hospital director of nursing and governance Zebina Ratansi says video calls with a group of friends who work in other sectors is helpful – although some other senior nurses have said they have shied away from this because they have spent much of their working day on Zoom.

Professor McMahon says his partner insists he puts his smartphone down in the evenings.

Getting time off – even if it is just a weekend – is also crucial when coping with stress. Some senior nurses had been working 12-15 hour days.

However, having the support of other staff at a similar level is also helpful.

‘The hardest thing any of us have had to deal with’

Nurses having a tea and a chat.

Picture: iStock

Professor McMahon says that the executive team he works with is a tight and supportive group that recognises when one of them is having a tough time and will offer practical help.

As a trained mental health nurse, he is used to thinking about coping strategies.

'But there have been times when I have said: “This is hard,”' he says.

'This is probably the hardest thing any of us have had to deal with.’

St Christopher’s Hospice in London’s care director Amanda Mayo says the COVID-19 crisis has been like an out of body experience.

‘Did that happen? Have we had ten weeks of living like that?’ she says.

'But my leadership will be better for it. I sense as a nurse there are lots of things that I have done that have had an impact on my life, things I have seen and been part of, and I sense they will just add to that tapestry of experience.'

Managing your personal work environment

Picture: iStock
  • Take time to regularly review and plan – learn to improve time management skills
  • Plan regular breaks – 30 minutes not working increases your effectiveness later on
  • Negotiate and if possible delegate, use ‘let me get back to you, ‘no’, ‘not now’, especially when you sense that others are offloading their work onto you
  • Learn to recognise your needs and be assertive in stating them
  • If the adjustments you are making are not working then make use of one-to-ones or appraisals to address your current situation

Source: RCN (2015) Stress and You: a Guide For Nursing Staff


Further information


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