Analysis

‘Flashbacks and depression’: depleted nurses talk about their health as cases surge

Many nurses report that their health has yet to recover after the COVID-19 first wave

Many nurses report that their health has yet to recover after the initial stages of the pandemic

  • More than 1,650 nurses completed a Nursing Standard survey about their health after working through the first stage of the pandemic
  • Eight out of ten respondents said their mental health has been affected by the pandemic, with some reporting symptoms of PTSD
  • Mental health and physical support offered by employers varied from non-existent to excellent. Find out what support is available to nurses

Nurses have laid bare how they are overwhelmingly mentally and physically drained as they head into the second wave of the COVID-19 pandemic.

In a Nursing Standard survey, eight

Many nurses report that their health has yet to recover after the initial stages of the pandemic

  • More than 1,650 nurses completed a Nursing Standard survey about their health after working through the first stage of the pandemic
  • Eight out of ten respondents said their mental health has been affected by the pandemic, with some reporting symptoms of PTSD
  • Mental health and physical support offered by employers varied from non-existent to excellent. Find out what support is available to nurses
Nurse in full PPE
Picture: iStock

Nurses have laid bare how they are overwhelmingly mentally and physically drained as they head into the second wave of the COVID-19 pandemic.

In a Nursing Standard survey, eight out of ten respondents said their mental health has been affected by the pandemic, and six out of ten said their physical health was suffering.

Anxiety, stress and fear have taken their toll

Anxiety, stress, and feelings of fear were widely reported by the more than 1,650 nurses who took part in our health and well-being at work survey.

Many reported they had gained weight, as opportunities to exercise had declined due to gym closures and because they were too tired to workout after working long hours.

‘Fed up, drained and not as happy as usual,’ one nurse said, in a weary summary of depletion echoed by many others.

Some reported feeling constantly anxious, especially when it came to going to work.

Many suggested they had symptoms of post-traumatic stress disorder (PTSD) following the first wave of COVID-19, including flashbacks and disrupted sleep.

‘I have never felt so anxious. Constantly being around people – in and out of work – who go on about it, makes me feel trapped and fearful all the time’

Nursing Standard survey respondent

‘I have suffered flashbacks, nightmares and depression after the death of many of my patients,’ one nurse reported.

Another said: ‘Since my stint working on a COVID-19 intensive therapy unit I have not slept through a single night. I am on antidepressants for anxiety and depression.’

How nurses are approaching the realities of a second wave

Many respondents to the survey, which was carried out from 11-19 October, questioned how they would make it through a second wave.

‘I’m carrying the mental scars of working in the intensive therapy unit through the first peak. We’re now heading into peak two and there is a lot of concern about the mental strain on staff,’ one respondent commented.

Another said: ‘I don't normally feel as down as I have this past eight months. I’m not living my life, I’m just existing.’

Concerns were voiced about how much harder it will be to cope with another peak during the winter months.

‘I don’t want to be at work anymore as I don’t want to go through what happened in March to May,’ a member of staff at a nursing home said.

Another said: ‘I have never felt so anxious. Constantly being around people – in and out of work – who go on about it, makes me feel trapped and fearful all the time. I would stop working tomorrow if I could. This sounds like a terrible thing to say, but I just don't feel able to cope with it for a lot longer.’

Respondents said their mental health was suffering as their usual support networks outside of work had been taken away. Many said working in healthcare settings meant they felt the need to be more cautious about who they mixed with outside of work.

Anxiety over transmission risks has increased feelings of isolation

Worry about taking the virus home or on to relatives who are older or in poor health was a constant source of anxiety for some.

One respondent described how she was ‘socially cut off from family, church, church activities and friends’.

A ward sister added: ‘I am suffering feelings of isolation from the rest of my family, especially the grandchildren. Working on a respiratory ward has placed me squarely on the front line and I am very aware of the possibility of passing on the virus to those I love.’

The loss of usual out-of-work activities and holidays is affecting many respondents’ mood and well-being.

‘It's the loss of contact with family and friends,’ said one nurse. ‘Plus being unable to do normal things like going to the theatre and cinema. It's just bed and work.’

‘We must ensure there is support in place to help staff during this surge. The NHS is only as good as the people working in it and they deserve to be protected’

Nicki Credland, senior lecturer at the University of Hull and chair of the British Association of Critical Care Nurses

University of Hull senior lecturer and head of the department of paramedical, peri-operative and advanced practice Nicki Credland says the results of the survey are not surprising.

Nicki Credland, chair of the British Association of Critical Care Nurses
Nicki Credland: ‘Nurses are scared for themselves and their families’

She has previously raised concerns about how exhausted nurses will cope with another peak.

Protecting staff during the second wave

‘Nurses have been under significant pressure since the start of this pandemic both physically and emotionally,’ says Ms Credland, who is also chair of the British Association of Critical Care Nurses (BACCN). ‘We already had a significant shortage of nurses and still had to step up to meet the huge challenges that COVID-19 presented.

‘Nurses, particularly those working in critical care, are really suffering from the psychological effects of caring for highly complex patients and the associated high mortality. They are scared for themselves and their families and we are seeing that now in terms of staff sickness.’

If staff are not supported, the quality of care will inevitably suffer, Ms Credland says.

‘We must ensure there is support in place to help these staff over the next surge,’ she says.

‘If we don't, I do not know how the health service can continue to deliver world-leading care. The NHS is only as good as the people working in it and they deserve to be protected and respected.’

Fitness levels have declined for many

When it came to physical health, respondents described how long hours and changes to access to sports activities had reduced their levels of activity compared with pre-COVID-19 levels.

A significant number of nurses reported having gained weight since the spring, due to reduced exercise levels, higher stress levels and more time at home – two said they had gained two stone since the spring.

Restricted access to gyms, and the financial impact of the pandemic meaning subscriptions had become too expensive to maintain, have limited access to normal exercise routines.

Opportunities to fit in unplanned exercise, such as walking to the train station, have diminished as nurses avoid public transport.

‘I’ve gained weight due to my anxieties about going outside and exercising for fear of judgement,’ one respondent says.

Meditation and gardening: hobbies that helped through the first wave

Growing vegetables, knitting and learning a new language are among the new activities that nurses have turned to during the pandemic.

Gardening was a particularly popular choice among survey respondents. With the first lockdown coinciding with a long spell of sunny weather, many said they embraced the simple pleasures of being outside when they had time. Several nurses reporting taking on allotments, while others were growing fruit and vegetables in their garden.

‘I have become an avid gardener, I walk more to avoid using public transport [and] I have a freezer full of home-baked goods,’ said one respondent.

Woman in workout clothing practising meditation
Mindfulness, meditation and exercise have been provided by some employers Picture: iStock

For some, the disruption to normal activities due to social distancing and opportunities provided by home working prompted them to try new activities.

Four in ten (41%) of the 1650 nurses who responded to the survey said that they had taken up hobbies since the pandemic began.

Often these pastimes were also a good way to tackle stress, anxiety and social isolation caused by the pandemic, respondents said.

Five respondents said they had got a new puppy since COVID-19 started and were enjoying walks in the fresh air.

Even exercise went remote

Mediation was a popular new activity choice to cope with the anxiety of working through the pandemic, especially with the support of apps such as Headspace (which remains free for staff with an NHS email until the end of the year).

Traditional crafts, including sewing, crocheting, knitting, embroidery and woodwork were all mentioned as new pastimes.

For those seeking more active pursuits, there was golf, sea swimming, running, paddle boarding, yoga, pilates and tai chi. People also did more sport remotely, joining dance, pilates and aerobics classes online as leisure centres became harder to access.

One nurse said the pandemic had prompted them to appreciate a ‘simpler life’, while others tried hobbies they had never had a chance to before. ‘It has given me the impetus to undertake a floristry course for some additional downtime from work pressures,’ one respondent said.

But for others, new or old pastimes were a struggle. Long working hours and the tiredness this created left them with little time or energy for any activities. ‘I haven't had time,’ a nurse said. ‘We've been nursing all of the time and covering each other.’

Nursing Standard podcast: Stress relief for busy nurses

Long-COVID and the physical effects of continued use of personal protective equipment

For those with pre-existing conditions, work and lifestyle changes since the first lockdown began have exacerbated their symptoms.

The survey heard from nurses with multiple sclerosis, ME and osteoarthritis, who all felt their conditions had deteriorated since the pandemic began.

A couple of nurses reported that planned surgery had been cancelled, affecting their quality of life.

Stress was causing physical symptoms, and the constant handwashing and use of personal protective equipment and alcohol gels was leading to sore and damaged skin.

Others said wearing masks constantly gave them sore ears, sinus problems and sore throats.

A worrying number also reported that they felt they had not yet recovered fully from having COVID-19 in the spring during the first wave.

Breathlessness and fatigue are among the symptoms that nurses reported. Some said they had long-COVID, a term coined for the long-term effects experienced by about 10% of people who have had the virus that can last weeks or months.

Many nurses have taken on extra physical strain under COVID restrictions

‘After having COVID-19, I now get breathless very easily,’ was one response, which was echoed by many others.

Some were feeling the physical effects of lifting more during the previous peak.

‘Nursing staff on our ward were expected to do a lot more heavy lifting during the pandemic as porters were told not to enter a red zone,’ one said.

‘All supplies were therefore left at the entrance to the ward. Additionally, nursing staff had to transfer patients between beds and trolleys and take them to the entrance. This extra physical strain continued for five months and contributed to muscular skeletal issues and general physical exhaustion.’

The experience of employers’ provision of physical and mental health support reported to the survey was extremely variable.

Many reported it was completely inadequate or non-existent, while some said it had started well during the previous lockdown and then tailed off rapidly. Many said their employer paid lip service to support, without actually delivering much.

Where to go for health and well-being support

Access to confidential support via phone and text message is provided to all NHS staff through the Our NHS People website.

It also provides a wide range of tools to help NHS staff manage their own health and well-being, including guides to managing your energy in the workplace, coping with bereavement, getting a good night’s sleep and building personal resilience.

The NHS has partnerships with groups providing free one-to-one counselling and support sessions for health staff that can be accessed through this site.

There is also free access to a number of well-being apps for NHS staff until the end of the year. These include SilverCloud, Sleepio, Daylight, Unmind and Headspace.

‘Meaningless platitudes’: support from employers has not always struck the right note

The focus of help that was available was strongly geared towards mental health, with little available for physical health.

Quite a few nurses reported accessing counselling through work, but some struggled to access any available activities or support as it was during work time.

‘There is an inadequate “well-being team” online information that repeats meaningless platitudes,’ one said.

‘All resources are geared towards intensive care unit staff while I see the wards struggling.’

Some staff reported the support was there but didn’t always feel it was easy to access.

‘There are psychologists available, but when working full-time I want days off for me, not to talk about work and it’s too busy [to do this] during work. I feel it’s been very much focused on supporting those who have had to remain off work due to health issues, and those having to work through it have been ignored.’

Woman dressed in scrubs speaking to another person in a counselling session
For some nurses, worplace support such as counselling was easily accessible, while others said they felt ‘ignored’ Picture: iStock

Mental health and well-being support varies from excellent to non-existent

In October, NHS England and NHS Improvement announced an additional £15 million investment to strengthen mental health support for nurses and other healthcare staff.

Some respondents to the Nursing Standard survey described a supportive work environment with employers that were trying to help their staff through the pandemic. Quite a few had ‘wobble rooms’ to allow staff to take time away from the clinical environment when they needed it.

One said they got lots of ‘treats, encouraging words and praise’ along with access to counselling.

Another suggested a comprehensive range of support. ‘My trust has a specific well-being support network to provide online and phone support,’ the respondent said.

‘Mindfulness, meditation and stretching exercises have all been provided regularly by psychologists and physios working for the trust. Plus my workplace set up monthly team support meetings online. Flexible working has also been enabled so I can work partly from home.’

How we conducted the survey

Nursing Standard asked nurses to share their views about their health and well-being at work during the COVID-19 pandemic.

The survey was conducted via the Survey Monkey online survey website from 11–19 October 2020.

It was promoted via email to registered users of RCNi.com, on social media and in online news articles.

It received 1,661 responses and the findings were analysed by Nursing Standard staff.


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