COVID-19: staff well-being initiatives are vital as nurses face greater pressures

Stress from the COVID-19 crisis and helping patients to cope with an uncertain future is stretching the resilience of nurses and staff well-being intiatives need to be in place

Picture shows a young nurse in scrubs looking weary with her hand to her head. Added stress from the coronavirus and helping patients to cope with an uncertain future is stretching the resilience of nurses.
Picture: iStock

In the space of a few short weeks, cancer nurses have been asked to confront new and daunting challenges as they work out how to best care for and support their patients in a difficult environment.

In conversations with nurses many deep-rooted concerns and feelings have been expressed. The first and overriding worry I have heard is that these nurses may themselves be unwittingly carrying COVID-19 and may pass it on to their vulnerable patients.

One nurse said that she could never forgive herself if she did so: ‘I am here to care for them and to help them recover – it feels like I could potentially be delivering a death sentence,’ she said.

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Feelings such as this have undoubtedly heightened nurses’ desires to promptly and diligently monitor themselves and to begin self-isolation at the slightest hint of a cough or temperature.

Concerns have been heightened by patients who are coming into hospital for treatment and voicing their worries that just by their attendance they are putting themselves at risk.

In a short space of time, innovative ideas have been rapidly implemented to enable as much care and treatment as possible to take place remotely. However, this isn’t always possible, so education has helped nurses to recognise that not every patient is in the very vulnerable category. This gives those nurses an opportunity to pass this information on to patients.

Nurses have to respond to distress and anger as patients come to terms with a less certain future

One of the hardest challenges faced by nurses, particularly clinical nurse specialists, is being involved in the kind of ‘hard conversations’ that involve telling patients their treatment won’t be going ahead because it would put them at too much risk, or conversations about end of life care and do not attempt resuscitation decisions.

These might feel premature, yet are so important as the country faces an immediate future with limited space in critical care.

Nurses are having to respond to distress and anger as some patients are facing coming to terms with a new future, one that is less certain and positive than they had previously expected.

These new and difficult challenges are layered on top of the universally shared experiences of uncertainty, fear and anxiety and the feelings of being overwhelmed, common to so many.

Our capacity to cope with stressful situations can be imagined as being like an elastic band. Elastic bands are amazing – they stretch and stretch, but if too much tension is put on an elastic band then it simply snaps.

Picture shows a young woman in scrubs talking to a patient. Stress from the coronavirus and helping patients to cope with an uncertain future is stretching the resilience of nurses.
Picture: iStock

Nurses are being amazingly resilient, adapting and stretching to meet the changing daily demands. Staff well-being initiatives are essential to reduce that stretch and help them to cope. At the Royal Marsden we are offering drop-in sessions for staff to speak with therapists to talk through the challenges they face.

Sharing difficult and distressing experiences helps us to process them

We are also offering staff emotional support in the evenings via telephone. Video reflective practice groups will be offered to staff who are caring for patients with COVID-19.

Connection with others in an environment in which everyone feels psychologically safe, allowing them to talk openly and honestly, is so important. Research shows that sharing difficult and distressing experiences helps us to process and make sense of what happened. 

The emotional cost of nursing at present is high – as carers of those in distress we give of our emotional and physical energy to do it, so I encourage staff to have a plan to refuel or revitalise.

I have been asking our nurses to share what they are doing to switch off and recharge when they leave work, within the bounds of social isolation – ideas have ranged from learning to hula hoop to teaching their partner to jive.

Sara Lister is head of psychological support and pastoral care at the Royal Marsden NHS Foundation Trust