COVID-19: what employers need to do to cushion the emotional impact on nurses

Nurses deserve support from government, their employers and each other to get through this pandemic

Picture: Tim George

The International Council of Nurses (ICN) has been in close contact with national nursing associations around the world since the appearance of the novel coronavirus in China at the beginning of this year.

We have shared information and lessons from the pandemic, and shown the advantage of international solidarity in a situation where national borders are no protection against the spread of a dangerous and highly infectious disease.

Nurses are exhausted, their work distressing and physically demanding

As the pandemic continues, it is not surprising many nursing associations have emphasised the fact that nurses around the world are exhausted, and they must not be allowed to become so drained of energy that they are unable to carry on working.

Those who are on the front line are working long hours with few breaks in uncomfortable protective equipment, making their challenging and often distressing work even more physically demanding.

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These nurses are seeing many of their patients deteriorate and become desperately ill with none of their family able to be present. It is nurses who are at the bedside, holding people’s hands as they die, bearing witness to the terrible toll the virus is having.

Nurses not directly involved with patients who have COVID-19 are working under the cloud of the virus and its potential to enter their lives, and the lives of their family and friends.

Shockingly, the ICN has also heard of abuse and physical attacks on nurses from people who are afraid that healthcare staff are spreading the virus in their communities. It goes without saying this is totally unacceptable. We have called on governments to provide accurate information for their citizens, and institute a zero-tolerance approach to any such attacks on nurses and other healthcare workers.

There is much managers and employers can do to mitigate the psychological toll on nurses

This situation is stressful, the sheer relentlessness of it all, with no end in sight, and it is having a detrimental effect on nurses’ mental health and well-being.

In the State of the World’s Nursing report, which I was privileged to co-chair, the World Health Organization, ICN and Nursing Now highlight the importance of retaining nurses. To do this, nurses need to be fit and healthy, and happy and willing to continue in their jobs.

But the current situation means many are at increased risk of psychological distress, burnout, anxiety, depression and post-traumatic stress disorder.

However, having such stress-related reactions is not inevitable. What is needed is action from managers and employers to provide resources to prevent and mitigate the emotional and psychological toll of intense and extended care-giving. Early intervention and ongoing support can help to limit the potential harm of working under such conditions.

What action is needed to support nurses’ well-being?

As a start, organisations should be implementing the World Health Organization’s (WHO) guidance on occupational safety and health in public health emergencies, which includes good practice and procedures in establishing systems that can:

  • Reduce occupational exposures, injury, illness and death among health workers
  • Decrease stress and reduce fear
  • Promote the health and well-being of healthcare workers

The ICN has been working with an expert group on how nurses can support their own mental well-being and capacity of cope, which includes: 

  • Debriefing sessions with co-workers and managers to restore perspectives
  • Minimising public and social media engagement if it causes emotional distress
  • Talking about the shock and disbelief of daily suffering and death with loved ones and 'checking-in' with friends
  • Recognising that families are strong supports in reinforcing resilience 
  • Remembering to have confidence in one’s own abilities and accepting that bouts of anxiety, and feelings of loss and self-doubt will occur
  • Recognising that at times of acute stress, feelings of isolation can result in depression, ruminative thoughts, unresolved grief and unhelpful coping strategies, including excessive alcohol consumption and drug use
  • Connecting with a mental health professional can decrease the severity of post-traumatic stress disorder and reduce the chances that mental health problems have a longer-term effect
  • Recognising, acknowledging and acting on your need for help


People need to feel they can be candid about the emotional fallout

The physical effects of working in the current climate are unlikely to be as long-lasting as the potential psychological and emotional effects.

So, it is important to provide a climate where people can speak honestly about how they feel without fear of being criticised for not coping, or stigmatised for having something wrong with them.

By accepting our own distress and that of our colleagues, we open up avenues that allow us to cope more easily, support each other and get through the roughest times as a team.

I hope nurses will support each other and get the support they need so that they will emerge from these troubled times having forged bonds with their colleagues that will last a lifetime.

Howard Catton, chief executive of the ICNHoward Catton is chief executive of the International Council of Nurses



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