In an August focus group conducted by the American Nurses Foundation, a nurse remarked, "I say I'm fine, but I feel scared to death every time I go to work."
She isn't alone.
In study after study, nurses report feeling exhausted and overwhelmed as they continue to respond to the COVID-19 outbreak. In our own surveys at the American Nurses Foundation—the philanthropic arm of the American Nurses Association—tens of thousands of nurses have shared insights on their practical concerns, their mental health and wellness, and their financial challenges. In one recent survey, more than half of nurses disclosed feelings of depression as the pandemic enters its seventh month in the U.S.
In many ways, the findings shouldn't be a surprise. For years, the healthcare workforce has confronted rising levels of professional dissatisfaction brought on by increased regulatory demands, burdensome electronic health records, poor work-life balance, and a loss of autonomy. Prior to the pandemic, one-third of nurses exhibited signs of burnout. And studies coming out of countries that have passed the peak of COVID-19 indicate that 45% of healthcare workers in direct patient-care experience anxiety.
This all raises the question of how institutions can best support those in the trenches. Statements of gratitude to clinicians must be accompanied by action.
In a recent Viewpoint in JAMA, Dr. Tait Shanafelt—director of Stanford Medicine's WellMD Center—and his colleagues discussed findings from a series of listening sessions with healthcare professionals in the early days of the pandemic. Through their conversations, they identified eight primary sources of professional anxiety—from access to personal protective equipment to added childcare challenges and financial strain. They say these myriad concerns can be organized into five categories of "requests to employers": prepare me, protect me, support me, care for me, and hear me.
Their framework is one that seems to be supported in the far larger dataset collected by the American Nurses Foundation since May. Based on qualitative data from our Pulse of the Nation survey series, we found that the responses of nurses fall into similar calls for assistance. What's more, like Tuckman's stages of team development or Kübler-Ross' stages of grief, the framework suggests an important pattern that we'd be wise to understand and anticipate.
In surveys collected at the onset of the pandemic, it seemed that concerns from healthcare professionals coalesced almost exclusively around the need for preparedness and protection. We heard frustrations about lack of training, equipment, transparency and timely information. Indeed, in a survey put out by the ANA shortly after the outbreak, a full 43% of responses to open-ended questions referenced shortages of staff and PPE, with 2 out of 5 nurses reporting that they had to make their own PPE. In a more recent ANA survey, 62% of nurses express feeling unsafe by employer requirements to reuse single-use PPE, like N95 masks.
As studies continue, the needs of nurses are evolving along Shanafelt's proposed progression line. The foundation's most recent survey, which explored the financial impact of the pandemic on nurses, revealed new vulnerabilities from deferred retirement investments, lost savings, and the end of student loan forbearance. This indicates the need for a greater emphasis among the workforce on planning for life after COVID-19.
As we face the cumulative impact of needs met and unmet, nurses are indicating a desire for more space to process grief, share stories, and plan ways to move forward. The foundation is conducting focus groups and many health systems across the country are planning town halls and listening sessions to hear and respond to the experiences of their healthcare professionals. These are essential spaces that employers should create now.
At the foundation, we've been preparing, protecting, supporting, and listening to our front-line caregivers since long before the pandemic. While we slowly wade through the phases of COVID-19 response and recovery, it's critical to recognize that we're also wading through the phases of personal recovery. Institutions play a key role in this process. We urge health systems and other industry employers to join us in listening to and supporting our healers, just as we will continue to stand by our nation's nursing workforce to advocate on their behalf.