The US is seeing some light at the end of the Covid-19 tunnel, but an unseen causality may remain in the mental health of its frontline healthcare providers, particularly nurses.

The pandemic continues to take a toll on nurses’ mental health, particularly those early in their career, according to a survey of 22,000 nurses nationwide released by the American Nurses Foundation, the charitable and philanthropic arm of the American Nurses Association. Among nurses aged 34 years and younger, 81% report feeling exhausted, 71% report feeling overwhelmed and 65% report being anxious or unable to relax. While nurses 55 and older reported some strain on their mental health, less than half reported feeling exhausted (47%), overwhelmed (37%) or anxious or unable to relax (30%).

“Nurses’ sustained exhaustion, stress and depression is a hit to their overall well-being and also takes a toll on our health system,” said ANF Executive Director Kate Judge. “This is especially so when you look at the disproportionate impact the pandemic is having on nurses who are early in their careers. As the future of our nursing profession, it is critical we give Millennials and Gen Z nurses the tools and time to recover and rebuild.”

Holly Carpenter, senior policy advisor for nursing practice and work environment and innovation departments at ANA, told SIA she was surprised that the numbers weren’t higher, especially for those exhausted and overwhelmed and anxious or unable to relax. “Nurses are a resilient lot by nature, so that was comforting to see,” she said.

Here are some of Carpenter’s suggestions for employers, including staffing providers, to help bolster their nurses emotional health:

• Optimal staffing. Making sure there is adequate staff to handle patient demand. Nurses should be able to take their scheduled breaks to hydrate, use the restroom, eat meals, etc. Nurses also may need a break after the death of a patient or other crisis. “The breaks are so critical,” Carpenter said. “If staffing agencies could write it in their contracts that their staff get assured breaks, that would be very helpful.”
• Guilt-free vacation time. Don’t make nurses feel guilty for taking their earned paid time off. “People earn vacation, they are not given vacation.” 
• Self-care. Provide access to healthy and whole foods and adequate time between shifts with no back to back shifts or mandatory overtime. In addition, provide low-cost confidential and assessable mental health assessments and treatment.
• Training. Make sure nurses have received the training and education for the unit they will be assigned to. Especially during the pandemic, nurses were often moved from unit to unit and expected to care for patients they were not used to.
• Personal protection equipment. Some of the urgency and shortages on PPE have been alleviated, but it is still something that needs to be prepared for.
• Safe, respectful workplaces. Make sure the hospitals nurses are sent to have the appropriate zero-tolerance policies and procedures in place and enforce them.
• Appreciation. Let your nurses know, in meaningful ways, how much they are appreciated. “We all owe them a debt of thanks and gratitude,” Carpenter said. “Have a system in place of meaningful recognition that rewards these employees that have literally been putting their lives on the line for all of us.”

Here are some resources ANA provides to help nurses:

Healthy Nurse, Healthy Nation: A free nurse health, safety, and wellness program open to everyone. It provides resources, challenges, discussions, a health survey, and more to help nurses be the best advocates, educators, and role models of health.

The Well-Being Initiative: It provides free tools and apps to support the mental health and resilience of all nurses.

Nurse Suicide Prevention/Resilience website: A robust website that provides current research and resources on: nurse suicide and prevention; mental health crisis situations; building resiliency, grieving a suicide death; honoring the memory of a suicide death; and a section for suicide attempt survivors, their employers and co-workers.

Trusted Health: Mental health amid pandemic impacting career plans

Nurse staffing platform Trusted Health’s second annual report on the mental health and well-being of frontline nurses expanded this year to look at the specific impact of the pandemic on nurses’ physical and mental health and how their experiences over the last year have impacted their career plans. 

The study found that nurses rated their mental health less positively now than before Covid-19; on a scale of one (most negative) to 10 (most positive), nurses rated their current mental health and well-being an average of 5.7 compare to 7.9 prior to Covid-19.

Other findings include:

• 66% have experienced feelings of depression
• 66% said their physical health has declined
• 64% have experienced compassion fatigue toward patients
• 51% have experienced feelings of trauma, extreme stress and/or PTSD
• 41% have experienced a moral injury or similar result of ethical dilemmas such as rationing patient care
• 20% have tested positive for Covid-19

Most surprising to Dr. Dan Weberg, head of clinical innovation at Trusted Health who has also been an ER and trauma nurse, was the number of nurses who were considering either changing jobs or leaving the profession.

The survey found 46% of nurses said they were less committed to nursing because of the Covid-19 pandemic, 18% of whom were actively looking for a job outside of nursing while another 7% were planning to retire from the workforce completely. In addition, 46% were not actively looking for a job outside of nursing but plan to within the next year.

“That’s really concerning to me,” Weberg told SIA. “We have an entire population that has put themselves in harm’s way and is now facing all these mental health challenges and considering leaving the profession that saved the country. That is something that is really worrisome.”

The results speak to the burnout that is happening with nurses. “They’ve been on the front lines, working three, four, five shifts in a row for the past year and a half now — and that is not sustainable,” Weberg said.

“I think nurses have felt disposable for a long time, even pre-Covid,” Weberg said. And as Covid hit, they were often treated like a commodity, often fluctuating between being furloughed and then reinstated to work incredibly difficult hours.

“We continue to find that health systems are not prioritizing the wellness of their clinicians — whether it’s nurses or physicians or anything else – and I think that has to be a core benefit for health systems to recruit and retain both travel and permanent staff,” he said.

Trusted Health’s study included more than 1,000 nurses, 80% of whom reported they were providing direct care to Covid-19 patients in their current role. The study was conducted online in March.