Nurses share impact of pandemic on mental health at Rutgers-hosted panel

The Rutgers School of Nursing held a panel on Thursday to discuss the psychological impact of the coronavirus disease (COVID-19) pandemic on nurses and other health care providers and to demystify the stigma surrounding mental health for frontline workers.

The panelists included School of Nursing experts Susan Salmond, executive vice dean, Charlotte Thomas-Hawkins, associate dean of nursing science, and Amita Avadhani, associate professor, as well as Donna Gaffney, a Rutgers alumna and licensed psychotherapist and Lindsey Greene, a Rutgers alumna and registered nurse at the Hackensack University Medical Center.

This discussion was moderated by Kelly Moore, a licensed clinical psychologist with a clinical specialty in the treatment of anxiety, trauma and perinatal disorders in youth and adults and director of the Center for Psychological Services at the Rutgers Graduate School of Applied and Professional Psychology.

Gaffney said she has seen how nurses have been given extra responsibilities on top of their existing workload due to the pandemic. Many school nurses, for example, have been given the tasks of contact tracing and becoming specialists on any pandemic-related information for schools.

She said she typically hears that nurses are overwhelmed with the number of regular patients who are worsening in condition and their usual coping strategies failing them during their 12-hour shifts.

“I’d like us to redefine the frontline,” Gaffney said. “I think all nurses are frontline nurses now.”

While some nurses struggled from the outset of the pandemic, Gaffney said others felt useful initially and only realized the depth of their stress and anxiety several months after. Those nurses with a history of anxiety or death in the family were at much greater risk of poor mental health, which she said is exacerbated by the fact that many are unwilling to reach out for support.

“I think all health care providers are reluctant to seek help,” Gaffney said. “It’s been pounded into our heads that we’re caring, we understand this, we know what happens, but when it’s us, everything goes out the window.”

Avadhani discussed her experiences as an acute care nurse practitioner working in intensive care amid much physical and emotional turmoil during the pandemic.

“Having all these years of experience that I did in acute care, I thought I had the knowledge, the skill, the experiential wisdom to handle the difficult situations that came my way,” she said. “The loss of life, particularly young life, that I witnessed during this time, was unimaginable, and something that no amount of education could prepare us for.”

Avadhani said there was no time to rest and mentally prepare due to the fast pace of dealing with infections and hospitalizations. The lack of resources did not make her situation, or that of any other health care professional, easier. 

Greene, a recent alum who joined the frontlines as a critical care nurse during the peak of the pandemic, said she saw much pain from patients and family members being isolated and unable to connect with their loved ones, even during the final moments of their lives.

She also witnessed the difficulty faced by health care providers in connecting personally to patients and the shock when patients became much sicker than anticipated.

“I saw a lot of anxiety and fear, and I held a lot of hands and shed tears myself but tried to really know that I was doing my best and putting my best foot forward through it all,” Greene said.

Thomas-Hawkins said that nurses of color have faced both the pandemic itself and racial disparities, with nearly one-half of all confirmed cases, hospitalizations and deaths among health care workers occurring among health care workers of color. She said this causes these workers a great deal of stress, as they must balance their own safety with workplace exposure.

In addition, the issue of persistent racial injustice and biases was brought to light as the pandemic emerged under global attention on racism, both in and out of the workplace, after the death of George Floyd, Thomas-Hawkins said.

“We know that nurses are no exception to experiences of workplace racial injustices and biases,” she said. “The experience of persistent and pervasive racism and discrimination in the workplace is the second crisis that is not new, but one also experienced by many nurses, especially nurses of color, amid the COVID(-19) pandemic.”

She said this crisis and the pandemic informed a November 2020 survey by her research team that questioned 800 hospital nurses of all races across New Jersey about emotional distress, the extent to which they worried about the virus, their perceptions about the racial climate in their workplace and the microaggressions they faced in the workplace.

Overall, nurses expressed a high level of emotional distress, which coincided with significant worry about the virus. Compared to white nurses, nurses of color expressed more negative racial climates in their workplace and a higher number of racial microaggressions, Thomas-Hawkins said.

“An important lesson that we learned from our survey is that workplace racism is a reality for hospital-based nurses, especially nurses of color,” she said. “The psychological impact of racial trauma experienced by nurses of color during the COVID(-19) pandemic can’t be overlooked as we implement strategies to address distress that frontline nurses in hospitals are currently experiencing.”

Salmond then spoke about her time working with nurses and discussing their emotional experiences in caring for patients as a part of the New Jersey Nursing Initiative.

She said many nurses described a noticeable shift in their lives when their careers turned from safe and comfortable to terrifying and uncertain, yet they remained committed to caring and supporting their patients in times of need.

Salmond said nurses built camaraderie to support one another during each surge of the pandemic and focused on the little victories and being there for patients, whether virtually through telemedicine or in-person. It was in between waves of the infection, she said, that nurses began to realize that they needed to reach out for help and resources.

The School of Nursing will begin having Schwartz Rounds for students to be able to discuss the human dimensions of medicine and their emotional experiences, Salmond said. The school will also introduce the implementation of stress first aid in the workplace as both an individual and organizational coping strategy to help recognize and respond to stress injury.

In addition, the School of Nursing will pioneer a new institute to focus on the emotional well-being of nurses via research and service, she said.

Linda Flynn, dean of the School of Nursing, provided closing remarks for the event, reemphasizing the importance of taking care of oneself and asking for help at this time.

“If you are suffering from depression, if you are suffering from anxiety, (post-traumatic stress disorder), burnout or any other major threat to your emotional and mental well-being, please reach out and know that you are not alone,” Flynn said. “Please reach out to counselors and professionals who can help you begin and end your journey towards healing.”

Editor's Note: This article was updated to include information about the event's moderator.