Our healthcare heroes have been in a constant state of exhaustion, panic, anxiety and stress for over a year, suffering from the traumatic effects of working with hospitalized COVID-19 patients.

The nightly 7 pm pot banging to acknowledge sacrifices made by healthcare professionals was also a demonstration of gratitude to those toiling inside hospitals “but the public didn’t really know or understand what people were really going through and feeling,” said Sarah Crowe, a nurse practitioner in critical care at Surrey Memorial Hospital.

She led a newly published study on the toll the pandemic has taken on the mental health of nursing colleagues caring for the most seriously ill COVID patients.

The study, published in the journal, Intensive and Critical Care Nursing, found that the majority of nurses working in critical care and high acuity units at SMH had symptoms of Post Traumatic Stress Disorder (PTSD) last May when they were surveyed and interviewed about their mental health. Crowe, also an adjunct professor at the UBC School of Nursing and vice president of the Canadian Association of Critical Care Nurses, gathered the data last spring with six other colleagues, including Dr. Gregory Haljan, head of the SMH ICU.

While other studies done during or after previous infectious disease outbreaks or natural disasters have shown healthcare providers suffer significant psychological distress, including PTSD rates ranging from 8.5% to 20.8%, the new study shows far higher mild to severe PTSD symptoms affecting 75% of nurses.

While critical care nurses are trained to work in units where deaths aren’t uncommon – and with patients whose lives often hang in the balance – the pandemic has magnified the negative impacts on nurses’ psychological distress. Thrown into battlefield medicine, they’ve been dripping in sweat under their personal protective equipment and consumed by dread and despair.

The majority of nurses described their depression, anxiety and overwhelming worries about caring for the sickest COVID patients, not to mention getting infected themselves and bringing COVID-home to their families. About 1,500 B.C. nurses have been infected by COVID-19 out of at least 6,600 cases in healthcare workers. Not all infections were acquired in the workplace and Crowe said while she knows nurses in the ICU who’ve been infected, “as far as I know, transmission did not occur in the hospital but rather in the community.

“That’s what I’ve heard and that’s what I’d like to believe. And when we had our first patient in the ICU with a (more transmissible) variant, we all got tested and no one got it so clearly, our personal protective equipment is working as intended.”

Nevertheless, the study shows that nurses’ psychological distress was directly tied to their anxiety at their jobs, fuelled in part by fretting over reported shortages of personal protective equipment (PPE) supplies. One nurse in the study said she found herself constantly having to “talk myself down” from moments of extreme anxiousness and panic over whether she was putting on – and taking off PPE – the proper way.

Nurses spoke about the discomfort of wearing masks, goggles and other PPE the whole day, and not being able to sip water during long shifts because PPE can’t be adjusted or removed.

They’ve had to cope with ever-changing infection control and other policies, and being overwhelmed with frequent and often unclear communication. They’ve been bombarded with emails about variations in policies and procedures, from unit managers, hospital directors, infection control specialists, and others.

The constant barrage of information was compounded by information also coming through provincial and federal government channels as well as news outlets.

That made them feel even more desperate; if they didn’t read everything coming at them they could be providing sub-optimal care, not to mention putting themselves, their colleagues and their families at risk.

They reported feeling drained by the fact that patients couldn’t have visitors unless they were deemed to be dying.

“It has been very troubling to observe patients go through this experience without the physical and emotional presence of their loved ones,” said one nurse. They could help facilitate telephone calls and video chats between patients and their loved ones but as everyone knows, such communication tools are a poor substitute. Nurses used cell phones and other devices to let family members see their comatose loved ones die while on Facetime.

It’s happening all over again in the Third Wave as COVID cases surge and nurses are back in their own survival modes.

“Today, we have more COVID patients than at any time in the pandemic,” said Crowe.

While nurses in the study described disconcerting changes to standard nursing practices, implemented to prevent potential exposure to COVID like “no longer listening to breath or abdominal sounds” Crowe insists patient care has not been compromised.

Study Design

In May 2020, 109 out of 240 nurses who work in the 26-bed ICU and 20-bed high acuity unit (ACU) completed online questionnaires that measured their psychological distress. Some of them also answered questions in one on one interviews. The average age of nurses who participated in the study was about 37.5 and the vast majority were female. Only a minority (25.7%) did not demonstrate signs of PTSD. 

Nurses in the study reported on how much their family life was upended as they tried to juggle homeschooling with household duties. Many said they were stigmatized by family and friends for even working in the COVID unit.

They felt isolated and shunned by family members and others who feared they might get COVID from the nurses. Some stopped sharing bedrooms with their partners; others moved out of their homes altogether.

Their self-care strategies included telephone and video chats, getting enough sleep, exercise, hobbies, gardening, and being outdoors. Their negative coping mechanisms included poor eating habits and drinking more alcohol.

“The overall findings produce a worrisome impact on our critical care registered nurses. The findings portray a large burden of psychological distress and therefore a need to provide support to build resilience in order to mitigate effects life burnout and desires to quit their professions,” the authors state.

Indeed, nursing organizations and media reports have warned of the flight of nurses from hospitals and other facilities, ominous indicators for healthcare systems consistently struggling to keep up with demands, even before the pandemic.

As a result of the study, supported by Fraser Health but not funded by any organization, various resilience-building measures were implemented including critical incident stress management sessions that value nurses’ insights and recognize their burdens, regular psychological first aid check-ins by a hospital psychiatrist and reminding nurses to use their extended health benefits for purposes like massage therapy and other wellness-promoting activities.

Crowe said she will soon launch another study but this time surveying nurses across the country. It will ask nurses about how the pandemic has affected their career plans. Will they retire early, seek jobs in less stressful units for example.

“We’ve already seen some nurses leave the critical care units, only to be redeployed back because we need them. We have sufficient staffing for now but we’re now running over-capacity and relying on help from nurses in other departments like emergency, recovery and cardiac units to help out.”

Crowe said healthcare professionals are bracing for the latest surge and she’s reminding nurses to be aware of their boundaries so they don’t crack under pressure.

“It’s ok to say no to work if you’re too tired. It’s a good idea to turn off social media. To find things that give you joy. To check in with others and to not be afraid to say ‘I’m struggling.'”

Source: American Psychiatric Association