In the pandemic Dark Ages -- spring 2020 -- I was asked to speak to union representatives besieged by nurses needing quick emotional relief. I wrote for the American Journal of Nursing blog. It was republished on Best of the Blog, then chosen as one of three posts to receive a . I'd hit a nerve.
Yet, as the pandemic wears on (and on and on), I've almost regretted the piece. It's not that self-care isn't good for everyone, nurses included. It's that I've become grimly aware of what a colleague dubbed "the tyranny of personal responsibility," a national subtext that expects nurses to self-care themselves into happiness.
There are simply not enough beach weekends, happy hours (Zoom or otherwise), or yoga classes to shield a nurse's psyche from pandemic moral distress, exhaustion and burnout. Being forced to care for too many patients to practice safely, getting called in on days off to work over-overtime, watching 20% of one's colleagues leave to take other jobs -- let alone care for those severely ill or dying due to COVID-19 vaccine refusal -- is untenable. It is, however, an excellent prescription for burnout.
In my psychiatric practice, I treat nurses. And I've learned what might help, from patients and a growing literature on nurse hopelessness, depression, anxiety. My suggestions aren't for nurses -- let's not further tyrannize them with responsibility for their plight as well as their healing. Burnout is a systemic issue due to prioritizing profits over patients and staff. "." I'll leave financial solutions -- critical to any nursing workforce fix -- to others. Instead, these are wellbeing precepts for executives and administrators interested in retaining or recruiting frontline nurses, to work and thrive. Moving on from the ABCDEs of the early pandemic days, I now offer the LMNOPs of nursing-workforce-care.
Listen
"One of the most sincere forms of respect is actually listening to what another has to say" (Bryant McGill). Listening breaks down the "us" and "them" mentality of administrative versus nursing staff that's so divisive. Truly listening turns an opponent into a relatable human, holds a perfect price tag (free) and means infinitely more than buttons or coins with hospital imprints that healthcare organizations doled out, expecting to impact burnout. Such gratuitous gestures were not met with appreciation by exhausted nurses who feel no one truly hears how hard they are working, at what personal cost and sacrifice. And a listening bonus: nurses are excellent problem solvers. Their solutions work, often save money as well as lives, and can ensure you maintain a nursing workforce.
Moments to mark grief
Hospice is leagues ahead of other healthcare sectors in interdisciplinary collaboration, collegial support, and burnout prevention. That's how they sustain the emotionality of helping patients die daily. But nurses caring for COVID-19 patients -- or any patients as hospital care becomes increasingly acute -- did not sign up for patients dying. They signed up for keeping patients alive. They can't simply move on to the next bed. In hospice, it's customary to light a candle at staff meetings and speak the name of patients who died, perhaps sharing an anecdote of a brief, intimate acquaintance. Simply embedding a time during report or other meetings where nurses name those that recently died, with a few silent seconds for grief, can offer a powerful healing antidote to feeling helpless and unseen.
Nurses included
The famous 2017 photo of the former Vice President and all-male, all-white GOP leaders ("") went viral for a reason. "Nothing about us without us" is best known as a slogan for disability rights activists, yet has been adopted by many groups seeking overdue self-determination and inclusivity. How often are nursing policies discussed, decided and enacted without a single nurse at the table? Invite a nurse! Make sure they serve on the frontlines. Invite another nurse each time. You'll gain multiple, intersecting, invaluable perspectives. And speaking of:
Open to other perspectives
A about how to repair relationships following conflict showed a simple, effective solution. Couples chose a recent disagreement, then thought about it from the perspective of the other person -- as a "neutral third party" would. This "reappraisal" involves nothing more than what nurses do with patients: considering patients' needs. But do executives do this? Just for a moment reappraise -- imagine -- what it's like for any nurse, quitting work she's loved for years because she can't sleep, finding herself snapping at kids or a partner, or finding herself having vivid, terrifying COVID-19 flashbacks. Maybe she's single, supporting aging parents or cannot afford to work less, but has panic attacks on shift, terrified about making a fatal mistake. Imagine she's your sister, daughter, cousin, niece, subway co-rider. Thinking or feeling your way into another's perspective not only creates compassion, it creates new, unconsidered avenues for solutions and repair. Everyone wins.
Peer-support and preventing PTSD
One nurse's burnout improved after committing to taking a couple minutes every shift to ask another nurse how she was doing. Next, a few nurses began a text chain to support each other. Some days, they stayed past shift to check in and debrief after a hellish day. They listened. Then the fourth surge hit and none of this was feasible. The nurse's emotional health relapsed. I hesitate to even mention peer-support, for fear of invoking the tyranny of personal responsibility. But if healthcare administrators facilitate and ensure peer-support time, say, compensating for 15-minute check-ins before or after shift, this helps prevent trauma. And if anyone questions that pandemic work is traumatizing nurses, don't. Women are as men to suffer PTSD, and nursing is . Nurses are especially vulnerable to trauma, and from the inception of the pandemic have verified this for women, and nurses, in particular.
Any LMNOP can help ensure a healthier, happier workforce. And all are evidence-based: demonstrates empathetic leadership, a manageable workload, and freedom to discuss mental health at work decreases burnout. Nursing long before COVID-19, and promises to be with us long after. Unless we learn something. We can start with LMNOP.
Diane N. Solomon, PhD, PMHNP-BC, runs a private psychiatry practice in Portland, Oregon. She is also vice chair of the Nurse Practitioners of Oregon and on the board of directors of the Oregon Nurses Association.