As I write this, we are in the tenth month of the coronavirus shutdown in the United States. I have never had so many of my nurse friends showing signs of mental stress. Their text messages and social media posts talk about feeling overwhelmed and under-appreciated and desperately bracing for the next wave of illness as we go into the winter months. 

No doubt about it, the pandemic has affected nurses’ mental health. Let’s look at the components that have been causing the most distress and how we can mitigate these in our lives and in our friends’ lives. 

Isolation 

The problem: Because of workplace requirements and governmental mandates and personal choices to attempt to protect the most vulnerable, nurses have often experienced even more social isolation than their none-nursing peers. This is especially true of those of us who work in long term care and intensive care, where the case load is high and visitors are barred or severely restricted. 

Even when surrounded by people during work hours, physical distancing and masking make social connection difficult. Trying to understand and connect with people through these barriers become emotionally exhausting. 

The (potential) solution: Find ways to connect face-to-face without a mask, outside of work. Sit on the porch and talk. Go for a walk. 

Get serious about building your quarantine pod. This can be people you already live with, or a small group that is dedicated to spending time together “as if” they were family. With these folks, consider giving (and receiving) lots of hugs and snuggle time. The immune benefits are likely to be greater than the potential for exposure. If face-to-face hugs look like too big a risk, sit back-to-back and facetime each other with microphone off. Get creative and find ways to see faces and get touch. 

Overwork and layoffs 

The problem: Critical care and other “essential” units have been running at capacity (and sometimes over; when surges occur). Due to mandatory quarantines of staff who test positive, hiring freezes, and parents needing to stay home with their children who are doing virtual school, these units are even more short staffed than usual. As we head into the winter months, this is only likely to get worse. Constant overwork and uncertainty is a stressor that affects mental health. 

However, in many other units and other areas of nursing, there have been unprecedented layoffs. Surgical centers cancelled all except emergent surgery for a number of months. Oncology and other specialty centers saw lower volumes as patients delayed accessing care due to fear of exposure. Some of these workplaces are still slow, or slow again. Others are seeing a surge as people start to schedule procedures they had delayed previously. The uncertainty of potentially losing a job, or having lost a job and having to start over in a different area of nursing has been and is stressful for many nurses. 

The solution: Readjust expectations and work on healthy coping skills. Remember that running at capacity is normal for the winter months. If you’ve been laid off, look around at what is available that is outside what you would normally be doing and apply there. If no nursing jobs are available, consider your other skills and leverage them. (Like I’m doing, writing about nursing stuff!) 

The coping skills discussed above in the section about isolation are helpful here too. Remember also to eat well, with plenty of whole foods and generous helpings of protein. Drink lots of water and get sufficient sleep. Attend to spiritual disciplines. Walk, run, or go to the gym. Taking care of your body is among the most powerful coping method that there is. 

Danger 

The problem: Nurses are on the frontlines of the pandemic. They are exposed, actually or potentially, every day. This constant awareness of danger is further highlighted by the PPE that is required now. And if PPE is in short supply, and/or being reused to conserve supply, the awareness of danger is heightened. 

This constant stress is wearing and can lead to mental health challenges. 

The solution: Ironically enough, the simplest solution is to accept the danger and be willing to face the risk. When once that cognitive hurdle has been crossed, fear cannot control one’s mind anymore. An entire team that has determined that they are willing to die is a force that cannot be stopped! 

Realize, too, that the survival rate is actually quite high. Simply knowing that one is facing illness, not certain death, and that there are ever-improving treatments, makes it easier to face the danger. 

Other solutions are more systemic and may be beyond the power of the individual nurse to create change. Supply issues are larger, systemic problems and most nurses are not in a position within their organization to bring about creative solutions. However, you can advocate up the chain for what you need in order to be safe as you work. 

In summary, face the fear, resolve to be willing to accept the danger, and advocate. 

Cognitive dissonance 

Coworkers, family, and friends are likely to be on opposite sides of the mask/no-mask debate, the push for or against rapid deployment of a vaccine, and pro- or anti-shutdown. Regardless where you personally fall on each of these issues, your work is quite likely to challenge what you believe. Whether you are desperately pleading for family members to be careful and stay home, or you are frantically trying to wake them up to the dangers of blind compliance, you are likely to be facing opposition and internal conflict. 

Even following the suggestions above will bring internal battle for many of us. Knowing that we need touch and socialization, but not knowing how to do so safely. Knowing that overwork is typical for inpatient units in the winter, but wanting to somehow get others to stop the flood. This is a problem for which I have no solutions. 

Each of us must battle this out on our own. 

The one suggestion that I have is that you choose integrity. Be honest with yourself and be willing to face facts that are not what you want to hear. 

Finally, know this. You are valued and needed. Thank you for being a colleague in this wonderful profession!