How nurses can manage COVID-related burnout

Nursing is a stressful career in “normal” times, and the global coronavirus health crisis is exacerbating stress levels across the profession. Many nurses are feeling the impact of severe burnout on their professional careers and their personal lives. Today, it’s almost difficult to recall life in the “before times” – before COVID, before overcrowded hospitals, before lockdowns. A year into the pandemic, the global crisis has battered the health care workforce for 12 long months and counting.

“The COVID-19 pandemic has taken an unimaginable and harrowing toll on our frontline workers, especially nurses,” states Alyza Berman, LCSW, RRT-P, founder and clinical director of The Berman Center, a CARF-accredited, nationally recognized mental health and psychotherapy treatment center in Atlanta. “The increase in burnout rates and high levels of anxiety is astounding,” Berman continues. “In my entire career, I’ve never witnessed anything like this before, where almost all of my clients are feeling some level of burnout or heightened levels of anxiety,” affecting their daily lives.

Studies reveal similar patterns of growing burnout rates. “Before the COVID-19 pandemic, research showed nurses’ burnout rates around 40%,” states Holly Wei, Ph.D., RN, CPN, NEA-BC, associate professor at East Carolina University’s College of Nursing. Now, that figure has grown to 70% of nurses who report experiencing burnout as of January 2021, according to a recent COVID-19 update from the International Council of Nurses.

Evolution of COVID-19 burnout

Before the pandemic, many nurses already experienced high levels of burnout due to staff shortages, long hours, and the stressful nature of caring for patients, especially the very sick or terminally ill. COVID-19 has intensified an already stressful career. “Nurses are experiencing a medical phenomenon with COVID-19 that most are trained for and never have had to actually experience,” Berman notes. “Over the last year, nurses have been subjected to emotional trauma in various waves and stages as the disease has developed from unknown threat to a widespread, infective killer,” and nurses’ fears and sources of stress have evolved and intensified over the course of the pandemic.

“The psychological trauma has morphed from the fear of the unknown into dealing with the ripple effects of a pandemic that’s been met with limited resources (PPE gear, treatment, vaccinations), minimal government intervention to help stop the spread, and an opposition from citizens to take simple and effective safety precautions for themselves and others, including wearing a mask and maintaining social distancing recommendations,” Berman explains.

This trauma, she says, manifests as a result of pandemic-induced situations and circumstances nurses are experiencing on the job such as:

· Medical staff rationing care due to the high level of COVID-19 patients in need

· Guilt of working with COVID-19 patients and unknowingly infecting others

· Dealing with their own COVID-19 symptoms and rehabilitation if they themselves were infected

· Watching hundreds of patients die due to this disease

Additionally, “whereas at the beginning of the pandemic, health care workers were treated as heroes…there’s been a noticeable shift from some people who now rally against nurses and doctors who view them as infringing on their personal rights and freedoms,” Berman adds. “Imagine…your job is to save lives and protect others, and then you’re mocked and ostracized by the very people you’re trying to save.”

Symptoms and consequences of COVID burnout in nurses

How do nurses know if they are experiencing burnout versus other mental health issues such as depression?

“When feeling burned out, nurses can feel physically and emotionally exhausted, lack interest in or empathy toward patients and co-workers, and have inadequate feelings of one’s competence or performance. For example, burned out nurses’ exhaustion may not be corrected with just a good night sleep or regular breaks,” Wei explains.

Wei, who has authored numerous peer-reviewed articles and reports on the topic of burnout among nurses and the health care workforce, including this one for the American Association of Critical Care Nurses (AACN), adds that failing to address burnout can lead to a long-term detriment. “Stress and burnout, if not managed, can lead to cognitive dysfunction, depression, and impaired sleep. These symptoms can affect nurses’ professional and personal life. Nurses may not [be able to] fulfill their daily life functions, family obligations, and professional duties, affecting their work performance and patient care quality,” Wei states.

Is COVID-related burnout different from the burnout nurses experienced before the pandemic? Experts say yes. “The main difference I’m witnessing between ‘common’ [pre-pandemic] burnout versus COVID-induced burnout is that COVID-related burnout can potentially create and develop long-lasting and detrimental psychological effects on the human psyche,” Berman states. “Common burnout is extremely serious and shouldn’t be taken lightly, but is also treatable with expert medical assistance and a regimen that includes a regular sleep schedule, change in food/alcohol intake, reevaluation of schedule and commitments, and other tangible and daily implementable changes,” Berman adds. “With COVID burnout, nurses and medical professionals are dealing with never-before-seen situations every single day that include life or death situations. And while the prospect of death is nothing new to working in medicine, COVID has exacerbated and heightened this culmination of physical and psychological exhaustion to levels unseen before.”

Tips and resources for nurses to combat burnout

As physical, mental, and emotional wellness are closely interrelated, a comprehensive, multi-faceted approach to alleviating burnout is recommended, utilizing a variety of resources and tactics to address the physical and psychological impact of burn-out.

Holly Wei recommends addressing the burnout problem in these three areas:

“First and foremost, nurses need to create meaning in what they do, especially during this difficult time when they face uncertainties and feel helpless and hopeless,” Wei advises.

“Secondly, we [nurses] all need to connect with energy sources. Besides basic physical needs, such as a balanced diet, sufficient sleep, and moderate daily exercise, nurses need to find healthy coping strategies to meet their psychological needs to help them relax, recharge, and replenish, including family support, social connections, or spiritual beliefs,” she continues.

“Thirdly, nurses need to be self-compassionate with oneself and recognize one’s value and limitations. Recognizing one’s value and limitations helps the nurses find their inner strengths and be kind toward self during difficult times,” Wei concludes.

Quick and simple tips

One fairly simple step to take, which was recommended by multiple experts, is to say no to overtime and extra shifts, and set clear boundaries with both personal and professional contacts. Additionally, taking time for self-care is important, and that can mean anything that helps nurses to feel healthier, more relaxed, and less stressed such as:

· Massage

· Meditation

· Exercise

· Adequate sleep

· Healthy diet – avoiding processed foods, etc.

· Staying well hydrated

· Sunlight and Vitamin D

Wellness and happiness coach, author and podcaster Evey Rosenbloom has published an online self-care framework and step-by-step guide aimed at helping those who are feeling overwhelmed by stress, fear, and grief. In addition to her online guide and podcast for the general public, Rosenbloom recommends nurses try to mindfully implement any small activities that bring joy into your day, such as:

· Reduce intake of stressful content

· Enjoy music, dance, singing – Musical activities are proven to reduce stress and improve physical and mental wellbeing, which is why these are incorporated into many therapeutic regimens.

· Fresh air – outdoor hikes, etc.

· Grounding and “earthing” – physical contact with the surface of the earth

· Make time for hobbies – favorite movies, crafts, etc.

· Napping or increasing amount of sleep or quality of sleep

· Positive affirmations

It’s OK for nurses to need help

Ultimately, one of the best and most reliable ways for nurses to alleviate severe burnout is with the assistance of a professional medical expert. As a psychotherapist herself, Alyza Berman wants nurses and medical professionals to know that “it’s okay to feel the need for help ... Just because you’re a medical professional working in health care doesn’t mean you’re immune to life,” or the pandemic, she states. “We put our health care workers on this pedestal, [and expect them to always be] ready and willing to jump in and help us with any medical needs. This, unfortunately, continues to set unrealistic expectations for nurses ... Remember that you’re human, you need support and assistance too, and your needs are no less important than the patients and clients you serve every day,” Berman says. She recommends that nurses and health care workers seek expert help, first and foremost. “Nurses should seek out a therapist or mental health professional and receive the proper psychological support needed to process their current work situation, learn the right coping mechanisms, and be in tune with their own needs and mental state.”

Additionally, Berman advocates open communication with co-workers and loved ones about how you’re feeling. “Being able to effectively express your emotions and tell someone what you need to manage a certain situation and be successful can make or break a work situation or relationship,” Berman explains. “Especially now during COVID, we must be able to talk openly about our feelings and express what’s on our minds, how the current situation is affecting us, and what we need in that moment to cope appropriately.”

Recognize intrinsic rewards and find meaning in your nursing career

Like Wei, Berman agrees that recognizing the intrinsic rewards of nursing, and focusing on the meaning and impact of nursing, may also help with burnout. This deeper meaning and impact on the lives of others can extend beyond nurses’ day-to-day work with patients.

“I think it’s also important for nurses to understand just how much of an impact they’re having on younger generations,” Berman states. Nurses may not realize that many of today’s children are being inspired to pursue their own careers in health care, as they look to nurses and see “the incredible work you’re doing to keep everyone alive, healthy, and moving forward. You’re inspiring an entire next generation of nurses, some of whom may have never even wanted to go down this career path until the COVID pandemic. The work you continue to accomplish does not go unnoticed and is creating a deep, tangible impact for many. Your work is recognized far outside the hospital walls in ways you cannot even imagine,” Berman concludes.