A year later: Life after the Year of the Nurse

The year 2020 should have been a year celebrating the remarkable contributions of nursing as a profession on society. The “International Year of the Nurse and the Midwife”, was so designated by the World Health Organization to honor the 200^th anniversary of Florence Nightingale’s birth and highlight the important role of nurses in addressing healthcare needs globally. In light of the events of 202 and the global pandemic, the World Health Organization extended the International Year of the Nurse and the Midwife through their “Year of Health and Care Workers” campaign while global partners have extended the International Year of the Nurse and the Midwife 2020/2021 through different campaigns. What started as a year to celebrate the work of nurses in advancing and promoting health globally transformed into a dramatic showcase of the extremely hard work of nurses in fighting COVID-19. The recognition and spotlight on nurses shifted from focusing on a thriving profession advancing health to a strong profession poised to be at the bedside responding to a global threat.

It seems fitting that in the International Year of the Nurse and the Midwife, the efforts of nurses were publicized across international news outlets. Some hailed nurses as heroes. The smiling faces of nurses to celebrate such a momentous year were replaced by images of nurses with masks with a look of care and compassion in their eyes, often behind goggles, fighting COVID-19. Nursing as a profession must examine the International Year of the Nurse and the Midwife in context with the global COVID-19 pandemic and reflect on the effects to the nursing profession.

The perception of nurses across the globe is generally one of positive regard outside of the pandemic response. In fact, in the United States, nurses are known as the most trusted profession by an annual, Gallup poll (Saad, 2020). Nurses have been played by political and religious leaders across the world recognizing the importance that nurses play in society and in the pandemic response. During the pandemic response, nurses have been excluded from society and alienated out of fear that being around a nurse will expose community members to the virus. Nurses have experienced ridicule and shame. In markets and amongst the community, instead of people seeing a nurse and consulting the nurse for health advice, nurses are told to get away. Nurses have sacrificed for the community at the expense that they are shunned by the community. Even in families, nurses may elect to stay in a separate room or location from their family so as not to expose their family. Nurses are making a huge sacrifice, and they do this out of a sense of duty, commitment, responsibility, and a sense of loyalty to their patients, their profession, and the greater global good.

There is an awareness in the global community that nurses and other healthcare workers are sacrificing for the good of the community, and there are several unique ways that communities have shown their appreciation. The Clap for Carers social movement originated in the United Kingdom by Annemarie Plas, to show support for those working in the National Health Service (NHS) received global attention as healthcare workers were recognized for approximately two months between March and May 2020. This movement garnered the support of many celebrities and politicians. Businesses, schools, and religious organizations have made different gestures to recognize the work of nurses and other healthcare workers. Some businesses have donated meals and treats to nurses while others have recognized the work of nurses through different public service announcements and campaigns to reinforce the valuable role nurses continue to play in the pandemic response. Praise continues for nurses and other healthcare workers (Gunawan, 2020).

A challenge that nurses face now is that as the pandemic response has persisted for well over a year, the public support has waned. The morale boost that nurses received from the public support was an important source of strength for nurses, especially considering the negative response from some community members (Gunawan et al., 2020). With that morale boost dwindling, the overall morale has declined amongst much of the nursing profession. Combined with the stress of caring for COVID-19 patients without fully understanding the virus and the fatigue from such a prolonged fight against the virus, members of the nursing profession are reaching alarming levels of fatigue and burnout.

Nurses everywhere are facing overwhelming responsibilities to provide care for increasingly sick patients. Nurses have always done a great deal with very little resources, and this increased workload is nothing new to nurses across the globe. However, with the novel COVID-19 pandemic, novel is the key. This virus has not been seen before, and while nurses are using the best tools they have to fight this malicious virus, there is an insurmountable burden that nurses are shouldering as they provide daily care for acutely ill patients with little known about the virus. While we continue to investigate the virus and treatment modalities that are effective in treating the virus, there is still a great unknown associated with the virus. This unknown creates a significant mental barrier and adds increased stress to nurses as they blindly fight the virus.

Nurses have historically provided care in extremely difficult circumstances, and nurses are familiar with carrying the burden of care in a professional and gracious manner. Nurses render aid in traumas and disasters worldwide, and this is nothing new. From Florence Nightingale providing care to British and Turkish soldiers in the Crimean War to today where nurses aid in epidemiological responses, war, and in treating viruses like Ebola, nurses place themselves in suboptimal situations out of a sense of duty to provide care. However, what exacerbates the strain and burden to nurses with the COVID-19 pandemic is the unknown and uncertainty associated with this virus. In different parts of the globe there are different variants and different responses to the virus. Despite these challenges and the unknown, nurses are on the front lines to provide care with a smile and a will to make patients as comfortable as possible while suffering from the devastating disease.

Fatigue and burnout are common problems in nursing. Even pre-COVID, nursing was a physically, mentally, and emotionally demanding job. Nurses provide care to patients when people are at their most vulnerable state, and in that vulnerability comes fear and a lack of control. Patients may displace their fear and feelings of lack of control on the nurse, and the patient’s family may also displace their fear and frustration on the nursing staff. Other healthcare team members experience stress and fatigue, and nursing often feels the effects of this stress as the healthcare team member at the bedside 24 hours a day, seven days a week. Nurses work long hours on their feet rushing from one patient to the next. Nurses are increasingly under intense pressure to discharge patients as soon as possible and make sure zero errors or mistakes are made. Short-staffing and patient over-crowding means nurses work increasingly longer hours each week, and there are few opportunities to rest and reset towards a healthier physical, mental, and emotional outlook. Since COVID, these factors are exacerbated, and fatigue and burnout has increased (Sasangohar et al., 2020).

As a profession, nursing needs to understand the role they continue to play in fighting the COVID-19 pandemic. The role of the nurse is invaluable in fighting this deadly virus. The long hours and fear of the unknown will continue as we work to control this virus and overcome. However, the fear and burden must be reconciled with the value of the nurse. Concerns that nurses have about contracting COVID-19, just like those in the general public, and fear of infecting family members are real concerns when providing care to patients with COVID-19. Feelings of isolation when choosing to quarantine to project the public, patients, and colleagues, and feelings of sadness when caring for patients are not improving are all real barriers and challenges that nurses face (Alharbi et al., 2020). Even if the role of the nurse goes unnoticed, underappreciated, or forgotten, the nursing profession must recognize their collective strength in fighting the virus. We must remember that 2020 was the International Year of the Nurse and Midwife and that as we progress through 2021, this designation as 2021 as the Year of Health and Care Workers, remains a tribute to the hard work and dedication of the nursing profession.

Nurses must continue to find ways to feel connected and engaged with their work so they reduce feelings of fatigue and burnout (Acob, 2020). Here are seven ways nurses can celebrate their hard work and dedication to the profession. These strategies celebrate the nursing profession and the collective strength of such an invaluable profession.

First, remember a special patient. All nurses have a story of one patient that was extremely meaningful for their career. When fatigue and burnout are looming, nurses can recall that patient and reflect on the care they were able to provide. Nurses can identify what felt rewarding and what you learned from the experience. Nurses can think about the patients in their care now and identify how they can translate that memorable patient to what they are doing now.

Second, celebrate small victories. Nurses have a demanding job with multiple competing tasks to complete of equal importance. At times, it can feel like the nurse is pulled in multiple directions at once. By celebrating small victories, such as helping a patient out of bed for the first time or assisting a family member with education they need to provide care to their loved one, nurses can remind themselves of the positive difference they have in their role as a nurse. Even small wins are worth celebrating.

Third, take a break. It can be easier to talk about taking a break instead of taking an actual break. If it is not possible to take an actual break, the nurse can take a mental break. The nurse can recall something relaxing and that brings them joy. The nurse can pause their focus on their patients and visualize that thing that provides joy. This mental break is a strategy to help reduce some of the mental fatigue felt by nurses.

Fourth, sleep. It goes without saying that sleep is restorative. Nurses work long hours and go home to complete housework, chores, and other responsibilities. All nurses have a life outside of work, and when work is done, those other responsibilities are priorities. Nurses often sacrifice their sleep to ensure that their work and home responsibilities are maintained. Insufficient sleep is a significant factor in fatigue and burnout, and this also depresses the immune system making nurses, just like every other human, more susceptible to illnesses like COVID-19. Nurses with too little sleep are more likely to make errors in patient care, and this adds to fatigue and burnout, too. It is ok for nurses to sleep and engage in that restorative practice. Sleep is important tool for nurses to fight fatigue and burnout and stay well while fighting COVID-19.

Fifth, proper nutrition. Nurses need proper nutrition to maintain their strength at work and help fight fatigue and burnout. Proper nutrition helps nurses boost their immune system and provide the energy needed to care for patients. Nursing is physically demanding work, and proper nutrition is the fuel that provides the strength to engage in such a physically demanding profession. Proper nutrition is a key component of addressing fatigue and burnout.

Sixth, do something that brings joy. While it may be difficult to find joy while working and providing care to patient, especially COVID-19 patients, it is important to do something that brings joy to the nurse outside of working hours. Perhaps the nurse enjoys reading, sewing, playing cards, watching television, or listening to music, whatever is a source of joy should be identified. Nurses should aim to do at least one thing that brings joy dally. During days where the nurse does not work, the nurse should aim to do at least three things that bring joy.

Seventh, reconnect to the profession of nursing. While it may seem counter-intuitive to reconnect to the profession when nurses are feeling fatigue and the burnout associated with providing care to patients suffering from COVID-19, nurses should challenge themselves to connect to the profession. Nurses can identify what led them to nursing and what they have found to be rewarding about nursing as a profession. Nurses should reconnect to the historical roots of nursing and the 200-year history of nursing as a profession since Florence Nightingale. The nursing profession has a long history of providing care, and reconnecting to the nursing profession can be a good reminder that nurses are part of an invaluable profession with a legacy of providing much needed care.

The International Year of the Nurse and the Midwife garnered attention and make history for the nursing profession, but not as originally intended. Nurses have sacrificed greatly, both professionally and personally, to provide the necessary care for COVID-19 patients. Nurses are invaluable member of the healthcare team, and despite the burnout, fatigue, public recognition, and social media campaigns to recognize nursing, nurses must capitalize on the 2020 International Year of the Nurse and the Midwife campaign and look forward to the 2021 Year of Health and Care Workers campaigns and focus on recognizing the value of nursing as a profession in society. Nurses face challenges daily, and burnout and fatigue are real. Nurses are encouraged to try seven recommendations to fight burnout and fatigue and celebrate being a member of such a profession as nursing.

Declaration of Conflicting Interest

The author declares no conflict of interest in this study.

Funding

This research did not obtain any research funding from any agency.

Author Biography

Colleen Marzilli, PhD, DNP, MBA, RN-BC, CCM, PHNA-BC, CNE, NEA-BC, FNAP is Associate Professor at the University of Texas at Tyler. She is also on the Editorial Advisory Board of Belitung Nursing Journal.