Nursing Resilience in the World of COVID-19

Resilience: “the capacity to recover quickly from difficulties; toughness.”—Dictionary.com

For the December issue of JoPAN, my editorial usually focuses on something holiday related. This year, I want to gift you a little information about stress and resiliency and how to stay healthy in the new year. Coronavirus disease 2019 (COVID-19) is our reality for the unforeseeable future. We are currently experiencing the third rise in cases at a time that we also expect flu cases to increase as well.¹ Nurses are dealing with a triple whammy. Not only do nurses have to deal with the reality of social distancing and how to manage family and children, but many nurses are on the frontlines on a daily basis managing the care of patients with COVID-19 or tangentially connected in the health care setting with the work they do. Perianesthesia nurses are no different. Some of you have worked in COVID-19 units; some of you have assisted in units that care for these patients; some of you were furloughed when surgeries came to a halt; and some of you may be recovering patients in the postanesthesia care unit who have COVID-19, but who needed emergency surgery.

Impact of COVID-19

Stress and anxiety are common in unpredictable situations such as the pandemic we find ourselves facing.² Stress-related symptoms may include anxiety, irritability, sleep disruption, and changes in concentration. These symptoms can occur in the general population but are more likely to occur in health care personnel.² Nurses who work on the frontlines may have to deal with social isolation because they stay away from family and worry about dealing with a contagious disease. On Twitter and Facebook I see the stories of nurses on the frontlines. I was devastated when I read at the beginning of the pandemic that nurses, physicians, and respiratory therapists working with COVID-19 patients were writing wills and giving their important passwords to family.

Nurses struggle with risk of exposure to the virus, worries about infecting their families, shortages of personal protective equipment (PPE), longer work hours, and moral distress related to resource allocation.³ In a study of New York health care workers (HCWs), Shechter et al⁴ discovered that 74% of the HCWs reported the possibility of transmitting COVID-19 to family as highly distressing; other highly distressing concerns were health of family and friends (71%), lack of control (70%), lack of testing (68%), and lack of PPE (68%). Nurses and advanced practice providers were significantly more likely than physicians to have acute stress and depressive symptoms.⁴ Anxieties and stress seem limited more to the acute phase of exposure to a pandemic, but burnout can be ongoing.⁵

Gaining Resilience

Why is resilience important? When a distressing event such as a pandemic occurs, resilience gives us the ability to resist disruption of how we normally function by anticipating and preparing for the event.⁶ Resilience also may play a role in the difference between those who experience burnout and those who do not. There are strategies we can use to increase resiliency, decrease burnout, and increase coping behavior.

Self-care is one of the strategies to improve or maintain resilience. Physical activity and a good sleep pattern are important. Physical activity allows us to maintain a healthy body, which helps us to cope. Suggestions for good sleep hygiene are to relax before bedtime and avoid screen time within 30 minutes of bedtime.^{6 , 7} Mindfulness, attention to the present moment, and stress management work to increase resilience; and mindfulness in combination with meditation, yoga, and group discussion have been effective.⁶ Another suggestion related to mindfulness is to reduce how much news you watch or watch with intention–in other words, plan to watch only specific programs of your choice.⁷ Other suggestions are to appreciate optimism, gratitude, and humor. We can also commit to health and well-being with a healthy diet, good sleep, relaxation, and plenty of water.⁷

Social support helps mitigate distress and build resilience. HCWs, including nurses, who have strong connections to others—whether personal or professional—are happier and have a lower risk of burnout.⁶ Staying connected and checking on those you care about is one way to facilitate relationship. I have family who connect virtually and friends with whom I have a virtual Happy Hour connection on the weekend. Those connections have provided relief from social isolation. Altruism and finding meaning in one's work is associated with less burnout as well.⁶ Interestingly, 61% of the nurses in New York reported an increased sense of meaning since the pandemic began.⁴

An important takeaway for organizations and managers is that when HCWs are provided with adequate protection, the risk perception is low. An adequate level of PPE and frequent provision of information are vitally important.⁵ Managers should be frank about the situation and monitor the well-being of the staff. Good communication and supportive professional leadership are protective.⁶ When sending staff to other areas outside their normal work duties, appropriate training in use of PPE and work duties is essential. Appropriate preparation and training decrease stress.⁶ Visibility of leadership and fair distribution of resources are also important.⁶ Managers and organizations can also provide psychological support for those nurses who need the resource—online resources work well in a pandemic.

The American Nurses' Association has a COVID-19 resource center devoted to information about the virus and ways to maintain resilience, including conversation with other nurses (https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/the-well-being-initiative/). Another resource on the website is Moodfit, which includes mood tracking and analysis, a gratitude journal, mindfulness meditation, breathing exercises, and other supportive information. The third resource is the Happy App, which gives you the “opportunity to talk with someone after a challenging shift, to relieve yourself of stressful thoughts and concerns, or to rebuild your resilience with emotional support.” ASPAN also has a resource for perianesthesia nurses' personal and professional use related to COVID-19 (https://www.aspan.org/Home/COVID-19). The resource includes Strategies for Caring for the Nurse, including self-care and donning and doffing; and Strategies for Caring for the Patient, including care of the critically ill COVID patient and other COVID-19 resources. See Box 1 for available hotlines.

Box 1. Available Hotlines.

• •
  National Suicide Prevention Lifeline

  • 1-800-273-TALK (8255)
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  SAMHSA National Helpline

  • 1-800-662 HELP (4357)
• •
  SAMHSA Disaster Distress Helpline

  • 1-800-985-5990

SAMHSA; Substance Abuse and Mental Health Services Administration.

I will end with what my Kentucky Governor says after every COVID-19 briefing: “We will get through this, we will get through this together.”