Addressing the mental health of nurses during the COVID‐19 pandemic: Time for support

The COVID‐19 pandemic has exerted a profound impact on the emotional and mental well‐being of nurses (Jackson et al., 2020). Globally, highly skilled nursing professionals, often with limited infectious disease experience, have encountered numerous stressors whilst providing vital nursing care to communities during this pandemic. These stressors include the risk of being infected with COVID‐19 because of inadequate protective equipment, bearing the brunt of verbal and physical violence from anxious consumers of health services, having to work in understaffed clinical areas and fear of exposing loved ones to infection. As a result, elevated levels of stress, anxiety, frustration, depression, burnout, sleep disruption, feelings of being underappreciated, and, in some cases, suicide has been reported in nurses during the pandemic. Many nurses have witnessed nursing colleagues, and other health professionals die after contracting the virus. The significant psychological strain experienced by frontline nurses during the pandemic has received much attention, reflected by research publications in the Journal of Clinical Nursing.

Given the extent of the psychosocial impact of previous public health emergencies on nurses, including, for example the Severe Acute Respiratory Syndrome (SARS) epidemic in 2003, supporting the mental health of nurses during a pandemic is of paramount importance. Indeed, as previously reported in the Journal of Clinical Nursing, the SARS outbreak demonstrated the need for appropriate psychological support for healthcare professionals affected by post‐traumatic stress disorders, anxiety and depression associated with the outbreak (Thompson, Lopez, Lee, & Twinn, 2004). Due to the unpredictable nature of COVID‐19, the demands placed on nurses are constantly changing, exemplified by the impact of the Omicron variant in the 5th COVID‐19 wave in Hong Kong. Since 2020, Hong Kong has appeared to have an effective response to the pandemic by pursuing a zero‐tolerance plan. However, the arrival of the highly contagious Omicron variant in Hong Kong in late 2021 changed that, with the healthcare system stretched to its limit, placing an enormous psychological burden on nurses, and other healthcare professionals, working on the frontline.

From an organisational perspective, the provision of psychological support for frontline workers is essential. Healthcare providers are uniquely positioned to alleviate or exacerbate adverse working conditions. However, despite awareness of the importance of providing organisational support for the emotional and mental health of nursing personnel working at the clinical frontline during the COVID‐19 outbreak, the response internationally does not appear to be at a scale commensurate with the nursing need for support. It is important that this is corrected as a failure to address the psychological health needs of nurses increases the ticking ‘time bomb’ scenario of mental health problems around the world, potentially leading to attrition of nurses from the profession.

Despite the unprecedented levels of resilience and versatility shown by nurses during the pandemic, the provision of psychological and emotional support for nurses appears to be lacking worldwide (Smith, Ng, & Ho Cheung Li, 2020). Therefore, appropriate organisations and professional bodies need to be informed of the need to implement mental health interventions and programmes to support nurses and other health staff, including self‐help interventions. The increased risk of developing mental health disorders, like PTSD, and suicide within the profession could be greatly reduced with appropriate measures. Additionally, providing appropriate support for nurses may reduce the risk of occupational burnout.

In the Journal of Clinical Nursing, Maben and Bridges (2020) highlighted the many stressors and challenges faced when addressing the psychosocial needs of nurses during the pandemic. A layered approach has been advocated that promotes psychological well‐being in nursing staff, including flexible organisational processes and offering a multitude of strategies that can be used effectively in various situations. These should be tailored to meet individual needs, including psychological support being provided in various formats, including e‐mental health counselling and Internet‐based interventions. Due to the unpredictable nature of COVID‐19, there will not be a quick fix as nurses will need access to interventions to deal with established trauma‐related mental health problems, including post‐traumatic stress disorder, which may be required now and long after this pandemic is over. It is important for healthcare providers to foster a proactive, as opposed to a reactive, approach towards the triage and management of emotional and mental health issues experienced by nurses because of the pandemic. Transparency in all forms of communication should be prioritised to destigmatise mental health issues, as well as to encourage and empower nurses to seek support for their mental health needs.

From a public health perspective, it is important that any support provided by organisations to nurses is supplemented with appropriate training and resources to enable them to access supportive networks and structures should future pandemics strike. Interventions could be mobilised from within the profession, for example the use of peer and team support that promotes psychological coping to deal with the adversity caused by COVID‐19. The emotional resilience of nurses is well recognised, and the importance of resilience is never far away in any discussion of nurses' psychological health during the pandemic. Personal resistance clearly plays a role; however, resilience should not be seen as an individual responsibility (Smith et al., 2020 JCN). Health care providers, health agencies and the public need to support nursing resilience with appropriate and supportive actions and resources.

The COVID‐19 pandemic has placed significant psychological strain on nurses working on the clinical frontline. Actions are clearly needed to mitigate the impact of COVID‐19 on mental health by protecting and promoting the psychological well‐being of nurses and other healthcare professionals. Support may be required to help improve and maintain levels of psychological health and resilience, as well as reducing the risk of developing long‐term mental health problems. Healthcare providers have a duty to provide short and long‐term support during and after the current COVID‐19 pandemic, to ensure that their nurses are retained within the profession, giving them an optimal clinical environment to enhance psychosocial well‐being. They also have a responsibility to signpost nurses to sources of support, encouraging work‐life balance initiatives that boost psychological health. Currently, protecting the mental health status of nurses around the world is an important component of public health measures to reduce the impact of this pandemic.

In the United Kingdom, considerable financial resources have been invested to support nurses experiencing difficulties with their mental health, due to working through the pandemic. The National Health Service has invested in providing support for nurses, including creating a national support service for critical care staff and a national outreach service giving frontline nurses rapid access to mental health services (https://tinyurl.com/2p963jmp).The Royal College of Nursing has also sought to ensure that their members are aware of their services (https://tinyurl.com/hnmmtrp9). What has yet to be determined is if these resources meet the needs of the nursing workforce or if nurses are accessing them. What is clear is that access to such valuable resources is not universal, and there are many nurses around the globe who have not experienced anywhere near this level of support. This calls for nursing leaders, directors of health services and political influencers across the world to share the learning from different countries, so that nurses globally can receive the support that they need.