Mental Challenges

Many Nurses on the Frontlines of COVID-19 Feel Overworked and Under-Appreciated—Here’s What Needs To Change

Emily Laurence

Photo: Stocksy/Santi Nunez; Art: W+G Creative
It's a Tuesday afternoon and Taylor*, a 27-year-old nurse, is driving around Philadelphia thinking about the week ahead of her at work. Even though she just had five days off, she doesn't feel rested. Instead, she feels anxious about what she'll face the moment she walks through the doors of her hospital—which, like many others across the country, is swamped with COVID-19 patients.

In November 2020, Taylor and 800 other nurses who work alongside her at a city community hospital staged a walkout and went on strike. They stood in the streets for five days demanding better treatment and pay. They felt too overworked to continue, and after months of voicing their concerns to hospital management and seeing no changes, they'd had enough.

This Philadelphia hospital—which Taylor refrains from naming in fear of losing her job—is hardly an anomaly. In a survey of 300 nurses conducted during the summer of 2020 by the University of Phoenix, 55 percent reported feeling as if their voices were not heard in the pandemic. Forty-one percent reported feeling that no one has taken their concerns or opinions seriously. And 84 percent of nurses surveyed wished they had a stronger leadership role during the COVID-19 crisis. Additionally, a separate survey released in September 2020 by scrubs retailer Healing Hands found that about half of health-care workers feel they haven’t been recognized for their work during the pandemic, and more than half of health-care workers have reconsidered their profession since the pandemic began.

Now, nurses are voicing these concerns in ways beyond anonymous surveys. In several hospitals across the country, nurses are going on strike to demand more agency, workload support, and better pay. In Southern California, 2,450 nurses went on strike, demanding a safer workplace and more staffing. Dozens of nurses in New Rochelle, New York, went on strike for the same reasons. It also happened in Albany, New York. All of these events took place just in December 2020.

As you will soon see, when nurses' voices aren't being heard it not only affects them directly but it puts patients' lives in danger—certainly risks that cannot be afforded for COVID-19 patients. Nurses are taking care of us, but who is taking care of them?

How nurses' pleas for more help are being ignored

Like virtually all health-care practitioners during the pandemic, "nurses' jobs have changed in many different ways [because of COVID-19]," says Liz Stokes, JD, MA, RN, director of the American Nurses Association Center for Ethics and Human Rights. Some nurses were furloughed from their jobs (aka asked to take unpaid leave) or were transferred to different units from where they normally work, Stokes says. "Some nurses, unfortunately, have lost their jobs. Other nurses have moved to critical areas where COVID-19 cases are especially high and [are] working on the front lines."  Stokes adds that nurses who work in places like schools or community health centers have had to adapt as well to be more flexible. "For example, many of these nurses were placed outside of their traditional setting and into a COVID-19 setting," she says.

Taylor and her fellow nurses have found themselves taking on additional work to keep up with the demands of COVID-19.  She works in the part of the intensive care unit (ICU) where patients aren't in critical condition, but still require a high level of care—including near-constant monitoring. "There are 26 beds and the ratio is normally divvied up so that it's two or three patients per nurse. But during the pandemic, that number has surged to four patients per nurse," Taylor says. "There's no time eat or even go to the bathroom," she says, adding that her shifts are 12 hours long. She also started performing some tasks on the doctor's behalf to minimize the number of people in a COVID-19 room, which further increases her workload. And because there is always another patient who needs her attention, Taylor is no longer able to stop and grieve when someone she has been caring for passes away—which has always been an important part of the coping process for her.

"We brought up our concerns to hospital management and administration and nothing changed," Taylor says. She, along with multiple other nurses, asked the administration if they could hire agency nurses—who take short-term work assignments—to help with patient load, but new hires were never brought on. "That's why we went on strike," she says.

Being left out of conversations about patient care

Not only do many nurses feel overworked, but they are often left out of critical conversations regarding patient care despite playing a crucial role in treatment. Kathleen O'Grady Winston, PhD, RN, the College of Nursing dean at the University of Phoenix, says this is the primary reason why she believes that nurses feel underappreciated. "This is about respect," Dr. Winston says. "One of the findings of the survey is that nurses' primary concern is patient safety and care. They feel it's very important for their voice to be heard by hospital administrators, physicians, and their health-care colleagues in making sure that the patient is safe and cared for correctly. It's important for them to be involved in the decision-making [regarding their patients] and that their perspectives are taken seriously."

Indeed, Dr. Winston says doctors and nurses have different, yet equally important roles when caring for COVID-19 patients. Along with their expertise and training as health practitioners, "the nurse is concerned with the whole patient as well as their relationship with their family and community," she says, particularly since nurses often have more communication and face time with patients and their families. For that reason, Dr. Winston says nurses' input is incredibly valuable and should be part of any conversation regarding patient care.

"This is about respect." —Kathleen O'Grady Winston, PhD, RN

Unfortunately, Dr. Winston says this issue isn't new to COVID-19. A 2017 review of studies found that being left out of the decision-making process (such as in making decisions regarding patient care) was one of the top reasons nurses said they experience burnout. In order for patients to truly receive the best medical care they can (now and in a post-pandemic world), Dr. Winston says physicians and nurses both need to have a place at the table. "When this happens, you get a richer tapestry of decision-making because the more perspectives and understandings of what a patient needs that are voiced, the better their care."

What needs to change

Some organizations have worked proactively to meet the most pressing needs of their nurses. Harley Jones is the U.S. COVID-19 response lead at Project HOPE, a non-profit that empowers local health care all over the world. During the pandemic, he has been working in Navajo Nation as a liaison between volunteer doctors and nurses and the Indian Health Service. "I've heard time and time again how grateful people are for the volunteer nurses who come in to help with the surge in COVID-19 patients. There's a strong feeling of support because the volunteer nurses alleviate some of the pressures the [staff nurses] are experiencing on a daily basis," Jones says. This serves as one example of a creative partnership that was formed to help alleviate workload among nurses, particularly among a population that was hit especially hard by the virus.

"I just want to be able to hold the hand of my patient who is dying all alone because their loved ones aren't able to be there." —Taylor*, a Philadelphia-based nurse

But what happens when nurses' needs aren't met? It looks a lot like what happened at the community hospital where Taylor works and other hospitals across the country: Nurses walking out and going on strike. Taylor says the nurses' strike at her hospital ended after five days because the nurses union and the hospital administration started to come to some preliminary agreements on how to move forward, including a pay raise for nurses. And nurses wanted to get back to their patients. "It was complete chaos without us," she says.

Stokes says the way forward comes down to hospitals creating truly collaborative environments where nurses are given crucial roles in the medical directive for patients. For example, she says beyond a doctor directing a medical plan of treatment, nurses can help provide a family plan which includes what care will look like at home and who will pick up any needed prescriptions. "Treatment is more than just medicine. It's these family and social components too," she says. Dr. Winston agrees, saying hospital administration needs to ensure nurses sit on more committees such as safety committees and patient care committees. As the strikes across the country indicate, better pay and staffing are also pressing needs that, in many hospitals, remain unresolved.

In the month since the strikes have ended at Taylor's hospital, she says some changes have been made, but not enough. While most nurses at her hospital have gotten a pay raise, she says the patient workload is still at an unmanageable level. Because of this, she says many units have experienced a "mass exodus" with a large number of nurses quitting. "In the end, it's the patient that suffers," she says. "I just want to be able to hold the hand of my patient who is dying all alone because their loved ones aren't able to be there. Please, can I just hold this patient's hand for the last 20 minutes of their life instead of being pulled away because there is someone else in need?... I can't be there for them. This is what keeps me up at night."

*Last name has been withheld. 

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