Joleen, a veteran nurse with a reputation for excellence in practice, has always exuded caring, warmth and a smile for everyone she greets. These days, she still smiles on the outside, but on the inside, she feels spent and shaky, lacking her old confidence in decisionmaking. Like many fellow health care workers, she feels fried and frayed from COVID-19 and its impact.
Medical professionals have been among the hardest hit by the pandemic. This past year, though hard on us all, had a deep and unrelenting impact on nurses. Some wonder if they are broken after the past year. In common parlance, “broken” people are so wounded that they can’t function in their daily life, be present with others, or even do the things they love. Grief can also look like that for a period of time.
The good news is that Joleen is not broken, nor are most of her colleagues. But neither are they okay.
As leaders at the Yale Center for Emotional Intelligence, we have had the unique opportunity to interview dozens of front-line nurses throughout the past 14 months. Through these conversations, we witnessed the emotional impact this year of trauma has had, and we learned how these heroic front-line workers found ways to keep going.
Some barely scraped by with the grave horrors at work and upheavals in their lives at home. Some coped but reported they were not working effectively or relating to others in helpful ways. Some said they were resilient and could manage to “do it” despite the anxiety they were experiencing. They used strategies like gratitude practices and affirmations to keep going and keep working and relating to patients. Still others found greater than expected internal strength, reporting that they were not just surviving but thriving as the months progressed. But that didn’t mean they were superhuman.
In the end, none emerged unscathed, and all need support from their colleagues, families and workplaces to help them continue to heal.
Before COVID-19, nursing was full of emotions, from the emotional exhaustion of long hours to the emotional high of saving lives to the grief of losing patients to the everyday frustrations of the workplace. But in the past year, nurses experienced an unprecedented intensity of emotions on a daily basis.
Across our interviews with nurses, the most prevalent emotion we’ve heard about this past year has been anxiety, with concerns about personal protective equipment (PPE) availability, shifting schedules, new and changing policies, overnight changes in roles and responsibilities, and anxiety about family members getting sick.
We also heard from nursing leaders about the guilt they felt for asking so much of teams that were out of their depth treating COVID-19 patients. Anger was another emotion nurses experienced. Especially in the early days, nurses found the lack of PPE, the unpreparedness of their hospitals, and their new and unmanageable schedules and responsibilities deeply unjust.
And, of course, many reported grief, not just for the many human lives lost but also loss of the ways we used to live our lives. For nurses, the pandemic has been marked by ongoing grief with no time to grieve. Many told us that they were completely unprepared for the feeling of being so suddenly overwhelmed with death — multiple deaths, sometimes every day.
Remarkably, the majority of nurses told us it was not all bad. They expressed gratitude for not being sick themselves — or for the fact that they or a family member had recovered.
Each of the nurses with whom we spoke also mentioned the generosity of others and how energizing it was to feel their support. Nurses were inspired by people showing up, by co-workers who covered for others, by the essential workers they would see every day on their way home, by the teamwork of their units, and by everyone’s willingness to put aside petty arguments to fight the common "enemy."
And, for many, a part of feeling good about themselves was taking care of others. One leader told us she found purpose and relief in helping others cope. Other leaders said they gained confidence knowing that others relied on them. One told us, “We had hope. As the pandemic went on, we started to realize that we needed to do our part, and we had capacity. … We had the opportunity to be part of a team. That was motivating.”
Surviving the war, tending to their wounds
But like anyone who has survived an intense battle, many nurses who moved through the pandemic better than expected would not say they are doing well.
They are facing challenges, especially when it comes to decisionmaking, compassion fatigue and ongoing anxiety.
During the pandemic nurses relied heavily on each other. Many decisions were collaborative. The proverbial pecking order was suspended in favor of cooperation, of intergroup reliance. Now, back to “normal,” minute-to-minute decisions are expected but many decisionmakers (nurses) feel unsure and insecure. They are afraid — some for the first time — of being wrong. Some are depleted and so fatigued they are afraid they are not thinking clearly.
Many report symptoms of compassion fatigue, like physical and emotional exhaustion and for some, difficulty sleeping and irritability. After more than a year caring for patients and their families in the most dire of circumstances, many nurses feel they have nothing left to give. And, yet they are still expected to continue to give daily. They still have to show up and care for patients, they still have families who demand attention, they still have co-workers who need help.
Despite the presence of vaccines and easing of restrictions, many also feel anxious about the “new normal.” They worry: Are we staying safe enough? Do I need to wear masks now? How long will the vaccine hold? What about other strains? Will I ever get time off to catch up?
Self-care was essential, but there is a limit
Even those who thrived and were proud to tell us their strategies (social support, meditation, prayer, good nutrition, exercise, establishing routines, positive self-talk, being their best self) acknowledged that there's a limit to self-help and personal resilience exercises. “Bringing my best self to work, is not the same as getting a few days off,” one told us. Another observed that “meditation, while amazing, doesn’t help me feel valued by people making the rules.”
Nurses need time to heal
Nurses need time to heal, and we can all help. At a systemic level, in hospitals, administrators and decisionmakers can do their part in making sure that well-being for all health care workers is a priority. For example, money can be allocated for well-being classes, activities and counseling as needed. Time off can be part of a hospital’s commitment to health care workers’ well-being. Supervisors and unit leaders can also create opportunities and events for staff to come together for social support, fun and healing.
Colleagues and co-workers can make a real difference for each other, every day. When you give and receive compassion, grace and gratitude, your brain, and the brain of the receiver, fills with chemicals that lift each of your spirits. Decades of research shows that social support, love and compassion are a key factor in building resilience and in healing. Compassion and kindness act like an elixir for the heart. Even when we are feeling fatigued ourselves, a simple hug or random act of kindness can brighten our day.
And, of course, saying thank you goes a long way. If you are the family of a patient, or the patient yourself, or a colleague, saying thank you and giving gratitude has been proven to boost the immune system of the giver and the receiver and strengthen the relationship. Even extending good will promotes empathy and makes both parties feel better.
Nurses and other health care workers are responsible for the health and well-being of millions of people who are alive and healthy because of their good care. They deserve our profound gratitude, deep compassion, and resources to help them heal.
If you know a nurse, thank him or her today. If you don’t know one personally, think about bringing a Starbucks or restaurant gift card the next time you go to your annual or sick visit to your family doctor. Generosity and gratitude build compassionate pathways to healing — and our nurses and health care workers deserve nothing less.
Robin Stern, Ph.D., is the associate director of the Yale Center for Emotional Intelligence and a consultant to physicians and nurses. Nicole Elbertson, M.Ed., is the director of content and communications at the Yale Center for Emotional Intelligence. Cecily Lipton is a researcher with a deep interest in the intersection of psychology and health care.