It probably comes as no surprise to anyone to hear that nurses are under unprecedented levels of stress, but a new study by the Ohio State University College of Nursing has confirmed that the critical care nurses in particular are reporting alarmingly high levels of stress–and that stress is translating into medical errors with their patients.
The study, Critical Care Nurses’ Physical and Mental Health, Worksite Wellness Support, and Medical Errors, published in the American Journal of Critical Care, was specifically designed to investigate the connections between critical care nurses’ physical and mental health and perception of workplace wellness support with self-reported medical errors. And the results revealed, more than ever, how crucial supporting nurses’ health and well-being is to patient care.
Stress in Nursing is More than Personal
By gathering responses from 771 critical care nurses on their overall health, symptoms of depression and anxiety, stress, burnout, perceived worksite wellness support, and self-reported medical errors, researchers were able to show that the stress nurses face at work extend far beyond the personal.
For instance, crucial care nurses who identified themselves in poor physical and mental health reported significantly more medical errors. And on the flip side, the results also showed that workplace support can translate to better physical health in nurses: nurses who perceived that their worksite was very supportive of their well-being were twice as likely to have better physical health. Who would have guessed that treating nurses as humans could translate to better health outcomes overall?
The study comes at a time when nurses need more support than ever. Anna Dermenchyan, MSN, RN, CCRN-K, Director of Quality in the Department of Medicine at UCLA Health, Los Angeles and Director, National Board of Directors, American Association of Critical-Care Nurses (AACN) tells Nurse.org that it’s clear that the pandemic has added additional work and mental health stressors to nurses that were already overwhelmed. She notes that experts are attributing many increased incidences of fatigue, stress, anxiety, depression, PTSD, moral distress, compassion fatigue and suicide as a direct result of the COVID-19 pandemic.
“During the peak of the pandemic, nurses were asked to work extra shifts, with little regard to their own well-being. Many have worked 60+ hours a week continuously and have had no time for self-care for more than 14 months. Before, there was some balance between work and personal life, but the pandemic introduced additional stressors at home for our colleagues who have children and elderly parents,” she points out. “Many nurses have been stretched thin in all their roles as caregivers.”
She adds that it’s the dangerous combination of nurses feeling overwhelmed and overworked or practicing in unhealthy work environments while also lacking support from colleagues and leadership that leads to things like extreme burnout and nurses wanting to leave the profession altogether.
Beating Back Stress with Support and Solutions
While the study painted a bleak picture for how stress levels in nursing can translate into risks for potentially poor patient care as well as a higher rate of nurses leaving the field, it also offered solutions. For instance, the study authors concluded that hospital leaders and health care systems need to prioritize the health of their nurses through actions such as resolving system issues, building wellness cultures and providing evidence-based wellness support and programming.
Dermenchyan tells Nurse.org that practical action steps could include:
- Limiting the number of overtime shifts
- Encouraging nurses to schedule time to sleep and rest, listen to music, read, spend time with your loved ones, or do something that brings them joy
- Educating RNs to feel comfortable to ask a colleague to double-check their work and process if they feel something is off
- Adding an additional resource staff on units to give nurses break relief. In this role, she explains that a full-time employee of the unit works a full shift as a designated resource nurse to help the unit with clinical duties such as conducting quality checks, giving breaks to other nurses, or helping with admissions. They can also be added on for a short shift or changing their full shift to a break shift based on the unit census.
The Resource Nurse
The resource nurse, which is a best practice at UCLA Health, is an interesting concept that could definitely be a game-changer. I had the opportunity to witness a resource nurse in action when my daughter had a stay in the NICU–as a former floor nurse and new parent without child care who worked night shift chronically sleep-deprived and well over safe patient ratios, I was amazed when I saw a nurse regularly check in on our baby’s nurses throughout the shifts. It clearly made a difference in the work culture at the hospital when RNs could know they were fully supported and able to access help or even a bathroom break when they needed it.
Dermenchyan explains that resource nurses are usually individuals who have been on the unit for a couple of years and are in informal leadership roles like precepting new nurses or involved in unit governance work. While providing breaks, the resource nurse can also perform quality and safety checks to support the primary nurse and provide peer coaching, if needed. If you’re a nurse reading this who knows exactly what it’s like to feel totally alone and overwhelmed at 3 AM, you know how vital a resource like this could be.
Leading The Way Through Leadership
Along with practical steps, Dermenchyan advocates for supportive steps from healthcare leadership that can make a difference in supporting nurses, especially in times of crisis like post-pandemic. She suggests several ways that leaders can support nurses at work such as:
- Being present during rounding and daily communication. “Areas where leadership was present through rounding and daily communication updates provided visibility and support for nurses,” she notes. “People didn’t feel alone and isolated.”
- An information hotline. She explains that a hotline or an expert pool who knows the latest science/evidence can provide nurses much-needed information on the most up-to-date work guidance, as well as peer support and referrals to mental health resources.
- On-site wellness support. Programs such as UCLA Health’s “Tea for the Soul” from the pastoral care department, which offers support and a sense of teamwork to the units facing stress, loss or difficulty through one-hour sessions to unwind. Plus, there’s tea and cookies.
- Schwartz Center Rounds. As opposed to rounding that focuses solely on the patient’s updates, Schwartz Center Rounds are focused on staff discussing the stressors surrounding their role as a healthcare professional. Dermenchyan notes that UCLA Health is among the many healthcare organizations that do Schwartz Center Rounds as a structured way to provide a safe forum to discuss the distressing experiences that nurses, and other members of the healthcare team are going through.
- Crisis housing. For example, during the pandemic, some organizations provided on-campus or nearby housing and complimentary hotel accommodations to allow COVID+ nurses a safe place to rest and recover without the fear of getting family members infected.
- Childcare support. HR solutions for childcare provide help for nurses who have school-aged children and need childcare support. It’s no secret that the lack of childcare and school for families has affected women in healthcare especially–and with three-fourths of healthcare workers identifying as female, that’s a really big problem.
It almost seems revolutionary to think of nurses getting something like childcare support, but workplace support translates into wide scale benefits, such as increased nurse retention, improved health and improved patient care.
“Organizations should provide a safe and healthy work environment where nurses feel like their physiological and safety needs are met,” Dermenchyan points out. “When the basic level of needs is met, nurses can have a sense of belonging and feel more ownership to contribute to their work. When all needs are met, nurses can engage more fully and function at their highest level.”
And when you think about it from a practical standpoint, nurses are the people we rely on to take care of us all, especially in a crisis. So maybe it’s time we start taking care of them.