Nurse Survey Spotlights Mental Health Difficulties During the Pandemic

More than half of nurses working in critical care said they were "not emotionally healthy," according to the latest COVID-19 survey on mental health and wellness conducted by the American Nurses Foundation and shared with MedPage Today.

Of 9,572 nurses surveyed in the third of a series of pandemic-related polls, 75% of nurses across all roles said they felt "stressed," and 10% said they felt "worthless."

"What really jumped out to me is how many different categories of nurses report such high levels of stress that they were at risk for suffering from PTSD," said Kate Judge, executive director of the American Nurses Foundation.

"We're seeing the stress and the burnout across the nursing profession," from school nurses, to nurse managers and nurse leaders, who are under "extraordinary stress," she noted.

The data also reflect some "really worrying statistics" among nurses working in critical care, as well as among younger nurses, which is particularly troubling because "they're our future," she added. Roughly 51% of nurses ages 25 to 34 reported feeling "not emotionally healthy."

As for critical care nurses, 80% reported feeling "stressed" or "exhausted" in the last 14 days, while nearly half felt "depressed," 39% reported feeling "numb," and 15% felt "worthless," according to the survey. Asked about their behavior, 71% reported increased difficulty sleeping in the prior 14 days, 45% reported overeating, 29% reported increased alcohol consumption, 6% reported increased suicidal thoughts, and 2% reported increased "self-injurious behavior."

Nurses Battling Mental Health, but Seeking Care

Among nurses of all types, nearly half said they felt "undervalued," 20% reported increased alcohol consumption, 5% reported feeling isolated, 4% reported increased suicidal thoughts, 3% reported increased substance use, and 1% reported "self-injurious behavior."

These unrelenting stressors that nurses are experiencing are likely to have health implications in the future, Judge said. Studies have shown that sustained stress can lead to a number of health issues, including diabetes and hypertension.

"We should be looking at, how can we intervene now to support nurses," she noted. "Nurses don't have the resources to cope effectively" in the current environment.

But, on the upside, she pointed out the "positive increase" in the number of nurses seeking professional mental health services. An earlier survey around the 1-year mark of the pandemic found that 24% of nurses sought professional mental health services since the start of the pandemic, while this latest survey showed that 31% of all nurses have done so.

Still, too many nurses reported feeling stigma around seeking professional mental health services, Judge added.

The Impact of Trauma

Nearly 70% of critical care nurses, and more than 40% of all nurses, reported having "an extremely stressful, disturbing, or traumatic experience due to COVID-19."

Of those reporting a traumatic experience, 65% of critical care nurses and 43% of nurses in all roles said they were "extremely," "quite a bit," or "moderately" avoidant of situations that reminded them of that experience.

In addition, 60% of all nurses who experienced a trauma also reported "difficulty concentrating" and feeling "distanced or cut off" from other people; 53% reported "repeated, disturbing memories or thoughts" and feeling "irritable or having angry outbursts."

Of note, 92% of all nurses surveyed reported that they had received a COVID-19 vaccine.

Among all nurses, 21% reported an "intent to leave" their position in the next 6 months, and another 29% said they may leave. Among critical care nurses, 30% signaled an intent to leave, and another third said they may leave their position in the next 6 months.

Additionally, close to 40% of nurses disagreed with the statement, "my organization really cares about my well-being."

"The environment itself is not one that is conducive to people feeling valued and supported," Judge said.

Judge also noted that financial stressors appeared to be "re-emerging" in this survey. The foundation has increased the amount of financial aid it distributes, and Judge said that she and her colleagues are "watching closely" to see what nurses say they are experiencing.

Hope on the Horizon?

Judge said that one of the things that the foundation asked in the 1-year survey was what gave nurses hope.

"The theme of being seen and heard was something that gave them hope," as did a sense that the needs they identified would be addressed, she said. "Nurses want to be there for us. They really, really deeply do ... I think that the hopeful piece is that they shared their true experience so that we can be part of the solution, so that we can care for them the way they care for us."

Survey Details

Of the survey respondents, 92% were women, 7% were men, and 1% were "other." Seventy-four percent were white, 10% were Black or African American, 4% were Asian, and 4% were Hispanic or Latino.

Sixty percent of respondents were 25 to 54 years old, and 76% reported providing direct care to patients.

As for the survey's limitations, Judge noted the usual challenges of self-reported data.

"This isn't a research study, this is a pulse of the nation's nurse, [a way] for them to be able to tell us what they are experiencing right now, and for us to be able to capture that, look at the data and the messages, and then share that," she said.

Judge also acknowledged that this survey had less than half the number of respondents as the previous one, but she stressed her confidence in the "high reliability" of the survey data.

"We're not discouraged," she added. "We've never seen a disaster that's gone on this long ... Nurses are tired and they don't have time to even tell us they're tired."

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