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Being on the front lines: The need for mental health PPE

By: Lillee Gelinas, MSN, RN, CPPS, FAAN, Editor-in-Chief

Nurses are experiencing psychological burdens of care.

Daily headlines, community-wide applause, and military flyovers honor the physicians, nurses, and first responders on the front lines of the war on COVID-19. The wonderful stories and videos posted online about these heroes being cheered are heartwarming. The outpouring of people who provide food and supplies as modest tokens of gratitude bring tears to my eyes. At first, I marveled at the increasing public response and support for nurses and other healthcare workers. Then I read a disturbing item the day before I wrote this editorial about an emergency physician who died by suicide after she became so emotionally exhausted by the stress of trying to help an overwhelming onslaught of very sick patients. Nurse suicides related to the COVID-19 pandemic also are occurring, according to data from Europe, where the pandemic struck earlier than in the United States, so data here isn’t yet known. Nurses, because of the very nature of their job, spend the most time with patients and are especially vulnerable to suicidal feelings. Nurse suicides were a serious problem even before the arrival of COVID-19.

The United States has an amazing army of healthcare providers, especially nurses, who go to work every day not knowing what they’ll encounter. In the past, an average nursing workday held a number of good and bad events. The pandemic has introduced something above and beyond the “average.” Not only are our knowledge, skills, and education being severely tested, but also the strength of our mental health has been assaulted to levels that I’ve never seen in my career. You and I are asked to apply our highest clinical abilities while bearing the stress that comes from the fear of contracting the disease ourselves, passing the disease on to colleagues and, most distressingly, passing the disease to our families.

This reality is an enormous mental health burden that comes with the extreme uncertainties surrounding COVID-19. The rules for how to protect ourselves and others from the disease change frequently. In addition, the personal protective equipment (PPE), such as masks and gowns, we need to protect ourselves has been in short supply. Stress mounts as well because we know so little about the disease. We can’t even be sure if the person next to us is spreading the virus even though he or she appears completely well. As clinicians grounded in science and evidence-based practice, the current ambiguous COVID-19 work environment is unsettling.

I’m a veteran of the U.S. Navy Nurse Corps, so military analogies come easily when referring to the current situation. One of the lessons we must never forget is that when you’re on the front lines of any war, especially one with a disease we hardly understand, the emotional and mental burden must be addressed. We need to provide the appropriate tools to help everyone on the front line cope with the remarkable burden that fear, fatigue, uncertainty, and frustration takes. We need to provide the personal protective mental health equipment caregivers deserve right from the start of every campaign in which we engage, no matter how small or how brief.

COVID-19 is teaching us many lessons about our healthcare delivery system and the strength of the nursing profession, but it’s also teaching us about ourselves. Let’s look for better ways of taking care of ourselves and each other while we do a great job of taking care of our patients. Otherwise, the lack of both types of PPE (supplies and mental health), could result in disastrous consequences.


Bolster C, Holliday C, Oneal G, Shaw M. Suicide assessment and nurses: What does the evidence show? Online J Issues Nurs. 2015;20(1):2.

Davidson JE, Proudfoot J, Lee K, Zisook S. Nurse suicide in the United States: Analysis of the Centers for Disease Control 2014 National Violent Death Reporting System dataset. Arch Psychiatr Nurs. 2019;33(5):16-21.

Davidson J, Mendis J, Stuck AR, DeMichele G, Zisook S. Nurse suicide: Breaking the silence. National Academy of Medicine. January 8, 2018.

Gelinas L. Nurse suicide: Breaking the silence. Am Nurse Today. 2018;13(9):6.

Rizzo LH. Suicide among nurses: What we don’t know might hurt us. Am Nurse Today. 2018;13(10):10-5.

lillee gelinas msn rn cpps faan editor in chief



– Lillee Gelinas, MSN, RN, CPPS, FAAN, Editor-in-Chief


1 Comment. Leave new

  • Sandra Tijerina
    July 12, 2020 3:31 pm

    Thank you Lillee. I believe I met you in Corpus my name is Sandra Tijerina. I read this article and as a front line emergency nurse we are faced with a lot of challenges besides the “normal ER days”. One of the most painful hurtful things that I recently went through was when my CNO decided to write on my face shield my name while I was wearing it. It felt like she had written on my forehead. I believe she may have been frustrated from staff asking for PPE so we were asked to write our names on the shields. That day I was asking for my “own” face shield when she decided to label it as mine. I cried in anger, embarrassment and hurt to one of my colleagues. The CNO had not even realized that it had someone elses name on the shield. I did step it up to report the incident to say “NO” we are not to be treated like children because you can not control your self and your emotions. I don’t know what will become of this since we have a zero tolerance policy on harassment. Thanks at least this has allowed mention what we are facing.


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