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From your ANA PresidentPractice Matters

Ending stigma

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By: Ernest J. Grant, PhD, RN, FAAN

From your ANA President:

Mental health support is vital for nurses to thrive.

If a flood or fire were to hit a community, RNs would spring into action, working long hours under stressful conditions to triage and treat the acutely ill and injured. Simultaneously, they would begin healing their patients’ and community’s emotional and physical scars. This crush of energy and practice would largely meet immediate needs, and while exhausting, likely wouldn’t deplete nurses’ long-term resiliency.

In contrast, the pandemic—an emergency that started in March 2020—persists, albeit modified over time. Nurses remain on the frontlines of this crisis, and they’re exhausted—physically, mentally, and emotionally. Yet relief has been in short supply, as chronicled in the American Nurses Foundation (the Foundation) and American Nurses Association (ANA) Pulse on the Nation’s Nurses Survey Series. In 14 surveys over 2½ years, more than 200,000 nurses have generously relayed their experiences on a wide range of issues and concerns.

These surveys have revealed, in sometimes stark terms, the strain the pandemic has placed on nurses. Regrettably, many of the dissatisfiers affecting nurses have deep roots in our healthcare system, which the pandemic only fed.

Just 42% of nurses now consider their work environment healthy, according to the 2022 Workplace Study, published in August 2022. Another 30% reported experiencing one or more incidents of violence at work in the past year; in the same time period, 60% reported one or more incidents of bullying or incivility. Nurses also face challenges in getting adequate restorative time. Nearly 60% reported being asked daily or weekly to cover additional shifts or to work beyond their shift to complete work or provide adequate care to patients.

Any person would feel stressed and even overwhelmed in these circumstances. Yet many nurses don’t feel comfortable seeking help when they need it. In the Workplace Survey, 35% said their supervisor would have less confidence in them for doing so. Another 27% indicated that they would be told to get over it and go back to work, while 43% said they would be embarrassed.

Not obtaining assistance harms not only nurses but also our patients. However, the stigma against seeking support is real. To find solutions to this challenge, the Foundation recently hosted a summit of 26 national leaders in mental health and well-being. Their deliberations identified 10 future state principles reflective of a transformed workplace culture that would normalize and encourage offering and asking for mental health and well-being services (bit.ly/3yRRM4q). Examples include challenging nurse heroism so as to change norms and perceptions that lead to stigma, and ensuring that licensure, accreditation, and certification policies don’t contribute to stigma. The Foundation plans a series of gatherings in 2023 to delve further into these recommendations. Learn more or contribute at nursingworld.org/foundation.

As the Foundation continues this vital work, its Well-Being Initiative resources and those of Healthy Nurse, Healthy Nation™, sponsored by the ANA Enterprise, are freely available 24/7. More than 500,000 individuals have accessed these tools, which provide a range of strategies to support one’s well-being.

Unfortunately, nurses have an increased risk of suicide compared to the general population. The 988 Suicide and Crisis Lifeline is available at all hours for anyone in crisis. ANA also offers nurse suicide prevention and resilience resources (nursingworld.org/practice-policy/nurse-suicide-prevention).

Every nurse is a whole person with a full range of emotions and life experiences. We aren’t merely the sum of our credentials and skills, the shifts we complete, or organizations we work for. Bringing our whole selves to our work enables us to serve our patients and the profession we love with passion, while living our lives fully with joy and purpose. We deserve nothing less.

– Ernest J. Grant, PhD, RN, FAAN, President, American Nurses Association

 

1 Comment. Leave new

  • I don’t feel it’s simply the pandemic that is causing a crisis for nurses. There was difficulty before the pandemic spilled into our lives in 2020. There is no denying that the pandemic compounded an ever exisiting problem even more. Mental health isn’t just about nurses dealing with the pandemic. I’d like to see more discussion about mental health awareness IN GENERAL for nurses. Leave out the pandemic part when discussing the mental health of nurses who are at the bedside dealing with the crisis of just being a nurse. Access to programs and services for mental health, for nurses, is not truly a problem. The problem lies within giving nurses literal TIME to seek and participate in these programs and services effectively. Nurses don’t have time for a “mental health” day. Then there are staff who take advantage of mental health days. These call-ins cause over-worked nurses to come in off shift to cover, or nurses to work short. This is not a new topic since the appearance of the pandemic. It’s a terrible cycle that repeats itself. At times, it feels like there is no hope. No way to fix it. In a culture where there are nurses who are Givers and nurses who are Takers, and no real action by administrators to quell this phenomenon. The Givers keep giving, and are not adequately appreciated for it; and the Takers keep taking, and are not rebuked for it. I feel this is a base, foundational component of why nurses have mental health issues. Anger, hopelessness, exhaustion, burnout, guilt… It’s not always from the stress of caring for terribly ill patients, littles all the way to geriatrics, and the deaths of same. Much of it has to do with lateral unspoke “violence” and the “quit quitters” in the nursing field today, and the burden put on Givers, by Takers. Those nurses who say “I hate coming to work.” “Why am I even a nurse?” “Ugh, I hate nursing.” These behaviors aren’t put in check. They are perpetuated from nurse-to-nurse in what I truly feel is a from of lateral soft “violence”. It’s a tale as old as time, and it causes many good nurses to quit and seek other careers, because there is no hope. The Takers stay and do their bare minimum, and hospitals/employers have no recourse. It’s a real ad difficult discussion to start. Some managers or administrators would additionaly put this burden onto Givers to “fix”, allowing them to avoid “Taker Behavior” all together. Asking Givers to: “..just keep encouraging them [Takers] to enjoy their work, keep being positive, keep turning the other cheek, (and my favorite) “just keep being you and the others will catch on”. I see a therapist. However, when you don’t have the luxury of a set day off, or you’re called-in off shift, it’s hard to make appointments for yourself from 0800-1700. I had to cancel one appointment because I couldn’t get away from my responsibilities at the hospital. I scheduled this over a late lunch hour. Another appointment I was grossly late for, for the same reason. Therapists don’t see patients on holidays or weekends, they shouldn’t haven’t to. Most therapists I know are Givers. Access is not an issue. It’s Time. I am a Giver, and even my heart tires of the strain on some days, but I LOVE being a nurse. When I speak up to defend my tiring heart, the strain on my mental health, the managers will say”just keep being the positive influence you are.”, and the Takers will always say, “Well, it’s your own fault, just so No like me.”; That just isn’t the answer though is it? That just cannot be the answer(s).

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