Nursing can be a stressful profession, especially for early career nurses, but the pandemic has magnified the challenges. The good news is that nurses are finding ways to minimize stress and gain confidence through peer and mentor support and by accessing mental health and well-being resources.
Faith Ahuvia, BSN, RN, who works as an acute care nurse in a teaching hospital in Omaha, Nebraska, described the pandemic as the most stressful period in her life. Sarena Love, BSN, RN, CDS, shared that sentiment while she worked as an oncology nurse and later as a hospice case manager in Little Rock, Arkansas.
Challenges for both included working increased overtime, concerns about exposure to COVID-19 without adequate protection, and worrying about spreading the disease to patients or family members.
New evidence gathered by the International Council of Nurses suggests that COVID-19 is causing mass trauma among the world’s nurses. In the United States, findings from the American Nurses Foundation Pulse on the Nation’s Nurses Survey showed that the strain has hit early career nurses harder than others—more than 80% report feeling exhausted, 71% report feeling overwhelmed, and 65% report being anxious or unable to relax (nursingworld.org/covid-19-survey-series-results).
“During the pandemic, nurses have been in constant fight or flight mode, always waiting for the next thing that’s going to happen,” said Tari Dilks, DNP, APRN, PMHNP-BC, FAANP, director of the psychiatric-mental health nurse practitioner graduate program at McNeese State University in Lake Charles, Louisiana. Dilks, who is immediate past-president of the American Psychiatric Nurses Association (APNA), a premier organizational affiliate of the American Nurses Association (ANA), believes that the next pandemic will be one of mental health.
Ahuvia, an RN since 2016 and a Nebraska Nurses Association member, experienced intense isolation during the pandemic. She quarantined in a hotel whenever she thought she had COVID-19–related symptoms. At times, her young children, who didn’t understand social distancing, would cry because she couldn’t hug them.
“One day when I came back from work, I sat in a corner in the garage and asked myself, ‘Why am I doing this? It is so painful.’” Soon after, this pain was interrupted by a thought about what initially motivated her to become a nurse. “At that point, I knew, instinctively, that there was nothing more I would rather do than continue taking care of patients,” said Ahuvia, who sees nursing as her calling. “I knew that healthcare was where I needed to be, and I found strength from within to just keep going.” To nurture her faith, she attends church, reads the Bible, and prays with her family.
Even before the pandemic, Ahuvia turned to the ANA Mentorship Program for support, finding a mentor who has inspired her to excel in nursing. “My mentor believes in me and that has helped me to believe more in myself,” she said, adding that, “being a novice nurse has a way of making you doubt yourself.”
Among other things, Ahuvia’s mentor, Alita-Geri Carter MSN, RN, CPNP-PC, a Maryland Nurses Association member, has supported her in creating a healthy work-life balance, a crucial resilience ingredient because she’s the mother of four children between ages 2 and 10 and a part-time doctor of nursing (DNP) student. Carter also has helped her develop planning and time management skills, encouraging her to build exercise, relaxation, and family time into her schedule, even when times are tough.
Coping in a pandemic
Now, more than ever, mentors are an invaluable resource for early career nurses, according to Aaron
Sebach, PhD, DNP, AGACNP-BC, FNP-BC, CNE, CNEcl, SFHM, a mentor in the virtual ANA Mentorship Program. “Nurses at all career levels have been stretched to unimaginable amounts with the pandemic. It takes a toll on any nurse, [but] particularly early career nurses who don’t have as much experience,” said Sebach, chair of the DNP program at Wilmington University in New Castle, Delaware.
Online forums are a wonderful way for nurses across the country to come together to discuss topics, share best practices, and develop solutions, according to Sebach, who is also the online community manager for ANA’s Up and Comers Community. “It broadens the horizons of early career nurses and allows them to have a wider support network,” he said.
ANA’s online communities have been an enormous support for Ahuvia, who contracted COVID-19 late last fall, passing it on to her husband. “The time I had COVID-19, I poured out my heart there. I found enormous encouragement from people,” she said.
Moving beyond fear
The stress and isolation of the pandemic was a catalyst for change for Love, who now works as a clinical documentation improvement specialist and will serve as the Region 5 director of the Arkansas Nurses Association beginning in November.
Love’s first job as an RN in 2017 was in a nurse residency program in the oncology division of a research hospital, an environment in which she felt comfortable asking questions. “It’s very common for young nurses to get thrown in [to nursing]. And it’s very scary because you know what you learned in the book, but this is real life, it’s real actual people, real families,” Love said.
But with the pandemic, the atmosphere at her workplace changed drastically. “Everyone was scared and tense. It was palpable,” recalled Love, who was sometimes pulled to the COVID-19 unit. In the beginning, she noted, there was a shortage of N-95 masks in the hospital, which added to her stress. For almost a year, to cut down on the risk of infection, Love and her husband mostly stayed in separate parts of their home, often communicating with each other via text. Added to this, Love could not see friends or go to the gym during lockdown—two ways she had dealt with stress before the pandemic.
Although she felt weighed down, Love was fortunate to have supportive friends. She also had the insight to realize she needed help and the grit to follow through with some new wellness strategies.
First, she connected with a counsellor from the employee assistance program. She also took up mindfulness meditation, including pausing for “sacred” moments. Learning to breathe and to be present helps to calm her mind, especially when called to multitask, Love said. In addition, she makes a point of expressing gratitude for things people might normally take for granted, such as her rescue dog Mazzy, a 10-year-old pointer mix who helps ease her mind.
Another change was joining ANA, where she found an online mentor who has helped her see her true potential. She also began sharing on the online ANA Community, which helps her feel less alone. In addition, she engages with the nursing community through the ANA Enterprise Healthy Nurse Healthy Nation™ (HNHN.org).
Love believes her new job takes advantage of her background in medical coding as well as nursing. “I feel like I’ve done a 360 with my life and tied it all together,” Love said. She advises new nurses to be open to new opportunities. “A beautiful thing about the nursing field is how many different things you can do. Just keep your eyes and ears open to different opportunities as you grow in your career.”
Expressing emotions fully
As for Ahuvia, she makes sure to keep connected to her emotions. Sometimes, when a patient is suffering and dying and she feels overwhelmed by the loss, she goes to the bathroom to cry, which then enables her to be present for her next patient. “Allow yourself to express the feelings deep inside,” she advised.
Dilks said, “When nurses don’t have an outlet and stuff emotions down, they will come out eventually. Nurses need a place where they can go and express their feelings fully.” When people get overwhelmed, they might be tempted to use drugs, alcohol, or food to cope, instead of dealing with the underlying feelings, Dilks added.
Nipping stress in the bud
Identifying the signs of burnout before it advances is crucial. According to Dilks, signs include numbness, feeling disconnected, and getting irritated easily.
For her part, Ahuvia knows her stress levels are too high when one of her children asks whether her “love tank” is empty. When “I am not hugging them as much, I’m not talking to them as much, then I know that something’s changing on the inside.” If she starts to become less interactive with patients or colleagues, she knows she needs to check in with close friends, supervisors, or her mentor.
Sebach, a Maryland Nurses Association member, said, “I think nurses get into the profession and are excited about their new role, but 12-hour shifts can be very daunting over time. A mentor who can focus on identifying burnout and promoting self-care activities is critical.”
To avoid burnout, nurses need to do something every day—even if only for 10 minutes—just for themselves, Dilks said. She encourages early career nurses to build resiliency by talking to other nurses and to reach out for help if they’re feeling overwhelmed.
“As a new nurse… get all the support that you can and allow [yourself] to be vulnerable, to learn, to ask questions,” Ahuvia said. “You can always soar above and beyond and come out of whatever challenging situation—be it COVID-19, be it anything—provided you have a supportive work environment, love what you do, have the right resources, and recognize when to utilize them.”
— Katherine O’Brien is a freelance writer focused
on health, nursing, and aging.